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)

Peripheral arterial disease (PAD) is a condition typified by decreased arterial blood flow in the non-coronary branches of the aorta as a result of chronic atherosclerosis. Despite the higher prevalence of PAD compared with other cardiovascular entities such as myocardial infarction and stroke, far less import is given to its diagnosis and treatment. In this review, we highlight principal diagnostic and therapeutic considerations in the management of PAD and its complications. We particularly emphasize the role of clopidogrel in the reduction of risks associated with PAD.
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PMID:Risk reduction with clopidogrel in the management of peripheral arterial disease. 1770 36

Peripheral arterial disease is one manifestation of systemic atherosclerosis. The prevalence of peripheral arterial disease increases with the age of the population. It is important to remember the significant association of coincident coronary artery disease, which is the major cause of mortality in these patients. Remarkable technological advances in the past decade, along with patient preference, have shifted revascularization strategies from traditional open surgical approaches toward lower-morbidity percutaneous endovascular treatments. The availability of stents, more than any other advance, has fueled the growth of catheter-based procedures by improving the safety, durability, and predictability of percutaneous revascularization.
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PMID:Endovascular therapies for peripheral arterial disease: an evidence-based review. 1798 90

Peripheral arterial disease (PAD) is a common manifestation of systemic atherosclerosis. Although clinical history in conjunction with ankle-brachial index and evaluation of segmental pressures/waveforms is sufficient to diagnose PAD in a large percentage of patients, imaging is required for disease localization and treatment planning. Contrast-enhanced magnetic resonance angiography (CE-MRA) is a noninvasive, three-dimensional technique that has emerged as a front-line imaging approach for comprehensive evaluation of PAD. Technical advances such as parallel imaging and moving-table, time-resolved angiography and extended field-of-view approaches have greatly improved the accuracy of CE-MRA. In the clinical setting, CE-MRA can be extremely helpful in the initial diagnosis as well as subsequent management of patients with PAD. Continued hardware and software improvements will enable further refinements in imaging protocol for peripheral MRA, consolidating its clinical role for the evaluation of patients with PAD.
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PMID:Technology Insight: magnetic resonance angiography for the evaluation of patients with peripheral artery disease. 1803 32

Peripheral arterial disease (PAD) is a common manifestation of systemic atherosclerosis that is associated with a significant limitation in limb function due to ischaemia and high risk of cardiovascular mortality. The lower limb manifestations of PAD principally fall into the categories of chronic stable claudication, critical leg ischaemia, and, rarely, acute limb ischaemia. Lower limb ischaemia induced by PAD is a major health problem. In the absence of effective pharmacological, interventional or surgical treatment, amputation is undertaken at the end-stage as a solution to unbearable symptoms. The concept of "therapeutic angiogenesis" has become widely accepted during the past few years. Bone marrow consists of multiple cell populations, including endothelial progenitor cells, which have been shown to differentiate into endothelial cells and release several angiogenic factors and thereby enhance neovascularisation in animal models of hind limb ischaemia. The promising results from various preclinical studies provide the basis for clinical trials using bone marrow-derived cells or non-bone marrow cells, like cells from the peripheral blood or other tissues. However, the mechanisms by which these cells exert their positive effects are poorly understood until now. This review summarises the data from experimental and clinical studies related to peripheral arterial disease and cellular therapy.
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PMID:Therapeutic angiogenesis for peripheral artery disease: stem cell therapy. 1835 16

Peripheral arterial disease (PAD), usually caused by atherosclerosis, is defined as an obstructive arterial disease of the lower extremities that reduces arterial flow during exercise or, in advanced stages, at rest. It affects more than 8.5 million people in the USA. PAD may appear as an asymptomatic arterial disease with abnormal noninvasive test results, or as a symptomatic disease presenting with atypical limb pain, classic intermittent claudication, or critical limb ischemia. The spectrum of PAD is not a continuum. Patients who present with critical limb ischemia may have experienced minimum symptoms. PAD results in limitation of exercise and walking ability, described as intermittent claudication. Patients with PAD are physically impaired and have a higher risk of cardiovascular events; therefore, the treatment goals are aimed at decreasing their cardiovascular risk, as well as improving exercise and daily functional performance. Apart from supervised exercise, which is a major treatment modality for patients with PAD, as of yet there have been very few significant pharmacological breakthroughs in the treatment of PAD that increases blood flow to the ischemic limb. Although percutaneous intervention has markedly improved the treatment of PAD, bypass surgery continues to play an important role. For the most part medical therapy for PAD is designed as a secondary prevention for cardiovascular risk. These include antiplatelet therapy, statins, ACE-inhibitors, smoking cessation and possibly antihypertensive therapy. Revascularization is most beneficial for patients with lifestyle limiting symptoms, acute or chronic limb ischemia with resting pain or nonhealing ulcers. In the following review article we will try to explore the clinical role of some of the latest developments in this field.
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PMID:Peripheral artery disease: therapeutic advances. 1840 43

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) is a manifestation of systemic atherosclerosis associated with impaired endothelial function and intermittent claudication is the hallmark symptom. Hypothesizing that osteopathic manipulative treatment (OMT) may represent a non-pharmacological therapeutic option in PAD, we examined endothelial function and lifestyle modifications in 15 intermittent claudication patients receiving osteopathic treatment (OMT group) and 15 intermittent claudication patients matched for age, sex and medical treatment (control group). Compared to the control group, the OMT group had a significant increase in brachial flow-mediated vasodilation, ankle/brachial pressure index, treadmill testing and physical health component of life quality (all p<0.05) from the beginning to the end of the study. At univariate analysis in the OMT group there was a negative correlation between changes in brachial flow-mediated vasodilation and IL-6 levels (r=-0.30; p=0.04) and a positive one between claudication pain time and physical function score (r=0.50; p=0.05). In conclusion, despite the relatively few patients in our study, these results suggest that OMT significantly improves endothelial function and functional performance in intermittent claudication patients along with benefits in quality of life. This novel treatment combined with drug and lifestyle modification might be an effective alternative to traditional training based on exercise.
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PMID:The use of osteopathic manipulative treatment as adjuvant therapy in patients with peripheral arterial disease. 1882 95

Peripheral arterial disease (PAD) is an important healthcare problem and is an indicator of widespread atherosclerosis in other vascular territories, such as the cerebral and coronary circulations. PAD is associated with considerable morbidity and mortality. Most population-based studies investigating PAD prevalence and risk factors for its development and progression have been based on predominantly White ethnic groups. Much less is known about the characteristics of this disease in other ethnic groups. Understanding the epidemiology of PAD amongst ethnic minority groups is relevant, given that the population of minority ethnic groups in countries such as the United Kingdom rose by 53% between 1991 and 2001 and is expected to rise further in the future. This article aims to provide an overview of possible pathophysiological differences between ethnic groups for PAD, focussing predominantly on South Asians (people originating from India, Bangladesh and Pakistan) and Blacks (people of Black Caribbean and Black African descent) as these groups comprise the majority of all ethnic minorities in the United Kingdom.
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PMID:Ethnicity and peripheral artery disease. 1894 71

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

Peripheral arterial disease (PAD) is associated with significant morbidity and mortality and is an important marker of systemic atherosclerosis. However, little is known about the associated risk factors for PAD in patients on maintenance hemodialysis (HD). We collected the basic data and possible risk factors associated with PAD for 277 patients on maintenance HD. Furthermore, we measured ankle-brachial blood pressure index (ABI) in these patients. PAD was defined as an ABI value less than 0.90. The prevalence of PAD in our HD center was 22.8% (61/268). Advanced age (P = 0.006), longer history of HD (P < 0.001), diabetes (P = 0.002) and presence of PAD symptoms (P < 0.001) were independent predictors of PAD. PAD patients with diabetes had shorter history of HD (P = 0.001). 2-vessel PAD had higher serum cholesterol in HD patients (>or= 200 vs < 200 mg/dL; Odds ratio, 12.12, 95% confidence interval, 2.199-67.79; P < 0.004).
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PMID:Peripheral arterial disease and clinical risks in Taiwanese hemodialysis patients. 1939 18


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