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

We are currently evaluating the inferior epigastric artery as an alternative arterial conduit for coronary bypass grafting. Fifty-seven inferior epigastric arteries were harvested from 47 adults. There were no differences in size between the right and left inferior epigastric arteries. Diameter was 2.5 to 3.5 mm proximally and 2 to 3 mm distally. Usable length was 6 to 16 cm (mean 11.2 +/- 0.25 cm). Grade I/IV atherosclerosis was found in one patient (2.1%). Duplex scanning was used for preoperative evaluation of the inferior epigastric arteries in 51 patients. In 21 patients the arteries were not harvested, in part because of duplex scan findings of small caliber or early bifurcation. In 30 patients the duplex findings could be compared with the surgical findings. The average length at operation was twice the length detected on duplex scan (11.2 cm versus 5.8 cm, p less than 0.001). There was a good correlation between diameter on duplex scan and that measured at operation (2.56 +/- 0.05 versus 2.62 +/- 0.07, p = not significant). Between December 1989 and May 1991, 38 patients (29 to 74 years, mean 56 years) received 42 inferior epigastric artery grafts. Proximal anastomoses were to the aorta in 17, to the vein graft hood in 20, or onto an internal mammary artery graft in 5. Distal anastomoses were to the left anterior descending artery in 2, the diagonal branch in 27, the marginal branch in 9, or the right coronary artery in 4. There were no early deaths. Complications included perioperative myocardial infarction in 1, deep sternal wound infection in 2, superficial infection at the harvest site of the inferior epigastric artery in 5, and reexploration for bleeding in 2. Because of its size and the low incidence of atherosclerosis, the inferior epigastric artery may evolve as an alternative arterial conduit for coronary bypass. Duplex scanning is a valuable noninvasive tool for preoperative evaluation of the artery's suitability. Long-term studies of patency of the inferior epigastric artery as a coronary bypass conduit are needed.
J Thorac Cardiovasc Surg 1992 Mar
PMID:The inferior epigastric arteries as coronary bypass conduits. Size, preoperative duplex scan assessment of suitability, and early clinical experience. 153 38

These specialized tracings illustrate several important patterns of coronary blood flow velocity that may occur in patients during diagnostic cardiac catheterization. Recent advances in catheter methodologies permit easy measurement of coronary blood flow during routine coronary angiography. At the current time, measurement of coronary blood flow velocity remains a research technique but is of continuing interest in clinical syndromes of atypical angina, myocardial hypertrophy and infarction, early transplant rejection, or premature (subangiographic) atherosclerosis in some patients. A later hemodynamic rounds will examine the effects of coronary blood flow velocity and various hyperemic stimuli to assess coronary vasodilatory reserve.
Cathet Cardiovasc Diagn 1992 Feb
PMID:Interpretation of cardiac pathophysiology from pressure waveform analysis: coronary hemodynamics. Part II: Patterns of coronary flow velocity. 154 59

Nitroglycerin has dependable, short-lived veno- and arterial vasodilatory effects ameliorating ischemia through both preload reduction and coronary vasodilation. Nitroglycerin should be used prior to left ventriculography in patients with elevated left ventricular end-diastolic pressure. The arterial pressure waveform alteration of nitroglycerin can be explained on the basis of changes in arterial distensibility and reflected wave patterns and may vary considerably among individuals with different degrees of atherosclerosis.
Cathet Cardiovasc Diagn 1992 Mar
PMID:Interpretation of cardiac pathophysiology from pressure waveform analysis: effects of nitroglycerin. 157 82

As the ages of patients undergoing cardiac operations have increased, noncardiac causes of death have increased. To identify these causes of death, we analyzed the autopsy findings in 221 patients undergoing myocardial revascularization or valve operations between 1982 and 1989. Mean age was 65.6 +/- 9.5 years and the range was from 32 to 94 years; 130 patients (58.8%) were male. Autopsies were complete in 129 patients (58.4%) and limited to the chest and abdomen in the remainder. Embolic disease was identified in 69 patients (31.2%). Atheroemboli or abnormalities consistent with atheroemboli were identified in 48 patients (21.7%). Fourteen patients had thromboembolism and 7 had disseminated intravascular coagulation. The prevalence of atheroembolic disease increased dramatically from 4.5% in 1982 to 48.3% in 1989 (p = 0.001). Atheroembolic disease was found in the brain in 16.3% of patients, spleen in 10.9%, kidney in 10.4%, and pancreas in 6.8%. Thirty (62.5%) of the 48 patients had multiple atheroembolic sites. Atheroemboli were more common in patients undergoing coronary artery procedures (43/165; 26.1%) than in those undergoing valve procedures (5/56; 8.9%) (p = 0.008). There was a high correlation of atheroemboli with severe atherosclerosis of the ascending aorta. Atheroembolic events occurred in 46 of 123 patients (37.4%) with severe disease of the ascending aorta but in only 2 of 98 patients (2%) without significant ascending aortic disease (p less than 0.0001). Forty-six of 48 patients (95.8%) who had evidence of atheroemboli had severe atherosclerosis of the ascending aorta. There was a direct correlation between age, severe atherosclerosis of the ascending aorta, and atheroemboli. Incremental risk factors for atheroembolic are peripheral vascular disease and severe atherosclerosis of the ascending aorta.
J Thorac Cardiovasc Surg 1992 Jun
PMID:Atheroembolism from the ascending aorta. An emerging problem in cardiac surgery. 159 74

Clinical and histological analyses were made of 18 consecutive cases of peripheral artery atherosclerotic aneurysms (PAAA) (common, deep femoral and popliteal arteries) and compared to a group of 10 specimens obtained from the atherosclerotic, non aneurysmal femoral arteries of 10 cadavers with similar characteristics to the 18 patients. Although neither the clinical nor the macroscopic morphological data indicated the presence of an inflammatory process in the PAAA, the histological examination revealed the presence of a considerable infiltrate (greater than 11 inflammatory cells/2116 microns2) in a surprisingly high percentage of cases (4 cases, 22.8%). In 5 other cases (27.7%) the presence of lymphomonoplasmonocytic cells, although less pronounced, was greater than normally seen in atherosclerotic arterial walls (greater than 4 and less than 11 inflammatory cells/2116 microns2). The median number of inflammatory cells present in the media and adventitia varied from 2.2 +/- 0.3 to 13.2 +/- 0.3 per 2116 microns2. These values are significantly different compared to the results of atherosclerotic arteries at the same level (P less than 0.001 Mann-Whitney's U test). These findings of lymphomonoplasmocytic infiltrates in the absence of other pathology, together with an analysis of the data in the literature, makes it possible to presume that the inflammation present is associated with atherosclerosis and is more common in aneurysmal rather than stenotic forms. The pathogenesis may be determined by immune reaction phenomena.
J Cardiovasc Surg (Torino)
PMID:Parietal inflammatory infiltrate in peripheral aneurysms of atherosclerotic origin. 160 18

Atherosclerosis was induced in 20 Hanford miniature swine. Subsequently, one iliac artery lesion in each of 16 pigs was stented with either a self-expanding (8 pigs) or a balloon-expanded (8 pigs) stent. Immediately after stent placement, 4 animals in each group were taken off the atherogenic diet and continued on normal chow for the remainder of the study. Four months after stents were placed, atherosclerosis and the mural changes associated with the stent were more clearly evident in the arteries of the pigs continued on the atherogenic diet. These pigs also exhibited significantly more neointimal proliferation. In addition, the arteries containing the balloon-expanded stents showed more extensive and complex intimal changes when compared with arteries with self-expanding stents. Although both stent designs were equally effective in maintaining vascular patency, the balloon-expanded stent was more traumatic to the vessel wall which resulted in a significantly greater neointimal thickness.
Cardiovasc Intervent Radiol
PMID:Treatment of experimentally induced atherosclerosis in swine iliac arteries: a comparison of self-expanding and balloon-expanded stents. 162 79

The aortic arch syndrome characterised by diminished or absent pulses in the arteries arising from the aortic arch has many etiologies, such as syphilitic aortitis, dissection of the aorta, atherosclerosis and Takayasu's arteritis. The diagnostic criteria of Takayasu's arteritis often do not mention histological investigations. We observed a case of an aortic arch syndrome, presenting as a classical case of Takayasu's arteritis but caused by a severe form of atherosclerosis.
J Cardiovasc Surg (Torino)
PMID:Takayasu's disease and atherosclerosis. 167 30

Analysis of 1735 patients who underwent coronary artery bypass grafting from January 1981 through December 1988 revealed 152 (8.8%) patients with mild (4.5%), moderate (2.2%), or severe (2.0%) atherosclerosis of the ascending aorta. Three distinct pathologic patterns were found. The prevalence of stroke in patients with the severe type of aortic disease prompted development of a new operative technique that has been used in 16 patients. It involves a "no-touch" technique of the ascending aorta whereupon the proximal saphenous vein anastomoses are performed end to side to internal mammary artery grafts. Ages ranged from 49 to 80 years (mean 68.9). The 16 patients had 62 distal artery and vein anastomoses and 26 proximal saphenous vein-internal mammary end-to-side anastomoses. Internal mammary artery free flows ranged from 130 to 420 ml/min. Two hospital deaths were unrelated to the technique. There have been no strokes or recurrences of angina. An inordinately high incidence of main left coronary disease (50%), significant carotid disease (79%), and abdominal aortic occlusive or aneurysm disease (93%) was discovered. Ascending aortic atherosclerosis must be suspected in all coronary bypass patients with associated significant carotid, abdominal aortic, and main left coronary artery disease, aortic wall irregularity on ascending aortic angiography, adhesions between the ascending aorta and its adventitia, pale appearance of the ascending aorta, and minimal bleeding of an aortic cannulation stab wound. A "no-touch" technique that avoids any manipulation of the ascending aorta and that uses the internal mammary arteries as the sole source of blood supply for coronary bypass is an effective method to prevent aortic clamp injury, "trash heart," or stroke from severe ascending aortic disease. Preoperative angiographic visualization of the ascending aorta of all patients undergoing coronary artery bypass is mandatory.
J Thorac Cardiovasc Surg 1991 Oct
PMID:Atherosclerosis of the ascending aorta and coronary artery bypass. Pathology, clinical correlates, and operative management. 168 Nov 38

As hypertension advances, secondary pathophysiologic changes are induced in multiple organs. Consequently, we investigated the pathophysiology of the earliest forms of hypertension--e.g., borderline hypertension. Borderline hypertension is associated with abnormal autonomic control of the circulation; sympathetic drive to the heart, blood vessels, and kidney is increased, cardiac parasympathetic inhibition is decreased, and plasma norepinephrine is increased. The hemodynamic picture is one of increased cardiac output not met by adequate vasodilation. The condition of "hyperkinetic" borderline hypertension is a precursor of more severe hypertension. In due course, a transition from high cardiac output to high vascular resistance occurs, while the enhanced sympathetic tone recedes toward normal values. The mechanism of hemodynamic transition is easily understood: cardiac output decreases due to structural changes and receptor downregulation, whereas ensuing vascular hypertrophy increases vascular resistance. The apparent regression of plasma norepinephrine values is explained in the framework of our hypothesis of the "blood pressure-seeking properties of the central nervous system." Large body mass and overweight are a consistent feature of borderline hypertension. A recent study in Tecumseh, Michigan shows that weight, plasma norepinephrine, a hyperkinetic state, and plasma insulin values are correlated in the general population. The explanation of this interrelationship will greatly advance our understanding of hypertension. From the pathophysiological viewpoint, the paradoxical outcome of clinical trials involving older antihypertensive medication is not surprising. The complexity of pathophysiologic interrelationships and the fact that risk factors for atherosclerosis are increased in hypertension suggest that reduction of blood pressure cannot be expected to ameliorate all consequences of hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)
J Cardiovasc Pharmacol 1990
PMID:Hemodynamic and neurohumoral evidence of multifaceted pathophysiology in human hypertension. 169 32

Hypertension, dyslipidemia, and glucose intolerance cocluster in the population and act synergistically in increasing coronary artery disease risk. The mechanisms by which these risk factors interact in atherosclerosis are complex. First, hypertension, dyslipidemia, and altered insulin sensitivity may have a common pathophysiological basis. Activation of neurohormonal mechanisms may be implicated in many or all of these processes. In addition, underlying these processes may be common genetic and environmental influences. Second, these risk factors ultimately act on the blood vessel, thereby leading to atherosclerosis. Elevated serum lipids lead to vessel wall responses, including endothelial dysfunction, smooth muscle cell proliferation, lipid accumulation, foam cell formation, and, eventually, necrosis and plaque development. Hypertension may induce shear-related injury to the vessel. Endothelial injury (caused by hypertension) and vascular cell proliferation (induced by increased pressure and/or vasoactive substances) are effects that amplify the atherosclerotic process. In addition, diabetes and hyperinsulinemia can increase vascular tone, impair endothelial function, and stimulate vascular smooth muscle cell proliferation. Control of these risk factors should prevent or attenuate the vessel wall responses. Emphasis is now being placed on pharmacological therapeutic modalities that decrease blood pressure and improve insulin sensitivity and lipid metabolism. Identification of common links between risk factors, such as neurohormonal mechanisms (e.g., angiotensin), should lead to better therapeutic strategies.
J Cardiovasc Pharmacol 1990
PMID:Atherosclerosis and hypertension: mechanisms and interrelationships. 169 33


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