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

Peripheral arterial disease requires different diagnostic strategies according to the clinical presentation: tissue ischemia, asymptomatic disease or polyarterial disease. In the presence of resting or effort ischemia, complementary investigations are indicated: arteriography should be reserved for indications of arterial reconstruction: ankle systolic pressure may be measured by all physicians to quantify the distal repercussions of the lesions. Asymptomatic peripheral disease is becoming more widely recognised and may be detected with flowmeter tests. Polyarterial disease is associated with increased mortality of patients with peripheral arterial disease. Symptoms of coronary artery disease are an indication for coronary angiography and myocardial scintigraphy. Patients with cerebrovascular events will require ultrasonic, CT scanning and cardiac investigations. The diversity of the diagnostic approach to peripheral arterial disease is creating a need for a new profile of vascular physicians.
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PMID:[Diagnostic strategy of vascular diseases of the lower limbs]. 176 85

Peripheral arterial disease (PAD) is an atherosclerotic disease which modifies lower extremity hemodynamics. There is considerable evidence that skeletal muscle metabolism is altered in PAD. Several studies have demonstrated altered mitochondrial enzyme content in PAD muscle as compared with controls, and enzyme activity may not increase normally in PAD with exercise training. A variety of metabolic intermediates, including acylcarnitines, accumulate in muscle of PAD patients, suggesting incomplete oxidative metabolism. Studies employing 31P-NMR (nuclear magnetic resonance) also suggest a metabolic myopathy in PAD. Strikingly, while hemodynamics do not predict claudication-limited performance, metabolic injury as evidenced by acylcarnitine accumulation is strongly correlated with patients' functional status in PAD. Further, exercise rehabilitation improves claudication-limited performance without modifying large vessel hemodynamics. The stress placed on skeletal muscle during exercise in PAD and the observed evidence of metabolic dysfunction is similar to ischemia/reperfusion injury in cardiac muscle. Recognition of the role of cellular metabolic injury and function in PAD has formed the basis for novel therapeutic strategies in this disease.
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PMID:Skeletal muscle metabolism as a target for drug therapy in peripheral arterial disease. 954 16

Peripheral arterial disease affects approximately 8-10 million people in the United States. Approximately one-third to one-half of these individuals are symptomatic. The risk factors that contribute to peripheral arterial disease are similar to those associated with other forms of atherosclerosis, including diabetes mellitus, cigarette smoking, hypercholesterolemia, high blood pressure, and hyperhomocysteinemia. Of these, diabetes and cigarette smoking pose the greatest risk for developing peripheral arterial disease. The prognosis of patients with these risk factors is limited because of their greater risks for myocardial infarction, stroke, and cardiovascular death. Cardiovascular mortality correlates inversely with the ankle/brachial index, and the risk of death is greatest in those with the most severe peripheral arterial disease. Treatment regimens to reduce cardiovascular morbidity and mortality in patients with peripheral arterial disease should include risk factor modification and antiplatelet therapy. The cardinal symptoms of peripheral arterial disease include intermittent claudication and rest pain, with the latter being indicative of critical limb ischemia. Therapeutic strategies that focus on improving the patient's quality of life, reducing the severity of claudication, and improving limb viability include supervised exercise training, pharmacotherapy, and revascularization. Two drugs-pentoxifylline and cilostazol-currently are approved by the Food and Drug Administration for the treatment of patients with claudication. Meta-analyses have suggested that, compared with placebo, pentoxifylline improves maximal walking distance by approximately 20-25%. Cilostazol is a phosphodiesterase type 3 inhibitor. In clinical trials, cilostazol has consistently improved maximal walking distance as compared with placebo, with the range of improvement being approximately 40-60%. Drugs that are currently under investigation include propionyl-L-carnitine, vasodilator prostaglandins, L-arginine, and the angiogenic factors, vascular endothelial growth factor and basic fibroblast growth factors.
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PMID:Medical management of peripheral arterial disease. 1140 4

Peripheral arterial disease (PAD) involving the lower extremities is presumably a disease of the elderly. The awareness of PAD in the general population, and in younger adults in particular, is low. Atherosclerosis is the major cause of lower limb ischemia in the young. Young adults with clinical manifestations of premature lower extremity atherosclerosis (PLEA) typically have multiple cardiovascular risk factors and the majority are smokers, with strong family history of cardiovascular disease, and typically have chronic symptoms of claudication at diagnosis. Frequently these symptoms are either not reported in a timely manner by the patients or are attributed to other, presumably more common causes of leg pain in the young. More than 70% of patients with PLEA have angiographic evidence of severe aortoiliac disease. The results of surgical revascularizations in young adults are inferior to those reported in older patients. Younger adults typically require multiple revascularizations with relatively high amputation rate. We conclude that PAD should be considered in adults with multiple risk factors regardless of their age if appropriate symptoms are present. There is a need for increased public health awareness for premature lower extremity atherosclerosis.
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PMID:Premature lower extremity atherosclerosis: clinical aspects. 1181 36

Peripheral arterial disease (PAD) is a common but under-recognized problem affecting older patients. Intermittent claudication is the most frequent symptom of PAD, although the diagnosis of PAD is often overlooked until the patient presents with limb-threatening ischemia. Importantly, PAD is a marker for generalized atherosclerosis and is closely associated with coronary and cerebrovascular disease. The severity of PAD has been correlated with an increased risk of myocardial infarction, stroke, and cardiovascular death. The recognition and diagnosis of PAD, combined with its appropriate medical management, may well reduce the overall risk of cardiovascular morbidity. When diagnosed early, both exercise and pharmacotherapy can ameliorate symptoms of claudication, augment functional performance, and improve quality of life.
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PMID:Peripheral arterial disease: medical care and prevention of complications. 1209 54

Peripheral arterial disease (PAD) is a common manifestation of systemic atherosclerosis that is associated with a high risk of cardiovascular mortality and significant limitation in function because of limb ischemia. Patients with PAD should be considered to have significant coronary and cerebral arterial disease that requires aggressive risk factor management, including the prescription of antiplatelet drugs, to lower the subsequent risk of myocardial infarction, stroke, and death. In the population with PAD, level 1 and level 2 evidence supports the use of statin drugs for lipid management, angiotensin-converting enzyme-1 inhibitors for blood pressure control, and aspirin or clopidogrel as antiplatelet agents. Once this is accomplished, the severity of limb symptoms should be assessed, and a structured exercise program or the selected use of drugs such as cilostazol to treat claudication should be prescribed. In patients primarily considered for surgical treatment, antiplatelet and anticoagulant drug therapy can be used as a means of promoting graft patency, and beta-adrenergic blockers can be used as a means of reducing the perioperative risks associated with vascular surgery.
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PMID:Pharmacologic therapy for peripheral arterial disease and claudication. 1246 66

Peripheral arterial disease (PAD) is most frequently caused by atherosclerosis. The prevalence of intermittent claudication is about 3 to 6% of the men over 60 years. But recent epidemiological studies demonstrate that prevalence of asymptomatic forms is two to three fold higher--about 3.4 to 12.1%. The most relevant diagnostic criteria for asymptomatic PAD is probably the measure of the ankle/brachial index. Most important risk factors for PAD are smoking and diabetes mellitus. Improving symptoms or stabilization are a common fate (50%) in PAD. About 25% will experience revascularization procedures (angioplasty or surgery), 4% will have severe amputation and worsening symptoms occur in 15% of patients. Critical limb ischemia is mostly rare (1%). It is not surprising that fate of claudicant and mortality is determined by coronary events and cardiovascular diseases.
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PMID:[Epidemiology of and risk factors for lower limb arteriopathy obliterans]. 1255 2

Peripheral arterial disease (PAD) is defined as atherosclerotic disease of the aorta and arteries of the lower extremities. The most frequent manifestations of ischemia occur in the lower extremity arteries, with intermittent claudication as the most common symptom. Intermittent claudication, which is characterized by temporary pain brought on by muscle exertion, is usually experienced in the calf muscles and typically subsides with rest. The atherosclerotic nature of PAD/intermittent claudication makes it an important predictor of risk for cardio- and cerebrovascular disease, as well as limb loss. Thus, active screening and early diagnosis of PAD/intermittent claudication, in addition to aggressive management that incorporates risk factor modification, exercise therapy, platelet inhibition and other appropriate pharmacotherapy, and potential lifestyle changes, play important roles in overall patient management. Pharmacotherapy with cilostazol has been shown to improve maximal and pain-free walking distances. Uncontrolled and severely debilitating intermittent claudication may require revascularization.
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PMID:The case for early detection and integrated intervention in patients with peripheral arterial disease and intermittent claudication. 1293 75

Peripheral arterial disease (PAD) is a common but under-recognized problem. Intermittent claudication is the most frequent symptom of PAD, although the diagnosis of PAD is often overlooked until the patient is presented with limb-threatening ischemia. Importantly, PAD is a marker of generalized atherosclerosis and is closely associated with coronary and cerebrovascular disease. The primary causes of death in patients with PAD are myocardial infarction and stroke. Reducing risk factors is an integral and aggressive part of the treatment regimen. The recognition and diagnosis of PAD, combined with its appropriate medical management, may well reduce the overall risk of cardiovascular morbidity. When diagnosed early, both exercise and pharmacotherapy can ameliorate symptoms of claudication. augment functional performance, and improve quality of life. This review focuses on the general medical management and specific therapeutic options. Because PAD is a manifestation of generalized atherosclerosis, the principal issue in medical management of PAD is a treatment plan that modifies known risk factors for atherosclerosis and its atherothrombotic complications. All patients with PAD should be receiving antiplatelet therapy to prevent ischemic events and ACE inhibitors should be used if appropriate. Medical treatment for patients with claudication includes exercise in rehabilitation and drug therapy. It is also recognized that selected patients with claudication symptoms may benefit from catheter-based interventions, and most PAD patients with critical leg ischemia require revascularization procedures. Although many therapies for claudication have been thoroughly investigated, research continues on new treatments. In contrast, more prospective, randomized trials are needed to evaluate various therapies for treating patients with PAD.
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PMID:Treatment of chronic peripheral arterial disease. 1532 Aug 44

Peripheral arterial disease is a major manifestation of systemic atherothrombosis that affects a large segment of the adult population. The major treatment goals for this population are to address the marked increase risk in cardiovascular events and then secondarily to treat the disability and reduced exercise tolerance. The primary goals for treating the limb symptoms of PAD are to improve functional capacity, exercise performance and qualify of life. Exercise training in a formal setting, revascularization with angioplasty and cilostazol all have proven efficacy. In addition, there is a major interest in developing new pharmacologic therapies for claudication. Prostaglandins have been utilized for critical leg ischemia for decades, but recent trials have not demonstrated any role for these drugs in treating claudication. Carnitine and its derivatives (propionyl-L-carnitine) have been shown to improve treadmill exercise performance and quality of life. These drugs also have an excellent safety profile. A final promising class of drugs is statins that not only reduce the increased risk of ischemic events but also appear to improve claudication symptoms.
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PMID:Treatment of disability in peripheral arterial disease: new drugs. 1537 14


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