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

A 69-year-old woman presented with bilateral arm claudication caused by segmental occlusions of both brachial arteries. Bilateral retrograde ring-desobliteration resulted in restauration of full pulses. Microscopic examination of the resected specimen revealed giant cell arteritis. No other manifestations of the disease could be detected. At autopsy affection of the aortic arch and of the arm arteries is found in about 70% of patients with giant cell arterities. Symptoms occur in only about 5% of them. Arterial stenoses are successfully treated with corticosteroids. In case of chronic occlusion, however, ischemia-induced symptoms may necessitate an operation. Endarterectomy (i.e. total dissection of the destroyed inner arterial wall layers) should be preferred to bypass procedures. Subsequent long-term corticosteroid therapy should be instituted in order to treat the underlying disease, and to prevent reocclusions.
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PMID:[Bilateral brachial claudication as the initial manifestation of giant cell arteritis. Case report and review of the literature]. 148 78

A 63-year-old male patient with both coronary artery disease and leg ischemia was successfully treated with a combined procedure. Coronary arteries were bypassed with the saphenous vein graft and in situ left internal mammary artery, and bilateral femoral arteries were bypassed with expanded polytetrafluoroethylene grafts descended from the ascending aorta through the preperitoneal abdominal wall tunnel. After this procedure he experienced neither angina nor claudication.
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PMID:[Combined revascularization of coronary and femoral arteries]. 151 5

The long-term efficacy of percutaneous transluminal angioplasty (PTA) for treatment of occlusive lesions involving arteries below the knee was evaluated in 168 consecutive patients. The procedure was preceded by intraarterial thrombolysis in 33 patients with failing femorodistal grafts. Indications were disabling claudication in 40 cases (24%), acute ischemia in 18 (11%), rest pain in 49 (29%), and tissue necrosis in 61 (36%). Angioplasty of tandem femoral and/or iliac lesions was performed in 58 cases (34.5%). Major complications were observed in 19 patients (11.3%) and minor complications in 12 others. Five patients died within 30 days (3%). Mean follow-up was 26.1 months (range, 4-72 months). Major amputation was required in 26 cases (15%). The cumulative clinical success at 3 years was 83% for a single stenosis, 76% for multilevel lesions, 44% following lytic therapy, 36% for segmental occlusions, and 14% for anastomotic stenoses. Infrapopliteal PTA is useful in selected patients. Factors associated with poor long-term patency include a single patent tibial artery (P = .039), acute ischemia (P = .03), anastomotic stenosis (P = .01), and, possibly, complete occlusion prior to treatment (P = .091).
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PMID:Distal popliteal and tibioperoneal transluminal angioplasty: long-term follow-up. 153 71

Between 1979 and 1988 43 percutaneous transluminal angioplasties (PTA) of the deep femoral artery were performed for treatment of severe claudication (n = 15) or for limb salvage (n = 28). Ateriographically, all patients had a long occlusion of the superficial femoral artery. Additional PTA of significant obstructions in the iliac and common femoral artery were performed in 6 patients of each group. Technical success was achieved in 41 of the 43 procedures (95%). Early clinical success was 60% for claudicants and 68% for patients with limb threatening ischemia. Success rates tended to be higher if additional PTA of the inflow tract was performed (75% versus 61%, n.s.). Patient with a good distal outflow benefited more frequently from PTA if they were treated for limb salvage (p less than 0.05). Within a follow-up period up to 24 months (mean 18.0 months) 5 patients died and one late failure occurred. Life table analysis lasting success in patients dilated for limb salvage, whereas success rate decreased to 48% in claudicants. PTA of the deep femoral artery is a less invasive and efficient treatment particularly for patients with limb threatening ischemia, an appropriate obstruction morphology provided.
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PMID:Percutaneous transluminal angioplasty (PTA) of the deep femoral artery. 153 43

The authors report their initial experience in 52 patients with three different techniques of peripheral artery atherectomy--the Tracwright (Kensey), used in 19 patients, the Simpson AtheroCath, used in 19 patients and the transluminal extraction catheter, used in 14 patients. The indications for atherectomy were claudication in 42 (80%) and limb-threatening ischemia in 10 (19%). There were no deaths. Complications included three arterial perforations, one thrombosis and one groin hematoma requiring operative evacuation. There were no distal embolizations. Atherectomy was initially unsuccessful in 15 (29%) patients. For the successfully completed procedures, the 1-year primary patency rates were as follows: Tracwright (Kensey) catheter 56%, Simpson catheter (63%) and transluminal extraction catheter (0%). Use of subsequent nonoperative procedures on recurrent stenoses produced secondary patency rates of 77% for the Tracwright (Kensey) technique, 80% for the Simpson catheter technique and 78% for the transluminal extraction catheter technique. The authors conclude that their early results justify further evaluation of these three techniques. Use of the transluminal extraction catheter is associated with higher rates of occlusion and restenosis.
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PMID:Atherectomy. Early use of three different methods. 153 42

The transcutaneous pO2 (TCpO2) response following release of tourniquet cuff occlusion is expressed as oxygen reappearance time (ORT) and oxygen recovery index (ORI). In the present study the effects of blood perfusion and tissue oxygenation on ORT and ORI in healthy control subjects and two patient groups with peripheral arterial insufficiency were assessed. In control subjects, ORT reflects diffusion time for O2 molecules from capillaries to the TCpO2 sensor. In patients with claudication, ORT was prolonged probably because of delayed postischemic reperfusion and reduced tissue oxygenation. In patients with critical ischemia, prolonged ORT seems to be attributed more to reduced tissue oxygenation than to delayed postischemic reperfusion. ORI in control subjects and patients with claudication apparently depends more on capillary pO2 than on magnitude and duration of the postischemic reperfusion. In patients with critical ischemia, ORI is more related to decreased O2 delivery subsequent to reduced or absent reactive hyperemia response. In addition, increased O2 extraction ("O2 steal") and extensive countercurrent O2 exchange during low flow states may reduce ORT and ORI in severely ischemic skin.
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PMID:The role of blood perfusion and tissue oxygenation in the postischemic transcutaneous pO2 response. 153 77

We reviewed the records of approximately 1,500 patients seen in the Vascular Laboratory of the Cincinnati Veterans Affairs Medical Center from 1980 to 1987 and identified 23 patients (25 limbs) who met all of the following criteria: 1) an ankle/brachial index less than or equal to 0.35; 2) an ankle or transmetatarsal pulse volume recording less than or equal to 3 mm in amplitude; and 3) no history of ischemic rest pain or gangrene. These patients were followed in the Vascular Laboratory for periods ranging from 11 to 127 months (mean 45.2 months). The study was terminated in March 1991 or when revascularization or amputation was required for limb-threatening symptoms or if the patient expired. Thirteen extremities (52%) showed no progression to limb-threatening symptoms. Claudication actually improved in three, remained unchanged in eight, and progressed in two. Twelve (48%) extremities developed limb-threatening conditions, with rest pain occurring in three, ischemic ulceration in six and gangrene in three. Eight of these limbs underwent revascularization and only one ultimately required major amputation. Another extremity presented with extensive gangrene and underwent a primary above-knee amputation. Three other patients did not undergo revascularization because of death in one and refusal in two others. Patients with intermittent claudication who have critical hemodynamic indices are at much greater risk for developing symptomatic limb-threatening ischemia. Close follow-up is mandatory since nearly half of these patients will eventually require operation for limb salvage. Patients who are unlikely to comply with a regular follow-up program may be considered for early revascularization to prevent complications of limb-threatening ischemia.
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PMID:Natural history of claudicants with critical hemodynamic indices. 154 73

The current retrospective study was performed on 747 patients with aortoiliac obstructive disease who underwent reconstructive operation. Unlike many other centers, the University Hospital Leiden has, throughout the years, maintained the strategy of avoiding the implantation of a prosthesis in patients with limited and localized obstructive disease that could readily be treated with an endarterectomy. When a prosthesis was used, it was anastomosed to the femoral artery if a more proximal anastomosis was not feasible. In the present study, the long term outcome of the strategy is evaluated. Three groups of patients were studied--245 patients with moderate claudication, 331 patients with severe claudication and 162 patients with critical ischemia at presentation. Thromboendarterectomies were used in 229 patients (30.7 per cent) and prosthetic reconstructions in 518 patients (69.3 per cent), of which 339 (45.5 per cent) were aortoiliac reconstructions. The perioperative mortality rates were 1.6, 3.0 and 3.1 per cent for the three groups, respectively. Atherosclerotic heart disease was the most common cause of perioperative (30.0 per cent) and late (30.8 per cent) death. Late complications of surgical treatment also contributed significantly to the causes of late deaths (12.1 per cent). Because over-all survival rates in the current series compared favorably with those in other series, the influence of reconstructive operation on late survival was compensated for by a beneficial effect in patients without such complications. Secondary operations for late complications, such as false aneurysms and aortoiliac reobstruction or for progressive obstructive disease, were necessary in 21 per cent of all 727 survivors of the first operation. Actuarial curves with various endpoints--mortality, secondary operation, patency of aortoiliac segments, functional failure, amputation, presence of mild, moderate and severe claudication--were calculated according to the standard method of life table construction. In terms of technical success rates, the results of our surgical technique strategy compared favorably with those reported in other series, in which most patients were treated with aortobifemoral prostheses. The chances of functional failure increased with time, amounting to about 23 per cent at 15 years postoperatively for each group of patients. Comparison of technical and functional success rates showed a significant disparity, which was explained by the effects of collateral blood flow in instances of aortoiliac reobstruction and of progressing femoropopliteal obstructions in instances of open aortoiliac vessels.
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PMID:Long term success of aortoiliac operation for arteriosclerotic obstructive disease. 159 26

Fibromuscular disease is rarely observed in the external iliac artery. During the last 15 years, eight symptomatic cases were encountered in six women and two men whose ages ranged from 29 to 63 years (mean: 47 years). Clinical onset was always recent, either progressive with claudication (three cases) or sudden with abdominal and pelvic pain and acute ischemia due to dissection (five cases). Diagnosis was established by arteriograms showing either a typical appearance of fibromuscular hyperplasia or a segmental dissection or occlusion. Two patients had associated fibromuscular disease of the renal arteries. One of these patients had dysplastic aneurysm of the thyrocervical trunk. Histopathological findings were typical of medial fibromuscular hyperplasia in the seven cases examined. Even though transluminal dilatation is presently simple, adequate, and durable for the management of non-complicated forms, all of our cases were treated surgically either because they were observed before transluminal dilatation was readily available or because of associated dissection. Results of surgery were satisfactory in all cases except one with a mean follow-up of 12.6 years. One patient was reoperated upon 13 years later.
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PMID:Fibromuscular disease of the external iliac artery. 161 Jun 49

The authors' experience with 113 aortic occlusions in 103 patients during a 26-year period (1965 to 1991) is reviewed. The authors found three distinct patterns of presentation: group I (n = 26) presented with acute aortic occlusion, group II (n = 66) presented with chronic aortic occlusion, and group III (n = 21) presented with complete occlusion of an aortic graft. Perioperative mortality rates were 31%, 9%, and 4.7% for each respective group and achieved statistical significance when comparing group I with group II (p = 0.009) and group I with group III (p = 0.015). Group I presented with profound metabolic insults due to acute ischemia and fared poorly. Group II presented with chronic claudication and did well long-term. Group III presented with acute ischemia but did well because of established collateral circulation. The treatment and expected outcome of aortic occlusion depends on the cause.
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PMID:Juxtarenal aortic occlusion. 161 81


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