Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We retrospectively analyzed a total of 580 blood access complications that occurred at one institution from January 1991 to December 1992. Dysfunction and thrombosis of arteriovenous fistulas (AVFs) due to insufficient blood flow were the most frequent complications (451, 77.8%). Two hundred sixty-eight (71.5%) patients were treated by reconstructing the AVF at a proximal location in the ipsilateral arm. Sixty seven patients had prosthetic material. Their cumulative patency rates for 1 year were 74.6% with expanded polytetrafluoroethylene and 64.2% with polyurethane grafts. Twenty patients had blood access infections, 15 of whom had artificial grafts. Six patients with infections of artificial grafts were successfully treated by local resection with graft rerouting. Venous hypertension due to deep venous thrombosis developed in 23 patients. Fifteen (65.2%) had no previous trauma, and 18 (78.3%) required closure of AVFs. Aneurysm occurred in 40 patients, which included 13 at an anastomosis site in autogenous AVFs, 13 in repeatedly puncturing shunt veins, 11 in prosthetic grafts, and 3 in superficialized arteries. One patient died from septic shock associated with graft infection, and 1 suffered a fatal pulmonary embolism after replacement with a prosthetic graft. The other patients who received surgical treatment for their complications were successfully treated without life- or limb-threatening consequences. Operations developed to provide adequate blood access for hemodialysis have significant rates of complications. Surgeons performing such procedures need to be well-versed in techniques for creating blood access and for treating attendant complications.
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PMID:Complications in blood access for hemodialysis. 802 76

Venous ulcers are the most common type of chronic lower extremity ulcers, affecting 1% to 3% of the U.S. population. Venous hypertension as a result of venous reflux (incompetence) or obstruction is thought to be the primary underlying mechanism for venous ulcer formation. Risk factors for the development of venous ulcers include age 55 years or older, family history of chronic venous insufficiency, higher body mass index, history of pulmonary embolism or superficial/deep venous thrombosis, lower extremity skeletal or joint disease, higher number of pregnancies, parental history of ankle ulcers, physical inactivity, history of ulcers, severe lipodermatosclerosis, and venous reflux in deep veins. Poor prognostic signs for healing include ulcer duration longer than three months, initial ulcer length of 10 cm or more, presence of lower limb arterial disease, advanced age, and elevated body mass index. On physical examination, venous ulcers are generally irregular and shallow with well-defined borders and are often located over bony prominences. Signs of venous disease, such as varicose veins, edema, or venous dermatitis, may be present. Other associated findings include telangiectasias, corona phlebectatica, atrophie blanche, lipodermatosclerosis, and inverted champagne-bottle deformity of the lower leg. Chronic venous ulcers significantly impact quality of life. Severe complications include infection and malignant change. Current evidence supports treatment of venous ulcers with compression therapy, exercise, dressings, pentoxifylline, and tissue products. Referral to a wound subspecialist should be considered for ulcers that are large, of prolonged duration, or refractory to conservative measures. Early venous ablation and surgical intervention to correct superficial venous reflux can improve healing and decrease recurrence rates.
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PMID:Venous Ulcers: Diagnosis and Treatment. 3147 35