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

The outcome of 127 femoropopliteal and 23 femorotibial arterial reconstructions carried out between January 1960 and December 1972 has been reviewed. The operative method was autogenous saphenous vein bypass in 109 cases, 82 of which were performed using unreversed vein with eversion valvectomy. The indication for reconstruction was advanced ischemia in 39%. Two patients died primarily and 23 late deaths have occurred subsequently. 19 grafts or reconstructed segments became occluded primarily. Most of them were femorotibial reconstructions of Dacron bypass reconstructions. Most of the failures occurred within 1 year of surgery. Using eversion valvectomy technique, the 1- and 5-year patency rates were 57 and 50% respectively. In femorotibial reconstructions the 1-year patency rate was 36%. There was a distinct difference in patency between the cases with excellent of good outflow and those with fiar or poor outflow. The difference was less distinct between patients with claudication and those with advanced ischemia. Eight limbs needed major amputation.
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PMID:Femoropopliteal and femorotibial arterial reconstructive surgery. Special reference to the autogenous venous bypass procedure using unreversed vein after eversion valvectomy. 12 95

Sixty-five patients treated by femoropopliteal bypass in 1974 were surveyed; the mean follow-up time was 10.4 months. The one year cumulative patency rate for velour Dacron was 50 percent; this was less successful than were the results from a comparable group in which vein grafts were used (79 percent). These poor results were due principally to the high failure rate of velour Dacron in patients suffering from clinically severe ischemia. In these only one in four grafts remained patent. If a less than perfect arteriographic runoff was obtained, only one in three still functioned. These results occurred despite high intraoperative graft flows. It appears that velour Dacron may be acceptable in patients treated for claudication if no adequate vein is available. This prosthesis gives an unacceptably high failure rate in patients with severe ischemia.
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PMID:Autogenous veins and velour dacron in femoropopliteal arterial bypass. 13 58

Between Jan. 1, 1970 and June 30, 1977, 50 men and 23 women underwent femorofemoral bypass grafting. The average age of the group was 64.7 years. The procedure was performed for disabling claudication in 50 patients and for limb threatening ischemia in 23. Knitted Dacron grafts were used in all but two patients. The operative mortality was 4.1% and the late mortality 21.9%. There were six complications related to the prostheses, three infected grafts and three false aneurysms. Thrombosis of the graft occurred in 15 patients; the graft was successfully revised in 2. The cumulative 5-year patency rate determined by life-table methods was 73.4%. The causes of failure appeared to be well defined and unilateral iliac artery disease. The donor iliac artery, poor runoff through a diseases deep femoral artery on the recipient side and infection of the graft. This study indicates that femoro-femoral bypass has a definite place in the management of patients with unilateral iliac artery disease. The procedure can be performed on selected patients with a low operative mortality and an acceptable patency rate.
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PMID:Treatment of unilateral iliac artery disease by femorofemoral bypass grafting. 15 15

Forty-eight arterial reconstructions were performed for chronic upper extremity ischemia in 43 patients, aged 31 to 81 years. Diagnostic arterial catheterization was the most frequent cause of symptomatic occlusion, followed by proximal arteriosclerotic lesions and noniatrogenic trauma. Doppler ultrasound evaluation provided important diagnostic and prognostic data that complemented information derived from arteriography. Indications for operation included disabling claudication (39 cases) or digital gangrene (four cases). Restoration of normal extremity function can be anticipated except in instances where poor forearm runoff exists. Autogenous saphenous and basilic interposition vein grafts have proved excellent for axillary-brachial revascularizations. Axillary-axillary bypass procedures for innominate-subclavian artery occlusions appear hemodynamically sound and technically simple. Follow-up, averaging 48 months, extended to 144 months. Late vein graft failure or progressive distal occlusive disease was not encountered.
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PMID:Chronic upper extremity arterial insufficiency. Etiology, manifestations, and operative management. 34 5

To determine the feasibility of limb salvage in elderly patients in whom severe ischemia of the lower extremity is present, the results of femoro-popliteal reconstruction done primarily for limb salvage were reviewed. Of 310 femoro-popliteal bypasses, 72 were performed on patients 70 years of age or older. In the over-70 group, ischemic necrosis was present in 70.8% rest pain in 22.2%, and claudication in 7.0%. Initial limb salvage patients 70 years of age or older was 71.4%. Cumulative limb salvage at 5 years was 51.1% and at 10 years was 44.8%. Operative mortality, including mortality of subsequent amputation, when required, was 8.3%. Appreciable limb salvage can be achieved by femoro-popliteal arterial reconstruction in lieu of primary amputation in elderly patients in whom severe arterial insufficiency of the lower extremity is present.
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PMID:The elderly patient with severe arterial insufficiency of the lower extremity: limb salvage by femoro-popliteal reconstruction. 44 69

Common femoral endarterectomy with profundaplasty has become accepted as a useful operation in the treatment of ischemic arterial disease which is the result of superficial femoral occlusion. However, objective assessment of its long-term postoperative hemodynamic effects has not been reported. This study determines the effect of this operation on the resting pressure index, the walking distance on the treadmill, the fall in postexercise ankle pressure, and the recovery time. Measurements were made just before operation and 1 month later in 20 patients with severe claudication and superficial femoral occlusion. Sixteen patients were available for follow-up at 1 year. These patients were matched according to the resting pressure index to another group of 20 patients with superficial femoral occlusion followed up conservatively. The results indicate that common femoral endarterectomy with profundaplasty improves the distal perfusion pressure and, by inference, flow, which provides strong objective confirmation of the clinical impression that this operation is of value and help in determining its place in the management of severe lower limb ischemia.
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PMID:An objective assessment of common femoral endarterectomy and profundaplasty in patients with superficial femoral occlusion. 62 94

Despite revascularization of the common femoral--profunda femoris system, many patients fail to obtain satisfactory relief from claudication or rest pain. Clinical observations were compared with objective physiological data in 54 technically successful aortoiliofemoral reconstructions for multilevel disease. Nine of 28 operations (32%) for claudication and five of 26 operations (19%) for ischemia at rest had poor results. While the average ankle pressure index (API = ankle blood pressure/arm blood pressure) rose from 0.52 +/- 0.03 (SEM) to 0.81 +/- 0.03 in limbs treated successfully for claudication, it changed insignificantly in those with an unsuccessful result (0.58 +/- 0.04 to 0.61 +/- 0.04). When ischemic symptoms were relieved, API rose from 0.23 +/- 0.04 to 0.55 +/- 0.03 but increased only from 0.22 +/- 0.09 to 0.40 +/- 0.02 in limbs with insufficient improvement. Preoperative thigh pressure index (TPI) in claudicating limbs with poor results (0.96 +/- 0.05) differed little from that in limbs with good results (0.92 +/- 0.05); nor was the TPI of ischemic limbs with poor results (0.83 +/- 0.13) significantly greater than that in limbs with good results (0.60 +/- 0.05). Neither the TPI nor the thigh to ankle pressure gradient was of value in predicting which extremities would respond poorly to aortoiliofemoral reconstruction.
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PMID:Aortoiliac reconstruction in patients with combined iliac and superficial femoral arterial occlusion. 68 26

Twenty-one femorofemoral grafts were placed in high risk patients with symptomatic, unilateral, iliofemoral, arterial occlusive disease. There was 100 per cent immediate postoperative relief of ischemia or improvement in claudication. Three late below-knee amputations have been performed. All other living patients had healed extremities and were ambulatory at last follow-up. Cumulative graft patency determined by the life table method was 95 per cent at twenty-four months. The physiologic "steal" created by a femorofemoral bypass with donor limb and/or outflow stenosis must be considered to prevent clinical donor limb functional impairment. A gradient of 10 mm Hg or less between the radial artery mean pressure and the donor femoral artery ensured adequate donor artery flow without regard to angiographic a-pearance of the donor artery. The crucial technical problem in patients operated on for ischemia was reconstruction of adequate outflow. All but one patient required at least minimal profunda endarterectomy, and nine of seventeen (53 per cent) required concomitant extended profundaplasty procedures.
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PMID:Femorofemoral grafts: the role of concomitant extended profundaplasty. 70 44

Because arteriosclerotic popliteal aneurysms so often present with complications, treatment results are less than optimal in contrast to aneurysms oat other sites. From 1963 to 1977, 40 surgically treated aneurysms in 30 patients were studied. Seventeen limbs presented as asymptomatic aneurysms (42.5%), four with pressure symptoms (10%), one with rupture and ischemia (2.5%), nine with acute thromboses and ischemia (22.5%), and nine with chronic ischemia and claudication (22.5%). Seventeen aneurysms were thrombosed (42.5%). Diameters of all aneurysms measured at operation ranged from 1.0 to 10 cm. It was of interest to note that, generally, larger aneurysms were patent, and thromboses were common in the smaller aneurysms, with an average diameter of 2.5 cm. Saphenous vein grafts were used most frequently for interpolation grafts (65%) and bypass grafts (12.5(). Prosthesis were used in 7.5%, endarterectomy and aneurysmorraphy in 5%. Popliteal reconstruction was accomplished initially in 40 limbs, with two early failures and 10 late failures with loss of two limbs. Cumulative patency rates for 40 limbs at risk at 5 and 10 years were 75.9%, at 14 years, 62.6%. Diagnosis is the most difficult aspect of this problem, as physical limitations impede early diagnosis. Thromboses being the natural history of popliteal aneurysms, early recognition and treatment are important to improve limb salvage rates.
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PMID:Complications and treatment of popliteal aneurysms. 71 97

One hundred and eighty-three lower limbs with arterial occlusion and stade II chronic ischemia were followed for 5 years. Two groups, comparable as to age, sex number and location of lesions were formed by prospective randomization. Ninety limbs were treated by lumbar sympathectomy and 93 were not operated. After 5 years there is no difference between the 2 groups as to mortality, cardiovascular morbidity, claudication or minor or major amputations.
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PMID:[Influence of lumbar sympathectomy on the proportion of amputation (author's transl)]. 84 28


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