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

Chronic arterial insufficiency of the lower limbs is characterized by intermittent claudication often localized to the calf. These early clinical symptoms are the results of the atherosclerotic process of the vasculature of the lower extremities. The treatment is aimed at reducing or eliminating the ischemic pain and at preventing progression of the atherosclerotic disease. Whether surgical or nonsurgical measures are used, the cornerstone of patient care lies in correction of the risk factors. Smoking cessation and exercise therapy remain the fundamental measures in medical treatment of intermittent claudication. percutaneous transluminal angioplasty is an appropriate therapeutic option under certain criteria, especially for the iliac arteries. In the absence of randomized studies, surgery remains the treatment of choice for peripheral revascularization in presence of limb-threatening ischemia or ischemic ulcers. New procedures and materials are presently under trial to test the safety and efficacy of alternative methods or revascularization that would provide better long-term patency rates and shorter hospitalization periods.
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PMID:[Chronic occlusive arteriopathy of the lower limbs: therapeutic approach]. 919 Jun 67

Giant cell arteritis is an inflammatory disease that can affect the arteries anywhere in the body. Two cases are reported in which the arteries of the lower limbs were involved. Intermittent claudication with a walking distance of only 30 m was the inaugural manifestation in both cases. A biopsy of the superficial femoral artery provided the diagnosis in the first case. Ergotamine toxicity was considered initially in the second case. Acute ischemia and gangrene requiring amputation can complicate giant cell arteritis of the lower limbs and consequently corticosteroid therapy in an effective dose should be given as soon as the diagnosis is made. The inflammatory arterial lesions improve under therapy, but irreversible fibrosis with stenosis can develop if treatment is initiated late.
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PMID:Giant cell arteritis involving the lower limbs. 933 33

Sudden occlusion of a peripheral artery by embolization or acute thrombosis results in acute ischemia. This is most commonly associated with sudden onset of severe pain, numbness and pallor. Chronic ischemia from peripheral vascular disease results in intermittent claudication. We present a case of peripheral embolization from a left ventricular aneurysm in a previously asymptomatic male who presented to the emergency department complaining of two weeks of pain in his left great toe. Included in the discussion are important diagnostic tests for peripheral thromboembolism and ventricular aneurysm as well as suggestions for emergency department management.
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PMID:Left ventricular aneurysm and peripheral embolism as cause of atypical foot pain. 943 78

Sudden extreme physical stress is associated with an increased risk of myocardial infarction mainly in people with preexisting atherosclerosis. In this study we compared the effect of submaximal exercise on coagulation and fibrinolysis in patients with peripheral arterial occlusive disease (PAOD) with that in healthy control subjects. Fifteen PAOD) patients with intermittent claudication and 15 healthy control subjects, matched for age, sex, medication use, smoking habit, and conditioning, were studied. Thrombin-antithrombin III complex (TAT), D-dimer, tissue plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI)-1 antigens (Ag), t-PA activity, and plasmin-alpha2-antiplasmin complex (PAP), as well as plasma catecholamines, were measured before and after a treadmill exercise test. At rest, fibrinogen (3.3+/-0.5 versus 2.9+/-0.5 g/L [mean+/-SD]; P<.05), D-dimer (392+/-128 versus 271+/-113 ng/mL; P<.05), t-PA Ag (9.1+/-5.1 versus 5.5+/-1.2 ng/mL; P<.02), and PAI-1 Ag (14.9+/-7.1 versus 7.6+/-3.8 ng/mL; P<.002) levels in plasma were markedly higher in the patient group than in the control group. In patients but not in control subjects, exercise of similar intensity elevated circulating concentrations of TAT (from 3.43+/-1.45 to 4.83+/-2.27 ng/mL; P<.05). Exercise caused a parallel increase in D-dimer, t-PA Ag, t-PA activity, PAP, and catecholamines in both groups, whereas PAI-1 Ag remained stable. Plasma lactic acid was significantly higher in patients after exercise and was associated with lower-limb ischemia. Compared with healthy control subjects, patients with PAOD showed higher t-PA Ag, PAI-1 Ag, and D-dimer levels both at rest and after exercise. Notably, submaximal exercise on a treadmill enhanced thrombin formation in patients with PAOD but not in the control subjects. Sudden catecholamine release and local ischemia during exercise may accelerate the preexisting prothrombotic potential of the atherosclerotic vessel wall.
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PMID:Physical exertion induces thrombin formation and fibrin degradation in patients with peripheral atherosclerosis. 948 89

We evaluated the value of dynamic transcutaneous oxygen tension measurement in 15 patients with Leriche stage II intermittent claudication treated with vascular bypass procedures. Fifteen men, median age 60 years (range: 37-72 years), were studied during six months; 19 limbs were revascularized: eight by angioplasty, 11 by patent graft. Claudication perimeter and dynamic transcutaneous oxygen tension measurement were evaluated before and after revascularization. The TcPO2 was continuously measured with a multimodular Kontron Supermon at seven different sites simultaneously: precordium (reference probe), thighs, calves and feet, in the dorsal recumbent position after 30 minutes rest, during a standardized exercise stress test at 50 W and during the recovery phase. The results were expressed as index of surface defect (ISD). After revascularization, the duration of significant ischemia was significantly reduced (P < 0.001 thigh, calf, foot) in 14 patients. Dynamic transcutaneous oximetry therefore seems to be a useful method in assessing stage II occlusive peripheral arterial disease and the topography of tissue hypoxia. Dynamic transcutaneous oximetry is helpful in the surveillance after revascularization and guides the choice of specific treatment (angioplasty or patent graft) especially for multiple lesions.
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PMID:[Evaluation of the revascularization process by staged dynamic transcutaneous oximetry in stage II of obliterative arteriopathy of the lower limbs: a prospective study of 15 patients]. 949 85

To determine the natural history of intermittent claudication, 110 patients were followed up for a mean period of 24.4 +/- 1.2 months. Four patients died during the follow-up. Of the survivors, 24 experienced a nonfatal cardiovascular event, myocardial infarction being the most frequent. Cumulative cardiovascular morbidity was 29% at 3 years. Cox proportional-hazards analysis showed initial ankle-brachial pressure index (ABPI) as a significant predictor for nonfatal cardiovascular events (p<0.002). With an initial ABPI >0.70, cardiovascular morbidity rate was 12% compared with 33% for those with initial ABPI ranging from 0.70 to 0.50, and 60% for those with ABPI <0.50 (p<0.005). Critical limb ischemia occurred in only four patients, amputation was required in two, and arterial reconstruction in five. Of the 85 patients who participated in the treadmill test, maximum walking capacity worsened in 26% and improved in 27%. This study elucidates the neglected area of cardiovascular morbidity in intermittent claudication. It has shown that ABPI identifies a subgroup of patients for whom the risk of cardiovascular events is especially pronounced. On the other hand, based on objective evaluation of the patient status, the relatively benign prognosis for the claudicant limb has been confirmed.
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PMID:Intermittent claudication and risk of cardiovascular events. 978 49

The role of polymorph nuclear neutrophils (PMN) in limb ischemia and reperfusion has been recognized only in recent years. The present study aimed to investigate the systemic and local (in femoral venous blood) effects of intra-arterially or intravenously applied prostaglandin E1 (PGE1) on systemic and ischemia-induced local changes in neutrophil function. Thirty patients with intermittent claudication were randomly assigned to intra-arterial or intravenous infusion of prostaglandin E1 (10 microg i.a. or 15 microg i.v. over 30 min). Prior to infusion femoral arterial and venous blood samples were obtained from the predominantly affected leg under resting conditions and immediately after a 3-min period of ischemia induced by suprasystolic thigh compression. After 24 h additional blood samples were obtained at baseline, following infusion of prostaglandin E1, and again after another 3-min period of ischemia following the prostaglandin E1 infusion. Intra-arterially administered prostaglandin E1 caused an increase in the PMN count by 3.5 +/- 2% (p<0.05) and a decrease in free oxygen radical production by 13 +/- 8% (p<0.05) measured by whole blood chemiluminescence. Additionally, a trend for lower PMN filterabilities (9 +/- 12%, NS) was observed. Intra-arterially infused prostaglandin E1 significantly reduced the ischemia-induced decrease in neutrophil filterability (arterial and venous blood difference after ischemia -- control: 22 +/- 17% (p<0.05); IA PGE1: 8 +/- 11% (NS), each compared to baseline). Intravenously administered prostaglandin E1 showed similar systemic effects as the intra-arterial application, but did not affect the ischemia-induced changes in neutrophil filterability. In conclusion, prostaglandin E1 reduces PMN activation in patients with peripheral arterial occlusive disease.
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PMID:Neutrophil function in peripheral arterial occlusive disease: the effects of prostaglandin E1. 989 9

We experienced two cases whose low back pain was improved after vascular reconstructive surgery for arteriosclerosis obliterans in the abdominal cavity. Based on these observations, we propose the term "vascular backache" and we discuss possible pathomechanisms underlying this condition. One patient had a stenotic lesion in the lower abdominal aorta and was operated transluminally; the other patient had a diffuse stenotic lesion from the abdominal aorta to the femoral arteries and had an axillofemoral bypass operation. After surgery, they experienced a reduction of backache along with an improvement of the vascular intermittent claudication. It is suggested that one factor leading to low back pain in some cases might be various degrees of ischemia of the extensor muscles in the lumbar spine.
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PMID:Vascular backache and consideration of its pathomechanisms: report of two cases. 1022 33

Cystic adventitial disease (CAD) is a rare cause of intermittent claudication, occurring in approximately 1:1200 claudicants or 1:1000 of those undergoing arteriography. It is most often described in the popliteal artery and is characterised by a mucinous cyst located in the adventitia of the artery, the contents of which resemble those of a ganglion. The origins of adventitial cysts are unknown, but connections to adjacent synovial spaces have been identified, suggesting that the cyst is a variant of a ganglion. In this report, we discuss a rare case of severe mucoid degeneration of the intima and media in a 67-year-old Saudi male patient. The patient presented with a saccular aneurysm of his right "mid-arm" brachial artery and critical ischemia of his right hand from distal embolisation.
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PMID:Mucoid degeneration of the brachial artery: case report and a review of literature. 1023 Feb 8

Endovascular procedures have deeply modified the treatment of patients with peripheral arterial diseases. However risks of transluminal angioplasty are increased with patient age. In patients with acute ischemia by distal embolism or in situ thrombosis percutaneous thromboaspiration is an alternative to the Fogarty catheter. In patients with chronic critical ischemia, revascularization is necessary. Risks of surgical treatment are rather in favour of endovascular procedures. In patients suffering of intermittent claudication, results of a series of 38 patients confirm the efficacy of angioplasty. Thus endovascular procedures can be proposed in alternative to medical treatment to patients over 70 years of age.
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PMID:[Role of endovascular treatments in the management of arteriopathies of the aged subject]. 1037 69


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