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

Aggressive revascularization of the ischemic lower extremity in atherosclerotic occlusive disease by femoropopliteal (FP) and femorotibial (FT) bypass or profundaplasty (P), as indicated, has been advocated by some authors for all patients. Others have recommended primary amputation, particularly for tibial occlusive disease. To clarify this clinical dilemma, we reviewed the results of 547 procedures performed during the last 5 years: revascularization in 375 (69%) instances and below-knee amputation (BKA) in 172 (31%) cases. Bypass procedures were used in 246 cases: FP in 155 (64%) and FT in 91 (37%). Reversed autogenous saphenous vein (ASV) was used preferentially in 125 (51%) cases, whereas polytetrafluoroethylene (PTFE) was used in 121 (49%) cases. P was performed in 129 instances accompanied by inflow procedures in 92 (71%) of these cases. Cumulative limb salvage (LS) exceeded bypass patency in all categories and resulted in 2- and 5-year LS rates of 83% and 81% for FP with the use of ASV and 52% and 35% for PTFE. The LS rate for FT was 53% and 47%, respectively, for ASV and 20% and 15% for PTFE. Rest pain was successfully relieved by P in 99 cases (77%), whereas healing occurred in only 51% of cases with tissue loss. The perioperative mortality rate for revascularization was 3%; 42% of the group died during follow-up, death usually resulting from complications of atherosclerosis. Of the 172 BKAs, primary healing occurred in 80%, but the perioperative mortality rate was 13%. FP and FT bypasses are preferred procedures if ASV is available, whereas use of PTFE should be limited to FP bypasses only. Rest pain is relieved by P but tissue loss should prompt consideration for bypass. BKA should be considered in cases of severe tibial disease only in the absence of a suitable ASV, as the perioperative mortality rate is high and ultimate rehabilitation (64%) is limited.
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PMID:Results of revascularization and amputation in severe lower extremity ischemia: a five-year clinical experience. 396 50

Under analysis are the factors of operative risk and results of operative interventions on distal segments of the arteries in elderly and senile patients with critical ischemia of lower extremities against the background of generalized atherosclerosis. Seventy-eight bypasses were fulfilled: ileo-femoral, femoro-popliteal, femoro-tibial, femoro-fibular. Pain at rest and gangrene of the foot and toes tissue were considered to he indications to bypasses. Among the risk factors smoking and arterial hypertension are particularly stressed. Postoperative lethality in patients of 80 years of age and older was 12.5%, among the patients from 70 to 80 years of age--7.7%. The active strategy is believed by the authors to be justified for revascularization of the extremity distal segments in critical ischemia and threatening amputation in the patients of 80 years of age and older.
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PMID:[Distal shunting in critical ischemia of the lower extremities in patients younger and older than 80]. 923 66