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

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 ischaemia, 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 and calculation of the Ankle Brachial Index was used to define the severity of peripheral vascular disease. Thirty-one percent 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% had hypertension. Among patients with renal artery stenosis and lumen reduction of more than 50%, 93% had hypertension (p < 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 renovascular 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 inhibitors is initiated, since treatment might lead to serious renal function impairment.
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PMID:[Occurrence of renal artery stenosis in patients with peripheral arteriosclerosis and hypertension]. 941 95

Axillobifemoral bypass (AxBFB) is considered an inferior operation because of comparatively poor long-term results. One factor that has not been considered in the literature is whether or not the operation is performed electively or for acute ischemia (< 24 hours duration). This may be a more important predictor of poor results than previously recognized. During the last 10 years, we have performed 59 AxBFB. In Group A, 41 patients (mean age 71) underwent elective AxBFB and in Group B, 18 patients (mean age 65) had emergency AxBFB. Indications for surgery in Group A were limb-threatening ischemia (30), infected aortic graft (5), and severe claudication (6); in Group B, indications for surgery were acute limb ischemia (16), and aortoduodenal fistula (2). Primary patency (p < 0.002), limb salvage (p < 0.002), and survival (p < 0.03) were significantly better in Group A versus Group B. We conclude that an AxBFB performed electively provides satisfactory palliation of severe vascular disease in high-risk patients. The indications for operation and timing of the operation may explain the widely disparate clinical results reported in the literature.
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PMID:Axillobifemoral bypass: elective versus emergent operation. 958 14

Thirty patients with occlusive peripheral vascular disease underwent clinical examination, segmental blood pressure determinations, intra-arterial digital subtraction angiography, and treadmill stress testing with injection of technetium 99m sestamibi at peak exercise. Radionuclide images of the thighs, calves, and feet showed clear delineation of major muscle groups. Diminished radiotracer distribution was closely correlated with the presence of occlusive vascular disease on angiography and with the presence of claudication and reduced segmental blood pressure. A quantitative scheme based on pixel intensity was developed to compare areas of regional perfusion.
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PMID:Evaluation of leg perfusion during exercise using technetium 99m sestamibi. A new test for peripheral vascular disease. 1014 94

A case of popliteal artery entrapment syndrome (PAES) is reported. A non smoker, 63-year-old man, consulted for severe claudication of the lower limb, with a sudden onset. There was no past history of vascular disease. Neither the arteriography nor the arterial doppler led to definite diagnosis. In our case, only the C.T. scan was contributive to the diagnosis. The age, 63, at which this abnormality became symptomatic, the abrupt appearance of ischaemic symptoms and the embryologic type of the arterial stenosis were particular. The surgical management was the only therapeutic option.
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PMID:Popliteal artery entrapment syndrome: specific aspect. 1058 82

Fibroblast growth factors (FGFs) are being investigated in human clinical trials as treatments for angina, claudication, and stroke. We designed a molecule structurally unrelated to all FGFs, which potently mimicked basic FGF activity, by combining domains that (1) bind FGF receptors (2) bind heparin, and (3) mediate dimerization. A 26-residue peptide identified by phage display specifically bound FGF receptor (FGFR) 1c extracellular domain but had no homology with FGFs. When fused with the c-jun leucine zipper domain, which binds heparin and forms homodimers, the polypeptide specifically reproduced the mitogenic and morphogenic activities of basic FGF with similar potency (EC50 = 240 pM). The polypeptide required interaction with heparin for activity, demonstrating the importance of heparin for FGFR activation even with designed ligands structurally unrelated to FGF. Our results demonstrate the feasibility of engineering potent artificial agonists for the receptor tyrosine kinases, and have important implications for the design of nonpeptidic ligands for FGF receptors. Furthermore, artificial FGFR agonists may be useful alternatives to FGF in the treatment of ischemic vascular disease.
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PMID:Semirational design of a potent, artificial agonist of fibroblast growth factor receptors. 1058 18

Although women are less likely to develop symptomatic atherosclerosis, little data exists on the long-term outcome of women undergoing infrainguinal arterial reconstructions. This study analyzes the operative mortality rate, complications, and the short-term and long-term results after these procedures in both men and women who had symptomatic vascular disease. From 1984 to 1997, 3956 infrainguinal arterial reconstructions were performed at Albany Medical Center. A total of 2474 (62.54%) reconstructions were performed in men and 1482 (37.46%) in women. The mean ages were 67 years for men and 71 years for women. Forty-three percent of the men were smokers compared with 26% of the women. Diabetes was present in 51% of the men and 55% of the women. Claudication was the indication for bypass in 298 (12.05%) men and 110 (7.42%) women. Limb salvage occurred in 2176 (87.95%) men and 1372 (92.58%) women. Perioperative 30-day patency rates were 96.66% in men and 96.50% in women. Primary patency rates at 1, 3, 5, and 10 years were compared; no significant difference existed between men and women. Secondary patency also was similar in both men and women. These results indicate that women requiring arterial reconstruction for infrainguinal occlusive disease had short-term and long-term graft patency results that were comparable with the results of men.
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PMID:Outcome after distal vascular reconstruction in women. 1060 22

Lower-extremity vascular surgery is most often indicated for patients with critical leg ischemia but has increasingly been used for patients with disabling intermittent claudication. This article reviews indications, follow-up protocols, and procedure-related outcomes including perioperative and late mortality, complications, and long-term patency rates, which vary with patient risk factors, vascular disease severity, and hospital volume. Population-based studies have yet to establish whether rates of limb-preserving bypass surgery are related to overall amputation rates, partly because of the continued high rate of primary amputation. The functional benefits of vascular surgery have been traditionally assessed by treadmill protocols and batteries of physical tests. Claudication treatment is increasingly being measured by both generic and disease-specific functional and health-related quality-of-life questionnaires. Patient self-reported measures of physical functioning and walking ability are reviewed. Finally, conclusions are presented about trends in lower-extremity bypass surgery rates.
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PMID:Measures of success and health-related quality of life in lower-extremity vascular surgery. 1077 55

Naftidrofuryl (Praxilene; NAF) significantly improves claudication distance in patients with peripheral vascular disease (PVD). Endothelin-1 (ET-1) is a powerful endogenous vasoconstrictor and the circulating levels of ET-1 are elevated in patients with vascular disease. Platelet rich plasma (PRP) was prepared from healthy volunteers. NAF at concentrations similar to therapeutic levels (3.5-14 micromol/l), inhibited (P < 0.02) platelet activation (as indicated by a fall in median platelet volume, MPV) induced by ET-1 (0.4 micromol/l) alone. NAF also inhibited (P <0.0001) shape change (PSC; an early phase of platelet activation, characterised by an increase in MPV) induced by ET-1 (0.4 micromol/l) in combination with ADP (0.05-0.15 micromol/l) or serotonin (0.03-0.13 micromol/ l). We assessed the effect of ET(A) (BQ123, 50 nmol/l) or ET(B) (BQ788, 50 nmol/l) receptor antagonists on PSC induced by ET-1 alone. Both antagonists significantly inhibited PSC. We conclude that ET-1 activates human platelets. Both ET(A) and ET(B) receptors probably contribute to this response by a complex mechanism that requires further elucidation. NAF antagonises the action of ET-1 on human platelets. These actions may contribute to the beneficial effects of NAF in PVD.
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PMID:Effect of endothelin-1 on human platelet shape change: reversal of activation by naftidrofuryl. 1103 Apr 61

Coral reef aorta is a rare calcifying disease of the juxtarenal and suprarenal aorta. We report here our surgical experience in treating 21 patients, with a mean follow-up of 4 years and 7 months. Both genders were equally affected. Ten male (48%) and 11 female (52%) patients with a mean age of 54.6 years (range 42-76 years) underwent surgery. The main symptoms were limb claudication (n = 11, 52%), renovascular stenosis (n = 9, 43%) with concurrent renovascular hypertension (n = 5, 24%), and angina abdominalis (n = 7, 33%). Most patients had multiorgan vascular disease such as iliofemoral arterial occlusive disease (n = 14, 66%), coronary artery obstruction (n = 8, 38%), or obstruction of the carotid artery (n = 6, 28%). Risk factors did not differ between coral reef patients and those with other occlusive vascular diseases. All patients were treated through vascular operations, including open thromboendarterectomy of the suprarenal (n = 9, 43%), infrarenal (n = 4, 19%), or supra- and infrarenal aorta (n = 8, 38%), and thromboendarterectomy of the following vessels: celiac artery (n = 7, 33%), superior mesenteric artery (n = 12, 57%), inferior mesenteric artery (n = 3, 14%), unilateral renal artery (n = 3, 14%), or bilateral renal artery (n = 9, 43%). Bypass reconstructions were performed in 39% (n = 8). A thoracoabdominal approach was used in 14 patients (67%) and a median laparotomy in 7 (33%). Our results show that coral reef aorta is not confined to either gender. It appears most frequently in the context of general atherosclerotic disease and patients benefit from timely diagnosis and operation before onset of severe, life-threatening visceral and renal complications.
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PMID:Coral reef aorta: a long-term study of 21 patients. 1112 58

In peripheral arterial occlusive disease (PAOD), arterial compliance of the central arteries has been reported to be reduced. It is, however, not clear whether, in PAOD, decreased arterial compliance is also accompanied by similar changes in the peripheral arteries. Therefore the aim of the study was to determine the large (C1) and small (C2) artery elasticity indices in PAOD and their relations to its well-accepted characteristics (ankle-brachial index, ABI; pulse pressure, PP; absolute claudication distance, ACD). A total of 43 patients with PAOD (mean age 68 +/- 9 years; ABI of the limiting leg 0.65 +/- 0.14; SBP (systolic blood pressure) 149 +/- 20 mmHg, and ACD 488 +/- 187 m) were enrolled as well as 16 control subjects of comparable age (69 +/- 4 years) and blood pressure (SBP 147 +/- 27 mmHg). All subjects underwent non-invasive pulse wave analysis in order to determine arterial compliance of the aorta and major side branches (C1) and of the distal circulation (C2), using a modified Windkessel model. In PAOD, both C1 (1.41 +/- 0.56 ml/mmHg) and C2 (0.023 +/- 0.012 ml/mmHg) were comparable to values in an age and blood pressure-matched control group (C1, 1.25 +/- 0.66 ml/mmHg; C2, 0.027 +/- 0.008 ml/mmHg). C1 was significantly correlated with ACD (r = 0.36, p = 0.02), PP (r = -0.33, p < 0.02) and only borderline with ABI (r = 0.28, p = 0.07). C2 was correlated with PP (r = -0.38, p < 0.01), ABI (r = 0.36, p < 0.02) but not with ACD. Large (C1) and small (C2) artery elasticity indices in PAOD were decreased but comparable to values in an elderly group with isolated systolic hypertension. Moreover, C1 and C2 correlated with markers (ABI and PP) of severity of vascular disease.
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PMID:Small and large artery elasticity indices in peripheral arterial occlusive disease (PAOD). 1195 85


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