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

The authors studied the development of transient disorders of blood supply in the spinal cord and radicles. Besides the well known clinical forms which are described as syndromes of intermittent claudication of the spinal cord and cauda equina, there are some other variants of this disorder. Transient ischemia of this localization as a rule is either connected with atherosclerosis of the abdominal aorta, either with degenerative-dystrophic or congenital changes in the sacral part of the spine. The authors underline the role of individual differences in the vascularization of the spinal cord in the development of disorders in spinal circulation. The prognosis of transient ischemia, its correlation with stable disturbances is assessed. A differential diagnosis is also made between different transient vascular spinal disorders and radicle disturbances.
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PMID:[Variants of transitory myeloradiculoischemic disorders]. 34 42

Forty-five limbs varying clinically from normal through moderate to severely ischemic were studied by noninvasive measurements of both arterial blood pressure and perfusion. From the values plotted on a two-coordinate system, they arranged themselves well into three clinical categories: (1) normal, (2) intermittent claudication, and (3) ischemia or ulceration and rest pain. Good clinical responses to arterial reconstruction were corroborated by postoperative measurements. Reinforcing the results of one measurement with those of the other has provided an objective, numerical, and graphic basis for decisions regarding the advisability of angiography or arterial reconstructive procedures or both. To date, almost 400 patients have been evaluated by these techniques.
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PMID:Noninvasive assessment of the peripheral vascular system. 87 Dec 45

A 15-year experience with 92 subcutaneous arterial bypass grafts for lower extremity revascularization has been reviewed. Fifty-nine AF and 33 FF bypass operations were performed on 89 patients whose average age was 66 years. The overall five-year survival was 33% compared to an expected survival of 80%. 88% of the AF, and 76% of the FF operations were performed for limb salvage, bypass of an aortic aneurysm, or replacement of an infected aortic graft. The remainder were performed for intermittent claudication on patients who were too ill to withstand an intra-abdominal operation. 75% of the patients with AF grafts and 64% of those with FF grafts experienced complete relief of lower extremity ischemia, including all of the patients with claudication. Graft patency was analyzed by the life table method. In the FF series, 74% of the grafts remained patent for one year; 73% for two years; 66% for three years; and 53% for four years. A 50% incidence of thrombosis occurred at the end of two years in the AF group. The patency rate of the AF grafts was also studied with regard to the type of graft material employed: a 50% incidence of thrombosis was reached at 36 months with knitted Dacron; at 18 months with weave-knit Dacron; and at 9 months with woven Dacron. THESE DATA INDICATE THAT: (1) contrary to our previous report, weave-grafts provide adequate blood flow to the lower extremities but do not remain patent as long as more conventional types of reconstruction; (2) subcutaneous grafts should be performed only when an intra-abdominal procedure is contraindicated or life expectancy is limited.
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PMID:Fifteen year experience with subcutaneous bypass grafts for lower extremity ischemia. 88 58

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 present study of 33 operatively treated patients, 88 per cent of whom survived the procedure, is concerned with an important problem associated with acute thoracic aortic dissection, the stenotic and obstructive lesions of the aorta and its branches. Their variety and nature are described, as are the additional operative procedures deemed necessary at the time of the operation, immediately thereafter, or later on. Much has been learned about these difficulties from clinical and autopsy observations and especially from careful arteriographic surveys. They seem to be generally well withstood following resectional and grafting procedures upon the affected segment of the thoracic aorta. Occasionally, additional operative manipulations may be necessary at the same time, for example, interpolation of grafts between the ascending aortic graft and a coronary when the origin of the latter is sheared off by the dissection, and distal arterial manipulations when the patient still has ischemic lower extremities immediately after the primary procedure. Later operations must sometimes be performed because of persistence of complaints such as intermittent claudication. It is extremely rare that immediate reoperation is advisable because of indications of intra-abdominal ischemia. Much more can be learned from careful pre- and postoperative arteriographic study.
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PMID:Stenotic and obstructive lesions in acute dissecting thoracic aortic aneurysms. 113 Aug 82

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

Calf basal resting and reactive hypercemia blood flow were measured at 4-h intervals during a day in fifteen healthy subjects and in fifteen patients with intermittent claudication by means of a venous occlusion plethysmograph. Mathematical-statistical analysis of the data failed to demonstrate circadian periodicity of calf blood flow in healthy subjects, but proved the existence of a 24-h rhythm of calf basal resting and reactive hyperemia blood flow in patients with intermittent claudication. This different behavior of calf blood flow can be understood if one considers that in healthy subjects the voluntary muscles in the extremities have a blood supply which can be instantaneously adjusted over a large area. In patients with peripheral arterial disease, on the other hand, the vascular responses in voluntary muscles of the limbs to various endogenous or exogenous stimuli are impaired and reduced. The circadian rhythm observed in patients with intermittent claudication has early evening peaks and a nocturnal trough with a nadir occurring after midnight and before 0400. This rhythm displays marked similarities with those of all other circulatory values. As to the mechanism of rhythm, it is hard to decide whether or not it has an independent endogenous origin. It is known that many of the circulatory variables are interrelated and that some are clearly related to other circadian rhythms. Perhaps the rhythmic reduction of limb blood flow which occurs during the night is the mechanism underlying the nocturnal pain of subjects with limb ischemia by peripheral arterial disease.
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PMID:Behavior of calf blood flow in normal subjects and in patients with intermittent claudication during a 24-h time span. 119 4

The late results of brachial thrombectomy following cardiac catheterization were evaluated in 20 patients. All patients had a radial pulse present and no symptoms or signs of ischemia of the hand at the time of discharge from the hospital. Late evaluation of these 20 patients revealed 8 in whom the long-term results were classified as failure of the thrombectomy. Four of these had intermittent claudication of the involved arm and hand. None had any tissue loss and four had no symptoms referable to the failed thrombectomy. The one patient who refused surgery had claudication of the affected arm. The mean period of followup was 20.8 months. The rate of failed thrombectomies was twice as high in females than in males. Prolonged time of cardiac catheterization (over 4 hours), delay in diagnosis of more than 24 hours, and omitting the use of systemic heparinization at the time of diagnosis are three factors that appear to increase the likelihood of late failures.
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PMID:Long-term results of brachial thrombectomy following cardiac catheterization. 126

Ten injections of O3 into femoral arteries were administered to 50 patients with atherosclerotic ischemia of the lower extremities and to 49 diabetic patients. All patients were assessed clinically with the ankle-arm index, measurement of intermittent claudication distance prior to and after the treatment. The treatment showed a significant improvement in both groups manifested by an increase in ankle-arm index, and prolongation of the intermittent claudication distance by more than twice. The treatment of atherosclerotic ischemia of the lower extremities with O3 is both valuable and safe.
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PMID:[Clinical assessment of treatment results for atherosclerotic ischemia of the lower extremities with intraarterial ozone injections]. 130 May 89

In 1983-1988, the results of conservative and surgical treatment of patients with atherosclerotic ischemia of the lower limbs were assessed with the aid of a questionnaire. A possibility of prognosis was assessed with the use of mathematically processed data obtained with such approach. An effect of clinical symptoms (intermittent claudication distance, resting pain, necrosis) and stage of the disease (duration, K/R index) and risk factors (blood cholesterol, triglycerides, diabetes mellitus, ischemic heart disease, arterial hypertension) on the result of surgical treatment was analysed. The obtained results suggest that clinical symptoms and risk factors may predict the results of surgical treatment in the atherosclerotic ischemia of the lower limbs.
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PMID:[Anticipated results of arterial surgery in chronic atherosclerotic ischemia of the lower limb]. 140 53


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