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

Cigarette smoking is associated with an increased risk and extent of advanced atherosclerotic vascular disease in peripheral as well as coronary arteries. The likelihood of claudication, amputation, stroke, abdominal aortic aneurysm, and failure of vascular reconstruction is higher in smokers than nonsmokers. Smoking exerts its deleterious effects through many interactive mechanisms. Nicotine and carbon monoxide produce acute cardiovascular consequences, including altered myocardial performance, tachycardia, hypertension, and vasoconstriction. Smoking injures blood vessel walls by damaging endothelial cells, thus increasing permeability to lipids and other blood components. Among metabolic and biochemical changes induced by smoking are elevated plasma, free fatty acids, elevated vasopressin, and a thrombogenic balance of prostacyclin and thromboxane A2. Chronic smoking is associated with a tendency for increased serum cholesterol, reduced high density lipoprotein, and other lipid effects that contribute to atherosclerosis. In addition to rheologic and hematologic changes from increased erythrocytes, leukocytes, and fibrinogen, smokers have alterations in platelet aggregation and survival that produce thrombosis. Considering the ubiquitous repercussions of this menace, vascular surgeons should play an active role in motivating their patients to quit smoking.
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PMID:The peripheral vascular consequences of smoking. 206 25

Intermittent claudication may represent a severe limitation in daily life-style for young, active patients and may result in loss of professional career for members of the armed forces. Our recent experience with young patients with atherosclerotic claudication was reviewed to determine whether more liberal use of angioplasty and surgery is warranted in these patients to salvage their military careers and improve their life-styles. A systemic review was made of patients aged 40 years and younger with atherosclerosis who have undergone arteriography at our institution during the past 67 months. From this study, 22 patients were found with the initial complaint of intermittent claudication. Fifteen of these patients (68%) had occlusive disease confined to the iliac arteries, and six (27%) had single-level occlusive disease in a femoropopliteal distribution. Only one patient had multilevel disease. Symptoms of coronary occlusive disease developed in five patients (23%) within 38 months of the onset of claudication, and two of these patients died of myocardial infarctions. Of 19 patients who underwent interventions to correct symptoms of claudication, 16 (85%) had complete relief of symptoms at the end of follow-up, ranging from 6 months to 7 years. Ten of these patients remained symptom free after a single intervention, but six patients had rapid progression of disease and required secondary procedures. These results indicate that a majority of young patients with claudication caused by atherosclerosis can be returned to full active-duty status in the military after angioplasty or surgery. However, some patients may require secondary procedures to relieve recurrent symptoms caused by rapid progression of disease. We believe that an aggressive interventional approach is warranted in the evaluation and treatment of young patients with work-limiting claudication caused by atherosclerosis. These patients are at significant risk of developing premature coronary occlusive disease and should be monitored closely.
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PMID:Intermittent claudication caused by atherosclerosis in patients aged forty years and younger. 213 46

External iliac fibromuscular dysplasia is a rare and usually asymptomatic disorder. We report eight symptomatic patients seen over a 15-year period and review pathophysiologic mechanisms accounting for the three following distinct lower extremity ischemic sequelae: (1) Emboli--episodic focal digital ischemia (blue toe) was seen in three patients. Resection and primary anastomosis of focal iliac ulcerative fibromuscular dysplasia (one patient) or resection and replacement (two patients) removed the embolic source and relieved the symptoms. (2) Chronic ischemia--gradual onset of full leg claudication in four patients was treated by operative graduated intraluminal dilation in three patients and prosthetic bypass in one. Arteriography subsequently showed a remodeled lumen in the three patients who underwent dilation. (3) Dissection--acute onset leg ischemia resulted from presumed dissection of the external iliac segment. After 4 months of conservative management of antiplatelet agents and exercise, symptoms resolved completely, and arteriogram showed spontaneous restoration of a normal lumen in the dissected segment. The clinical presentation of fibromuscular dysplasia may mimic other arterial processes such as atherosclerosis. Diagnosis is made only by arteriography with specific magnification views of the external iliac arteries and careful surveillance of the renal arteries. Appropriate treatment should be tailored to the clinical presenting symptom. For microembolic disease, resection and replacement are required. For chronic ischemia, intraluminal dilation is generally sufficient and durable and has proved to be a simpler and acceptable alternative to replacement or bypass. In acute dissection, surgical intervention may be deferred if the limb is viable to allow spontaneous healing and remodeling. Persistent symptoms may be the only indication for intervention in this ischemic manifestation of external iliac fibromuscular dysplasia.
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PMID:Clinical spectrum of symptomatic external iliac fibromuscular dysplasia. 221 43

Juvenile peripheral atherosclerosis is seldom reported in healthy men younger than 30 years. A case report describes a healthy young man in whom claudication developed due to an isolated vascular lesion in the superficial femoral artery documented by arteriography. The symptoms, diffential diagnosis and treatment are discussed.
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PMID:[Macrostress claudication. Isolated juvenile arteriosclerosis in a lower limb of a young athlete]. 227 37

In recent years double-blind trials have proved the effectiveness of nonsurgical therapy in the treatment of peripheral obstructive arterial disease (POAD). Among the non-pharmacologic measures taken, walking distance was increased by 40% in subjects who stopped smoking and by more than 100% in those who undertook physical exercise. Drug treatment reduces the atherosclerotic process and brings about an improvement in the symptoms of the disease. In subjects given hypolipidemic treatment the progression of the disease was reduced by two thirds. Two separate studies suggest that antiplatelet drugs, taken over a period of two to four years, significantly slow the progression of atherosclerosis in lower extremity arteries. In the treatment of claudication, two vasodilating drugs, naftidrofuryl and buflomedil, have shown a significant improvement in painfree walking distance and/or total walking distance, compared with treatment with placebo. Another effective approach is in the treatment of blood rheology through drugs such as pentoxifylline or by hemodilution. Double-blind trials with pentoxifylline demonstrated an average increase of 66% in maximum walking distance as compared with 22% with placebo. The effectiveness of hemodilution was demonstrated by two controlled trials, during which the reduction of the hematocrit to values of 40-42 for periods of four to six weeks increased both walking distance and resting blood flow. When introduced intraarterially in low doses in the vicinity of the occluding thrombus, thrombolytic agents have been found to be helpful in the treatment of acute and chronic POAD. This therapy should, however, be regarded as a substitute for surgical treatment only in high-risk patients. Further, after having produced the lysis of thrombi, the treatment permits the underlying parietal lesions to be accurately identified; at this point the appropriate therapy can be decided upon, either an operative procedure or a balloon dilation. In conclusion the many controlled clinical trials carried out over the past few years have clearly demonstrated that conservative treatment can alleviate clinical signs and symptoms in patients with claudication and pain at rest.
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PMID:Current therapy of peripheral obstructive arterial disease. The non-surgical approach. 240 52

In a retrospective study the relevance of revascularisation of the deep femoral artery was evaluated in 100 geriatric patients with obliterative atherosclerosis. The results of profundaplasty were good in 91% of patients with claudication (follow-up 47 months). In patients with rest pain the limb salvage rate was 77% (follow-up 39 months). In comparison with femoropopliteal or femorocrural bypass the results were at least even but had lower lethality. In a state of gangrene the limb salvage rate was 39% overall (follow-up 31 months). Diabetics had a limb salvage rate of 28% versus 43% in non diabetics. In a state of claudication and rest pain with stenosis of the deep femoral artery its revascularisation is in our view the treatment of first choice. In a state of gangrene bypass implantation, especially in diabetics, seems to have better results, but as additional palliation before primary amputation profundaplasty should be performed.
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PMID:[Profundaplasty--a palliative operation in leg arterial occlusion of the aged?]. 240 95

Implementation of a protocol that monitored in situ saphenous vein bypass hemodynamics for low-flow states provided insight into the pathophysiologic characteristics and time course of graft failure. From 1981 to 1988, 250 in situ bypasses to popliteal (n = 83) or tibial (n = 167) arteries were performed in 231 patients. Indications for operation included critical limb ischemia in 232 cases (93%), popliteal aneurysm in 11 cases (4%), and disabling claudication in seven cases (3%). Arterial pressure measurements, continuous-wave Doppler spectral analysis, and duplex ultrasonography were used to assess patency, detect hemodynamic changes indicative of graft stenosis, and localize anatomic hemodynamic changes indicative of graft stenosis. Seventy grafts with correctable anatomic lesions (retained venous valves, graft stenosis, arteriovenous fistula, native vessel atherosclerosis) that decreased graft blood flow or ankle arterial pressure or both were identified. Correction of vein conduit or anastomotic lesions comprised 73 (77%) of the 95 revisions performed. Vein-patch angioplasty of a stenosis was the most common secondary operation performed. Graft revision was highest in the perioperative period (10% at 30 days), decreased to 7% per 6-month interval until 18 months, and was 3% per year thereafter. The primary patency rate of grafts not identified to have a correctable lesion was 86% at 4 years, a level similar to the secondary patency of 81% for grafts requiring one or multiple revisions. The surveillance protocol identified grafts with correctable lesions before thrombosis thereby permitting elective revision of patent grafts. Hemodynamic studies confirmed that a frequent mechanism of late failure of grafts was the development of a low-flow state produced by lesions not amenable to revision.
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PMID:Monitoring functional patency of in situ saphenous vein bypasses: the impact of a surveillance protocol and elective revision. 252 7

To determine the efficacy of extending vascular reconstruction to the pedal vessels, the records of 115 in-situ saphenous vein bypasses to the infragenicular vessels were examined. Ninety-four percent were performed for limb-threatening ischemia and 6 percent for claudication. Ninety-one bypasses were to tibial vessels in the calf (Group 1), whereas severe disease of the tibial vessels in the calf necessitated bypass to arteries at the ankle and beyond in 24 (Group 2). Life-table analysis was used to calculate limb salvage, graft patency, and functional status for Group 1 and Group 2 36 months postoperatively; there were no statistical differences between groups with regard to these variables (p = 0.38). Diabetes had no impact on the success of reconstruction, and preoperative noninvasive testing was not predictive of graft failure in either group. Significantly, limb salvage closely paralleled graft patency and functional status, illustrating the severe disease in all patients. Patients with severe tibial-peroneal atherosclerosis may benefit from bypass grafting to the pedal arteries with a success rate equal to those done to more proximal sites.
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PMID:Results of in-situ saphenous vein bypass to the foot. 258 78

The authors examined the relationship between the ankle pressure, or pressure gradient on the one hand, and the walking distance and different actions, i.e. equalting and standing on tip toes, on the other hand. In 56 male patients with obliterating atherosclerosis, the first stage showed both pressure parameters as closely correlated to the final claudication distance, but not to the actions indicated above. At the second stage, 62 persons showed both the initial and final claudication distances as dependent on the poststenotic pressure as well as on the pressure gradient. Stepwise regression analysis showed a significant dependence of both distances on the lowest pressure measured on four crural arteries. The closest correlation [R = 0.98] was found between the initial and final claudication distances which persisted even after elimination of all pressure parameters.
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PMID:[What is the relation between pressure parameters and claudication distance?]. 260 13

Progressive peripheral atherosclerosis commonly leads to failure of a bypass graft. Lowering blood cholesterol retards coronary atherosclerosis and similar treatment might limit peripheral atherosclerosis. To identify lipid risk factors for peripheral atherosclerosis, 144 patients with peripheral atherosclerosis (98 with severe disease and 46 with stable claudication) and 61 age-matched control subjects were studied. Fasting lipid (cholesterol and triglycerides) and lipoprotein (high-density lipoprotein [HDL], low-density lipoprotein [LDL], and very-low-density lipoprotein [VLDL] cholesterol [C]) levels were measured. The incidence of hypertension and diabetes mellitus, amount of previous tobacco use, and location and severity of the peripheral atherosclerosis were also determined. Patients with peripheral atherosclerosis had higher VLDL-C and lower HDL-C levels than controls had, but serum cholesterol and plasma LDL-C levels were similar. Patients with peripheral atherosclerosis also had a higher incidence of diabetes mellitus and hypertension. Predictors of peripheral atherosclerosis by regression analysis were diabetes mellitus, low HDL-C levels, and tobacco use, with diabetes mellitus being the strongest variable. Peripheral atherosclerosis below the inguinal ligament was strongly predicted by low HDL-C and increased VLDL-C levels but not by increased cholesterol or LDL-C levels. Thus lipid risk factors for peripheral atherosclerosis are different, and attempts at limiting late graft failure by lowering lipid levels should be directed toward these lipoproteins.
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PMID:Lipid risk factors in patients requiring arterial reconstruction. 279 67


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