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

Between January 1, 1969, and December 31, 1984, 55 operative procedures were carried out in 47 patients to correct subclavian-axillary artery lesions resulting from compression at the thoracic outlet. The most common causes of compression were a long cervical rib (27) and an anomalous first rib (15). Presenting features included claudication, vasomotor phenomena, digital gangrene, and acute limb-threatening ischemia. A combined supraclavicular and infraclavicular approach was preferred. Decompression was best achieved by excision of the cervical rib and the first rib and division of all soft tissue elements. The most common methods of arterial repair were resection-anastomosis (23) and replacement of vein graft (11). Embolic occlusions were frequently present (35). Axillary emboli were amenable to direct revascularization at the time of subclavian artery repair. If possible, more-distal embolic occlusions were managed without recourse to embolectomy catheter manipulations. The mean follow-up was 5 years 8 months (range 4 months to 16 years). Patients were assessed clinically, and the arterial repair was monitored by Doppler ultrasonography, B-mode scanning, and digital subtraction angiography. Of the 39 patients available for follow-up, 35 had no symptoms and four had residual claudication. There were no amputations. In the remaining cases the subclavian-axillary artery segment showed no hemodynamic or anatomic abnormality.
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PMID:Arterial complications of the thoracic outlet syndrome: fifty-five operative cases. 265 21

Twenty-seven externally supported polytetrafluoroethylene (PTFE) grafts were implanted in the femoropopliteal position crossing the knee joint. All patients underwent surgery because of limb threatening ischemia (rest pain or gangrene). There was one early graft failure (successful thrombectomy). No patient died postoperatively. The mean follow-up period was 17.32 months (range 3-44 months). Cumulative patency rate for this follow-up period was 73%. Absence of kinking when bending the knee joint was determined by ankle Doppler pressure measurements and arteriography. If an adequate saphenous vein is not available for knee-crossing femoropopliteal bypass, externally supported PTFE can be used, yielding short-term patency rates comparable to those obtained with autologous venous bypasses.
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PMID:Below-knee femoropopliteal bypass using externally supported polytetrafluoroethylene (PTFE) grafts. 276 59

A retrospective review was undertaken of 127 lower extremity fasciotomies performed for compartment syndrome after acute ischemia and revascularization in 73 patients with vascular trauma and 49 patients with arterial occlusive disease. One hundred twelve (88%) fasciotomies were performed early (at the time revascularization); 15 (12%) were delayed because of late compartment syndrome diagnosis. Ninety-four (77%) patients had more than one accepted indication for fasciotomy. Double-incision fasciotomy was used in 98 (77%) extremities, single-incision fasciotomy was used in 19 (15%), and fasciotomy-fibulectomy was used in 10 (8%). Fasciotomies were closed in 88 (69%) patients an average of 14 days after surgery. Seven patients needed multiple skin grafting procedures or myocutaneous flaps to close the wound; none compromised limb salvage. Five other patients had minor wound infections that resolved. Functional status returned to preoperative levels by the time of discharge from the hospital in 59 (48%) patients. Thirty-one (24%) patients had residual lower extremity disability related to delayed union of the fracture (five), chronic neuropathy (20), leg swelling (one), or ischemic nonhealing fasciotomy wounds (three); two patients had unrelated disabilities. Fourteen (11%) amputations were required for refractory limb ischemia; two (1.6%) were required for wet gangrene of the foot, which infected the fasciotomy site; the others had open noninfected incisions. Eighteen (15%) patients died of cardiopulmonary failure or multisystem failure or both, without fasciotomy-related problems. Open fasciotomy for compartment syndrome after acute lower extremity ischemia and revascularization was associated with an increased risk of minor wound morbidity. However, limb loss and death resulted from persistent ischemia and underlying systemic disease processes or injuries, but not from open fasciotomy wound complications.
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PMID:Does open fasciotomy contribute to morbidity and mortality after acute lower extremity ischemia and revascularization? 277 98

The importance of postoperative wound infection in major amputations was elucidated by recording the organisms isolated in preoperatively infected gangrene and in postoperatively infected wounds of patients undergoing lower-limb amputations for ischemia. Sixty-four amputations were performed on 61 patients. The frequency of coexisting diabetes mellitus was 34%. Postoperative infections occurred in nearly two-thirds of the 19 cases of infected gangrene, as compared with less than one-third of cases of noninfected gangrene. The presence of diabetes mellitus did not significantly influence the infection rate. Preoperatively as well as postoperatively, the most frequently isolated bacterium was Staphylococcus aureus. Clostridium perfringens was cultured in four cases. Postoperative wound infection following lower-limb amputation for ischemia is the main reason for reamputation, especially in patients with infected gangrene.
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PMID:Wound infection after lower extremity amputation because of ischemia. 286 53

A 26-year-old male shortly after an acute respiratory disease was affected by a thrombophlebitis of the left leg. After a few days he had two syncopal attacks. Later on, a myocardial ischemia was diagnosed. Subsequently the patient began to complain of a bilateral claudication of the calves; after an attack of fever, the ischemia of the lower limbs worsened with recurring pain at rest. At the same time, in absence of any symptom, a myocardial ischemia occurred again and the presence of a thrombus was observed in the right atrium. After surgical removal of it, the ischemic troubles of the lower limbs once again began to worsen with the occurrence of bilateral gangrene of the feet. An amputation of both the legs was promptly performed at the level of the thighs. The histological examination of the arteries of the amputated legs showed segmental arteritis with partially recanalized thrombi of the popliteal, left femoral and tibioperoneal arteries. In the meantime, the titres for Coxsackie virus B2 and B6 were found slightly increased. One month later, the left radial pulse disappeared for a few days. The histopathological findings may relate this arteritis to a form of Buerger's disease even if a systemic thromboangiitis obliterans is not commonly accepted. In case that the acute respiratory infection represented the true onset of the sickness, it seems conceivable that the hypothesis of a viral infection gave raise to arteritis with morphological features recalling those of Buerger's disease.
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PMID:An uncommon systemic arteritis--a case report. 286 78

Sixty-five lower-extremity amputations were performed as a result of sepsis in diabetic patients during a 3-year period. Chronic plantar ulcer was the most frequent cause of infection. Other causes of infection included ischemic gangrene, trauma, and web space fissures. Advanced ischemia was infrequent; only 21 (32.3%) had ankle-brachial indices (ABI) less than 0.5. Eight (23.5%) deaths and 12 (35.3%) stump failures followed 34 amputations where the stump was closed, compared with no deaths and 4 (12.9%) stump failures when open amputations were done (p less than 0.02). Partial foot amputations with aggressive local debridement resulted in healing in 10 (71.4%) of 14 cases with revision or grafting. Guillotine transmalleolar amputation is advised when foot salvage is not possible, because only 1 (5.9%) of 17 such procedures could not be revised to the below-knee (B-K) level, whereas 8 (33.3%) of 24 definitive, closed B-K amputations were unsuccessful (p less than 0.02). Infections were polymicrobial, with 5.8 bacterial isolates and 2.3 anaerobes recovered per patient. Anaerobic antibiotic coverage, however, failed to alter outcome. Sepsis, often without advanced ischemia, is an important cause of limb loss in patients with diabetes. Open amputations are recommended, with foot salvage possible in many cases.
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PMID:The septic foot in patients with diabetes. 290 97

A case of extensive gangrene of the colon secondary to fecal impaction is reported. The role of ischemia in the management of colonic obstruction and the pathogenesis and treatment of colonic gangrene are discussed.
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PMID:Massive gangrene of the colon--a complication of fecal impaction. Report of a case. 291 28

On a continuous series of 1000 lower limbs, the Author correlates the by Leriche and Fontaine described stages in arterial occlusive disease of lower limbs, with parameters given by a set of functional vasculary tests: Doppler, tetrapolar rheography, digital plethysmography, transcutaneous measure of PO2 (Tc PO2). The ankle systolic pressure index is a good method to value the importance of arterial occlusion, but it reflects not so well the clinical severity of ischemia. The degradation of the digital plethysmography pulsated signal and of the Tc PO2, is proportional to the ischemia degree with a very good specificity in stages III and IV. The reography indexes, the quantification of leg arteries (Doppler), the digital plethysmography, show that the major opposition between stage II and stage III - IV is the quality of peripheral vascular bed. It appears that the notion of leg arteries outflow must be completed with a notion of compensation in distally and of global peripheral vascular bed (leg arteries--arteriolary system--microcirculation). The set of the used methods allows only to retain two different groups: the first one gathering asymptomatic or responsible of an effort ischemia lesions (corresponding to stage I and II), the other gathering responsible of permanent ischemia, which impends gangrene (corresponding to stages III and IV). In the presence of rest pain or trophic disorder, the joined data of digital plethysmography and of Tc PO2, are more discriminating than the single impression and allow to discover some false stages III and IV.
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PMID:Exploration of arterial function with noninvasive technics. Results in chronic arterial occlusive disease of the lower limbs according to Leriche and Fontaine classification. 293 58

Axillofemoral bypass (AXB) was performed on 100 patients who had claudication (19), pain at rest (42), gangrene or ulcer (22), aortic sepsis (14), or unresectable abdominal aneurysm (3). Unilateral (27 grafts), double unilateral (1), or axillobifemoral (72) grafts with Dacron (58), polytetrafluoroethylene (PTFE) (28), ring-supported Dacron or PTFE (12), or other material (2) were performed by 13 surgeons. Eight patients died within 30 days and three major amputations were necessary. Fifty-two (57%) of the 92 survivors had a total of 92 graft complications during a mean follow-up period of 21.5 months. Thirty-two patients underwent 57 reoperations of various types, incurring an additional three deaths and three amputations. Sixty (65%) of the original 92 survivors of AXB avoided reoperation. The 89 patients who survived the original and repeat procedures were followed up through the end of 1984 (62 patients), to late death (23), or to late graft removal (4), whichever occurred first. At these end points, 83 of the 89 (93%) patients had patent grafts. The graft patency rate of the original 100 AXBs by life table was 54% at 36 months; but with reoperation, it was 72%. Among those patients who left the hospital after AXB, the survival rate at 36 months was 69%. Statistically insignificant trends toward improved early patency were noted with bilateral femoral anastomoses, total iliac occlusion, and less severe ischemia. AXB provided safe palliation of severe arterial disease, with overall graft patency exceeding postoperative patient survival according to life-table analysis. However, the safety of AXB was tempered by frequent complications and the necessity for many reoperations to provide maximum efficacy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Axillofemoral bypass: a tool with a limited role. 293 65

Since 1971 175 femoro-crural bypasses were performed. Rest pain and gangrene were present in 90% of the cases; 28% had undergone previous surgery for ischemia of the same limb. The autogenous saphenous vein was the first choice and could be used in 81% of cases. Prosthetic material consisted consecutively of the regular PTFE (N = 12), the Dardik biograft (N = 13) and the thin-walled reinforced PTFE (N = 7). One dacron prosthesis was used. The two-year patency (Life-table) for the prostheses was 18%. Results of the composite grafts were as poor as those of complete prosthetic grafts. Saphenous vein grafts had a two-year patency of 70% and a five-year patency of 59%. Veno-venous anastomoses had no adverse influence on patency. Exploration of both legs for acceptable parts of the saphenous vein is indicated before the use of prosthetic material is justified.
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PMID:Results of prosthetic grafts in femoro-crural bypass operations as compared to autogenous saphenous vein grafts. 294 65


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