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

Between January 1982 and April 1993, 8 patients suffering from a typical clinical picture of chronic intestinal ischemia, have been observed. All these patients were symptomatic and 7 cases presented stenosing or occlusive lesions of at least 2 of the 3 splanchnic trunks. 5 of these 7 patients underwent a corrective surgical procedure. 2 patients underwent percutaneous transluminal angioplasty. One patient affected by stenosis of the coeliac trunk due to external compression caused by the median arcuate ligament of the diaphragm was not operated because the symptomatology was atypical and the other 2 splanchnic trunks were perfectly patent. Three patients died following the therapeutic procedure: a woman in whom an aorto-mesenteric bypass graft was inserted, underwent, 4 months after, an intestinal infarction due to thrombosis of the graft; another woman, whose coeliac trunk and superior mesenteric artery were thrombosed and whose inferior mesenteric artery was reimplanted on the common iliac artery, died for acute hepatic failure, after 12 months of total parenteral nourishment; a third patient, successfully submitted to PTA of the superior mesenteric artery, died after 4 months due to the occurrence of acute renal insufficiency.
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PMID:[The physiopathology, clinical picture and therapy of chronic intestinal ischemia]. 802 43

The treatment of peripheral arterial occlusive disease is based on conservative treatment, surgical revascularization, and percutaneous transluminal catheter-based methods. The differential indication for treatment is mainly influenced by clinical and angiographic parameters. The indications for surgical and catheter-based revascularization are relatively clear: Short occlusions and stenoses of the iliac and femoropopliteal arteries in symptomatic patients are ideal indications for PTA. In patients with critical leg ischemia percutaneous revascularization techniques should always be considered to treat these patients with the minimal invasive approach. Long occlusions of iliac and femoral arteries and diffuse occlusions of multiple segments in patients with severe claudication, ischemic rest pain or gangrene are best treated by primary surgical revascularization. Beside the established percutaneous transluminal balloon angioplasty several new interventional techniques were developed to extend the indications for percutaneous treatment, improve acute success rates and reduce complications. Probably, also long-term results after catheter-based therapy of peripheral arterial occlusive disease may be improved by these new technologies.
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PMID:[Operation and angioplasty in peripheral arterial occlusive disease]. 815 49

Intravascular ultrasonography, balloon angioplasty, stent placement, and endovascular septal fenestration have been used in the evaluation and treatment of vascular complications of acute and chronic aortic dissection in five patients. There were three men and two women with an average age of 52 years (range 39 to 64 years). There were three chronic type A dissections, one acute type B, and one subacute type B dissection. Intravascular ultrasonography was used in all five cases. The three patients with chronic type A dissections underwent unilateral renal artery angioplasty (RA PTA) and stent placement; one patient with an acute type B dissection and associated fibromuscular dysplasia underwent bilateral RA PTA without stent placement. These procedures were performed to ameliorate severe hypertension. The final patient, with a subacute type B dissection, underwent iliac artery stenting to correct severe lower extremity ischemia. During a second intervention, this patient, who also had bowel ischemia and nonresolving acute renal failure, underwent balloon dilatation of a preexisting septal fenestration to augment visceral blood supply and bilateral RA PTA and stent placement in an effort to improve renal function. This patient eventually died of gut ischemia. After RA PTA and stent placement, one patient had a major intrarenal hemorrhage that required coil embolization and transfusion. In the four survivors, RA PTA and stent placement resulted in immediate improvement in blood pressure control. This response has been sustained during follow-up intervals ranging from 8 to 18 months (average 10 months). Intravascular ultrasonography can clearly demonstrate the pathologic anatomy associated with aortic dissection (even when angiography is ambiguous) and is essential for guiding therapeutic endovascular interventions. Further exploration of the efficacy of these endovascular techniques is warranted in this high-risk group of patients with aortic dissection who have appropriate clinical indications.
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PMID:The use of endovascular techniques for the treatment of complications of aortic dissection. 826 33

Atherosclerotic occlusive disease of the lower extremity in patients exhibiting severe rest pain, ulceration, or tissue necrosis represents a serious threat to extremities. In the past two decades the surgical approach in the treatment of lower extremity ischemia has changed significantly due to better understanding of segmental disease and infrapopliteal disease. Also, better visualization of leg and foot arteries due to improved angiographic and surgical techniques aided by magnification have all significantly contributed to increased limb salvage. Vein, when available, is the ideal graft material both for supra and infrapopliteal reconstruction. Availability of vein as a conduit can be increased when ectopic veins such as cephalic etc., are used and also when short segments of veins are used with unconventional distal inflow sites such as SFA, distal deep femoral artery, and popliteal artery. However, when vein is unavailable, PTFE graft is a good option particularly in patients with life expectancy of less than three years. Better understanding of graft failure has lead to better graft surveillance with PVR, ABI and Duplex scanning. Timely intervention with either PTA or surgery has lead to better secondary patency of grafts. Veith et al. looked at amputation rates during the period of changing therapeutic approach and found both a decrease in primary and secondary amputation rate implying the effectiveness of an aggressive therapeutic approach. Not all aspects of lower extremity disease are understood. However, infrapopliteal disease has now been addressed and new, innovative therapeutic approaches have made significant advances in limb salvage.
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PMID:Lower extremity revascularization. 834 73

Chronic critical limb ischemia is defined as ischemia which generally endangers the distal part of a limb. If the ischemia is unrelenting, there is a high risk that amputation will be required. These critical limbs were amputated as an initial treatment long ago. Now it becomes clear that disabling patients have very poor quality of life after major amputation, and ischemic leg produces noxious substances which circulates whole body. So that primary amputation should not be a first choice for the most of the cases. And excellent techniques or new surgical materials bring successful vascular reconstruction to critical limb ischemia. Since we have not a clear definition, European and US criterion seems to be useful for a while. Macrocirculation is represented by ankle systolic pressure and microcirculation by transcutaneous oxygen pressure as well. Its value of les than 10 mmHg means urgent critical condition. Main surgical repairs include below knee bypass using autovein or fine profundaplasty with or without PTA. Usually patients should receive general cares because of high risks.
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PMID:[Critical limb ischemia]. 880 9

Indications of interventional radiological procedures in patients with chronic critical limb ischemia are not clearly defined. PTA of limb arteries is used only in 3 of 4% of patients, although 20 to 40% might be candidates for a proximal intervention in the iliac arteries. Following PTA of intrapopliteal arteries, limb salvage varies from 56 to 82% and arterial patency rate from 34 to 100% after 1 to 2 years follow-up in non controlled case series studies. Arterial local thrombolysis shows better results than surgery in subgroups of patients in a few studies. Pulse spray technique does not show better clinical results than conventional infusion of the plasminogen activator. Overall, radiological interventions give similar results compared with surgery, concerning limb salvage rate, length of hospital stay, morbidity and mortality, but significantly more patients are discharged home versus a nursing institution after radiological treatment than after surgery. Radiological techniques seem to be cost effective compared to surgery. Amputation should be carried out only after all revascularization possibilities have been ruled out at a multidisciplinary vascular center.
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PMID:Chronic critical limb ischemia: what is the benefit of radiological intervention? Indications and results. 964 Aug 78

We reviewed our work and evaluated clinical and angiographic results, as well as the follow up of young adult patients < 40 years that were subject to percutaneous trans-clinical coronary angioplasty (PTCA) with an endovascular prostheses (stent). From January 1995 to December 1999, 896 PCTA's performed using stents in 770 patients. Only one selected group of 30 patients (with 32 procedures, and an average of 1.06 stents per patients. Patients age ranged from 21 to 39 years old with an average of 32.8 + 52, 2, 29 (96%) were male and only one woman (3.3%). Nine patients (30%) had a severe angina, class III Braunwald and 21 (70%) had a previous history of myocardial infarcts. The average percent of arterial obstruction was 90.88 +/- 5.22 and the expulsion fraction. (EF) had a percent of 46.8 +/- 4.3 with ranges of 35 to 60%. Immediate angiographic success was 93.75% in only two patients (6.25%) with a 100% occlusion, and more than twelve weeks. There was no mortality, nor infarct, and no patient was sent to an urgent revascularization surgery. Clinical follow up lasted 50 weeks in all patients with the effort test using the electric Bruce type and for nuclear medicine. Only in 3 patients EF was reported, and tHalium with a slight septal ischemia. Angiographic control was included in 27 (90% patients between the 4th and 6th month. PTA with stent is a successful angiographic and clinical procedure in young adults < 40 years old; it constitutes a complete and efficient therapeutical revascularization procedure, and is an excellent option before undertaking an aortocoronary revascularization surgery.
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PMID:[Clinical and angiographic follow-up of young adults after PTCA plus intracoronary stents]. 1156 60

Technical success of endovascular measures in the femoropopliteal region has increased since the introduction of new technology (hydrophilic guide-wires, stents, stent grafts) in the last decade to rates of more than 90%. If the initial revascularization--even of long segment occlusions--is successful, the modern armamentarium of interventional radiology enables to keep the vessel open acutely. Evidence, that the immediate success of revascularization leads to a continuous improvement of the clinical symptoms, measured by clinically relevant end points (e.g. improvement of walking distance, increase of limb salvage, increase of survival), has yet to be shown. Several prospective randomized trials demonstrated improvement of walking distance after one year follow-up, but not after two years follow-up in patients with chronic femoropopliteal obstructions, who were treated with PTA compared to walking exercise only. The only two prospective randomized trials comparing vascular surgery and endovascular therapy for femoropopliteal obstructions could not demonstrate any advantage of one of the two modalities in patients with claudication or critical ischemia. The transatlantic consensus document (TASC) recommends PTA as therapy of choice in the femoropopliteal arteries only for single stenosis < 3 cm and does not recommend primary stenting. In order to evaluate endovascular therapy in the femoropopliteal region outcome studies are needed, which carefully assess clinically relevant end points like improvement of walking distance, limb salvage, and survival, but also disease specific quality of life evaluations. Several meta-analyses, performed in recent years, have demonstrated that endovascular therapy has a definite role in the femoropopliteal segment. However, the particular role has to be evaluated for the individual clinical case in the light of case-specific findings and symptoms.
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PMID:[Current status of endovascular therapy in the femoropopliteal vascular segment in chronic peripheral arterial occlusive disease]. 1223 18

Lower extremity wounds resulting from ischemia are increasingly becoming a common indication for surgical revascularization. Techniques in minimally invasive vascular surgery for the treatment of lower extremity chronic ischemia have expanded rapidly in recent years. The current standard of care with which all new modalities should be compared is the restoration of arterial flow via direct arterial revascularization using the autogenous reversed saphenous vein that can yield limb salvage rates of approximately 95%. Percutaneous transluminal angioplasty and stenting (PTA/S), cryoplasty, catheter-directed atherectomy, laser-assisted PTA/S, drug-eluting stents, and subintimal angioplasty are emerging minimally invasive modalities used for the treatment of lower extremity ischemia. Early success rates using many of these techniques have been promising. The outcomes of randomized controlled trials with long-term follow-ups are needed to make confident remarks about the effectiveness of these techniques.
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PMID:Minimally invasive revascularization strategies for chronic lower limb ischemia. 1654 11

Despite recent studies highlighting the advantages of endoluminal intervention in the management of chronic limb ischemia (CLI), outcomes following failed peripheral angioplasty remain less well described. We present a retrospective analysis of failed transluminal infrainguinal percutaneous arterial angioplasty with or without stenting (PTA/S) in patients with CLI. A database of patients undergoing infrainguinal PTA/S between 2002 and 2005 was maintained. Patients underwent duplex scanning follow-up at 2 weeks, 3 months, and every 6 months after the intervention. Angiograms were reviewed in all cases to assess lesion characteristics. Results were standardized to current Transatlantic Inter-Society Consensus (TASC) criteria. Kaplan-Meier survival analyses were performed to assess time-dependent outcomes. In total, our analysis involved 246 patients who underwent treatment for CLI using PTA/S. Eighteen percent of procedures (n = 46) were considered an intervention failure secondary to restenosis by duplex ultrasound, returning clinical symptoms, a nonhealing foot lesion, or the absence of a prior palpable pulse. Indications for the original procedure in patients whose PTA/S failed were tissue loss in 44%, claudication in 44%, and rest pain in 12%, while TASC lesion grades were A (0%), B (18%), C (18%), and D (64%). Of patients failing PTA/S, 4% failed in the first 30 days, 78% failed between 1 and 18 months, while 18% failed following 18 months, with a mean time to failure of 8.7 months. Also, 82% of PTA/S failures were candidates for a second endovascular procedure, 11% were suitable for only traditional open bypass, and 4% demonstrated progression of disease necessitating amputation. Of patients undergoing a second endovascular procedure, limb salvage rates were 86% at 12-month follow-up and there was a single periprocedural mortality and complication rate of 6.6%. Of patients requiring open surgical bypass after failed PTA/S, 20% (n = 1) required a major amputation and there were no mortalities. Failure of endoluminal therapy for treatment of lower extremity arterial occlusive disease is amenable to subsequent endovascular intervention for limb salvage with limited morbidity and mortality.
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PMID:Analysis of outcomes following failed endovascular treatment of chronic limb ischemia. 1686 6


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