Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 55-year-old man was hospitalized for endovascular stent placement in both right common iliac and femoral arteries for relief of claudication symptoms due to peripheral vascular disease. Angiography demonstrated diffuse atherosclerosis of the infrarenal aorta and severe stenosis of the right common iliac and right femoral arteries. Physical examination showed diminished but palpable peripheral pulses. Uncomplicated stent placement was done in the right common iliac and right femoral arteries via a left femoral artery approach resulting in improved pedal pulses. Over the next 36 hours, the patient developed severe bilateral lower extremity pain followed by extensive livedo reticularis over lower extremities, elevated creatine kinase levels, myoglobinuria, and a rise in serum creatinine to 1.5 mg/dL (133 micromol/L). Pedal pulses continued to be palpable. This was followed by bilateral lower extremity compartment syndrome, requiring fasciotomies. Myoglobinuria cleared with hydration and creatinine kinase levels returned to normal; however, the patient ultimately developed gangrene of both lower extremities. Bilateral below the knee amputations were performed and histopathology showed wide spread cholesterol crystals in arterioles and small and medium sized arteries in skin and muscle of both lower extremities. This case emphasizes the potential for major complications of cholesterol embolism associated with even uncomplicated vascular procedures performed for treatment of peripheral vascular disease.
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PMID:Catastrophic cholesterol crystal embolization after endovascular stent placement for peripheral vascular disease. 1848 Jun 61

Critical limb ischemia (CLI) represents the most severe clinical manifestation of peripheral arterial disease (PAD), defined as the presence of chronic ischemic rest pain, ulcers, or gangrene attributable to objectively proven arterial occlusive disease. The occurrence of CLI in patients with kidney insufficiency portends a strikingly high rate of subsequent morbidity and mortality. Generally, the primary therapy for CLI is revascularization of the affected limb. However, patients with CLI and kidney insufficiency represent a unique and challenging patient subset, and data from surgical series suggest reduced rates of limb salvage and higher medium and long-term mortality rates for patients with kidney insufficiency compared with those with normal kidney function. In contemporary practice, endovascular techniques are fast replacing surgical bypass as the first-line revascularization strategy for CLI, based on high technical success rates and low rates of procedure-related morbidity and mortality. However, a large series on endovascular outcomes for the treatment of CLI in patients with kidney insufficiency is lacking. Based on the severely reduced long-term survival rates of patients with CLI and kidney insufficiency, future efforts should focus on early detection of PAD in patients with kidney insufficiency and institution of aggressive medical therapy to prevent progression in the global burden of atherosclerosis in this patient population.
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PMID:Interventional management of critical limb ischemia in renal patients. 1880 85

Management of advanced obstructive vascular disease affecting the extremities poses tremendous challenges for physicians and patients. Peripheral arterial disease is often a consequence of obstructive atherosclerosis affecting the ileofemoral circulation but is also rarely a result of nonatherosclerotic conditions such as thromboangiitis obliterans (Buerger's disease). Consequences range from the presence of asymptomatic obstruction to intermittent claudication, development of rest pain, ulceration, gangrene, and amputation. A relatively new and promising approach using cell therapy has recently been developed to treat intractable symptoms related to ischemia in subjects with peripheral arterial disease in whom conventional medical therapy and revascularization modalities have been exhausted.
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PMID:Cell therapy in peripheral arterial disease. 1881 33

Peripheral arterial disease (PAD), a manifestation of systemic atherosclerosis, is a significant health problem. It manifests in lower extremities as intermittent claudication, limb ischemia, or gangrene and other locations as stroke, renal failure, or mesenteric ischemia. Fontaine and Rutherford classifications are the 2 commonly used classifications to stage the severity of PAD. The diagnostic tools include ankle-brachial index, a valuable tool in diagnosing lower extremity PAD, and a treadmill test. Other useful diagnostic tools include the San Diego Claudication Questionnaire to screen patients for symptoms and imaging modalities such as duplex scan, angiogram, computer tomographic angiogram, and magnetic resonance angiogram. Medical management of PAD involves comprehensive care, including risk factor modification of etiologies predisposing to atherosclerosis. These involve using antiplatelet therapy with aspirin or clopidogrel, controlling hypertension, managing hypercholesterolemia, and using vasodilators such as cilostazol. Exercise rehabilitation is an efficacious approach to improve intermittent claudication and should be recommended to each patient. Revascularization therapy is indicated for those who have critical limb ischemia or severe claudication not improved by medical management. Revascularization consists of endovascular techniques to open up the vessel and traditional bypass surgery to bypass the diseased segment. Recent published guidelines detailing recommendations on different treatment modalities in patients with PAD are described.
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PMID:Management of lower extremity peripheral arterial disease. 1900 88

Critical limb ischaemia (CLI) is a manifestation of peripheral arterial disease (PAD) that describes patients with chronic ischaemic rest pain, or patients with ischaemic skin lesions, either ulcers or gangrene. The clinical diagnosis of CLI should be confirmed by haemodynamic parameters such as the ankle- or toe systolic pressure. The estimated annual incidence of CLI ranges between 500 and 1 000 new cases per 1 million, with diabetes being the most important risk factor. CLI is also a marker for mostly generalized and severe atherosclerosis, and therefore the prognosis of patients is poor concerning overall survival. The primary goals of treatment in patients with CLI are to relieve ischaemic pain, heal ulcers, prevent limb loss, improve patient function and quality of life and prolong overall survival. Any kind of revascularization should be done whenever technically possible, and therefore most patients should be referred to a vascular center. Furthermore, in patients with CLI a multidisciplinary approach is recommended to control pain, cardiovascular risk factors and other co-morbid disease. In patients with CLI not eligible for arterial revascularization, prostanoids are the only vasoactive drugs with proven efficacy. The safety and efficacy of the various forms of therapeutic angiogenesis still have to be proven before one can conclude on its role as an additional limb saving strategy.
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PMID:Critical limb ischaemia. 1915 58

Patients with reactive thrombocytosis are generally asymptomatic and platelet counts of up to 1,000,000/microL are seen in this disorder. However, in a small proportion of cases platelet counts may be in the range generally seen in Clonal Thrombocytosis (CT). In elderly patients or those with symptomatic atherosclerosis or thrombotic disease or immobility, thrombosis may occur even with reactive thrombocytosis. We report a case of a rare presentation of Reactive Thrombocytosis with digital gangrene in an elderly lady. She was evaluated for thrombocytosis and was given supportive treatment after which she clinically improved.
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PMID:Reactive thrombocytosis with digital gangrene. 1915 29

A 60-year-old insulin dependent, diabetic male with severe atherosclerosis requiring multiple amputations in the extremities in the past, with normal renal function presented with gangrene of glans penis. He was initially treated with debridement but as the gangrene progressed, partial penile amputation was performed. He showed no further progress of the disease and had no voiding difficulties even after 4 years of follow up.
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PMID:Gangrene of the penis in a diabetic male with multiple amputations and follow up. 1946 42

Atherosclerosis, the cause of myocardial infarction, stroke and ischemic gangrene, is an inflammatory disease. When LDL accumulates in the intima, it activates the endothelium to express leukocyte adhesion molecules and chemokines that promote recruitment of monocytes and T cells. Monocyte-derived macrophages upregulate pattern recognition receptors, including scavenger receptors that mediate uptake of modified LDL, and Toll-like receptors, which transmit activating signals leading to release of cytokines, proteases, and vasoactive molecules. T cells in lesions recognize local antigens and mount Th1 responses with secretion of pro-inflammatory cytokines, thus contributing to local inflammation and growth of the plaque. Intensified inflammatory activation may lead to local proteolysis, plaque rupture, and thrombus formation, triggering ischemia and infarction. Inflammatory markers are already used to monitor the disease process and anti-inflammatory therapy may be useful to control disease activity.
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PMID:Inflammatory mechanisms in atherosclerosis. 1963 Aug 27

Penile gangrene associated with chronic renal failure is very uncommon. A 52-year-old man with diabetes mellitus, diffuse atherosclerosis, ischemic cardiomyopathy and end-stage renal disease presented with blackening of distal penis for 10 days. His general condition was poor and gangrene of prepuce and glans was noted. Doppler and magnetic-resonance angiography revealed bilateral internal iliac artery obstruction. He underwent trocar suprapubic cystostomy and was planned for partial penectomy. But he died of severe diabetic complications in the interim period. Penile gangrene is a manifestation of widespread vascular calcifications associated with end-stage renal disease and is a marker of poor prognosis.
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PMID:Penile gangrene in diabetes mellitus with renal failure: A poor prognostic sign of systemic vascular calciphylaxis. 1967 7

Digital ulcers and gangrene are common skin manifestations of connective tissue diseases, especially systemic sclerosis, although they are relatively rare in systemic lupus erythematosus. We describe here three patients with digital gangrene and systemic lupus erythematosus. None of the patients showed high disease activity of systemic lupus erythematosus at the time the digital gangrene developed. Two patients were positive for anti-RNP antibodies; however, no symptoms of other collagen diseases were present. One patient had anti-phosphatidylserine/prothrombin complex antibodies, and the other had anti-cardiolipin beta2 glycoprotein I antibodies and lupus anticoagulant at low titre. All patients showed narrowing or occlusion of radial and/or ulnar arteries in addition to digital arteries. Although a complication of anti-phospholipid syndrome is considered to be a possible cause, there may be unidentified causes other than thrombosis, atherosclerosis, overlap syndrome and vasculitis.
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PMID:Digital gangrene in systemic lupus erythematosus. 1968 54


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