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

Lesions in skeletal muscle resulting from ischemia caused by peripheral vascular disease in two patients were essentially identical to the early muscle lesions of Duchenne muscular dystrophy (DMD) patients and carriers of that disease, as well as to the early muscle lesions of experimental animals with aorta ligations plus a small dose of 5-hydroxytryptamine (serotonin). The one similarity is harmonious with, although does not necessarily advance, the ischemia hypothesis of DMD, and the other supports the ischemia mechanism proposed in the animal model.
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PMID:Focal lesions of muscle in peripheral vascular disease. 6 85

The existence of symptomatic aortoiliofemoral occlusive vascular disease would appear to result in approximately a 10 year decrease in life expectancy compared to that of the "normal" population. However, a significant proportion of the cumulative mortality rate appears to be due to both coronary artery disease and diabetes mellitus, as patients with peripheral vascular disease had a near "normal" life expectancy in the absence of either coronary artery disease or diabetes mellitus. Neither the presence nor the anatomical location of occlusive disease distal to the comon femoral bifurication by itself decreased life expectancy compared to those patients with aortoliofemoral disease but without similar distal occusive disease. Low operative mortality rate, excellent long-term patency, and potentially "normal" life expectancy all encourage an aggressive operative approach in patients with symptoms of peripheral vascular disease but without either diabetes mellitus or coronary artery disease. Revascularization in those patients with diabetes mellitus should be directed at limb salvage rather than at relief of minor symptoms of ischemia.
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PMID:Life expectancy following aortofemoral arterial grafting. 85 Aug 71

From January 1985 through January 1990, 244 patients (168 males, 76 females, mean age: 69 +/- 14 years) received epidural spinal cord stimulation for the treatment of advanced, nonreconstructable, peripheral vascular disease of the lower limbs due to atherosclerosis in 180 patients, atherosclerosis and/or diabetes in 49, and thromboangiitis obliterans in 15 patients: previous surgery included 101 bypass-grafts in 70 patients, 51% of which below the knee, and 117 sympathectomies in 113 patients as the last resource in face of distal peripheral vascular disease of the lower limbs. Mean ankle-to brachial systolic pressure ratio was .31 +/- .34 on symptomatic limbs; due to pain and advanced disease, walking capacity was assessed in only 151 patients, either on treadmill in 25, or in a metered corridor in 126; angiogram of the lower limbs was performed in every patient unless one not older than three months was readily available; pain at rest was assessed after an analogical scale; partial transcutaneous oxygen tension was measured on the dorsum of the fore-foot of 77 symptomatic limbs (mean: 13.35 +/- 14 mmHg). According to clinical and functional evaluation, 18 patients had exertional ischemia (group I), 87 had permanent ischemia with pain at rest and no tissue loss (group II), and 139 had chronic tissue loss (group III), including 93 ischemic ulcers (mean surface: 3.7 cm2, mean duration: 3.5 months) in 88 patients, 27 limited gangrene, and 24 previous limited non-healing distal amputation. After temporary spinal cord stimulation at T12-L1 level (mean duration: 9 +/- 4 days) with a percutaneous quadripolar electrode lead had allowed for selection of responders, 212 patients received an implantable neurostimulator.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Electric stimulation of the spinal cord in arterial diseases of the legs. A multicenter study of 244 patients]. 143 7

The natural history of peripheral arterial occlusive disease is discussed. Severe limb-threatening ischemia is the most serious consequence of chronic arterial occlusive disease. Severe ischemia and amputation can be considered as an endpoint in peripheral vascular disease. Severe limb ischemia is relatively uncommon in isolated aortoiliac disease and this is more than twice in patients with either femoropopliteal or multisegmental disease. Subsequent studies have also demonstrated that both smoking and diabetes are associated with a substantial risk for sudden ischemia. A clear majority of about 50% deaths are caused by associated coronary artery disease, 15% to stroke and 10% to vascular disease in the abdomen. Ankle systolic blood pressure is one of the most significant factors in the progression of peripheral arterial occlusive disease and also for cardiovascular mortality. In the future, men need to know how therapies as exercise, during regimens would influence the most frequent complications besides severe limb ischemia, namely brain infarction and coronary artery disease.
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PMID:Natural history and evolution of peripheral obstructive arterial disease. 146 Mar 49

Five hundred and twenty consecutive heart transplant cases (458 adult, 62 pediatric) were reviewed to assess the impact of peripheral vascular problems. Peritransplant interventions requiring vascular cannulation (e.g., intraaortic balloon pump procedures, catheterization of the right and left sides of the heart, femoral bypass) resulted in 10 complications that necessitated nine surgical procedures. Five aortic aneurysms (three infrarenal and two suprarenal) were resected. There was one death unrelated to the aneurysm resection. Sixteen patients had evidence of peripheral vascular disease (PVD). There were three deaths in this group, none directly related to the PVD. Three patients required vascular reconstruction (axillobifemoral, bilateral femoral distal and popliteal endarterectomy) in the posttransplant period, all for advanced ischemic symptoms. Except for one patient in whom ischemia-related ulcers developed on the heels, all patients had improved or stable symptoms that did not require intervention. There were no limb losses or vascular infections. We conclude that despite the rigors of posttransplant immunosuppression, patients with stable manifestations of PVD may successfully undergo heart transplantation and subsequent vascular reconstruction, when indicated, without prohibitive risk.
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PMID:Management of peripheral vascular problems in recipients of cardiac allografts. 146 Jul 16

The availability of O2 in the human vastus lateralis muscle has been investigated with non-invasive near-infrared spectroscopy (NIRS) using a commercially available unit (RunMan, NIM Inc. Philadelphia). The measuring probe placed above the skin illuminates the underlying tissue and measures the reflected light at two wavelengths (760 and 850 nm). Due to differences in the absorption spectra between HbO2 and Hb the difference in light intensity at these two wavelengths will be a relative index of tissue oxygenation. Prolonged arterial occlusion and static contraction have been studied. Arterial occlusion resulted in a decreased O2 saturation with a half-time of 2.3 +/- 0.2 min (mean +/- SE, n = 4). Restoration of blood flow resulted in a rapid tissue reoxygenation with a half-time of 24 +/- 2 s. Reoxygenation after static contraction occurred with a half time of 19-37 s. The half-time of reoxygenation subsequent to exercise and/or ischemia may be a valuable parameter in sports medicine and in the evaluation of peripheral vascular disease.
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PMID:Non-invasive measurements of O2 availability in human skeletal muscle with near-infrared spectroscopy. 148 60

For detection of myocardial ischemia, exercise testing is a better tool than AEM and therefore should be preferred procedure for this purpose. In patients who exhibit ischemic changes on exercise testing, the presence of ischemic changes on AEM carries significant prognostic information beyond the results of exercise testing; therefore, it is recommended that this test be performed in those who have ischemic changes on exercise at a moderate or low workload. AEM together with exercise testing can be used to assess efficacy of anti-ischemic drugs, can help to define the underlying mechanism of ischemia during daily life, and in certain groups of patients, like those with unstable angina, peripheral vascular disease, or after cerebrovascular events, it can replace exercise testing as a method for detecting ischemic changes.
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PMID:Complementary role of ambulatory electrocardiographic monitoring and exercise testing in evaluation of myocardial ischemia. 150 76

To improve the chances for the amputee to become ambulatory the most distal level of amputation should be selected in patients with end-stage peripheral vascular disease. Physical examination alone provides insufficient information when amputation levels are closely related to areas with signs and symptoms of ischemia. In the present series of 85 lower extremity amputations the predictive values of clinical parameters and skin perfusion pressure measurements are assessed. The role of clinical judgment is clarified: the most distal level of amputation is to be selected by physical examination, but further information is required to assess the healing potential at the selected level. The presence of palpable pulses immediately above the selected level correlates well with primary wound healing (p less than 0.001, negative predictive value 100%). The absence of palpable pulses and angiographic patency scores are of no clinical value in amputation level selection. Skin perfusion pressure measurements were of excellent predictive value (p less than 0.001, positive predictive value 89%, negative predictive value 99%). According to these data a strategy is proposed for routine determination of the lowest level of amputation, where primary wound healing can be expected.
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PMID:Criteria for reliable selection of the lowest level of amputation in peripheral vascular disease. 153 11

Pentoxifylline, a hemorheologic drug reputed to reduce blood viscosity, can be used to improve the microcirculation in peripheral vascular disease. The authors report on 2 patients who were being followed up for possible glaucoma and whose visual field constriction became worse at about the same time as their peripheral vascular symptoms began to increase in severity. Following initiation of treatment with oral pentoxifylline, their peripheral vascular complaints decreased and their visual fields gradually expanded over the next several months. This dual effect seemed more than a coincidence. It may in fact indicate that the same mechanism said to aggravate the peripheral ischemia (ie, increased blood viscosity) in patients with peripheral vascular disease may also have been the basis for the visual field contraction in these 2 patients, possibly by producing retinal ischemia. The reversal of the contracted visual fields would then seem to be due to the ameliorative effect of the pentoxifylline treatment on the blood viscosity.
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PMID:Expansion of contracted visual fields following treatment with pentoxifylline in two patients with coexistent peripheral vascular disease--case reports. 155 23

Noninvasive testing for peripheral vascular disease is a simple and painless method to detect and localize arterial and venous pathology. It is recommended for clients experiencing symptoms of muscle or tissue ischemia and for clients who have a history of atherosclerosis prior to any operative procedure of the lower extremity where the potential for healing is in question. Postoperatively, noninvasive testing is used to assess graft patency after lower extremity revascularization. Venous evaluation for deep vein thrombosis is also performed. This article discusses techniques involved in noninvasive testing.
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PMID:Noninvasive testing in the evaluation of peripheral vascular disease. 156 98


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