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

Conventional PTA represents the state of the art method for treating arterial occlusive disease of the leg arteries. Rotational angioplasty is an improvement over conventional PTA in treating long proximal occlusions of the SFA. It can also be used as a second treatment in cases that were primarily unsuccessful with PTA, with an initial success of 59%. Stent implantation is mainly indicated in limb-threatening ischemia. It also permits successful management of an aneurysm as a late and rare complication correlated to PTA. Atherectomy produces better initial success in eccentric stenotic lesions than PTA. It also permits the successful management of obstructive intimal flaps after angioplasty. The new techniques only improve on PTA, if they are used in the differential therapeutic strategy mentioned above.
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PMID:[Progress in arterial reconstruction of the upper and lower leg--percutaneous transluminal procedures]. 149 4

A retrospective study of 93 patients who have had repeat surgery at the tibial level for critical limb ischemia was carried out. In 21 patients a pseudoocclusion with a patent bypass graft was diagnosed and treated by PTA, thrombendarterectomy, or distal extension of the graft. The 5-year bypass patency was 60%, compared to 38% in those 72 patients that required a new bypass at the tibial level. Vein bypasses were better than prosthetic grafts. The number of previous operations did not negatively influence the outcome. However, the distal anastomosis should be placed on an artery that was not previously thrombectomized or operated on.
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PMID:[Crural bypass as reoperation]. 179 58

PTA is an established method of revascularization in a variety of medical conditions. It is performed for specific morphologic and clinical indications. PTA is the procedure of choice in Fontaine stage IIB through IV lower extremity ischemia due to iliac and/or femoropopliteal stenosis or short occlusion. Its role is less certain in infrapopliteal disease, although current studies have begun to establish long-term effectiveness. PTA is the procedure of choice for renal revascularization in renovascular hypertension due to fibromuscular disease or non-ostial atherosclerosis, selected cases of renal artery stenosis associated with renal insufficiency, and transplant renal artery stenosis. It is also useful in treating the renovascular component of complex hypertension and may be indicated in severe renal artery stenosis (75%-99%), even in the absence of clinically demonstrable RVHTN. PTA has limited applications in the venous system and only short-term success in the treatment of stenoses in dialysis access fistulas. PTA often serves as an important adjunct to surgical revascularization by providing improved inflow or outflow. PTA is the procedure of choice when anatomically feasible in subclavian steal syndrome. The role of PTA in carotid artery disease, particularly atheromatous disease of the internal carotid artery, is uncertain. The same may be said of PTA for vertebral artery stenosis, although the overwhelming majority of vertebral artery stenoses are morphologically suitable for PTA. PTA and surgery are both effective in the treatment of abdominal angina. There are more data available to verify the long-term patency of thromboendarterectomy and bypass grafts than PTA for mesenteric ischemia. However, since the technical success for PTA is high and since coronary co-morbidity is the most common cause of perioperative mortality in surgical series, PTA should be seriously considered as the procedure of first choice. Serious complications of PTA occur in approximately 5% of cases. Two to three percent of PTA patients have complications requiring surgery or causing a prolongation or alteration of hospital course. The morbidity, mortality, and cost associated with PTA are low. The discomfort is minor, and postprocedural recovery rapid. The major limitations of PTA include its unsuitability for some lesions (long-segment occlusions and stenoses, orifice lesions, eccentric lesions) and postangioplasty restenosis. These problems are being addressed by ongoing laboratory and clinical research. In the near future, it is likely that endoluminal transmural sonography of the vessel wall will help guide our interventions.
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PMID:Noncoronary angioplasty. 252 45

Twelve patients with brachial ischemia and/or subclavian steal syndrome underwent PTA of the subclavian, innominate and axillary artery. One technical failure occurred in a patient with a high grade stenosis of the subclavian artery. All other patients were successfully dilated. On long-term follow-up (mean: 12 months) only one patient had a recurrent stenosis which was successfully recanalized by PTA. This patient is asymptomatic since 12 months. The only severe complication was a transient amaurosis which occurred during catheterization. Balloon angioplasty was, therefore, not performed. In summary, PTA is an effective therapy for patients with brachial ischemia and/or subclavian steal syndrome. The long- and short-term results compare favorably with results obtained by surgery.
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PMID:PTA of the subclavian and innominate artery: short- and long-term results. 252 92

We have treated 14 patients with acute arterial thrombosis with intravenous infusion of streptokinase using a standard dosage scheme. The indication for treatment was critical ischemia due to arterial thrombosis and a presence of symptoms for less than 30 days. The arteriography showed no possibility of reconstructive vascular surgery. The results showed that this treatment is not a good alternative for this group of patients. On the same indications we also treated two patients with intra-arterial infusion of streptokinase at a dosage of 5,000 U per hour. Successful thrombolysis was achieved in both patients. Arteriograms demonstrated that the small distal vessels were opened, along with the femoro-popliteal segment, which showed significant stenosis. The patients could then be helped by reconstructive vascular surgery. We conclude that thrombolysis with intra-arterial infusion of streptokinase is a good choice as the initial treatment for this group of patients. However, the follow-up must include immediate reconstructive vascular surgery or radiological treatment with PTA.
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PMID:[Thrombolytic treatment of acute arterial thrombosis]. 281 71

If myocardial ischemia always results from an imbalance between the needs and supplies in oxygen of the myocardium cells, the physiopathology of this process seems today infinitely more complex than the mere diminution or interruption of the output in a coronary artery. The extension of atheromatous lesions, the platelets aggregation, thrombosis, the coronary spasm, the release of products from the arachidonic cascade, the reactivity of the vascular endothelium, the profibrinolytic activity of the tissues are many of the intricate factors inducing myocardial ischemia. Cellular alterations, of which some are triggered by the release of oxygenated free radicals, lead then to an irreversible necrosis. The medications used until now in the treatment of angina are oxygen scavengers and research goes on in this direction with vaso-dilators beta-blockers, prolonged action nitro-compounds (nicorandil) or nitro-compounds with an action reinforced by N-acetyl-cysteine, bradycardiac derivates of alinidine and the new calcium antagonists dihydropyridine. However, the new physiopathological concepts of ischemia have opened new directions for the research: products which modify the arachidonic cascade by increase of synthesis or release of PGI2 (nafazatrom, defibrotide), by inhibition of TXA2 synthesis or blocking of TXA2 receptors, and similar products of PGI2 (iloprost); thrombolytic agents more specific of thrombin (PTA) or fibrinolysis activators (defibrotide), and anticoagulants with extended action; chelating agents of oxygenated free radicals (peroxide dismutase, catalase, peroxidase) or xanthine oxidase inhibitors; platelets anti-aggregates like ticlopidine which blocks the platelets receptors to fibrinogen, or inhibitors of the synthesis of pro-aggregating agents.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Current therapeutic concepts in the treatment of myocardial ischemia. Current and future drugs]. 287 4

The role of balloon catheter femoropopliteal percutaneous transluminal angioplasty (FP PTA) continues to be controversial 14 years after its initial description. In high-risk patients with limb-threatening ischemia, the role of FP PTA is unknown. We reviewed the cases of 27 patients in whom high operative risk and advanced ischemia resulted in referral for PTA of the femoropopliteal segment. Technical and hemodynamic success rates were 74% and 52%, respectively. Patient follow-up was 3 to 84 months after PTA (mean 24 months). Nine patients (33%) had successful limb salvage for more than 12 months. The cumulative limb salvage rate was 47% at 2 years. Established prognostic criteria did not predict this subset of patients. Hemodynamic improvement after PTA did correlate closely with both early and late successful limb salvage. There were two periprocedural deaths. Morbidity included an acute arterial occlusion necessitating an emergency FP bypass and two minor complications. FP PTA is useful in selected high-risk patients with limb-threatening ischemia. Protocols to facilitate successful long-term limb salvage must include close liaison between the vascular surgeon and interventional radiologist, intensive periprocedural monitoring, and serial noninvasive hemodynamic assessment.
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PMID:Femoropopliteal percutaneous transluminal angioplasty for limb salvage. 297 Nov 20

Using PTA-method, the structure of para-membrane neurofilament density of interneuronal synapses and PTA-positive contacts in neocortical molecular layer were studied in rats during ischemia and postischemic period. Marked reduction of definite contacts (by 25.4%) was recorded by min 90 of ischemia. However, reorganization of asymmetric contacts started during ischemia and continued in postischemic period. Changes in neurofilament density of synapses (primarily, dense projections of presynaptic grid) underlie the early reorganization of synapse architectonics.
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PMID:[Para-membrane neurofilament structures of cerebral cortex synapses during ischemia and in the early postischemic period]. 373 May 74

Popliteal artery aneurysms (PAA) frequently remain asymptomatic up to the event of acute thromboembolic occlusion. Acute occlusions in the femoro-popliteal level without cardial source of embolism, a pulsating tumor in the knee pit or preexisting abdominal-or groin aneurysms are suspicious for the disease. Between 01/87 and 07/93 we saw 21 popliteal aneurysms in 14 patients. In 50% of the cases the aneurysms were found bilaterally. Arteriosclerosis was the most frequent cause, in 30% as a generalised dilative angiopathy. 18 aneurysms were operated upon, 11 in the stage of acute ischemia among a total of 190 acute vascular occlusions in the same period. Treatment consisted in total resection and anatomical reconstruction by means of saphenous vein interposition. The patency rate in our patients operated in the stage of acute ischemia was 73% during this observation period; one major amputation was carried out. The postoperative course of all 7 electively operated aneurysms was without complications. PAA is readily diagnosed by ultrasound. Because of the catastrophic consequences of an acute ischemia resulting from thrombosis we also tend to operate asymptomatic cases. For that reason the contra lateral knee of the healthy appearing leg should be included in the examination as well as higher located possible locations of dilatative angiopathy. A thrombotic treatment, PTA, stent implantation or embolectomy cannot be recommended because of remaining wall adhesive thrombi with danger of embolisation.
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PMID:[Thrombosed popliteal aneurysm--a cause of acute lower leg ischemia]. 775 23

From 1982 to 1992, 25 patients with subclavian steal syndrome (SSS) were admitted with 20 undergoing surgery. Etiology included atherosclerosis 56% (14/25), Takayasu's disease 36% (9/25), 14 of them were smokers. Stenosis or occlusion of the left subclavian artery were found in 14, the right in 7, and bilateral in 4. 14 cases had vertigo symptoms, 24 cases had claudication of the arm, 9 of them complained transient ischemic attack (TIA). Carotid to subclavian bypass were performed for 15 cases. Two patients underwent axilloaxillary bypass with evidence of both clinical and laboratory improvement. Aorta-Carotid graft bypass was done in 2 cases with good result in one. PTA was done for a girl with innominate severe stenosis but symptom recurred three months later. Symptoms of the upper extremity ischemia were relieved in 75% of the patients, and of the cerebrovascular ischemia in 50%. Our conclusion is that surgical therapy remains the treatment of choice in symptomatic patients.
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PMID:[Subclavian steal syndrome: a report of 25 cases]. 784 5


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