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

In this prospective study we sought to establish the incidence and nature of lower limb ischemia in patients undergoing treatment with intraaortic balloon pump (IABP) counterpulsation and to determine risk factors for its development. The sample was composed of all 258 balloon catheter insertions or attempted insertions for IABP therapy in 249 patients during a 16-month period. Assessment of the lower limbs, hemodynamic status, and pertinent medications were recorded daily throughout the patient's hospitalization. Lower limb ischemia was present in 47%, with 14% having major ischemic complications. Multivariate logistic regression, which was based on variables found to be significant in univariate analysis, revealed that preexisting peripheral vascular disease, female sex, and diabetes mellitus were related to the development of the whole range of lower limb ischemic problems. Diabetes mellitus, cardiogenic shock, and a history of smoking were associated with major ischemia. Evaluation of risks and benefits before treatment with IABP counterpulsation and careful lower limb assessment before, during, and after counterpulsation may help reduce the complications associated with this lifesaving device.
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PMID:Lower limb ischemia related to use of the intraaortic balloon pump. 258 43

The purpose of this study was to determine a standard set of conditions for detecting peripheral arteriosclerosis with ischemia. One series of studies was done to determine the influence of room temperature on peripheral flow in healthy subjects and patients with peripheral vascular disease. The room temperature was varied from 30 degrees to 35 degrees C. The temperature from 24 degrees to 30 degrees C had only minor effects on the circulation. Thus, it seemed appropriate to use a room temperature in the lower range, usually 23 degrees C. Another series of studies showed the effect of changing skin temperatures locally at the finger tip or toe tip on the plantar and volar surfaces in healthy subjects and in patients with peripheral vascular disease. Results showed that as temperature was increased from 10 degrees to 45 degrees, there was a marked increase in the finger and toe circulations, which was considerably greater in the normal subjects as compared with those with digital disease. The ideal temperature at which to work as a routine is 40 degrees C as opposed to the lower temperatures, which did not separate healthy subjects from patients with peripheral vascular disease. A third experiment was done to study normal subjects and patients by using the finger circulation as control against the toe circulation when the conditions were a local skin temperature of 40 degrees C and a room temperature of 23 degrees C. A toe-finger index was established to detect abnormalities in the circulation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Influence of local and environmental temperatures on cutaneous circulation with use of laser Doppler flowmetry. 265 May 84

Atrial pacing was performed either alone (n = 23) or in combination with thallium-201 scintigraphy (n = 113) in 136 patients referred for evaluation of chest pain. The presence of coronary artery disease (CAD) was excluded by cardiac catheterization in 12 patients and confirmed in 124. Both pacing-induced ST depression and angina had sensitivities of 48% for CAD; specificities were 75% and 83%, respectively. An abnormal thallium-201 scan (one or more reversible and/or fixed perfusion defects) was seen in 72% of patients with CAD (specificity 83%). Reversible perfusion defects were present in 47% of patients with CAD (specificity 83%), and fixed defects in 36% (specificity 100%). Pacing was associated with either ST depression or an abnormal perfusion scan in 81% of patients (specificity 67%). There were no significant differences in the results of atria pacing or thallium-201 scintigraphy in patients with or without a history of myocardial infarction, or in those with or without previous coronary artery bypass surgery. Pacing-induced ST depression, or both ST depression and a reversible perfusion defect occurred significantly less frequently in patients with peripheral vascular disease than in those without this diagnosis (p less than .05). With only one exception, there were no significant differences in the sensitivities of any indicators of ischemia (ST depression, angina, or perfusion scans), either individually or in combination, as the peak pacing rate or double product achieved increased.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Diagnostic value of atrial pacing and thallium-201 scintigraphy for the assessment of patients with chest pain. 265 82

A double-blind, crossover study was designed to evaluate the effect of L-carnitine on the reactive hyperemia in patients with peripheral vascular disease. After drug washout, 18 patients were randomly assigned to receive placebo or L-carnitine, 3 g IV as a bolus, followed by continuous intravenous infusion of 2 mg/kg/min for thirty minutes. Blood flow in the affected limb was measured by impedance plethysmography, under resting conditions and every two minutes for ten minutes after a five-minute ischemia induced in the affected limb. As compared with placebo, L-carnitine did not modify blood flow at rest. On the contrary, the hyperemic response with carnitine was higher than that observed with placebo. A significant increase in blood flow was found two, four, and six minutes after the release of ischemia with placebo, whereas the blood perfusion to the affected limb rose significantly at all times of recording after carnitine administration. Moreover, the values of the blood flow at two and ten minutes with carnitine were significantly higher than those recorded after placebo at the same times of recording. After the release of ischemia, the mean maximum value of blood flow observed after carnitine was 3.1 +/- 1.4 mL/min/100 mL, a value significantly higher than that recorded after placebo, which was 2.7 +/- 1.3 mL/min/100 mL (p less than 0.05). In conclusion, this study demonstrates that L-carnitine, although not affecting blood flow and ankle/arm systolic blood pressure ratio under resting conditions, improves the functional circulatory reserve in patients with peripheral vascular disease.
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PMID:Effect of L-carnitine on the reactive hyperemia in patients affected by peripheral vascular disease: a double-blind, crossover study. 267 40

Despite advances in intra-aortic balloon catheters and consoles, the vascular complication rate of IABP has not decreased. Predisposing complication factors identified through research include gender, diabetes, peripheral vascular disease, catheter size, prolonged pumping, ankle-arm index less than 1.0, and insertion method. Signs and symptoms of leg ischemia due to thromboembolus or compartment syndrome may occur in as high as 40 per cent of patients. Assessment, documentation, and teaching remain important aspects of the nurse's role in the prevention and detection of vascular complications.
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PMID:Vascular complications of the patient undergoing intra-aortic balloon pumping. 268 38

Modifications in transcutaneous oxygen pressure (TcPO2), induced by the administration of 3 mg/kg/day buflomedil chlorhydrate for seven days were evaluated in 12 subjects suffering from peripheral vascular disease (PVD). After the treatment a significant increase in TcPO2 basal values was observed in Stage III and Stage IV PVD patients (+32.2%) while a significant reduction of 12% in the half-recovery time to basal values after an induced ischemia was recorded in Stage II PVD patients by the seventh day. Buflomedil did not, however, cause any significant variations in the ankle/arm pressure ratio or in the plethysmographic peak flow.
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PMID:Effect of buflomedil chlorhydrate on local oxygen delivery in peripheral vascular disease. 271 40

The quantitative and qualitative behavior of hemorheologic factors both at rest and after treadmill exercise in 30 male patients with stage II peripheral vascular disease compared with 20 sex- and age-matched healthy controls have been studied. The aim of our study was to identify functional rheologic markers for peripheral vascular disease. At rest, whole blood viscosity (corrected for hematocrit at both high and low shear rates), fibrinogen levels (4.23 +/- 1.39 vs. 3.23 +/- 1.5), and white blood cell count (7.05 +/- 1.25 vs. 6.03 +/- 1.28) were significantly different between patients and controls. After treadmill exercise, white blood cell counts increased in both patients and controls, whereas only the filterability of mononuclear leukocytes showed a significant variation in the patient group (5.47 +/- 1.54 vs. 7.26 +/- 2.00, p less than 0.002). In this group, mononuclear filterability improved during the recovery period. The results suggest a relation between exercise-induced ischemia of the lower limb and mononuclear filterability in patients with peripheral vascular disease. Mononuclear filterability could be a functional rheologic marker for peripheral vascular disease.
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PMID:Peripheral vascular disease. Rheologic variables during controlled ischemia. 275 61

Patients with diffuse peripheral vascular disease, resulting in inadequate arteriographic runoff, and/or multiple failed bypasses almost inevitably face amputation. We have previously used an arteriovenous reversal (AVR) procedure at the popliteal level to salvage severely ischemic canine hind limbs. This procedure is followed by the development of an intense network of new vessels in the proximity of the arteriovenous anastomosis. The present study was designed to define the nature of these vessels and their role in providing nutrient perfusion to the limb. Using an established model to create severe limb ischemia. AVR was performed in 24 dogs. Tissue perfusion and neovascularization were assessed by angiography, transcutaneous oximetry (TcpO2), tritiated thymidine uptake combined with autoradiography, and histologic capillary density measurements. Angiography revealed the intense vascular network in the region of the anastomosis by postoperative Day 22 in all dogs. TcpO2 on Day 1 was indicative of severe ischemia in the operated calf compared to controls (12 vs 80 mm Hg, P less than 0.01) but returned to normal by Day 22 (81 vs 76 mm Hg). A progressive, significant increase in tritiated thymidine uptake was seen by Day 22 (0.36 vs 0.27 microCi/g, P = 0.005); on autoradiography 95% of these labeled nuclei in the operated limbs were in endothelial cells compared to only 5% in the control limbs. Finally, capillary density studies of the calf muscles showed a substantial increase in the operated limbs (mean, 1011 vs 605 cap/mm2, P = 0.0004). These studies suggest that the dramatic increase in vascularity observed angiographically following AVR in a severely ischemic limb consists primarily of a rapidly expanding capillary network.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A demonstration of vascular proliferation in response to arteriovenous reversal in the ischemic canine hind limb. 277 Feb 91

The combination of continuous light spectrophotometry (CWS) and time resolved spectrophotometry (TRS) afford for the first time a quantitation of the optical path and the concentration changes detected by the CWS instrument. The application of these two techniques and magnetic resonance spectroscopy (MRS) to muscle during exercise affords a correlation of the biochemical activation and the response of the peripheral circulation (NRS) to the exercise stress (MRS). In preliminary experiments, the well-trained endurance performance limb shows a near perfect homeostasis to exercise stress while ischemia will cause a significant deoxygenation and an impairment of the work output. The use of this device in evaluation of peripheral vascular disease is obvious and hemoglobin deoxygenation may well occur at work levels less than those at which the diseased limb is capable.
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PMID:Time resolved spectroscopic (TRS) and continuous wave spectroscopic (CWS) studies of photon migration in human arms and limbs. 278 47

Arm exercise with myocardial scintigraphy and oxygen consumption determinations was performed by 33 men with peripheral vascular disease, 40 to 74 years of age (group 2). None had evidence of coronary disease. Nineteen age-matched male control subjects (group 1) were also tested to determine the normal endurance and oxygen consumption during arm exercise in their age group and to compare the results with those obtained during a standard treadmill performance. The maximal heart rate, systolic blood pressure, pressure rate product, and oxygen consumption were all significantly lower for arm than for leg exercise. However, there was good correlation between all these parameters for both types of exertion. The maximal heart rate, work load and oxygen consumption were greater for group 1 subjects than in patients with peripheral vascular disease despite similar activity status. None of the group 1 subjects had abnormal arm exercise ECGs, while six members of group 2 had ST segment changes. Thallium-201 scintigraphy performed in the latter group demonstrated perfusion defects in 25 patients. After nine to 29 months of follow-up, three patients who had abnormal tests developed angina and one of them required coronary bypass surgery. Arm exercise with myocardial scintigraphy may be an effective method of detecting occult ischemia in patients with peripheral vascular disease. Those with good exercise tolerance and no electrocardiographic changes or 201T1 defects are probably at lower risk for the development of cardiac complications, while those who develop abnormalities at low exercise levels may be candidates for invasive studies.
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PMID:Arm exercise testing with myocardial scintigraphy in asymptomatic patients with peripheral vascular disease. 292 3


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