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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This paper presents the long-term results of 221 thrombendarterectomy operations during the period 1955-61, and of 86 femoro-popliteal venous bypass operations during the period 1961-64. The indication for surgery was in the majority of the patients disabling claudication. When pain at rest or ulceration was present, arterial reconstruction was performed even when the outlook for a lasting result was poor. Preoperatively a major amputation seemed inevitable in 31 limbs. Thirteen of these are considered to have been saved by the operation. After aortoiliac thrombendarterectomy patent arteries were found in 80% of the extremities after one year and in 48% after 10 years. Forty-five per cent of the extremities were patent on re-examination or remained patent until death. After fermoro-popliteal thrombendarterectomy, 61% of the arteries were patent after one year and 26% after 10 years. Thirty-nine per cent of the arteries were patent on re-examination or remained patent until death. After femoro-popliteal venous bypass, 88% of the grafts were patent after one year and 58% after 5 years. Forty-nine per cent of the grafts were patent on re-examination or remained patent until death. The postoperative mortality was small (4.4% after aortoiliac surgery and 2.0% after femoro-popliteal surgery), and mostly caused by widespread atherosclerosis in other parts of the arterial system. On re-examination 8 to 16 years after the operation, 63% of the patient were dead. Almost 50% of the deaths were caused by coronary heart disease, 17% by cerebrovascular catastrophes, and 13% by other manifestations of atherosclerotic disease. The results are discussed, and it is concluded that long-term results after vascular surgery may be favourable. Peripheral atherosclerosis is, however, a local manifestation of a generalized disease. The indications for reconstructive arterial surgery should therefore be relatively restricted.
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PMID:Long-term follow-up of patients with peripheral arterial obliterations treated with arterial surgery. 121 35

Atherosclerosis is often a generalized disease, affecting not only coronary circulation, but other parts of vascular system as well. Vascular diseases most commonly encountered in patients with coronary atherosclerosis are carotid disease, abdominal aortic aneurysm and obliterative atherosclerosis in aortoiliac segment. In such situation two options are available: to treat the more significant, life-threatening manifestation first and postpone the other operation--staged approach; or to perform coronary artery bypass grafting (CABG) and other vascular procedures during one single operation--synchronous surgery. The advantages of this latter approach are obvious: patient has to undergo only one operation; there is no additional risk in the waiting period for second operation; surgical treatment is greatly accelerated. From 1978 until July 1990 a total of 123 synchronous CABG and vascular procedures were carried out in our clinic. In the same period, CABG was performed in 3867 pts in the same institution; combined procedures amount to 3.5% of all coronary revascularisations performed in the same period. CABG was done together with carotid endarterectomy (CEA) in 45 pts, associated with resection of abdominal aortic aneurysm (AAA) in 31 and in 28 pts it was combined with vascular procedures in aorto-iliac or femoral segment. In 4 pts a triple procedure--CABG, CEA and peripheral vascular reconstruction--were undertaken. Thoracic aortic aneurysm and CABG were performed in 15 pts. CEA is performed immediately prior to CABG in symptomatic carotid disease, past history of transient ischemic attack, severe bilateral carotid disease and unilateral carotid obstruction with contralateral stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Simultaneous coronary and vascular surgery interventions: indications,technique and results]. 186 43

Atherosclerosis of the cervico-cerebral arteries is a generalized disease which frequently involves the whole carotid system. The bifurcations (48.7%), the proximal 2 cms. of the internal carotid arteries (61.6%) and the carotid siphons (60.3%) are most frequently affected. Angiography may demonstrate ulcerated lesions in up to 25% of cases. "Tandem stenoses" in both the extracranial segments of the carotid arteries (4.6%) and isolated hemodynamically significant stenoses in the carotid siphons (.7%) are uncommon. Nevertheless their presence may play an essential role in therapeutical decision making. Because of the multiplicity of lesions, the claim for preoperative selective arteriography is justified. IA DSA may replace film angiography, if image quality and medical information are identical. IV DSA and Doppler-procedures as a rule cannot replace selective arteriography in preoperative work-up.
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PMID:[Distribution pattern of atheromatous lesions of the carotid circulation--significance for the angiographic strategy of cerebrovascular insufficiency]. 260 37

Quantitative assessment of atherosclerosis from arteriograms was applied in clinical follow-up trials for the evaluation of lipid-modulating treatment or risk factors. Computer-estimated lumen volume and arterial edge roughness in the femoral artery and in the aorta, visual scoring of aorto-femoral arteriograms and manual measuring of coronary artery stenosis were used. In each of 276 hypercholesterolaemic patients two femoral arteriograms were made, with a 10-minute interval. The reproducibility of the computer analysis method was found to be constant over the years, with slightly better reproducibility for lumen volume than for edge roughness. A small but significant drift in the radiological equipment was confirmed by the use of phantoms. In 290 patients, atherosclerosis assessments from the femoral artery (lumen volume and roughness) and visual scoring of the aorto-femoral arteriogram were correlated with clinical symptoms of coronary artery disease or previous myocardial infarction to test whether femoral atherosclerosis estimates can replace coronary studies in clinical trials. Both men and women with coronary artery disease had lower values for femoral lumen volume and more edge roughness than patients without these symptoms. Men with previous myocardial infarction had higher mean visual scores than those without. Thus, femoral atherosclerosis is an expression of a more generalized disease associated with clinical symptoms of coronary heart disease. The 290 patients were tested for correlation between degree of peripheral atherosclerosis and various metabolic risk factors. In women, high serum triglyceride values were associated with more extensive atherosclerosis. High fasting glucose values were associated with more extensive atherosclerosis in men. In men and women, high uric acid values were associated with greater roughness in the femoral artery. The effects of smoking, hypertension, poor physical fitness and body mass index on the development of peripheral atherosclerosis in hypercholesterolaemia were also investigated. The results indicated that the hypercholesterolaemic patients most likely to develop peripheral atherosclerosis are male and female smokers who do not take any physical exercise, and who have increased values of systolic blood pressure, uric acid and fasting glucose concentrations. Aortograms from 293 subjects were digitized and circular lumen volume and edge roughness were computer-estimated in a 7.35-cm segment of the distal aorta. A correlation between atherosclerosis in the aorta and in the femoral arteries indicated that aortic atherosclerosis is a manifestation of a more general disease.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Femoral and coronary atherosclerosis in patients with hyperlipidaemia. Arteriographic findings correlated to clinical and biochemical parameters. 818 97

Arteriosclerosis obliterans (ASO) has become one of major health problems in the elderly people in Japan. This paper reviews the recent progress in the diagnosis and treatment of ASO. Both medical and surgical treatments, such as atherectomy catheters, endovascular metallic stenting, laser angioplasty and LDL-apheresis have recently been greatly developed. As atherosclerosis is a generalised disease, patients with ASO tend to have other atherosclerotic diseases, i.e., cerebrovascular disease, coronary heart disease and renal vascular disease. For the selection of treatments, we have to consider the whole background of the patients, including a quality of life.
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PMID:[Arteriosclerosis obliterans]. 841 86

The vascular endothelium plays a central role in the regulation of the arterial tone and in the control of the local hemostasis. It is also involved in the regulation of proliferation processes of the vascular wall. The presence of risk factors for coronary artery disease and/or manifest atherosclerotic lesions are associated with an impairment of endothelium-dependent vasoregulation. Since the assessment of coronary vascular reactivity requires an invasive approach, it would be desirable to non- or semi-invasively evaluate blood flow regulation and its impairment by atherosclerotic processes. Indeed, endothelial dysfunction of the coronary arteries parallels endothelium-related impairment of vasoreactivity of the brachial artery. Analysis of flow-dependent dilatation of the brachial artery by means of ultrasound represents a non-invasive diagnostic tool to assess endothelium-mediated vasomotion. By means of venous strain gauge forearm occlusion plethysmography, it is possible to measure the blood flow in a semi-invasive way. The endothelium-mediated forearm blood flow response is obtained by the infusion of acetylcholine into the brachial artery, whereas infusion of sodium-nitroprusside provides information about the endothelium-independent vasodilator capacity of the forearm resistance vasculature. Assuming that the atherosclerotic process is a generalized disease, the assessment of the forearm blood flow by venous strain gauge occlusion plethysmography may provide some information applicable to the coronary circulation. However, the proof of a positive correlation between the degree of the impaired forearm blood flow responses measured by occlusion plethysmography and the extent of coronary atherosclerosis and its disturbed vasoregulation remains to be established.
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PMID:[Analysis of forearm circulation--a substitute for diagnosis of coronary atherosclerosis?]. 959 8

The epidemiology, costs, and comorbidities associated with atherosclerosis and the role of newer antiplatelet agents are reviewed. Cardiovascular disease is the leading cause of death in the United States. More than 60 million Americans have one or more types of cardiovascular disease. The total annual cost of coronary heart disease has been estimated at $95 billion. Patients with an existing atherosclerotic disease in one vascular bed are at high risk of having an ischemic vascular event in the same or another vascular bed. Peripheral arterial disease is a strong marker for underlying cerebrovascular and cardiovascular disease. The common link among these diseases is atherosclerosis leading to atherothrombosis. Platelets play an integral role in atherosclerosis and the formation of arterial thrombus as well as in subsequent acute events such as ischemic stroke, myocardial infarction, and vascular death. Arterial thrombosis can be mediated by shear-stress-induced platelet aggregation. Currently, only one third to one half of all eligible patients with stroke, myocardial infarction, or peripheral arterial disease receive antiplatelet therapy. Thienopyridines such as ticlopidine and clopidogrel are effective inhibitors of shear-stress-induced and endothelial-injury-induced platelet aggregation. Advances in antiplatelet therapy provide an opportunity to use newer antiplatelet agents in the prevention of atherosclerosis-related morbidity and mortality; therapeutic approaches should be directed toward recognizing atherosclerosis as a generalized disease process and preventing ischemic events in multiple vascular beds.
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PMID:Atherosclerosis: a unifying disorder with diverse manifestations. 978 96

Atherosclerosis is the primary cause of peripheral arterial disease. Because atherosclerosis is a generalised disease, it is possible that patients with peripheral arterial disease may have other arterial disorders. Such patients have a reasonable chance of continuing to walk, although their general prognosis is less favourable because of high cardiovascular morbidity and mortality. Nevertheless, the following approaches can be used to improve the management of patients with peripheral arterial disease: diagnosis of peripheral arterial disease in its early stages by systematic measurement of the ankle/brachial index; improvement in screening for lesions in other arteries by analysing the clinical symptomatology and performing simple complementary examinations; improvement in the management of atherosclerosis risk factors, particularly cigarette smoking, as well as in the treatment of diabetes, arterial hypertension and hypercholesterolaemia; enhancement of antithrombotic agents by the development of new, more effective antiplatelet drugs. Finally, quality of life should be considered an essential factor governing treatment choice. A self-administered questionnaire concerning intermittent claudication has been used to assess the quality of life of patients with peripheral arterial disease undergoing treatment with ifenprodil tartrate. This study showed that the evaluation of intermittent claudication should not be limited to walking distance alone, but that a more general criterion, better adapted to atherosclerotic disease, should be considered: measurement of quality of life.
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PMID:[Quality of life and peripheral obliterative arteriopathy. Perspective for the future]. 984 2

Atherosclerosis is a generalized disease which afflicts a considerable number of patients in both the carotid and coronary arteries. Although the risk of stroke or death use to combined carotid endarterectomy (CEA) and coronary artery bypass graft (CABG) is thought to be higher than that of each individual operation, the combined procedure is generally preferred over staged operations to treat such patients. We performed the combined procedure safely with the aid of intraoperative portable digital subtraction angiography (DSA). This report describes our experience with the operative strategy of simultaneous CEA and CABG. Ninety CEA and 404 CABG were carried out between January 1989 and December 1997. A total of six patients received the combined procedure with the aid of intraoperative DSA; they were studied retrospectively. Postoperative mortality and morbidity after the combined procedure was 0%. In the combined procedure, neurological complications are difficult to detect after CEA because the patient must be maintained under general anesthesia and extracorporeal circulation during the subsequent CABG. However, intraoperative DSA can confirm patency of the internal carotid artery and absence of flap formation after CEA, and the CABG can be performed safely. Intraoperative portable DSA between CEA and CABG is helpful in preventing perioperative stroke in the combined procedure.
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PMID:Combined carotid endarterectomy and coronary artery bypass graft. 1006 57

Atherosclerosis involves structural change to the intima and media of medium- and large-sized arteries. Although an atherosclerotic plaque may remain clinically silent, it is prone to disruption, leading to local platelet activation and aggregation. Therefore, the major complication of atherosclerosis is thrombosis, with local occlusion or distal embolism - a generalized disease process known as atherothrombosis. The three main clinical manifestations of atherothrombosis are coronary heart disease (myocardial infarction and angina), peripheral arterial disease and cerebral ischaemia. Atherothrombosis is a leading cause of mortality, and stroke is the leading cause of disability in adults, the second most important cause of dementia and the third most common cause of death in Western countries. Ischaemic stroke accounts for 80% of strokes and atherothrombosis accounts for approximately 20% of all strokes. Criteria for atherothrombotic stroke are evidence of a 50% (or greater) stenosis of a cervical artery and exclusion of other potential causes. The incidence of cerebrovascular events is 2,900 per million inhabitants per year, consisting of 500 transient ischaemic attacks and 2,400 strokes, of which 75% are first-ever stroke. The prevalence of stroke in the same population is 12,000, of which 800 patients (7%) per year have recurrences. The risk of ipsilateral stroke is 5% per year and the risk of a cardiac event is higher at 7%. Besides optimal management of risk factors for atherothrombosis and carotid surgery, antiplatelet therapy is the cornerstone of vascular prevention. In secondary prevention, antiplatelet agents are effective in reducing the risk of further ischaemic events in patients with atherothrombosis. Clopidogrel, a newly licensed ADP receptor antagonist, is the only antiplatelet agent to have demonstrated its superiority versus aspirin for the reduction of major ischaemic events (myocardial infarction, ischaemic stroke, vascular death) in patients whose initial manifestation of atherothrombosis was one of the three main clinical manifestations of the disease (recent ischaemic stroke, myocardial infarction, established peripheral arterial disease).
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PMID:Atherothrombosis: a major health burden. 1131 15


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