Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the Whitehall study, 18,388 subjects aged 40-64 years completed a questionnaire on intermittent claudication. Of these subjects, 0.8% (147) and 1% (175) were deemed to have probable intermittent claudication and possible intermittent claudication, respectively. Within the 17-year follow-up period, 38% and 40% of the probable and possible cases, respectively, died. Compared with subjects without claudication, the probable cases suffered increased mortality rates due to coronary heart disease and cerebrovascular disease, but the mortality rate due to noncardiovascular causes was not increased. Possible cases demonstrated increased mortality rates due to cardiovascular and noncardiovascular causes. This difference in mortality pattern may be due to chance. Possible and probable cases still showed increased cardiovascular and all-cause mortality rates after adjusting for coronary risk factors (cardiac ischemia at baseline, systolic blood pressure, plasma cholesterol concentration, smoking behavior, employment grade, and degree of glucose intolerance). Intermittent claudication is independently related to increased mortality rates. It is not a rare condition, and simple questionnaires exist for its detection. The latter can be usefully incorporated in cardiovascular risk assessment and screening programs.
 ...
PMID:Intermittent claudication, heart disease risk factors, and mortality. The Whitehall Study. 224 47

A series of 62 femorofemoral bypass grafts (FFBG) is reported. The indication for this operation was unilateral iliofemoral occlusion with severe ischemia of the lower limb in poor-risk patients. Severe ischemia presented as rest pain and/or minor necrotic lesions to the foot fingers, while patients were defined poor-risk for aging and concomitant diseases advising major surgical procedures and general anaesthesia. Claudication was not considered as an indication for this operation, and this statement is discussed in detail reviewing the literature. Operative death rate was approximately 6.4% (4 subjects), due to acute renal failure, revascularization syndrome, cardiac arrest and pulmonary oedema. Twenty subjects had had a total of 33 previous vascular reconstructive procedures; this occurrence did not reveal any statistically significant consequences on long-term patency rate, although a difference was seen in favour of the patients who had not undergone previous vascular reconstructive procedures. In the group of patients who underwent FFBG as the first vascular procedure, five early occlusions occurred: three Fogarty catheter thrombectomies were successful. Cumulative patency rate was then 77% at 36 months in the series of 58 survivors. Rest pain was relieved in any instances and a satisfactory improvement of claudication was obtained.
 ...
PMID:The femorofemoral bypass graft. Report of a 11-year experience. 225 Sep 77

From January 1980 through December 1988, 564 limbs in 434 patients were treated for infrainguinal arterial ischemia. Of these, 516 limbs in 387 patients underwent reversed vein bypass grafting. The remainder were treated by primary amputation (11 limbs, 1.9%) or by prosthetic bypass (37 limbs, 6.4%). The indications for operation were limb salvage in 80% of limbs and claudication in 20%. Adequate ipsilateral greater saphenous vein was available for 285 (55%) grafts, with reversed vein bypass achieved in the other 231 operations by use of distal graft origins (151 grafts), use of alternate vein sources (120 grafts), and splicing of venous segments (81 grafts). Seventy-six grafts (15%) were to the above-knee popliteal artery, 199 grafts (37%) were to the below-knee popliteal artery, and 241 grafts (47%) were to infrapopliteal arteries, 26 of which (11%) were to inframalleolar arteries. The primary and secondary patencies for all grafts at 5 years were 75% and 81%, respectively. Grafts to infrapopliteal arteries had significantly worse primary patency (69%) at 5 years than did grafts to the popliteal artery (77%, above knee; 80%, below knee) and grafts formed of adequate ipsilateral greater saphenous vein had significantly better primary patency (80%) than did grafts performed when this conduit was not available (68%). Secondary patency of all graft categories ranged from 76% to 85%, and there were no significant differences regardless of site of distal anastomosis, source of venous conduit, or site of graft origins. We prefer the use of reversed vein bypass grafting for lower extremity revascularization both because of the excellent patency results and because the technique can be applied to the larger number of patients in our practice who lack intact ipsilateral greater saphenous vein, in contrast to in situ vein bypass procedures.
 ...
PMID:Present status of reversed vein bypass grafting: five-year results of a modern series. 229 43

The long-term effect of two surgical techniques for repair of coarctation of the aorta in infancy, namely, resection and end-to-end anastomosis (RETE) and subclavian flap angioplasty (SFA) on the blood supply of the upper left limb, was quantified by Doppler spectrum analysis of blood flow velocities in the left brachial artery at rest and during postocclusive reactive hyperemia. Twenty-three patients participated in this study: nine patients after SFA (median age, 8 years), 14 patients after RETE (median age, 8 years), and 10 control subjects (median age, 9.5 years). At rest, a highly significant decrease of blood flow velocities in the left brachial artery was measured in all patients of the SFA group compared with those of the RETE and control groups, as documented by various Doppler spectrum parameters: maximal frequency of advancing curve (p = 0.0001), pulsatility index (p = 0.0005), and resistance index (p = 0.039). During reactive hyperemia, a moderate capacity of physiologic augmentation of blood flow velocities was observed in five patients of the SFA group. This capacity was marginal in two patients with complaints of claudication in the left upper limb during strenuous exercise, which can be related to the number of branches of the left subclavian artery ligated during operation. This study indicates that SFA in infancy may lead to compromised hemodynamics of the upper left limb with potential for symptoms of ischemia during exercise.
 ...
PMID:Detrimental sequelae on the hemodynamics of the upper left limb after subclavian flap angioplasty in infancy. 230 43

Acute upper-extremity arterial occlusion may be due to embolic phenomena or de novo thrombosis. If the occlusion is left untreated, claudication or ischemia necessitating amputation can occur. Operative Fogarty-balloon embolectomy has been the treatment of choice for this entity. In a 6-year period the authors used fibrinolysis on nine occasions in eight patients to treat acute upper-extremity arterial occlusions. Concomitant balloon angioplasty was helpful in four cases. Success, defined as a normal hand with at least one artery that was continuously patent to the wrist, was achieved in all patients. A single significant groin hematoma was seen. Neither stroke nor death occurred in any case, and no amputations were necessary. Local transcatheter intraarterial administration of urokinase can be considered a first-line treatment for brachial artery embolus and other causes of acute upper-extremity arterial occlusion.
 ...
PMID:Fibrinolytic therapy for upper-extremity arterial occlusions. 198 30

We report a prospective study with 2 years of follow-up including 105 consecutive symptomatic patients (58.1% claudication and 41.9% severe ischemia) undergoing aortobifemoral bypass surgery (ABF/BP). Proportional-hazards, stepwise regression, and life-table analyses were used to determine predictors of the following outcome criteria: graft patency, amputation, mortality, symptomatic recurrence, and palliation. The operative mortality was 5.7% and the 2-year cumulative mortality was 15.5%. Most deaths (61.5%) were cardiac-related. There were 3 predictors of mortality: the presence of more than 1 surgical risk factor (relative risk [RR] 6.2; p less than 0.001), advanced age (RR 2.9; p = 0.03) and the presence of ischemic heart disease (RR 1.5; p = 0.045). No patient required amputation. Early graft patency rate was 94.3% and the 2-year cumulative patency was 92.8%. The only predictor of graft failure was preoperative ankle/brachial index (ABI) of less than 0.4 (RR 6.1; p = 0.003). Early symptomatic relief was 98.1% and at 2 years it was 77.3%. There were 2 predictors of symptomatic recurrence: postoperative smoking (RR 2.4; p less than 0.001) and impaired runoff (RR 2.5; p = 0.017). Cumulative palliation was 87.6% at 1 month and 66.5% at 2 years postoperatively. There were 2 predictors of palliation: the presence of more than 1 surgical risk-factor (RR 1.8; p = 0.001) and postoperative transcutaneous oximetry (PtcO2) of less than 35 mmHg (RR 3.1; p = 0.04). We conclude that the best predictors of outcome in patients undergoing ABF/BP surgery were the number of preoperative risk factors, age, ischemic heart disease, ABI, PtcO2, postoperative smoking, and angiographic runoff.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Predictors of surgical outcome in patients undergoing aortobifemoral bypass reconstruction. 237 Feb 67

This study investigated local alterations in neutrophil activation and deformability after intermittent claudication. In 17 patients with one-sided peripheral arterial occlusive disease, neutrophil count, proportion of activated neutrophils (by nitro blue tetrazolium test), and neutrophil filterability as a measure of passive deformability were assessed in the femoral arterial and venous blood of the diseased leg and in the femoral venous blood of the healthy leg (n = 10). The values were obtained at rest, immediately after claudication, and 10 minutes after claudication induced by repetitive toe stands. Immediately after exercise, the arterial and venous blood differences in the diseased leg were 1) neutrophil count, 9% (95% confidence interval [CI], 5-14%; relative increase in the venous blood compared with arterial blood); 2) the proportion of activated neutrophils, 26% (CI, 10-42%); and 3) the neutrophil filterability, -10% (CI, -4% to -15%). At rest and 10 minutes after exercise, neutrophil parameters did not differ significantly between the femoral arterial and venous blood. Furthermore, no arterial and venous blood differences in the neutrophil parameters were found in the healthy leg. In addition to local changes, systemic changes occurred immediately after exercise. In the femoral arterial blood, the total neutrophil count had risen by 13% (CI, 8-18%), the proportion of activated neutrophils had risen by 41% (CI, 25-58%), and average neutrophil rigidity had risen 17% (CI, 11-22%) compared with the values obtained before exercise. At 10 minutes after exercise, all neutrophil parameters were still elevated. We conclude that even short periods of ischemia, as in intermittent claudication, cause local alterations in neutrophil function and distribution.
 ...
PMID:Activation and decreased deformability of neutrophils after intermittent claudication. 239 12

Patients with atherosclerotic peripheral arterial disease (PAD) of the lower extremities have impaired walking ability due to exercise-induced muscle ischemia and the resultant pain of intermittent claudication. To evaluate the benefit of exercise training as a treatment for patients with PAD, as well as possible mechanisms associated with improvement, we randomly assigned 19 men with disabling claudication to treated and control groups. Treatment consisted of supervised treadmill walking (1 hr/day, 3 days/wk, for 12 weeks) with progressive increases in speed and grade as tolerated. Graded treadmill testing was performed to maximal toleration of claudication pain on entry and after 12 weeks of training to define changes in peak exercise performance. After 12 weeks, treated subjects had increased their peak walking time 123%, peak oxygen consumption 30%, and pain-free walking time 165% (all p less than 0.05). Control subjects had no change in peak oxygen consumption, but after 12 weeks, peak walking time increased 20% (p less than 0.05). In treated subjects, maximal calf blood flow (measured by a plethysmograph) increased 38 +/- 45% (p less than 0.05), but the change in flow was not correlated to the increase in peak walking time. Elevated plasma concentrations of acylcarnitines have been associated with the functional impairment of PAD and may reflect the metabolic state of ischemic skeletal muscle. In treated subjects, a 26% decrease in resting plasma short-chain acylcarnitine concentration was correlated with improvement in peak walking time (r = -0.78, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Benefit of exercise conditioning for patients with peripheral arterial disease. 240 33

Implementation of a protocol that monitored in situ saphenous vein bypass hemodynamics for low-flow states provided insight into the pathophysiologic characteristics and time course of graft failure. From 1981 to 1988, 250 in situ bypasses to popliteal (n = 83) or tibial (n = 167) arteries were performed in 231 patients. Indications for operation included critical limb ischemia in 232 cases (93%), popliteal aneurysm in 11 cases (4%), and disabling claudication in seven cases (3%). Arterial pressure measurements, continuous-wave Doppler spectral analysis, and duplex ultrasonography were used to assess patency, detect hemodynamic changes indicative of graft stenosis, and localize anatomic hemodynamic changes indicative of graft stenosis. Seventy grafts with correctable anatomic lesions (retained venous valves, graft stenosis, arteriovenous fistula, native vessel atherosclerosis) that decreased graft blood flow or ankle arterial pressure or both were identified. Correction of vein conduit or anastomotic lesions comprised 73 (77%) of the 95 revisions performed. Vein-patch angioplasty of a stenosis was the most common secondary operation performed. Graft revision was highest in the perioperative period (10% at 30 days), decreased to 7% per 6-month interval until 18 months, and was 3% per year thereafter. The primary patency rate of grafts not identified to have a correctable lesion was 86% at 4 years, a level similar to the secondary patency of 81% for grafts requiring one or multiple revisions. The surveillance protocol identified grafts with correctable lesions before thrombosis thereby permitting elective revision of patent grafts. Hemodynamic studies confirmed that a frequent mechanism of late failure of grafts was the development of a low-flow state produced by lesions not amenable to revision.
 ...
PMID:Monitoring functional patency of in situ saphenous vein bypasses: the impact of a surveillance protocol and elective revision. 252 7

This paper presents the results of a retrospective study of 110 percutaneous transluminal angioplasties done over a period of two years on 110 consecutive patients. Anticoagulation or antiplatelet drugs were not used during or after percutaneous transluminal angioplasty. Life-table analysis was used to calculate success rates at one and three months following the procedure. Success rates were determined using three criteria: clinical improvement, pre- and post-percutaneous transluminal angioplasty Doppler studies, and radiographic appearance. Claudication was present in 87 (79%) patients and severe ischemia in 23 (21%) patients. Sixty-eight (62%) PCTAs were done in the iliac arteries, 35 (32%) in the femoral arteries, and 7 (6%) in the popliteal artery. The majority of patients (61%) had 50%-75% arterial stenosis and only 18% had complete occlusion. Percutaneous transluminal angioplasty in the iliac arteries had the best results with cumulative success rates of 90% and 85% at one and three months, respectively. Success rates in the femoral arteries were 83% and 79% and in the popliteal artery 71% and 57% at one and three months, respectively. None of our patients required amputation. Ten patients (9.1%) suffered the following complications within 30 days of percutaneous transluminal angioplasty: death (2), thrombosis (2), perforation (3), minor hematoma (2), and false aneurysm (1). In conclusion, we have shown that percutaneous transluminal angioplasty can be performed safely and effectively without the use of anticoagulation and its associated risks.
 ...
PMID:Percutaneous transluminal angioplasty without anticoagulation. 252 66


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>