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

Lower limb ischemia is a frequent complication of intraaortic balloon pump (IABP) use. The incidence and risk factors for acute ischemia have been well-defined, but little is known about long-term ischemic complications. This prospective study evaluated the incidence, nature, progression and predisposing factors for long-term lower limb ischemia in 151 patients who were previously treated with the IABP. These persons were interviewed and their lower extremities examined 12 to 20 months after undergoing IABP counterpulsation. Limb ischemia, characterized primarily by ipsilateral discomfort and diminished pulses, occurred in 18% of those evaluated. Evidence of ischemia worsened over time in 14%. Logistic regression analysis, which was based on variables found to be significant in bivariate analysis, revealed that the occurrence of limb ischemia acutely, cardiogenic shock as an indication for IABP insertion, and smoking (at the time of hospitalization or having quit < 10 years previously) were risk factors for long-term lower limb ischemia. The adjusted odds ratio for acute limb ischemia was 8.89 (95% confidence interval 2.80 to 28.21), for cardiogenic shock 3.59 (95% confidence interval 1.01 to 12.75), and for smoking 2.87 (95% confidence interval 1.10 to 7.46). Increasing numbers of patients are undergoing IABP counterpulsation and a greater proportion of these are surviving their acute event and resuming active lives. It is essential to recognize that detrimental consequences of this device can persist long after hospitalization.
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PMID:Frequency of long-term lower limb ischemia associated with intraaortic balloon pump use. 141 46

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

A group of patients undergoing aortic replacement of thoracic and abdominal aneurysms were studied by intraoperative recording of Somatosensory Evoked Potentials (SEPs). Lower limb nerves were stimulated and SEPs recorded at spinal and cortical level. Progressive changes of cortical SEPs until their disappearance were observed. In operations on the thoracic aorta, the spinal response was essentially unmodified, so that the observed alterations reflected true dysfunction of the spinal cord. The only patient who developed an intraoperative anterior spinal infarct had the longest period of absent SEPs and a striking latency prolongation when they returned. Postoperative recordings were absolutely normal. When the abdominal aorta was occluded, SEP alterations involved both cortical and spinal responses, so that it is difficult to distinguish between the relative roles of peripheral nerve and spinal cord ischemia. These findings indicate that SEPs can be reliably applied to spinal cord monitoring in the course of aortic surgery, even though they are mainly conducted in the posterior cord tracts.
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PMID:Evaluation of spinal cord function by means of lower limb somatosensory evoked potentials in reparative aortic surgery. 341 41

Five cases of aorto-enteric fistula (AEF) are reported. The first case was a primary AEF from rupture of the infrarenal section of the abdominal aorta treated successfully by an obliteration and graft. The second patient had a primary AEF from rupture of an abdominal aorta aneurysm, complicated after an obliteration and graft of the primary AEF, requiring excision of the graft and an extra-anatomical shunt (EAS): healing following parenteral hypernutrition. The third case, a patient with a primary AEF from rupture of an aortic adventitial cyst in the left colon, died from septic complications. The fourth case died with heart rhythm disorders on the 4th day after resection and EAS for an aortic fistula. The fifth patient had a secondary AEF with cataclysmic digestive hemorrhage: excision of the graft with digestive closure and aortofemoral bypass did not prevent a fatal outcome on the 20 th day. Digestive hemorrhage and septic signs may be combined or occur as isolated complications. The most valid complementary investigation is fibroscopy, bacteriological culture of arterial blood distal to the prosthesis having an orientation value. Ultrasound, computed tomography or Gallium scintigraphy imaging may detect a retroperitoneal abscess. Effective treatment of all aneurysms can prevent primary AEF and avoidance of infection and interpositioning of viable tissue between duodenum and anastomotic line reduce the risk of secondary AEF. Maximum chances of success require aggressive surgery: aortic ligature; excision of all septic material and duodenal closure or segmental digestive resection with discharge of proximal pocket. Lower limb ischemia is treated by insertion of an EAS.
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PMID:[Aorto-enteric and paraprosthetic fistulas. Apropos of 5 cases]. 647 78

Lower limb ischemia represents the most common single threat to the success of operations for abdominal aortic aneurysms. It can occur because of distal embolization from a number of sites or because of thrombosis either at sites of anastamosis or in diseased arteries at or beyond sites of clamping. Preoperative angiographic studies in patients with missing lower extremity pulses aid in planning reconstructive procedures if ischemia occurs in the postoperative period. Systemic heparinization during the stage of interruption of the circulation and specific techniques of dissection, clamping, anastamosis, flushing, and unclamping resulted in an incidence of 0.57% postoperative limb-threatening ischemia in a series of 700 abdominal aneurysm operations in which the incidence of lower limb gangrene was 0.28%.
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PMID:Abdominal aortic surgery: prevention of lower limb ischemia. 684 83

Lower limb critical ischemia is a clinical condition typical of patients with severe chronic obstructive arterial disease (Fontaine's IIIb and IV degree). This condition often leads to amputation of the limb involved. The authors present to the use PGE1 in 50 patients with Fontaine's IIIb-IV degree chronic obstructive arterial disease of lower limbs in which the indication of amputation was done. All the patients, admitted to the emergency ward, complain of rest pain and distal ulcers. The administration of PG5(1) was given as follows: 40 mg/bid/e.v./20 days. A 6 months long follow-up was installed with the instrumental evaluation of: Transcutaneous oxygen pressure; Distal blood perfusion with Doppler; cardiac pulse; blood pressure. Eighteen patients became to a Fontaine's II degree during the next 2 months after therapy, 25 patients came back to a severe claudicatio: of them 18 underwent successfully vascular surgery, 7 underwent amputation of the lower limb. In 7 patients the PGE1 did not influence the natural progression of the disease. Among the side-effects of therapy we can mention: headache (4%), erythema and pain of injected vein (8%), sick (4%). All the side effects were transient and never led to interruption of therapy.
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PMID:[Use of PGE1 in severe ischemia of the lower extremities. Clinical study]. 756 37

Incidence of vascular complications in intraaortic balloon counterpulsation is still high despite major refinements in catheter design and techniques. One hundred twenty-six patients in whom intraaortic balloon pumping was attempted were divided into two groups on the basis of insertion technique. Group 1 included 77 patients in whom the conventional percutaneous insertion was used. In group 2 (n = 45 patients), a sheathless insertion technique was used. The overall vascular complication rate was 19.6%, with the lower limb ischemia as the most common complication. The vascular complication rate was 25.9% in group 1 and 8.8% in group 2 (p < 0.01). Lower limb ischemia was noted in 17 patients in group 1 and 3 patients in group 2 (p < 0.01). These results suggest that sheathless insertion of the intraaortic balloon pump catheter can minimize vascular complications. This technique will be especially useful in patients with peripheral vascular disease, in whom the likelihood of vascular complications is high.
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PMID:Vascular complications of intraaortic balloon pumping: unsheathed versus sheathed insertion. 851 5

48 patients with heart failure were supported by intra-aortic balloon pumping (IABP) from 1985 to 1993. The disease included rheumatic (39 patients), congenital (7) and coronary hearts (2). The average time of supporting with IABP was 27 hours, 23 patients (48%) survied inclading 19 patients with postoperative lower cardiac output syndrome. Hemodynamics was improved. IABP increased cardiac output syndrome, and hemodynamics was improved. IABP increased cardiac output (50%), cardiac index (60%), stroke volume (50%), stroke volume index (60%) and decreased left atrial pressure or pulmonary wedge pressure. The mortality was 25 patients (52%). The death causes were as follows: arrhythmia (4), renal failure (6), lung failure (2), DIC (1), and the other (12). The main complication of IABP was lower limb ischemia particularly in surgical cut-down method to establish IABP. The analysis indicated that the temporary pacing maker with IABP could prevent some arrhythmia such as frequent premature ventricular beats. Lower limb ischemia and renal failure should receive much attention because they are easy to be confused with shock symptom when IABP.
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PMID:[Intra-aortic balloon pumping in 48 patients with heart failure]. 870 69

This is a case report of polytrauma in a 4-year-old boy who sustained a rare aorto-iliac dissection injury along with pelvic fracture and rupture of posterior urethra. This child was initially treated for the rupture of posterior urethra and extravasation of urine with suprapubic cystostomy and drainage. Lower limb ischemia developed later. Exploration showed aorto-iliac dissection injury for which aorto-iliac replacement grafting was carried out. Subsequently delayed repair of posterior urethral rupture by transpubic urethroplasty was carried out.
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PMID:Rare traumatic aorto-iliac dissection injury in a child with pelvic fracture and urethral rupture: a case report. 912 75

The epidemiology of the diabetic foot is still unknown because this heterogeneous pathologic condition is non uniformly classified and described. Lower limb peripheral vascular disease has a preferential distal location strongly associated with the classical factors of cardiovascular risk. Ulcers occur in 15% of diabetics and 6-20% of all hospitalized diabetic patients are affected by ulcers of the foot. There is a predictive feature of the severity of the ulcer in relation to its location. In the USA, ischemia-related amputations are about 200 per million per year for non diabetics as against 3900 per million for diabetics; furthermore the incidence of a second amputation rises to 51% 5 years after first amputation. Risk factors for amputation are: smoking, hypertension, dyslipidemia, elderly age, glycosylated hemoglobin levels. Although mortality has decreased in the last 50 years, the diabetic foot is still a huge economic problem.
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PMID:The diabetic foot: epidemiology. 955 Aug 92


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