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

In order to demonstrate common pressure gradients and peripheral arterial pressure in ileo-femoro-popliteal arteries before and after reconstruction for atherosclerosis, intra-operative pressure measurements were performed on 204 patients. Before reconstruction, the pressure differential was 44.3 mmHg in femoro-popliteal arteries and 29.0 mmHg in the iliac arteries. This was reduced to 8.4 and 4.1 mmHg by the reconstructions. In patients with femoro-popliteal disease, the pressure gradient was higher when gangrena or rest pain were present than when claudication was the principal symptom. When the iliac arteries were mainly involved, no such difference was seen. Postoperative gradients were slightly higher in arteries subjected to primary failure than in vessels remaining patent. The blood flow increase from intra-arterial papaverine injections accentuated existing pressure gradients and frequently disclosed gradients not manifest at basal flow rates.
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PMID:Hemodynamics in arterial reconstructions of the lower limb. II. Blood pressure. 93 50

Sixty-one cases of thromboangitis obliterans (TAO) were studied during 1969-70. Nearly all were males, smokers, of poor socio-economic status. Average age of presentation was 34.2 years. A majority (64%) presented with claudication pain. About one fifth gave history of migratory thrombophlebitis and venography and histological investigations suggested that sixty per cent had venous involvement. Nearly half the patients had involvement of upper limb vessels. Clinical and arteriographic studies showed femoral-popliteal junction to be the commonest site of block. No evidence of coronary artery disease, cerebral vascular disease, abnormal glucose and lipid metabolism was seen in these patients. Arteriographic findings were unlike atherosclerosis obliterans (ASO). From this study we conclude that thromboangitis obliterans (TAO) is a separate and distinct clinical and pathologic entity and the incidence of venous involvement is very high if venographic investigations are combined with clinical examination.
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PMID:Thromboangitis obliterans: a clinical study with special emphasis on venous involvement. 105 73

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

The local oxygen pressure of muscle tissue was measured in 10 patients with occlusive atherosclerosis and in 9 healthy volunteers using a micro-Pt-electrode. In 3 cases, the muscular pO2 values of an ischemic leg were compared to the non-ischemic leg of the same patient. In both groups, there was a statistically significant difference in the oxygen pressure of the muscle tissue in normal legs of volunteers as compared to the ischemic legs. Measurements of the local oxygen pressure in the muscle enables us to have a quantitative measure for the ischemic situtation. It is a useful diagnostic method in patients suffering from ischemic claudication and seems to be an objective criterium of therapeutical methods.
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PMID:[Oxygen pressure values in the ischemic muscle tissue of patients with occlusive arterial diseases (author's transl)]. 121 82

Post-reconstructive graft blood flow (basal flow') was measured by means of an electromagnetic flowmeter in 72 consecutive femoropopliteal reversed saphenous vein grafts performed for occlusive atherosclerosis causing leg ischaemia. In the last 48 operations, post-reconstructive pre- and post-graft intra-arterial pressures were recorded, and graft blood flow after papavarine-induced vasodilation ('maximal flow') was measured. Mean 'basal flow' was 132 ml/min, mean 'maximal flow' 285 ml/min and mean flow increment after papavarin 136%. Mean 'basal flow', mean 'maximal flow' and mean flow increment after papavarine were higher in the claudication group than in the gangrene group, and higher in cases having good angiographic run-off than in those having poor. Mean common femoral and popliteal pressures were 85 and 80 mmHg, with no differences between different groups. Mean post-reconstructive graft pressure gradient was 5.1 mm. Mean peripheral resistance was 769 milliprus, being higher in the gangrene group and in cases having poor run-off. The prognostic significance of these findings was evaluated by analysing patency in all patients living 3 months ('early') and 1 year ('late') after operation. Cases having a 'basal flow' less than 60 ml/min, a 'maximal flow' less than 200 ml/min or a flow increment after papavarine less than 100% had significantly poorer 'early' patency (p less than 0.01) and 'late' patency (p less than 0.05). Femoral and popliteal pressures, graft pressure gradients and peripheral resistance did not influence patency significantly.
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PMID:Intra-operative haemodynamic findings and their prognostic significance in femoropopliteal reversed saphenous vein graft bypass operations. 127 60

The use of beta-blockers in the treatment of angina, claudication or hypertension is a therapeutic paradox. All those conditions feature increased constrictor tone, so it appears to make little sense to treat them with drugs which block the action of vasodilators. The paradox would disappear, however, if vasodilators could be shown to have the ability to increase constrictor tone in certain circumstances. This paper argues that they have. It presents evidence that isoprenaline, a potent dilator of the dog's saphenous vein, is a powerful constrictor of the vein when it is released from the vasa vasorum of the vein. Indeed, on a molar basis, it appears to be a more powerful constrictor of the vein than exogenous noradrenaline is. Since there is no reason to suppose that isoprenaline is unique among dilators in demonstrating this type of bimodal behaviour, it is possible to justify the proposal that compounds which are normally classified as endogenous dilators may, when released from the pathological vasa vasorum which neoproliferate in atherosclerosis, be responsible for the constrictor effects associated with claudication, and some forms of hypertension and angina. If true then beta-blockade would not be a paradoxical choice of treatment for those conditions.
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PMID:The vasa vasorum and the paradox of beta-blocker therapy. 135 18

Patients with extensive atherosclerosis are at increased risk of developing embolic complications during cardiac catheterization. We describe a 51-year-old man with unstable angina and bilateral leg claudication who developed fever and right upper abdominal pain shortly after cardiac catheterization. Liver-spleen scintigraphy demonstrated a wedge-shaped filling defect compatible with splenic infarction, and serial scans performed over a period of five months showed resolution of this finding. Splenic infarction tends to be under-diagnosed, and physicians should be aware of this potentially serious complication of cardiac catheterization.
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PMID:Splenic infarction: a complication of cardiac catheterization. 139 6

Thirty-two patients (median age: 51 years) underwent aortoiliac endarterectomy between 1982 and 1990, for disabling claudication (27), rest pain (3), and tissue loss (2). There was no post-operative death and morbidity affected 6 patients. Five patients showed insufficient or suboptimal vascularisation of a limb which justified early reoperation in four. Follow-up was obtained in 31 patients with a median time of 36 months (6 months to 8 years). Five patients experienced recurrence of claudication symptoms: two received an aortofemoral bypass at 6 and 36 months. In the other patients, distal arterial occlusive disease accounted for recurrence alone (2 patients) or in association with aortoiliac involvement (1). Technical problems or disputable indications were responsible for postoperative failure in 3 cases or early recurrence of symptoms in 2. Cumulative patency rates of aortoiliac endarterectomy were 94 and 90 per cent at 2 and 5 years, and actuarial rates of clinical improvement were 90 and 82 per cent at 2 and 5 years, respectively. Aortoiliac endarterectomy provides the advantages of avoiding foreign material. The success of this reconstruction depends on strict criteria of selection and surgical expertise. It is indicated for the relatively young patient with nonectasic disease where atherosclerosis has not attacked the external iliac arteries.
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PMID:Aortoiliac endarterectomy: a 9-year experience. 141 83

Although results of iliac artery balloon angioplasty have been shown to be good, there are much less data regarding initial success and durability of superficial femoral artery (SFA) dilation. The authors retrospectively reviewed the results of 22 patients treated for 27 SFA lesions between 1981 and 1986. Mean age was 64.5 years (fifty-five to seventy-six). Results were analyzed with respect to initial, early (< twelve months), and late (> twelve months) angiographic and clinical success. Indications were claudication (22), nonhealing ulcer (3), and rest pain (2). Mean follow-up was 30.9 months; 100% at one year and 92% at two years. Initial failure occurred in 9 (33%) lesions. There were 2 early and 2 late failures for a cumulative patency rate of 90.3% and 78% at one and two years, respectively. Predictors of clinical failure were: (1) initial--age, SFA occlusion, and angioplasty rating; (2) early--age, SFA occlusion, degree of atherosclerosis, and angioplasty rating; (3) late--angioplasty rating. There were 3 complications (11%). The authors conclude that: (1) 33% of attempted SFA angioplasties were initially unsuccessful and that the cumulative patency rate was 78% at two years. (2) Age is predictive of initial and early failure; SFA occlusion, of initial and early failure; degree of atherosclerosis, of early failure; and angioplasty appearance, of initial, early, and late failures. (3) Complications did not result in limb loss or require surgery.
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PMID:Determinants of failure in superficial femoral artery angioplasty. 144 60

Percutaneous balloon angioplasty is a recognized treatment for peripheral atherosclerosis involving the iliac and femoropopliteal segments. From their experience in 38 patients the authors have examined the efficacy of intraoperative balloon angioplasty for tandem lesions requiring both balloon angioplasty and surgical intervention. Between January 1988 and July 1990, 43 intraoperative balloon angioplasties were performed in 19 women and 19 men who required inflow or outflow angioplasty in addition to surgical bypass. The indication for surgery was incapacitating claudication in 32 (74%) patients and limb salvage in 11 (26%) patients. Initial technical success was achieved in 17 (89%) of 19 patients who required iliac surgery and in 22 (92%) of 24 patients who required femoropopliteal balloon dilatations. There were four major complications (9%), all requiring surgical intervention. In two cases there was dissection with thrombosis and in two cases failure to improve the pressure gradient. Patients were followed up for up to 24 months. Two of the inflow angioplasties failed between 6 and 9 months. Two of the outflow angioplasties failed between 12 and 15 months. Three patients died in the follow-up period, two from myocardial infarction. In the authors' experience intraoperative balloon angioplasty has proven a worthwhile adjunct for tandem lesions in the iliac and femoropopliteal segments.
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PMID:Intraoperative balloon angioplasty: a surgical approach. 153 43


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