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PubMedDate not supplied

The non-healing leg ulcer: peripheral vascular disease, chronic venous insufficiency, and ischemic vasculitis.

The non-healing leg ulcer is examined by discussing three disease processes: peripheral vascular occlusive disease (PVOD), chronic venous insufficiency (CVI), and vasculitis. For PVOD, management decisions are based on risk factors and disease history. Comprehensive management includes the discontinuation of smoking, exercise conditioning and regulation of diabetes, hyperlipidemia, hypertension, and the appropriate application of anticoagulant/antiplatelet drugs. Methods of surgical management include bypass with autogenous or synthetic material in addition to reconstructive surgery with patch angioplasty or extra-anatomic bypass, amputation, percutaneous transluminal angioplasty/stents, thrombolytic infusion, atherectomy, intraluminal ultrasound, and angioscopy. The optimal healing environment for all ulcers prevents contamination, pain, and fluid loss. In CVI, higher venous pressure in the veins of the lower limb during exercise results in ambulatory venous hypertension and ulceration. Various theories are associated with the disease and ulceration process; the classic treatment of elevation, ambulation, and compression for venous disease remains unchallenged. Diagnosis is based on history, physical examination, invasive venography, and/or non-invasive studies. Two groups of vasculitic disorders that share varying degrees of vascular inflammation and necrosis are arteritis (lupus, erythematosus, periarteritis nodosa, dermatomyositis) and blood dyscrasias (sickle cell disease, thalassemia). Leg ulcers associated with vasculitis are due to inadequate tissue oxygenation at the local level, are typically chronic, slow to heal, and commonly recur.

Education, Nursing, Continuing↗
PubMed1988

Concurrent lumbar spinal stenosis and peripheral vascular disease. A report of nine patients.

Intermittent claudication from peripheral vascular disease is sometimes difficult to distinguish from neurogenic claudication secondary to lumbar spinal stenosis. Of 172 patients with symptoms of claudication and lumbar spinal stenosis proved by myelography or computed tomography (CT), nine had peripheral vascular disease identified with ultrasonography and arteriography. All of the nine patients had a laminectomy performed to decompress the narrow spinal canal, and two had an additional posterolateral fusion. Two patients were treated with an excision of their abdominal aortic aneurysm, while one of those patients later required a bypass graft for iliac stenosis. One patient had had an aortofemoral bypass graft, one a femoropopliteal graft, and one a lumbar sympathectomy. Follow-up study ranged from three to eight years, with an average of five years after their last surgical procedure. Paresthesias generally dissipated after the spinal surgery. The cramping-type discomfort associated with walking was not easily attributed either to vascular or a neurogenic etiology. Five patients had initial weakness, which invariably improved. A secondary etiology contributing to claudication must be excluded in those patients with persistent discomfort following previous lumbar spinal or vascular surgery for arterial insufficiency.

Aged↗
PubMedDate not supplied

Antihypertensive treatment in patients with peripheral vascular disease.

BACKGROUND: Some specific treatment goals are indicated for patients with hypertension complicated by peripheral vascular disease. OBJECTIVE: To review the available information about treating hypertension in patients with atherosclerosis or aneurysms of the aorta or peripheral arteries. SUMMARY: Patients with peripheral vascular disease and hypertension should be treated according to the general guidelines for all patients with hypertension. However, specific treatment goals include improvement or stabilization of intermittent claudication and associated conditions such as coronary artery disease, hyperlipidemia, and diabetes mellitus. The ideal therapy for most of these conditions is nonpharmacologic: achievement of ideal body weight, a diet low in cholesterol, saturated fat, and salt, and a regular exercise program will improve blood pressure control, lipid values, blood glucose control, insulin sensitivity, symptoms of intermittent claudication, and long-term survival. Patients who smoke should stop. Patients with aneurysms should receive beta blockers. CONCLUSIONS: Antihypertensive therapy in patients with peripheral vascular disease should be part of a general program of risk-factor reduction.

Aneurysm↗
PubMed1996

Prevalence of renal artery stenosis in patients with peripheral vascular disease and hypertension.

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.

Aged↗
PubMed2003

From the RSNA refresher courses: MR imaging of aortic and peripheral vascular disease.

Acquired diseases of the aorta and peripheral arteries are common. Owing to technical advances, magnetic resonance (MR) angiography has become the primary imaging modality for assessment of aortic and peripheral arterial disease. Contrast material-enhanced MR angiography is a rapid and robust technique that has emerged as the principal MR angiographic technique for evaluation of vascular disease. Two-dimensional time-of-flight MR angiography still has some well-validated applications, especially in distal peripheral vascular disease. Phase-contrast flow imaging is an important technique for quantification of blood flow. Black-blood imaging is a valuable tool for evaluation of the vessel wall. Understanding the principles of the main MR angiographic techniques is essential for consistent acquisition of diagnostic images. In addition, tailoring the acquisition parameters and the imaging protocol to the vessel being imaged and the clinical question is mandatory for optimal results. Future technical developments that will lead to faster image acquisition and better contrast agents promise to further improve image quality.

Adult↗
PubMed2002

The effects of a low frequency acoustic waveform on peripheral vascular disease: a pilot study.

OBJECTIVE: To evaluate the effects of a low frequency acoustic waveform on peripheral vascular disease (PVD). DESIGN: Pilot study utilizing a one-group pre-intervention, post-intervention design. SETTING: Adults with peripheral vascular disease were recruited through local advertisements. The study was conducted at a local facility housing the electroacoustic transducer. INTERVENTION: A 25-min exposure to an electroacoustic transducer. OUTCOME MEASURES: Pre- and post-measurement of Doppler ultrasound blood-flow velocities in 10 arteries, ankle brachial index (RBI), foot assessment, and 1-week post telephone survey. RESULTS: A significant increase was noted in the right ankle brachial index (RABI) but not the left. Blood flow increased in all arteries, significantly in four. Thirteen participants reported improvement in symptom of peripheral vascular disease over the following week. CONCLUSIONS: While conclusions must be viewed cautiously, the significant differences noted warrant further study to examine effects of acoustic waveforms on peripheral vascular disease.

Acoustics↗
PubMed1981

Effect of total leucocyte count on whole blood filterability in patients with peripheral vascular disease.

An abnormal filterability of whole blood through micropore membranes in vitro has been reported in peripheral vascular disease and has been thought to indicate abnormal red cell deformability. Blood from 68 patients with symptomatic peripheral vascular disease of varying severity and from 32 age-matched controls without a history of peripheral vascular disease was studied by the technique of whole blood filtration. In agreement with earlier findings, whole blood filterability was significantly reduced in patients with symptoms of vascular disease, but also their total leucocyte count was significantly higher than that of the controls. Variation in leucocyte count was found to affect significantly whole blood filterability, and the abnormal filterability in peripheral vascular disease could be entirely ascribed to this factor and not to an alteration in red cell deformability. The raised leucocyte count was not due to smoking but its cause could not be explained.

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