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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

303 limbs in 270 patients were operated by endarterectomy for femoro-popliteal atherosclerosis from January 1967 to April 1975. 236 reconstructions were carried out as semi-closed endarterectomy. Sixty-seven open endarterectomies were performed during the same period. In the 2 groups 37% and 33% respectively of the patients were treated for rest-pain and distal gangrene. The remaining patients had intermittent claudication as the main symptom. The operative mortality of the two groups were 2.5% and 4.5% respectively. Although the early results were encouraging, the long-term patency following semi-closed endarterectomy was significantly lower than after saphenous vein by-pass. Open endarterectomies had the same 5-year patency as vein by-pass grafts. This may at least partly be due to case selection, since open endarterectomy was mainly used for short obstructions in limbs with good run-off. Even if fair results may be obtained when semi-closed endarterectomy is performed between 2 arteriotomies above the knee in limbs with good run off, we recommend this method only to be used in cases with insufficient vein for by-pass grafting and sometimes for the treatment of short obstructions of the superficial femoral artery. Since the choice of operative method often has to be done during operation, familiarity with both methods is necessary.
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PMID:Endarterectomy for femoro-popliteal atherosclerosis. 85 54

The long term results of profundaplasty in the treatment of femoropopliteal arterial occlusion have been reviewed. Fifty patients have been studied with a mean follow-up period of 4 years (range 6 months to 8 years). Intermittent claudication was abolished or substantially improved in 5 of the 25 cases (20 percent); rest pain was relieved in 10 of the 25 cases (40 per cent), the remainder requiring a major amputation. Lumbar sympathectomy produced little additional benefit in either group. The mortality rate in the rest pain group was high and only 5 patients survived for more than 3 years with both legs intact. The state of the distal 'run-off' and the degree of preoperative profunda stenosis appeared to have little influence on the clinical outcome. After operation pedal pulses were restored in 16 per cent of those presenting with claudication. Profundaplasty was without significant effect on the ankle systolic pressure index both in patients with claudication and those with rest pain.
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PMID:The long term results of profundaplasty in femoropopliteal arterial occlusion. 86 80

From January 1, 1974, to January 1, 1976, 15 premenopausal women aged 35-48 years were treated for complaints of intermittent claudication. The pain generally occurred in the calves, and none felt pain at rest. All the patients used an oral contraceptive composed of a progestative and an estrogenic component, with average duration of use of 7 years. All the women were of small stature with normal weight. A systolic souffle could be heard above the bifurcation of the aorta. In all patients an angiographic examination revealed local obstruction in the distal aorta, a gracile vascular system, and the absence of defects of the arteries outside the distal part of the aorta. No defects were found in other vessels, and there were no indications that hypertension, excessive smoking, hypercholesterolemia, or hyperlipidemia played a role in the cases. Local end-artereictomy of the distal aorta via a median laparotomy was the treatment. The part of the aorta wall that was removed showed signs of arterioschlerosis obliterans. There were no complaints of symptoms during the follow-up which ranged from 3 months to 2 years. A correlation is suggested between the defects of the distal aorta and prolonged use of oral contraceptives.
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PMID:Intermittent claudication in premenopausal women. A correlation with the long-term use of oral contraceptives? 86 65

Forty-five limbs varying clinically from normal through moderate to severely ischemic were studied by noninvasive measurements of both arterial blood pressure and perfusion. From the values plotted on a two-coordinate system, they arranged themselves well into three clinical categories: (1) normal, (2) intermittent claudication, and (3) ischemia or ulceration and rest pain. Good clinical responses to arterial reconstruction were corroborated by postoperative measurements. Reinforcing the results of one measurement with those of the other has provided an objective, numerical, and graphic basis for decisions regarding the advisability of angiography or arterial reconstructive procedures or both. To date, almost 400 patients have been evaluated by these techniques.
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PMID:Noninvasive assessment of the peripheral vascular system. 87 Dec 45

In 20 limbs of 10 healthy subjects and 55 limbs of 41 patients with occlusive areterial diseases of the legs, muscle blood flow was measured in the flexor hallucis brevis muscle by 133Xe clearance technique. The clearance curves after the ischemic exercise differenciated limbs with intermittent claudication of the foot from normals and limbs without claudication. An attempt was also made with arteriographic findings in 102 limbs of 84 patients with occlusions of the leg and/or foot arteries only. From results obtained, it is concluded that 133Xe clearance technique applied in the flexor hallucis brevis muscle can be used for diagnosis of foot pain during walking of uncertain origin and intermittent claudication of the foot is caused by severe circulatory insufficiencies of the plantar muscles during walking in the patients with involvements of the posterior tibial and/or plantar arteries.
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PMID:Intermittent claudication of the foot in view of foot muscle blood flow measured by 133Xe clearance technique and arteriographic findings. 93 23

Symptoms suggestive of vascular origin, both venous and arterial, may be the presenting complaints in patients with lumbar spondylosis. Fourteen patients suspected of having vascular intermittent claudication were found to be free of vascular disease, but had cauda equina compromise from herniated disk, osteoarthritis, and hypertrophic ligaments. Complete follow-up data were available for seven patients. In three, claudication seemed typical; in four, atypical. At operation, herniated intervertebral disks, osteophytic bone, or hypertrophied ligamenta flava, or a combination, were found. All benefited from lumbar laminectomy. When patients with vascular-like symptoms are found to be free of arterial or venous disease, lumbar spondylosis (narrow lumbar canal syndrome) should be considered. Chronic incapacitation pain without vascular disease provides a clue, as does electromyography. Plain X-ray films of the lumbar spine do not show the abnormality; thus, myelography should be carried out even in the absence of neurologic signs.
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PMID:Narrow lumbar spinal canal with "vascular" syndromes. 93 26

On the basis of our experience with 1827 femoropopliteal arterial reconstructions performed from 1959 through 1974 we have worked up a system of strict guidelines for the choice of procedure. The vein bypass is the method of choice in all cases at stages III/IV (i.e. resting pain or gangrene), in lengthy occlusions of the femoral arteries continuing into the distal popliteal arteries or in stenotic lesions or occlusions of the tibial arteries, in all recurrent occlusions, and in cases with calcification or dilatation of the arterial wall. The indication for endarterectomy is restricted to stage II (i.e. intermittent claudication) and to segmental occlusions of the femoral or popliteal arteries as well as transitional or lengthy occlusions of the femoral artery continuing to the proximal popliteal artery. Under these guidelines a total group of 645 patients underwent 721 femoropopliteal reconstructions-307 endarterectomies and 414 vein grafts-from 1971 through 1974. The average age of the patients was 60 years. In 50% of all cases operations were carried out for advanced ischemia treatening the extremity. For all the series the patency rate of vein bypass was 79% and of endarterectomy 71%. Accumulative patency rates by the life table method according to the preoperative degree of arterial insufficiency and the postoperative follow up period of 4 years do not show statistically significant differences between both procedures under the given guidelines.
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PMID:[Endarterectomy versus vein bypass grafts in femoropopliteal occlusions (author's transl)]. 101 10

Eighty-seven limbs in 48 patients have been studied with an electromagnetic flow meter at the time of arterial reconstruction designed to restore blood flow from the aorta to the femoral artery system. The mean overall flow was 339 ml per minute. Blood flow in aneurysmal disease was significantly higher than that recorded in obstructive disease. Blood flow in arteries running into a fully patent femoral system was significantly higher than in those that ran only into the profunda. Age, sex, type of surgery and size of graft had no influence on the flow achieved. Reconstructions for rest pain or advanced trophic change produced flows of the same magnitude as reconstructions for intermittent claudication. The patient's weight correlated significantly with the intraoperative flow. The mean flow in the limbs of 28 patients in whom an accurate preoperative weight was known was 2-56 ml/100 gm/minute, taking the hind limb and hemi-pelvis as 25% of the body weight. This is an acceptably "normal" value. A flow of less than 100 ml per minute in an aortoiliac reconstruction was found to be not likely to result in long-term patency.
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PMID:Mean flow measurements in aortofemoral arterial reconstructions. 105 96

Signs of intermittent claudication in the phantom leg developed in two patients 18 and 27 years, respectively, after mid-thigh amputation. Symptomatic treatment of the phantom pain was without success. Clinical, oscillographic and angiographic studies demonstrated atherosclerotic arterial stenoses of the iliac arteries. After successful vascular reconstruction (iliac-femoral and aortic-femoral bypass, respectively) on the side of amputation both patients are without pain or other symptoms and can again walk with restriction.
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PMID:[Arterielle occlusion in two leg amputees ("phantom claudication" due to pelvic-artery stenosis) (author's transl)]. 118 25

Calf basal resting and reactive hypercemia blood flow were measured at 4-h intervals during a day in fifteen healthy subjects and in fifteen patients with intermittent claudication by means of a venous occlusion plethysmograph. Mathematical-statistical analysis of the data failed to demonstrate circadian periodicity of calf blood flow in healthy subjects, but proved the existence of a 24-h rhythm of calf basal resting and reactive hyperemia blood flow in patients with intermittent claudication. This different behavior of calf blood flow can be understood if one considers that in healthy subjects the voluntary muscles in the extremities have a blood supply which can be instantaneously adjusted over a large area. In patients with peripheral arterial disease, on the other hand, the vascular responses in voluntary muscles of the limbs to various endogenous or exogenous stimuli are impaired and reduced. The circadian rhythm observed in patients with intermittent claudication has early evening peaks and a nocturnal trough with a nadir occurring after midnight and before 0400. This rhythm displays marked similarities with those of all other circulatory values. As to the mechanism of rhythm, it is hard to decide whether or not it has an independent endogenous origin. It is known that many of the circulatory variables are interrelated and that some are clearly related to other circadian rhythms. Perhaps the rhythmic reduction of limb blood flow which occurs during the night is the mechanism underlying the nocturnal pain of subjects with limb ischemia by peripheral arterial disease.
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PMID:Behavior of calf blood flow in normal subjects and in patients with intermittent claudication during a 24-h time span. 119 4


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