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

A prospective study was made with a view to analyse and to identify two particular forms of the post-thrombotic syndrome. The post-thrombotic syndrome of the shank can be recognized on the basis of the clinical and of the phlebographic examination. It has a serious prognosis and can be treated either conservatively or by surgery according to case. Its frequency is probably higher than it was presumed on the basis of the first observations. The post-thrombotic venous obstruction may be a cause of arterial ischemia during effort but this occurs only in very few cases. This particular syndrome is manifested as intermittent claudication which occurs in the clinical picture of chronic orthostatic venous failure. The probable mechanism is the direct effect of increased pressure in the arterial and venous circulation in vessels with normal walls, as a result of an important obstruction in the return circulation. Lumbal sympathectomy appears to improve durable claudication and hyperhidrosis.
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PMID:[Unique forms of the postthrombotic syndrome]. 252 84

In the presence of peripheral atherosclerotic disease, inappropriate adenosine release during exercise might promote excessive arteriolar dilation leading to steal phenomena and ischemia. In order to test this hypothesis, IV aminophylline (6 mg/kg over fifteen minutes), a dosage known to effectively block adenosine receptors, was acutely administered--in a double-blind, placebo-controlled study design--in 13 patients with intermittent claudication and documented atherosclerotic disease. All patients performed two treadmill exercise tests at the same hour on two consecutive days, five minutes after aminophylline or placebo administration randomly allocated. Pain-free time was 109 +/- 133 (mean +/- SD) seconds after placebo and 173 +/- 165 seconds after aminophylline (p less than .01); maximum time to claudication was 273 +/- 191 seconds after placebo and 397 +/- 318 seconds after aminophylline (p less than .05). The authors conclude that intravenous aminophylline markedly increases the walking capacity in patients with intermittent claudication, possibly by preventing flow maldistribution phenomena through adenosine receptors blockade.
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PMID:Increase of walking capacity after acute aminophylline administration in intermittent claudication. 259 36

Intermittent claudication and limb-threatening ischemia caused by occlusion of large and medium-sized arteries are rare manifestations of systemic lupus erythematosus. So far only eight documented cases have been reported, predominantly in young women. In this report two more patients are described. There is no common opinion concerning pathophysiologic mechanism, but immunologic endothelial damage and circulating antibodies to phospholipid probably play a role. The results of medical and surgical treatment are disappointing, and amputation becomes necessary in more than half of the patients.
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PMID:Intermittent claudication and limb-threatening ischemia in systemic lupus erythematosus and in SLE-like disease: a report of two cases and review of the literature. 266 62

Stiffness of the jaw was noted in the first descriptions of temporal arteritis. It was only in 1944 that Horton used the term intermittent claudication and related this sign to effort ischemia due to thrombosis of facial arteries. The introduction of ultrasound techniques has enabled the permeability of facial arteries to be confirmed in spite of induration and absence of pulsatility clinically. Anatomical studies have defined the preponderant role of the internal maxillary artery in the vascular supply of the masseter muscles and have enabled the localization of an appropriate and reliable site for ultrasound study: the pterygo-maxillary fossa. The velocimetric data thus collected confirm that the internal maxillary artery is affected and define the etiopathogenesis of intermittent jaw claudication during temporal arteritis. This sign is observed on average in one patient in three suffering from temporal arteritis. While several cases of intermittent jaw claudication have been described in severe atheromatous stenosis of the common carotid or external carotid arteries, or in relation to other causes (rheumatological, neoplastic, psychological ...), the observation of this syndrome in a suspicious clinical and paraclinical context constitutes an excellent orientation sign in favor of temporal arteritis.
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PMID:[Intermittent claudication of the jaw in temporal arteritis]. 269 73

Twenty-five men aged 53-70 years, with stable intermittent claudication and similar symptoms and walking distance, were investigated with myocardial scintigraphy, duplex ultrasonography of carotid arteries and femoral angiography. Each patient was scored according to the degree of stenosis in the popliteal trifurcation and the aortoiliac and carotid arteries. Eighteen of the 25 men had coronary heart disease, which was clinically evident in nine cases and scintigraphically demonstrated in 17/24. Ischemia or infarction without clinical manifestation was located in the atrio-ventricular septal region in all nine cases. Eight of the 25 patients were shown to have carotid lesions. Significant correlation was found between lesions in the trifurcation and in the carotid arteries, but not between aortoiliac and carotid lesions. Trifurcational disease was a somewhat weaker marker for coronary heart disease. The high prevalence of coronary heart disease is noteworthy, especially the septal pathology, and further studies on the clinical significance of the findings appear to be urgently required.
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PMID:High prevalence of coronary heart disease in patients with intermittent claudication. A preliminary report. 305 77

Intermittent claudication is due to ischemia of working muscles in patients with stenoses or obstructions of large or medium sized arteries. Arteriosclerosis obliterans is by far the most common etiology. As an arterial stenosis develops, the distal blood flow and blood pressure are not affected until a critical diameter occurs. Then, blood flow and blood pressure fall precipitously with further narrowing of the lumen area. The most important factors that influence blood flow and the blood pressure drop across a stenosis are the radius of the stenosis and of the artery, and the velocity of blood flow. The velocity of blood flow varies inversely with the peripheral resistance. A decrease in peripheral resistance which occurs with exercise, vasodilator drugs, or sympathectomy leads to an increased blood flow velocity and an increased pressure drop across a stenosis. Thus, a non-critical stenosis at rest can become critical and limit blood flow during exercise. In arterial occlusions and critical arterial stenoses, the distal perfusion pressure is decreased due to the high resistance of the small collateral vessels but blood flow may be normal at rest. With exercise, the distal perfusion pressure decreases to a lower level due to the fall in peripheral resistance. Then, the external pressure of muscle contraction may close the arterial bed and stop blood flow. The stimulus to collateral blood vessel development is not known but may involve the pressure differential across the involved vascular bed and metabolic products produced during the ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pathophysiology of obstructive arterial disease. 306 15

163 patients underwent surgery for acute ischemia of the lower extremity between 1982 and 1986. Thrombosis was present in 50 cases and embolism in 113. Half of the patients with thrombosis showed signs of chronic occlusive disease of the arteries (intermittent claudication); in the latter group 2/3 of the patients had atrial fibrillation and 1/4 coronary heart disease. For embolism Fogarty-catheter clot extraction was performed, mainly under local anesthesia. This procedure is easy to perform even under emergency conditions (mortality 10%, amputation rate 8%). In contrast, the surgical procedure in thrombotic occlusion was more demanding (mortality 4%, amputation rate 16%) and in the case of severe ischemia had to be carried out on an emergency basis. In case of less severe ischemia the treatment consisted in initial heparinization and elective revascularization when the patient was stabilized. A new therapeutic approach involving local catheter thrombolysis, catheter clot aspiration and balloon dilatation is presented. The combined catheter intervention produces good results in 70% of patients, particularly those with femoral thrombosis.
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PMID:[Clinical aspects and treatment of acute arterial occlusion]. 314 37

We first studied the distribution of radioactivity during continuous inhalation of C15O2 and 15O2 in traverse tomograms of the greatest diameter of legs, at rest and immediately after exercise (ankle flexions). C15O2 and 15O2 were distributed homogeneously and symmetrically in both legs of normal subjects at rest. The activity accumulated in the anterolateral region after exercise. In patients, this pattern of distribution was similar but asymmetrical, depending on the arterial pathology. No systematic distribution of either C15O2 or 15O2 was observed. In a second step, we studied quantitatively blood flow (F), oxygen uptake (R) and oxygen extraction (E) in 11 subjects: 5 normals (23 +/- 1 years) and 6 patients (60 +/- 11 years) suffering from unilateral intermittent claudication. We used the bolus inhalation technique of C15O2 and 15O2. In the normal leg at rest, ranges were 2.5 to 8.0 ml/min.hg for F, 0.9 to 21.3 mumol/min.hg for R and 3.6 to 33.4% for E. In the pathological leg at rest, ranges were 3.7 to 11.3 ml/min.hg for F, 3.8 to 10.6 mumol/min.hg for R and 7.1 to 24.5% for E. After exercise, ranges were 6.4 to 62.8 ml/min.hg for F, 66.0 to 386.3 mumol/min.hg for R and 29.2 to 89.5% for E in both legs. There was no straight difference between normal and pathological legs soon after exercise. This study allows us to expect that the demonstration of such a difference implies a longer delay of data acquisition following the slow post-ischemia recovery.
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PMID:[Regional blood flow and oxygen consumption in the leg muscles of normal subjects and in those with arterial insufficiency. Study of the distribution of C15O2 and of 15O2 using positron emission tomography]. 326 Sep 34

Peripheral arterial obstructive disease with symptoms of ischemia in the limbs is a common cause of disability, morbidity, and even mortality in the elderly. The most important cause is atherosclerosis, which is ultimately a systemic problem, but the cardinal symptom in the limbs is intermittent claudication. Unfortunately, the elderly patient often displays severe ischemia with pain at rest, and ulceration or gangrene of the extremity, even where there was a paucity of prior claudication, perhaps due to associated illness which reduces mobility. The essential aspects of clinical diagnosis and assessment of severity of ischemia involve relatively simple bedside techniques, and noninvasive laboratory methodology is mainly of value in selection of patients for angiography and potential revascularization. While conventional therapy involves bypass surgery, an expanding array of drugs and the advent of interventional angiographic measures including angioplasty offer alternatives which were not available even a few years ago.
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PMID:Peripheral vascular disease: medical evaluation and treatment. 331 89

The authors reviewed 460 patients with intermittent claudication. With primarily conservative management, these patients were followed for an average of 4.1 years (one to ten years). The mean age was 71.7 years, ranging from thirty-six to eighty-four years; 55.9% were males. The subsequent follow-up study revealed that the status of 44.1% of the patients with underlying arterial insufficiency deteriorated. Eventually, they underwent vascular surgery for limb-threatening ischemia. From this study, the analysis of the parameters could predict the clinical outcome of intermittent claudication at the time of initial and follow-up evaluation. During initial evaluation, when the ankle brachial index (ABI) was higher than 0.7 or when follow-up evaluation did not show a decrease of ABI by 0.15, the chance of favorable outcome was increased by 2.4 and 1.6 times respectively. When the ABI was less than 0.5 at the initial evaluation and decreased 0.15 or more during follow-up studies, the risk of requiring vascular surgery for limb salvage increased by 3.8 and 1.9 times, respectively. The onset of major vascular events in other areas appeared to influence the time of significant deterioration in the lower limb arterial disease, indicating multifactorial and systemic contribution in the natural history of intermittent claudication. In this homogeneous patient population with arterial insufficiency referred to the vascular surgeon, conservative management with strong supervision for smoking cessation, exercise, diet control, body weight reduction, and medical regimen can modify the natural course of intermittent claudication and associated vascular problems.
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PMID:Intermittent claudication: predictors and outcome. 334 4


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