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

The axillofemoral bypass graft, an extra-anatomic graft, connects the axillary artery to the femoral artery and is used in the treatment of significant aortoiliac occlusive disease in poor-risk patients. A common indication for axillofemoral bypass is a "hostile abdomen" (postoperative adhesions, neoplasms or radiation). Less frequent indications are aortic mycotic aneurysm, infected aortobifemoral bypass graft, aortoduodenal fistula, inflammatory aneurysm and extensive retroperitoneal fibrosis. Spinal cord injured patients with peripheral arterial disease have two problems: 1) lack of premonitory symptoms (absence of claudication, paresthesias or rest pain) and 2) difficulty preventing pressure sores in the already poorly perfused limb. Indications for arterial reconstructive surgery are more drastic in this set of patients (impending gangrene and/or ischemic ulcers). Many spinal cord injured patients have sources of possible contamination (cystostomy and/or colostomy) which make intra-abdominal clean surgery impossible. We present a spinal cord injured patient with a permanent cystostomy and impending gangrene of the left foot. He underwent a left axillofemoral bypass graft and had a good postoperative course. We conclude that axillofemoral bypass graft is a good alternative for limb salvage in the spinal cord injured patient, especially when there is a source of possible contamination (colostomy and/or cystostomy) that would interfere with more common bypass grafting. The role of the noninvasive vascular laboratory for early detection of vascular disease is emphasized.
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PMID:Axillofemoral bypass graft in a spinal cord injured patient with impending gangrene. 786 60

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

Postmortem thoracolumbar aortography with solidifying contrast medium to visualize the arteries of the lower part of the spinal cord was performed in two patients with a long history of intermittent neurogenic claudication and degenerative spinal stenosis, as well as in six controls. One of the patients proved to have advanced atheromatous lesions in the aorta, several obliterated intercostal and lumbar arteries, and a blocked caudal portion of the anterior spinal artery. The other had an arterious malformation in the spinal cord at the thoracolumbal junction. The angiographic findings for these patients differed remarkably from those of six age-matched controls, indicating that disturbed blood flow in the lower part of the cord probably contributed to the symptom complex in the patients with claudication. The potential combination of local compression and vascular disease of the cord may explain why decompressive procedures sometimes fail to eliminate a patient's symptoms.
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PMID:Intermittent medullary claudication: postmortem spinal angiographic findings in two cases and in six controls. 791 48

From January 1990 to December 1992, 25 balloon angioplasties were performed in the Department of Surgery, La Chaux-de-Fonds, Switzerland. The indications were claudication in 19, and limb salvage in 6 patients. In 4 patients, the stenosis was dilated in association with a femoropopliteal bypass (2 patients) or an intraluminal stent (2 patients). The follow-up period ranged from 3 to 36 months with a cumulated patency rate of 81%. Percutaneous transluminal angioplasty for atherosclerotic lesions of the lower extremity is associated with a good success rate. Important variables influencing patency include indications, site and extent of lesion and whether the responsible lesion is stenotic or occlusive. The advent of endovascular surgery has transformed the landscape of vascular disease management. In so doing it has confused the border between the various medical specialties. The decision to use transluminal angioplasty, should be a joint decision between surgeon and radiologist, but transluminal angioplasty should be part of the vascular surgeon's armamentarium.
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PMID:[Transluminal dilatation by surgeons. Technique, results and advantages]. 796 Sep

At the present, patients with obstructive vascular disease in the lower extremities can be treated with percutaneous procedures without surgery. By what is called Interventional Radiology. Three patients with iliac or femoral arterial obstructions were treated with Percutaneous Transluminal Angioplasty (PTA). For all of them, claudication was the principal symptom and was treated with PTA due the failure of regular treatment. The dilatation was performed with high pressure balloon. Both technical and clinical results showed success and there were no complications.
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PMID:[Percutaneous transluminal angioplasty. An efficient alternative in the treatment of peripheral obstructive arteriopathy]. 856 Jan 46

A sufficient understanding of the risk factor and the natural history of arteriosclerosis obliterans, ASO, is essential for selecting the optimal treatment for this condition. Hypercholesterolemia, hypertension and cigarette smoking have been identified as independent major risk factors of ASO, and diabetics, obesity, hypertrigriceridemia, low HDL-cholesterol level, aging, gender, etc, as minor factors. The patients with ASO often have multiple risk factors, synergistically accelerating the disease progression. Recent objective studies on natural history of claudicants have demonstrated a more morbid prognosis, especially in the patients with disabling claudication, than that outlined by previous historical studies. Mortality rates for ASO patients in long-term follow-up have revealed to be significantly higher than those observed in control groups. The causes of death are mostly arteriosclerotic vascular disease, particularly coronary artery and cerebrovascular diseases, which indicate the significance of the systemic evaluation in treating patients with ASO.
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PMID:[Risk factor, natural history and prognosis of the patients with arteriosclerosis obliterans]. 880 7

The aim of this study was to evaluate the prevalence of renal artery stenosis in patients with clinical signs of peripheral vascular disease and hypertension. One hundred patients, mean age 69 years (range 45-88) with symptoms and clinical signs of severe peripheral ischemia, underwent aortography to determine the degree of peripheral vascular disease and possible renal artery stenosis. History of claudication, and measurement of systolic distal blood pressure (BP) and calculation of the Ankle Brachial Index was used to define the severity of peripheral vascular disease. A total of 31% had renal artery stenosis (14% greater than 50% reduction in luminal diameter). In a subgroup of patients with hypertension and peripheral vascular disease (n = 74), 34% had renal artery stenosis. In the subgroup of patients with renal artery stenosis, 81% have hypertension. Patients with renal artery stenosis and lumen reduction of more than 50%, 93% have hypertension (P < or = 0.001). In conclusion this study shows that the combination of peripheral vascular disease and hypertension is an important clinical clue for renovascular disease. Examination for reno-vascular disease in this population should be considered, since the prevalence of the condition is high. Furthermore examination for renal vascular disease in this population is mandatory, before treatment with angiotensin converting enzyme (ACE) inhibitors is initiated, since treatment might lead to serious renal function impairment.
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PMID:Prevalence of renal artery stenosis in patients with peripheral vascular disease and hypertension. 886 60

The timely detection of peripheral vascular disease (PVD) in spinal cord injury (SCI) patients is difficult because the usual symptoms of claudication and rest pain are absent. In fact, the initial manifestation of PVD in SCI patients is often advanced gangrene, so that healing, primarily or following major amputation, is either difficult and prolonged or impossible. In addition, sacral and ischial pressure sores common among SCI patients may be exacerbated and reconstruction made more difficult by PVD. Five SCI patients presented with lower extremity gangrene as the initial recognized manifestation of PVD at our institution between January 1992 and January 1994. All 5 patients had risk factors for PVD. Four out of ten limbs in these patients required amputation, either above the knee or below the knee. Three patients required concurrent vascular reconstruction of the aortoiliac segments, including an aortobiprofunda femoral bypass, an iliac embolectomy with femoral-femoral bypass, and iliac angioplasty. Three patients had ischial and/or sacral pressure sores that had recurred following multiple musculocutaneous flap reconstructions before vascular disease was recognized. The timely diagnosis of PVD involving the iliac segment in the SCI patient is sometimes overlooked and is often necessary to optimize the treatment of both lower extremity ulcers and sacral/ ischial pressure sores common among these patients.
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PMID:Peripheral vascular disease in spinal cord injury patients: a difficult diagnosis. 893 2

The disabling pain of intermittent claudication (IC) arises from oxygen deprivation in the lower limbs during walking. Measurement of the oxygen deficiency within the limb tissue now appears possible with recently expanded understanding of the photon transport through tissue for photons in the visible and near infrared range. Noninvasive measurement consists of preferentially measuring photons that have traveled more deeply into limb tissues and that, therefore, may reach locations of ischemic tissue. Oxygen measurements appear to be possible up to a depth approaching 1.5 cm beneath the surface of the skin. The present study reports on data acquired from the limbs of 11 subjects with IC and 12 subjects without IC. The subjects with IC are patients with clinical findings of claudication based upon segmental Doppler pressure profiles and subjective reports by the patient of pain during exercise. The subjects without IC are individuals with no prior history of ischemic vascular disease. The results consist of photon reflectance measurements at red and infrared wavelengths (approximately 660 nm and 880 nm respectively) taken before, during, and after exercise. Infrared reflectance indices are plotted as well as oxygenation indices generated from combining red and infrared reflectances. A compilation of exercise data shows responses that are generally consistent with the expected physiological responses to mild exercise in subjects with and without IC. We anticipate that the findings of this study may lead to an objective noninvasive testing procedure for measuring the ischemic and exercise-induced changes in muscle oxygenation in the presence of claudication. If the testing of ischemic hypoxia continues to show consistency and accuracy in determining the disability of the subjects with IC, future studies can more effectively test modes of conservative management, such as cessation of smoking, alternative exercise regimens, weight loss, and alternative pharmacological agents.
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PMID:Noninvasive quantification of muscle oxygen in subjects with and without claudication. 902 24

Spinal cord stimulation was used in 46 patients for pain associated with lower extremity ischemic vascular disease that was considered to be nonreconstructable. Thirty-nine patients who had a follow-up examination between 2 and 36 months after the procedure form the basis of this report. Thirty (77%) of 39 cases were considered successful. Clinical endpoints indicating failure included amputation, vascular reconstruction, poor pain relief, or hardware malfunction. The transcutaneous partial pressure of oxygen (TcPO2) increased in both target and control feet. In patients with good outcome with a preimplantation TcPO2 of less than 30 mm Hg, TcPO2 increased significantly (p < 0.05). Pulse volume recording improved significantly (p < 0.05) at the thigh, metatarsal, and great toe levels in successfully treated patients. Peak blood flow velocity also showed a significant increase in patients with good outcome (p < 0.05). Patients with a TcPO2 of less than 10 mm Hg following stimulation tended to undergo amputation within the first 3 months. Improvement in pain control, combined with an increase in TcPO2 values that was greater than 10 mm Hg, were significant early predictors of long-term success. An initial increase in peak blood flow velocities (measured in Doppler studies) of greater than 10 mm also signified a good long-term outcome. Spinal cord stimulation appears to be a useful therapeutic modality for controlling pain and improving perfusion in a select group of patients with end-stage ischemic vascular disease considered nonreconstructable. The best results were seen in patients with severe claudication and rest pain without trophic changes in the foot. The mechanism of this beneficial effect is not yet completely understood.
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PMID:Improvement of limb circulation in peripheral vascular disease using epidural spinal cord stimulation: a prospective study. 912 Jun 31


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