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

From 1980 to 1988 we performed 288 femoropopliteal bypass operations in 231 patients at the Oregon Health Sciences University. The indication for the procedure was claudication in 31% and the relief of limb-threatening ischemia in 64%. Operative mortality occurred after four of these operations (1.4%), including three deaths from myocardial infarction and one death from stroke. The femoropopliteal bypass patients were divided into groups for patency analysis, including those undergoing bypass surgery with a good quality greater saphenous vein versus alternate bypass conduits and patients undergoing primary limb bypass versus those undergoing repeat bypass after prior bypass failure. Our overall primary graft patency for all femoropopliteal grafts was 79% at 5 years. Patients undergoing bypass with a good quality greater saphenous vein had primary graft patency of 85% at 5 years. Patients undergoing bypass using a conduit other than greater saphenous vein had a 5-year patency of 73%. Patients undergoing repeat bypass after a prior failed bypass had a 5-year patency of 57%.
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PMID:Clinical and anatomic considerations for surgery in femoropopliteal disease and the results of surgery. 199 2

The proximal anastomosis is still a controversial issue in vascular surgery. To compare end-to-end (EE) and end-to-side (ES) proximal anastomoses, the authors undertook a prospective study with 3 years' follow-up involving 120 patients, all of whom had aortobifemoral bypass. Fifty-one (42.5%) patients received the EE and 69 (57.5%) the ES anastomosis. The indications for surgery were abdominal aortic aneurysm (EE 51%, ES 0%; p less than 0.05), claudication (EE 33.3%, ES 53.6%; p less than 0.05) and critical ischemia (EE 15.7%, ES 46.4%; p less than 0.05). Patients in the EE group were older (mean age: EE 66.1 +/- 2.8 years, ES 60.9 +/- 1.1 years; p less than 0.05) and had more ischemic heart disease (EE 39.2%, ES 27.5%; p less than 0.05). Postoperative mean increases in transcutaneous oximetry (EE 15.5 +/- 3.9 mm Hg, ES 12.6 +/- 2.3 mm Hg) and the ankle-brachial pressure index (EE 0.34 +/- 0.05, ES 0.30 +/- 0.03) were not significantly different in the two groups. The operative death rate was higher for the EE group (EE 11.8%, ES 1.4%; p less than 0.05). Early thrombosis occurred in six patients, two in the EE group and four in the ES group. Computed tomography, done 1 year postoperatively in 95 patients, revealed two small (less than 3 cm) distal anastomotic dilatations, one in each group. At 3 years, cumulative survival and patency were similar in both groups. The authors conclude that the two anastomotic groups had very similar short- and long-term results, except for the operative death rate which was higher in the EE group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:End-to-end versus end-to-side proximal anastomosis in aortobifemoral bypass surgery: does it matter? 205 57

In the course of reviewing a 10-year experience with popliteal artery embolism (PAE), two distinct patterns of clinical presentation were identified. In addition to those patients presenting with typical acute (symptom duration less than 7 days) arterial ischemia, a second group was identified who presented with more chronic symptoms. The present study was conducted to contrast the clinical factors and treatment of these two temporal patterns of presentation with PAE. Sixty PAEs in 58 patients were documented by the combination of angiography and/or exploration of the popliteal artery. Acute presentation (AP) was seen in 41 (68%) of these and delayed presentation (DP) was noted in 19 (32%) patients. Delayed presentation patients typically presented with a history of sudden onset of claudication or rest pain and a median symptom duration of 30 days. Eighty per cent of AP patients presented with immediately threatened limbs. Angiography was generally diagnostic of chronic popliteal embolism. In the acute group, 90% were treated with embolectomy alone, while 20% of the DP group required bypass grafting. However in two thirds of the DP group, embolectomy alone performed through a direct popliteal approach was possible. Current results with overall limb salvage (92%) and mortality (7%) represents a substantial improvement compared to the authors' previous experience with PAE. The current study suggests that as many as one third of patients with popliteal artery embolism may present in delayed fashion with chronic symptoms. Furthermore most of these patients can be treated with direct popliteal embolectomy alone with favorable results.
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PMID:Delayed presentation and treatment of popliteal artery embolism. 206 71

The tests in the noninvasive vascular laboratory are highly accurate for assessing the patient with extremity or visceral artery disease. Once the location and severity of any arterial disease in patients with claudication or critical limb ischemia (ie, gangrene, ulceration, rest pain) is determined by the noninvasive tests, a treatment plan can be developed and then discussed with the patient, with consent obtained prior to any invasive procedure. The presence of hypertension from renal artery stenosis, or chronic mesenteric ischemia from visceral artery stenosis, can be evaluated by duplex scanning, without the need for invasive contrast angiography. Monitoring the function of revascularization procedures, such as angioplasty or bypass grafts, is also possible and significantly improves long-term patency and organ or limb salvage by identifying the need for elective revision of failing reconstructions prior to thrombosis. Noninvasive vascular laboratory tests are the initial procedures of choice for the evaluation of patients with extremity or visceral arterial disease.
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PMID:Indications and uses of the noninvasive vascular laboratory: extremity or visceral arterial evaluation. 206 53

Between 1978 and 1988 133 extra-anatomical grafts were performed in patients presenting with aorto-iliac occlusive disease. These series include 50 cross-over grafts, 46 axillofemoral and 37 axillobifemoral grafts. The indication for operation was acute ischemia in 26.4%, claudication in 9.7% and limb salvage in 63.9% of cases. Perioperative mortality rate was 10.4%. The early patency rate decreased from 92% after cross-over grafting to 86% in the axillofemoral series and 8% of the patients needed a major amputation in the immediate postoperative period. With a mean follow-up of 32 months, 62% of the patients died within 5 years of the operation, 54% of deaths being due to cardiovascular complications. The 3-years patency rate decreased to 78% after cross-over grafting and 49% after axillofemoral grafting. The 3-year limb salvage rate decreased to 89% and 75% respectively. Although our results are definitely less favourable than those of direct aortofemoral grafting, they seem to support the further use of the cross-over graft in patients with unilateral occlusive disease. Axillofemoral grafting on the other hand should be preserved for limb saving reconstructions in high risk conditions.
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PMID:Extra-anatomical grafting for aorto-occlusive disease: the outcome in 133 procedures. 207 10

Prospective cost and reimbursement data were collected from 10 centers in various parts of the United States on 566 patients undergoing lower extremity arterial reconstructions for limb salvage and nonlimb salvage indications. Information for each patient was available on indication and type of procedure, length of stay, the type of hospital insurance, and hospital costs/charges. Diagnosis related group payments from each center were used to determine net gain or loss for each patient. Patients were classified as having claudication or critical ischemia (limb salvage). Reimbursements matched costs/charges for the claudication group; overall mean loss in this group was only $915 per patient. However, all centers had important losses in the limb salvage group. Reimbursements averaged 60% of costs/charges, with a mean loss of $8158 per patient and an overall loss for all 10 centers of $3,653,918. An effort to remedy this inequity is progressing via a dialogue between representatives of the Society for Vascular Surgery, the North American Chapter of the International Society for Cardiovascular Surgery, and the federal government.
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PMID:Inadequacy of diagnosis related group (DRG) reimbursements for limb salvage lower extremity arterial reconstructions. Ad hoc committee of the Joint Council of the Society for Vascular Surgery and the North American Chapter of the International Society for Cardiovascular Surgery. 210 1

Results of 127 iliac and femoropopliteal transluminal angioplasties in 97 diabetic patients are presented. Patients who had undergone iliac (n = 70), femoral (n = 41), and popliteal (n = 16) angioplasties for stenoses up to 15 cm long were followed up for 6-60 months. In diabetic patients presenting with only claudication or adequate runoff, the 5-year iliac patency rate was 76% and the femoral patency rate was 60%; these results were comparable with those found in nondiabetic patients. For limb salvage, 3-year patency rates were 66% for iliac, 37% for femoral, and 37% for popliteal angioplasties, and 5-year patency rates were 29% for iliac, 7% for femoral, and 0% for popliteal angioplasties. Severe peripheral ischemia, poor runoff, and diffuse stenoses all had negative effects on angioplasty results.
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PMID:Five-year results of iliac and femoropopliteal angioplasty in diabetic patients. 213 39

From July 1988 through December 1988 laser "hot tip" angioplasties coupled with balloon dilations were performed on 95 patients at the Union Memorial and University of Maryland hospitals. The patients ranged in age from 42 to 84 years (mean, 66.4 years), and there were 61 men and 34 women in the study. Indications for the procedure included claudication in 70 (74%) and severe ischemia in 25 (26%). Noninvasive studies were performed on all patients before and after the procedure. One hundred seventeen segments were treated in 28 iliac arteries and 89 superficial femoral/popliteal arteries. No tibial arteries were treated. Fifty-two stenoses and 65 occlusions occurred. The procedures were performed percutaneously in 52 patients (55%), and open surgical technique was used in 43 patients (45%). Nine immediate failures (9.5%) and 86 successes (90.5%) were noted within 24 hours of the procedure. Follow-up ranged from 1 to 6 months with a mean of 3.2 months. Late failures within this time period occurred in 21 patients (22%). The total failure rate was 30/95 or 31.5%. Only one of the patients was made worse by a failed laser-assisted balloon angioplasty. Immediate complications consisted of formation of subcutaneous hematoma in 20 of the 52 patients having percutaneous procedures (38%) and healing difficulty in 3 of the 43 patients having open surgical procedures (7%). Hospital stay was usually 1 day longer in the latter group. No patient required surgical intervention for bleeding as a result of a vessel perforation. However, this phenomenon was noted during the course of three superficial femoral artery laser-assisted balloon angioplasties.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Laser angioplasty in the lower extremities: an early surgical experience. 213 44

Angioplasty using the percutaneous popliteal approach was utilized in 50 patients (PTS) to recanalize 59 occluded superficial femoral arteries which had been unsuccessfully canalized by using the antegrade approach because of either a flush origin occlusion or inability to maintain the guide wire in the true lumen. All PTS had claudication; 8 had rest pain; 3 had non-healing ulcers. The laser Probe was used in 17 cases and the Rotablator in 3 cases. Occlusion length varied between 1 and 40 cm: 7 lesions were less than 10 cm (group 1); 9 were between 10 and 20 cm (group 2); and 43 were greater than 20 cm (group 3). An angiographic success was obtained in 48/59 lesions (81%): 14/16 (87%) in groups 1 and 2 and 34/43 (79%) in group 3. Three PTS needed complementary common femoral endarterectomy and one required percutaneous aspiration of a thromboembolus. Complications included: arterial perforation and/or dissection (without clinical sequelae) in 11 and a popliteal hematoma in 1 PT. One patient with a severely ischemic leg underwent successful emergency vascular surgery, while another limb salvage patient required below-knee amputation. There was no worsening of limb ischemia from any popliteal approach attempt. At discharge, 39 patients (78%) whose outcome would have been unsuccessful with the traditional antegrade approach were clinically improved after utilizing the popliteal approach to achieve a successful angioplasty procedure.
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PMID:Percutaneous popliteal approach for angioplasty of superficial femoral artery occlusions. 214 24

External iliac fibromuscular dysplasia is a rare and usually asymptomatic disorder. We report eight symptomatic patients seen over a 15-year period and review pathophysiologic mechanisms accounting for the three following distinct lower extremity ischemic sequelae: (1) Emboli--episodic focal digital ischemia (blue toe) was seen in three patients. Resection and primary anastomosis of focal iliac ulcerative fibromuscular dysplasia (one patient) or resection and replacement (two patients) removed the embolic source and relieved the symptoms. (2) Chronic ischemia--gradual onset of full leg claudication in four patients was treated by operative graduated intraluminal dilation in three patients and prosthetic bypass in one. Arteriography subsequently showed a remodeled lumen in the three patients who underwent dilation. (3) Dissection--acute onset leg ischemia resulted from presumed dissection of the external iliac segment. After 4 months of conservative management of antiplatelet agents and exercise, symptoms resolved completely, and arteriogram showed spontaneous restoration of a normal lumen in the dissected segment. The clinical presentation of fibromuscular dysplasia may mimic other arterial processes such as atherosclerosis. Diagnosis is made only by arteriography with specific magnification views of the external iliac arteries and careful surveillance of the renal arteries. Appropriate treatment should be tailored to the clinical presenting symptom. For microembolic disease, resection and replacement are required. For chronic ischemia, intraluminal dilation is generally sufficient and durable and has proved to be a simpler and acceptable alternative to replacement or bypass. In acute dissection, surgical intervention may be deferred if the limb is viable to allow spontaneous healing and remodeling. Persistent symptoms may be the only indication for intervention in this ischemic manifestation of external iliac fibromuscular dysplasia.
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PMID:Clinical spectrum of symptomatic external iliac fibromuscular dysplasia. 221 43


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