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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the elderly, revascularization of a severely ischemic lower extremity with occlusion of both femoral and popliteal arteries often can be achieved by surgical construction of a distal bypass to the tibial or peroneal arteries. An aggressive diagnostic and therapeutic approach is necessary, in an attempt to prevent recourse to primary amputation. Femoroperoneal or femorotibial bypass can be performed safely and is recommended in elderly patients with advanced ischemia of a lower extremity with absolute indications for surgical intervention, e.g., gangrene, gangrenous ulceration or rest pain. A significant number of limbs can be salvaged by this method. Although the mortality rate in the older age groups is predictably higher, the overall rate for this operation compares favorably with that for primary amputation.
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PMID:Femorotibial bypass in the elderly for revascularization of the severely ischemic lower extremity. 97 35

We describe 31 patients in whom proximal lesions in the arterial tree were identified as probable sources of emboli causing the "blue toe" syndrome. This syndrome consists of acute digital ischemia caused by microembolization to the digital arteries from a proximal source via a patent arterial tree, as evidenced by an otherwise well-perfused foot. It is closely analogous to the transient ischemic attacks of the brain, and carries the same potential for serious tissue loss because of repeated embolic showers. The prompt delineation and eradication of the embolic source is of prime importance, in addition to restoration of arterial continuity. Along with the other well-known features of chronic severe ischemia, that is, rest pain, gangrene, etc, the "blue toe" syndrome is therefore an indication for limb salvage surgery.
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PMID:"Blue toe" syndrome. An indication for limb salvage surgery. 98 75

On the basis of our experience with 1827 femoropopliteal arterial reconstructions performed from 1959 through 1974 we have worked up a system of strict guidelines for the choice of procedure. The vein bypass is the method of choice in all cases at stages III/IV (i.e. resting pain or gangrene), in lengthy occlusions of the femoral arteries continuing into the distal popliteal arteries or in stenotic lesions or occlusions of the tibial arteries, in all recurrent occlusions, and in cases with calcification or dilatation of the arterial wall. The indication for endarterectomy is restricted to stage II (i.e. intermittent claudication) and to segmental occlusions of the femoral or popliteal arteries as well as transitional or lengthy occlusions of the femoral artery continuing to the proximal popliteal artery. Under these guidelines a total group of 645 patients underwent 721 femoropopliteal reconstructions-307 endarterectomies and 414 vein grafts-from 1971 through 1974. The average age of the patients was 60 years. In 50% of all cases operations were carried out for advanced ischemia treatening the extremity. For all the series the patency rate of vein bypass was 79% and of endarterectomy 71%. Accumulative patency rates by the life table method according to the preoperative degree of arterial insufficiency and the postoperative follow up period of 4 years do not show statistically significant differences between both procedures under the given guidelines.
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PMID:[Endarterectomy versus vein bypass grafts in femoropopliteal occlusions (author's transl)]. 101 10

The case of a 75 year old white male, with severe ischemia of the left lower limb and gangrene of its fifth digit, is presented. Because of early post-operative thrombosis after insertion of an autogenous composite femoro-popliteal venous by-pass graft and recurrence of symptoms, a fresh frozen human varicose vein allograft procedure was performed. A pseudo-aneurism which occurred along the graft on the 13th postoperative day was successfully treated by segmental excision with "end-to-end" reconstruction of the allograft itself. This was followed by plastic reconstruction of his foot with primary healing and complete disappearance of symptoms. The patient is now eight months post- op with excellent functional result. Only twenty two similar cases were gathered from the literature. All problems associated with allograft transplantation of fresh and frozen veins are discussed. This case further supports the facts that bloodgroup incompatibility is not a major problem and that reinterventions on such grafts are feasable.
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PMID:[On frozen vena saphena magna as an allograft in peripheral vascular surgery. Report of a case]. 111 77

A seven day old dehydrated male infant was found to have acute ischemia of the leg due to acute thrombotic occlusion of an external iliac, common and superficial femoral, and popliteal arteries. Early thrombectomy and arterioplasty resulted in complete remission of ischemia. Our success with direct vascular surgery prompts us to recommend this form of treatment in preventing neonatal gangrene. To our knowledge, this is the first report of successful thrombectomy in a newborn infant.
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PMID:Acute ischemia of the limb in a newborn treated successfully by thrombectomy. 111

Of more than 600 patients seen for intermittent claudication by this group and not primarily considered for surgery, 104 had angiographic studies and are the basis for this report. The follow-up period varied from 6 months to 8 years, with a mean of 2.5 years. Classification by severity of claudication revealed 33 with less than one block, 36 with two blocks, and 35 with two or more blocks, foot, calf, or thigh claudication. Eighty-two remained stable or improved and 22 worsened. Of the 22 who worsened, 16 had only worsening of claudication (six of them requiring arterial reconstruction) and six progressed to gangrene and required amputations. Of the 82, 66 either had marked improvement of claudication or remained sufficiently stable not to require any operative intervention. Sixteen required arterial reconstruction for persistent, intolerable, or incapacitating claudication. Five of the six amputees were from the less than one half block claudication group. Angiographic studies were significant only in relation to the below-knee runoff in that three of 25 with less than one vessel runoff, two of 23 with one to two vessel runoff, and one of 56 with two to three vessel runoff came to amputation, regardless of the pattern of more proximal arterial occlusions. The study suggests that intermittent claudication is relatively benign, with only 5.8 percent coming to amputation in a 2.5 year mean follow-up. Prognosis is determined by the severity of below-knee arterial involvement and apparent inability to compensate for ischemia via the collateral circulation since only 12.5 percent of those with the most pronounced involvement came to amputation.
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PMID:Intermittent claudication: its natural course. 118 22

When an ischemic contracture develops after injury it appears that the ischemia has pursued a middle course between full recovery and gangrene. The mechanism of such a pathology is difficult to understand. There appear to be two distinct types of injury that precipitate such a contracture; one where a major vessel is occluded and the ischemic tissue lies distal to the injury; and a second where the injury is a direct one and the ischemia develops at the site of the injury. The ischemic changes that develop after both types of injury appear to be remarkably similar and they develop, almost exclusively, where the tissues involved lie within unyielding osteofascial compartment. In both types, compartmental syndrome could have been precipitated; on the one hand by the ischemia of arterial interruption and on the other by direct tissue damage. Early fasciotomy is advocated after both types of injury, quite apart from any necessary arterial repair.
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PMID:Compartmental syndromes following trauma. 119 81

Preoperative Doppler ultrasonic assessment of below-knee (BK) arterial signals and systolic blood pressures was performed on 50 patients undergoing 53 BK amputations for advanced ischemia. No patient was excluded from initial BK amputation unless gangrene at that level or severe joint contracture was present. Failure of healing of the BK amputation occurred in all five limbs with an undetectable Doppler arterial signal (and thus pressure) below the knee. Failure of amputation occurred in four of 16 limbs with detectable arterial signals and BK pressures less than 70 mm. Hg. Healing occurred in all 32 limbs with BK pressures greater than 70 mm. Hg. The differences in healing between these three groups are highly significant (p less than 0.005). This study suggests that Doppler ultrasonic assessment of BK arterial signals and pressures may be a simple hemodynamic correlate of healing of a BK amputation. Absence of a detectable arterial signal below the knee may be an indication for initial above-knee (AK) amputation in advanced ischemia.
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PMID:An index of healing in below-knee amputation: leg blood pressure by Doppler ultrasound. 124 88

The deep femoral artery is often peculiarly resistant to atherosclerosis when the common and superficial femoral arteries are severly affected. At the Mayo Clinic between 1964 and 1972, 43 patients had aorta-deep femoral artery bypass as the definitive revascularization procedure for arteriel insufficiency of the lower extremities. Of the patients with grade 1 ischemia, 82% became asymptomatic as did 44% of those with grade 2 ischemia and 43% of those with ulceration and incipient gangrene. After 2 years, 25 of 40 (62%) previously symptomatic lower extremities had remained asymptomatic (in 31 patients available for follow-up evaluation). The rates were 68% and 55% after 3 and 4 years, respectively.
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PMID:The role of the deep femoral artery in revascularization of the lower extremity. 126 91

The profunda femoris artery is the primary source of collateral flow to the lower extremity in the presence of superficial femoral and/or popliteal occlusion. The arteriosclerotic disease involvement of this segment is relatively less frequent and in the majority of the cases localized on the ostium and reaches to the first branch. Profundaplasty to relieve limb-threatening ischemia is infrequently employed as an isolated procedure. However many Authors reported their experience on this treatment, in case of critical limb ischemia in patients without significative lesions of the aortofemoral district. Our late four year experience concerns of 22 patients (18 male, 3 female). All the patients had severe ischemia of the lower limbs, with serious symptoms, such as invalidating claudicatio (13), rest pain (7) and gangrene (2). Twenty-two profundaplasty were performed as the only reconstructive procedure. There was no postoperative mortality. Two patients had above knee amputations (15 days and 14 months after the revascularization). All of the other patients improved and follow-up extended to 48 months shows a limb salvage rate of 90%. In conclusion, on the basis of our experience, we think that the operation is recommended, whenever possible, in patients with critical ischemia when the possibilities of more extensive revascularization procedures are considered to be poor.
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PMID:[Profundaplasty as the only revascularization procedure in ischemia of the leg. Clinical contribution]. 129 22


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