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Query: UMLS:C0042373 (vascular disease)
 17,070 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The effects of experimental coronary atherosclerosis on myocardial high energy phosphates and regional coronary perfusion and oxygen delivery were studied. Hypercholesterolemic (HC) New Zealand white rabbits developed mild to moderate coronary vascular disease in 4 months when serum cholesterol levels were maintained at 1500--2000 mg/dl. Resting left ventricular levels of creatine phosphate, adenosine triphosphate (ATP), and the cellular energy charge were unaltered after 2 months of diet but were decreased after 4 and 6 months. Tissue lactate and the lactate/pyruvate ratio were increased after 4 months, suggesting mild tissue ischemia. The regional blood flow rate was measured in rabbits given pentobarbital after 6 months of diet using labeled microspheres, and the response to stress was tested after 5 minutes of hypoxic ventilation (5% O2/N2). The percentage of cardiac output to subendocardium (endo) and subepicardium (epi) in HC rabbits and that in control animals were similar at rest, but unlike that of control animals, the endo perfusion did not increase significantly in HC animals during hypoxic stress. Baseline regional left ventricular oxygen deliveries were similar between groups, but the baseline endo/epi oxygen delivery ratio was reduced in HC rabbits. In control rabbits hypoxia did not alter total O2 delivery, and the endo/epi oxygen delivery ratio was constant, whereas hypoxia in HC animals produced a decrease in total oxygen delivery and a further decrease in the endo/epi oxygen delivery ratio. Thus, moderate long-term coronary occlusive disease produced alterations in the distribution of coronary perfusion that are similar to those after acute partial occlusion, ie, selective reductions in blood flow and oxygen delivery to subendocardium. These results may relate to the pathogenesis of subendocardial infarction in man, which often occurs in the absence of complete coronary occlusion.
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PMID:Regional coronary perfusion and bioenergetics in experimental atherosclerosis. 736 55

Thromboangiitis obliterans (Buerger's disease) is an inflammatory obliterative, nonatherosclerotic, vascular disease that affects the small- and medium-sized arteries, veins, and nerves. It is causally related to tobacco use, although the exact mechanism is unknown. Its clinical presentation is manifested by distal arterial ischemia and superficial thrombophlebitis. Thromboangiitis obliterans usually becomes quiescent if the patient is able to stop smoking cigarettes. However, if smoking continues, amputation commonly results.
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PMID:Thromboangiitis obliterans. 751 38

Variation of high-density lipoprotein cholesterol (HDL) levels in man show a strong inverse relationship to the incidence of atherosclerotic vascular disease. Conversely, effects of atherosclerosis and ischemia on lipoprotein metabolism are unclear. We investigated 41 patients, 10 women and 31 men, undergoing percutaneous transluminal angioplasty by measuring fasting lipoprotein cholesterol including high-density lipoprotein subfraction analysis before and one as well as 12 weeks after the procedure. Successful reopening of a haemodynamically significant iliac, femoral or popliteal obstruction was achieved in all patients. A highly significant (p < 0.001) increase of HDL cholesterol from 1.10 +/- 0.05 to 1.31 +/- 0.06 mmol/l was revealed 12 weeks later. This was due to a significant (p < 0.001) increase in HDL3 cholesterol by 26%, whereas HDL2 cholesterol did not change significantly. We conclude that HDL cholesterol levels increase after recanalization of a significant atherosclerotic obstruction which may be a direct effect of reperfusion or an indirect effect due to an increase in exercise tolerance.
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PMID:Reversal of atherosclerotic obstructions by percutaneous transluminal angioplasty raises high-density lipoprotein cholesterol. 772 72

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

Female reproductive hormones are considered to be protective agents in atherosclerotic vascular disease and stroke. The present study determined if there are unique cerebrovascular responses in female animals to global cerebral ischemia and if 17 beta-estradiol is important to postischemic outcome in brain. Three groups of anesthetized, sexually mature rabbits were treated with normotensive four-vessel occlusion (6 min) and 3 h of reperfusion: females chronically instrumented with 17 beta-estradiol implants (EFEM; n = 8, plasma estradiol level = 365 +/- 48 pg/ml), untreated females (FEM; n = 8, estradiol = 13 +/- 3 pg/ml), and untreated males (M; n = 8, estradiol < limit of radioimmunoassay). CBF (microspheres) and somatosensory evoked potential (SEP) amplitude were measured during ischemia/reperfusion. Baseline hemispheric blood flow and regional flow distribution were not altered by chronic estradiol treatment. Hemispheric blood flow was equivalently reduced during ischemia in FEM and M (6 +/- 1 and 9 +/- 2 ml min-1 100 g-1, respectively); however postischemic hyperemia was greater in FEM than M (CBF = 257 +/- 27 and 183 +/- 27 ml min-1 100 g-1. However, EFEM experienced higher CBF during ischemia (e.g., 13 +/- 2 ml min-1 100 g-1) and less hyperemia (134 +/- 4 ml min-1 100 g-1 in hemispheres) in numerous brain regions than FEM. CBF at 3 h reperfusion was not different among the groups. Recovery of SEPs was incomplete and similar in all groups. We conclude that chronic exogenous 17 beta-estradiol treatment increases CBF during global incomplete ischemia and ameliorates postischemic hyperemia in the female animal.
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PMID:Postischemic cerebral blood flow recovery in the female: effect of 17 beta-estradiol. 779 Apr 16

Acute dysvascular limb in young adults is a rare entity. Diagnosis is often difficult because symptoms are not recognized as ischemic. The most common causes of this condition are premature atherosclerosis, thromboangiitis obliterans, microemboli, popliteal entrapment syndrome, collagen vascular disease, Takaysu's arteritis, and coagulopathy. A case study is presented to illustrate the disease process. A systematic approach to diagnosis, consisting of history and physical examination, palpation and auscultation of peripheral pulses at rest and following exercise, and noninvasive vascular examination at rest and following exercise, is recommended. Suggestion of an ischemic condition following noninvasive studies should be followed up with an arteriogram. The prognosis is dependent on the underlying etiology of the ischemia, early detection, and appropriate treatment.
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PMID:Acute dysvascular limb in a young adult. A case study. 785 53

A retrospective review of 266 patients undergoing infrainguinal revascularization for limb salvage and/or major amputation (transmetatarsal, below-knee or above-knee) from 1984 to 1990 was conducted to determine comprehensive procedure-specific 30-day operative morbidity and mortality rates. Some 211 patients underwent 295 infrainguinal vascular reconstructions (195 primary and 100 secondary reconstructions). There were 122 major amputations in 98 patients (29 above-knee, 70 below-knee and 23 transmetatarsal). Most amputations were performed in patients with unreconstructable vascular disease, including 39 patients (41 extremities) with failed infrainguinal reconstruction. Procedure-specific morbidity and mortality rates were 48 and 2% for primary revascularization, 35 and 2% for secondary revascularization and 37 and 4%, for amputation, respectively. The difference in mortality between revascularization and amputation approached but did not achieve statistical significance. Cardiac, graft and wound complications were the major causes of morbidity in all groups. Nine of the 12 deaths were of cardiac etiology. Revascularization can be performed in almost all patients with advanced limb ischemia, with a mortality rate equivalent to, or perhaps lower than, that of amputation. When limb amputation is required, it can be performed with a mortality rate remarkably lower than that described in the older literature.
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PMID:Relative risks of limb revascularization and amputation in the modern era. 785 94

NO has been shown to be a biologic substance important to normal physiologic functioning. It appears to be an endogenous vasodilator and is involved in hemostasis and inflammation. Endothelial cell dysfunction often leads to diminished NO production; this reduction in NO concentrations may be an etiologic factor in systemic hypertension, myocardial and splanchnic ischemia, atherosclerosis, CHF, and pulmonary vascular disease. A new class of drugs, NO donors, have potential utility in the treatment of coronary and pulmonary arterial diseases. Their major advantage over nitrates and nitroprusside is a lack of pharmacologic tolerance. Clinical trials with drugs of this class are now in progress.
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PMID:Nitric oxide donors in the treatment of cardiovascular and pulmonary diseases. 787 93

Fibromuscular dysplasia is an uncommon angiopathy that is principally observed in the renal and carotid arteries. Digital ischemia resulting from fibromuscular dysplasia of the forearm arteries is a rare occurrence. This article describes a case of distal radial and ulnar artery fibromuscular dysplasia presenting as paresthesia, claudication, and finger ulceration. Angiography was diagnostic in visualizing the characteristic "string of beads" appearance. In addition to the typical histological findings, we also observed a previously undescribed pathological finding. Surgical management involved resection of the diseased segment and primary anastomosis.
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PMID:Fibromuscular dysplasia of distal radial and ulnar arteries: uncommon cause of digital ischemia. 788 60

The frequency of silent infarction is an important issue because it is a marker of vascular disease. We studied the occurrence of silent infarction in a sample of patients from the Dutch TIA trial, in which patients were randomized between 30 and 283 mg of aspirin. A total of 91 patients with TIA or non-disabling ischemic stroke and who did not suffer a stroke during a period of one to four years (mean 32 months) underwent CT scanning both on entry and at the end of the study. A cardiac source of embolism was an exclusion criterion for the trial. We found only one patient with a possibly silent infarction; in four patients a previously detected symptomatic infarct on CT was no longer visible. The rarity of silent infarction in this study may have several explanations; (1) the relatively short period of follow-up, (2) the selection of patients (no cardiac source of embolism), (3) the clinical monitoring at four monthly intervals aimed at detection of focal ischemia, (4) the use of aspirin. Given these circumstances, silent infarction is an infrequent problem.
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PMID:Silent infarction on a second CT scan in 91 patients without manifest stroke in the Dutch TIA trial. 798 89


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