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

To determine the prognostic significance of the level of arterial disease in claudicators, risk factors affecting the progression of intermittent claudication, including hemodynamic variables obtained from noninvasive vascular laboratory examinations, were assessed. We identified 378 patients with intermittent claudication by characteristic history and the presence of abnormal treadmill exercise examination results. Results of serial examinations were available for 195 of these patients, who had 310 claudicating limbs. Life-table analysis revealed that after eight years, 41% of these patients had progressed to critical ischemia, defined as rest pain or tissue loss, and 50% had died. Cox proportional hazards general linear regression analysis found that at a patient's first examination in the vascular laboratory, the ankle-brachial index and the decrease in ankle-brachial index after exercise were significantly associated with the subsequent development of critical ischemia. The level of disease at the initial examination in the vascular laboratory was not a significant risk factor for progression to critical ischemia and therefore should not be used as an indicator for or against operation in patients with intermittent claudication.
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PMID:Risk factors affecting the natural history of intermittent claudication. 338 53

In 20 patients (24 limbs) with peripheral occlusive arterial disease involving the lower extremities, foot and chest transcutaneous oxygen tension (tcPO2) and ankle and arm systolic blood pressures were measured, with the patient's legs horizontal and with them in an elevated position, before and after revascularization procedures. Eighteen of the procedures were unilateral and were performed to alleviate severe ischemia; the three bilateral procedures were done to relieve intermittent claudication. Regional perfusion index (RPI) was calculated for each foot (RPI = tcPO2 foot/tcPO2 chest) with the legs horizontal and with the legs elevated for 3 minutes (RPI3). The ankle/brachial index was calculated from ankle and arm systolic blood pressures. Limbs with severe ischemia had considerably decreased RPI and RPI3 before revascularization, whereas limbs affected by claudication had only a modest decrease in RPI but a pronounced decrease in RPI3. The tcPO2, RPI, and RPI3 increased substantially after revascularization.
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PMID:Effect of arterial revascularization on transcutaneous oxygen tension of the ischemic extremity. 341 29

For the clinical management of patients with a mild ischemia or intermittent claudication, ambulatory exercise plus the administration of antiplatelets and vasodilators is recommended. Patients with a ischemia related with small ulcer and slight pain at rest often show improvement while on conservative treatment. For patients with a severe ulcer and pain, reconstructive surgery has to be done. In management of patients with extensive or diffuse arterial occlusive lesions amenable to direct reconstruction, A-V shunt procedure, forced pulsatile perfusion technique and artificial CO2 baths have been devised. Tibial artery bypass associated with adjunctive arteriovenous fistula has also been recommended for those with poor distal outflow vessels. To assess the outcome of the reconstructed artery and to prevent early postoperative occlusion, flow waveform analysis is useful. This approach also aids in detecting preocclusive lesions of the reconstructed artery during postoperative follow-up.
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PMID:Current status in treatment of the Japanese with chronic arterial occlusive disease of the lower extremities. 344 46

ECG monitoring during treadmill exercise testing was performed in a prospective series of 105 consecutive patients with intermittent claudication scheduled for peripheral vascular surgery. ECG monitoring during the exercise test was useful in predicting perioperative cardiac complications. In 55 patients with evidence of coronary artery disease by history and ECG obtained at rest, a strong association (p less than 0.001) between an ischemic response to exercise testing and the occurrence of perioperative cardiac events was observed. ECG monitoring during the exercise test also revealed previously unsuspected ischemia or arrhythmias in six of the remaining 50 patients and predicted perioperative cardiac problems in four of these six. An ischemic response to low-level treadmill exercise testing probably indicates advanced coronary artery disease and offers valuable predictive information when a revascularization procedure is considered for the relief of intermittent claudication.
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PMID:Prediction of perioperative cardiac complications by electrocardiographic monitoring during treadmill exercise testing before peripheral vascular surgery. 370 17

To evaluate the patency of PTFE (Gore-tex) as a femoropopliteal bypass, a prospective randomized trial was performed between PTFE and saphenous vein. Forty-nine consecutive patients with intermittent claudication, rest pain, or tissue loss due to an occlusion of the superficial femoral artery entered the study. Randomization between PTFE and saphenous vein was performed at the time of operation after assessment of the quality of the latter. The two groups did not differ significantly regarding stage of peripheral ischemia, outflow tract, or localization of the distal anastomosis. The patency rate 6 weeks after operation was 92% for each group. After a mean follow-up of 54 months, the patency rate for the PTFE group was 37% and 70% for the saphenous vein group (p less than 0.001). In the PTFE group, there were eight major amputations. No amputations were performed in the saphenous vein group. It is concluded from this study that the saphenous vein is by far superior to PTFE as a femoropopliteal bypass.
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PMID:Saphenous vein or PTFE for femoropopliteal bypass. A prospective randomized trial. 390 50

Subjective evaluation of hemodynamics by stress tests in claudicants should be made to establish severity of functional ischemia. As an indispensable examination of vascular laboratory, non-invasive, simple methods can only satisfy methodological conditions. The aim of this study was to apply the transcutaneous oxygen tension measurement for a non-invasive, continuous detector of hemodynamic responses in skin circulation by stress tests and to elucidate the clinical usefulness of this technique. Investigated were 20 legs in patients with intermittent claudication and 9 legs in healthy persons as controls. Ten legs with ischemic pain during exercise loading revealed abnormal transcutaneous oxygen tension (tcPO2) curves in comparison with those with in normal legs. Over the continuous tcPO2 curve, the minimum tcPO2 at the reverse postural change after exercise loading was the most reliable indicator for evaluating induced ischemia. We conclude that hemodynamic responses on stress tests should be analyzed both during and after exercise loading, and that the continuous tcPO2 curve constitutes a useful method for evaluating and following up the claudicants.
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PMID:Continuous measurement of transcutaneous oxygen tension on stress test in claudicants and normals. 394 31

The most common cause of intermittent claudication is atherosclerotic occlusive arterial disease. Differentiation of the common musculoskeletal and neurologic conditions that may mimic intermittent claudication is often possible with a careful history, but when insufficient detail is provided or multiple conditions exist, the findings on physical examination and noninvasive studies are useful. While physical examination provides a rough estimate of the degree of ischemia, assessment of functional impairment produced by occlusive arterial disease is best made with noninvasive studies before and after standard exercise. Arteriography is reserved for the patient for whom restoration of pulsatile flow is planned.
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PMID:Evaluation of the patient with intermittent claudication. 402 47

In addition to the determination of the presenting symptom of patients with peripheral vascular occlusive disease, evaluation of these patients may include the noninvasive measurements of ankle/arm pressure ratio, limb blood flow, and treadmill testing to evaluate the severity of the reduction in blood flow. We have included metabolic studies to assess the effect of this reduced blood flow in patients with stable intermittent claudication (n = 20), and with end-stage ischemia (night and rest pain) (n = 11), and in a control group without vascular disease (n = 8). No correlations were found between the resting limb blood flow, ankle/arm pressure ratios, maximum walking distance, and stated walking distance for the patients with stable claudication. Although the oxygen consumption was reduced only in the patients with end-stage ischemia, the percent oxygen extraction was increased to the same level in the patients with stable claudication and those with end-stage ischemia. Intramuscular stores of high-energy phosphates and glycogen were maintained in all groups with the lactate/pyruvate ratio increased only in the patients with end-stage ischemia. The complex interrelationships between the rate and distribution of blood flow with exercise and enzyme adaptation in patients with vascular disease make current resting hemodynamic and metabolic evaluations a poor reflection of the severity of the clinical condition within each patient group. Therefore laboratory testing may offer no advantage over clinical presentation in the overall evaluation of these patients.
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PMID:Laboratory evaluation of patients with vascular occlusive disease. 405 49

This work was done to evaluate the transcutaneous oxygen tension (TcPO2) in ischaemic legs introducing two variables: O2 breathed at 40% and heating with an electric blanket (HEB). Forty nine legs were studied and divided into three different groups: Normal (N) 19 legs, Intermittent Claudication (IC) 12, and Rest Pain (RP) 13. The transcutaneous sensor was placed on the Anterior Chest Wall (AChW), High thigh (HT), Anterior Tibial Compartment (ATC) and Dorsum of the Foot (DF). Measurements were done at each area with and without 40% O2 and with and without HEB. The TcPO2 readings increased significantly (P less than 0.05) in the three groups (N, IC, RP) at all leg levels (HT, ATC, DF) when the patient breathed 40% O2 with and without HEB. In the N group no significant differences were noted between the three leg levels whether the 40% O2 or the HEB was used or not (P less than 0.05). In the RP group significant differences were obtained when the HEB was used whether the patient was breathing ambient O2 or at 40%. On the contrary, when the HEB was not used, the differences between HT and ATC disappeared but persisted at the DF (P less than 0.05). There was a good correlation at the DF and at the AChW (DF/AChW) (r: 0.8012; P less than 0.001). From these results, we conclude that the TcPO2 is a good method of differentiating different degrees of leg ischemia in vascular patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Assessment of transcutaneous oxygen tension in ischaemic legs by means of using an electric blanket and 40% O2. 406 35

During the last 8 years, arterial reconstructive operations such as bypass grafting, thrombendarterectomy and percutaneous transluminal angioplasty were performed on 282 lower extremities with chronic arterial occlusion. Operative indications were intermittent claudication in 57.1% and limb salvage in 42.9%. Early and late failure rate following operations was 31.2%: for claudication group 24.0% and for limb salvage group 40.7%. In 30.6% of claudication group and in 45.7% of limb salvage group, ischemia of limbs, compared to their preoperative status, worsened following occlusion. These limb worsening-rates were high and not negligible. Main causes of failures were poor run off and poor graft. Because chronic arterial occlusion is not a malignant disease, it is not forgivable to worsen limb status by surgery. Therefore, the operative indication for claudicant should be the need of patients in their daily life. For femoro-popliteal bypass grafting in claudicant, not artificial graft but auto vein graft should be used. When no suitable vein is available, conservative therapy is the choice of treatment. In case of limb salvage, artificial graft may be used.
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PMID:[The effects of failure of arterial reconstruction on limb status]. 649 84


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