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PubMed1992

Prevalence of lower extremity arterial disease among elderly people in the community.

To estimate the prevalence of lower extremity arterial disease, all patients aged over 65 years registered with a rural general practice near Cambridge were invited to attend for examination of the circulation to the lower extremities; 265 subjects (80%) accepted. Three methods were used to investigate the presence of lower extremity arterial disease - enquiring about symptoms of intermittent claudication; clinical examination (and particularly the detection of arterial bruits); and pressure index calculations from measurements of the ankle and brachial systolic blood pressure using a Doppler ultrasound probe. When examining the legs, the presence of a bruit was taken as stronger evidence of disease than inability to palpate the pulses which may be difficult or impossible to detect for a number of reasons. Forty seven of the 264 patients examined (18%) showed evidence of lower extremity arterial disease. Seven patients showed unequivocal evidence of lower extremity arterial disease as demonstrated by all three criteria, 12 by two criteria and 28 patients on one criterion alone. While the pressure index followed a normal distribution curve, there was a tendency for it to decline with age. Other risk factors which showed a correlation with evidence of disease including current, but not previous, cigarette smoking, and a history of stroke. The significance of the findings is discussed in the context of some degree of arterial pathology in many British subjects in this age group.

Age Factors↗

PubMed2004

Prevalence of lower-extremity disease in the US adult population >=40 years of age with and without diabetes: 1999-2000 national health and nutrition examination survey.

OBJECTIVE: Although lower-extremity disease (LED), which includes lower-extremity peripheral arterial disease (PAD) and peripheral neuropathy (PN), is disabling and costly, no nationally representative estimates of its prevalence exist. The aim of this study was to examine the prevalence of lower-extremity PAD, PN, and overall LED in the overall U.S. population and among those with and without diagnosed diabetes. RESEARCH DESIGN AND METHODS: The analysis consisted of data for 2873 men and women aged >or=40 years, including 419 with diagnosed diabetes, from the 1999-2000 National Health and Nutrition Examination Survey. The main outcome measures consisted of the prevalence of lower-extremity PAD (defined as ankle-brachial index <0.9), PN (defined as >or=1 insensate area based on monofilament testing), and of any LED (defined as either PAD, PN, or history of foot ulcer or lower-extremity amputations). RESULTS: Of the U.S. population aged >or=40 years, 4.5% (95% CI 3.4-5.6) have lower-extremity PAD, 14.8% (12.8-16.8) have PN, and 18.7% (15.9-21.4) have any LED. Prevalence of PAD, PN, and overall LED increases steeply with age and is higher (P < 0.05) in non-Hispanic blacks and Mexican Americans than non-Hispanic whites. The prevalence of LEDs is approximately twice as high for individuals with diagnosed diabetes (PAD 9.5% [5.5-13.4]; PN 28.5% [22.0-35.1]; any LED 30.2% [22.1-38.3]) as the overall population. CONCLUSIONS: LED is common in the U.S. and twice as high among individuals with diagnosed diabetes. These conditions disproportionately affect the elderly, non-Hispanic blacks, and Mexican Americans.

Adult↗

PubMed2002

Functional performance deficits in athletes with previous lower extremity injury.

OBJECTIVE: To evaluate the influence of previously treated, though clinically resolved, lower extremity injury on performance in a timed 20-meter shuttle run. DESIGN: Case control study. SETTING: National Collegiate Athletic Association (NCAA) Division I college during the 2000/2001 preparticipation physicals. PARTICIPANTS: NCAA Division I athletes (n = 213) participated in this research study. Athletes were excluded if they presently had an unresolved lower extremity injury or low back pain. MAIN OUTCOME MEASURES: Time to complete a 20-meter shuttle run was recorded. Previous lower extremity injury and college year were recorded via a short questionnaire. RESULTS: A significantly slower response time on the 20-meter shuttle run was observed in freshman athletes with a history of a lower extremity injury, as compared with freshmen without a previous injury (p = 0.01). No significant difference was noted in non-freshman collegiate athletes regardless of injury history (p = 0.98). CONCLUSION: Kinetic chain deficits may exist long after symptomatic recovery from injury resulting in functional deficits, which may be missed on a standard physical assessment. The slower shuttle run times observed in freshmen with previous lower extremity injury may be a manifestation of insufficient treatment received at the high school level or the benefit of a mandatory core strengthening program in returning athletes. Further study is necessary to identify and validate the cause-and-effect relationship. CLINICAL RELEVANCE: This study may support residual functional deficits in incoming college athletes, which may be related to inadequate care in the high school setting.

Adolescent↗

PubMed2000

Arm vein conduit is superior to composite prosthetic-autogenous grafts in lower extremity revascularization.

PURPOSE: Various alternative conduits have been used for lower extremity revascularization when an adequate ipsilateral greater saphenous vein is absent. This study compared the effectiveness of all-autogenous multisegment arm vein bypass grafts with that of composite grafts composed of combined prosthetic and autogenous conduits. METHODS: One hundred fifty-three lower extremity revascularization procedures performed between 1990 and 1998 were followed up prospectively using a computerized vascular registry. The grafts were composed of spliced arm vein segments with venovenostomy in 122 and of composite prosthetic-autogenous conduit in 31. Arm vein conduit was prepared by means of intraoperative angioscopy for valve lysis and identification of luminal abnormalities in 47.7% of cases. RESULTS: Bypass graft configurations were as follows: femoropopliteal (12 arm vein, 2 composite); femorotibial (75 arm vein, 23 composite); femoropedal (14 arm vein, 6 composite), and popliteo-tibial/pedal (21 arm vein, 0 composite). The indication for surgery was limb salvage in 98% and disabling claudication in 2% of cases. The mean follow-up was 25.1 months (range, 1 month to 7.9 years). Overall survival at 4 years was 51%. Overall patency and limb salvage rates were as follows: primary patency, at 1 year-arm vein, 76.9% +/- 4.8%; composite, 59. 5% +/- 9.6% (P =.02); at 3 years-arm vein, 70.0% +/- 8.0%; composite, 43.7% +/- 12.4% (P <.01); and at 5 years-arm vein, 53.8% +/- 8.7%; composite, 0%; secondary patency, at 1 year-arm vein, 77.5% +/- 4. 6%; composite, 59.8% +/- 9.5% (P =.02); at 3 years-arm vein, 70.7% +/- 7.5%, composite, 44.9% +/- 13.1% (P <.01); at 5 years-arm vein, 57.7% +/- 8.0%; composite, 0%; limb salvage, at 1 year-arm vein, 89. 3% +/- 3.7%; composite, 73.9% +/- 8.9% (P <.01); at 3 years-arm vein, 80.5% +/- 7.0%; composite, 49.6% +/- 14.3% (P <.01); at 5 years-arm vein, 76.3% +/- 9.9%; composite, 0%. CONCLUSION: In this study, multisegment autogenous arm vein was used successfully in a wide variety of lower extremity revascularization procedures and achieved good long-term patency and limb salvage rates, well in excess of those achieved with composite prosthetic-autogenous grafts. The use of autogenous conduit appears to offer superior results to composite conduit in lower extremity revascularization. The superior durability of arm vein makes it one of the alternative conduits of choice when an adequate greater saphenous vein is not available.

Aged↗

PubMed1992

[Analysis of factors influencing on the surgical results of arterial embolism in the lower extremities].

130 patients with arterial embolism in the lower extremities underwent surgical treatment. The curative rate was 66.9%, amputation rate-19.2% and the mortality rate-13.8%. Statistical study showed that sex, age and recurrent embolism had few effects on the surgical results (P < 0.05). One of the influencing factors was the ischemic time of the lower extremities. The mortality rate was 33.3% in the distal abdomen with aortic embolism and 8.7% in the lower extremities (P < 0.005). The mortality rate and amputation rate were significantly higher in embolic patients with atherosclerotic stenosis and occlusion (9% and 17%). The mortality rate and amputation rate were 2.3% and 3.4% in patients with good blood flow and were 42.1% and 57.9% in patients without good blood flow uspectively. Reembolectomies showed no satisfactory effect. The results indicated that embolectomy combined with other necessary operations did not increase the mortality rate and amputation rate (P < 0.05). Postoperative anticoagulation therapy is extremely important.

Adolescent↗

PubMed2005

Lower extremity amputation in Hong Kong.

OBJECTIVE: To evaluate the characteristics and outcome of patients undergoing lower extremity amputation in Hong Kong. DESIGN: Cohort study. SETTING: University teaching hospital, Hong Kong. PARTICIPANTS. One hundred and eighty-four Chinese adults who underwent lower extremity amputation. MAIN OUTCOME MEASURES: Demographic data of the cohort, wound complication and revision amputation rates, prosthesis use, functional ambulation level and institutionalisation at postoperative 6 months, operative mortality, and long-term survival. RESULTS: The majority of patients (83.1%) who underwent lower extremity amputation were aged over 60 years. Vascular occlusive disease was the most common underlying pathology, followed by infection. The wound complication and operative mortality rates were high. Only 43.0% of patients were able to resume community ambulation at 6 months and 40.7% became institutionalised. After high-level amputations, 22.3% managed to use a prosthesis. The median survival after lower extremity amputation was 1008 days. High-level amputation was associated with lower wound complication and revision amputation rates, but an inferior functional outcome and survival compared with foot amputation. CONCLUSIONS: Lower extremity amputation is associated with high morbidity and mortality, especially with high-level amputations. It places a heavy burden of care on patients, their families, the health care system, and society. Appropriate health care planning, provisions, and coordinated efforts at various levels are necessary to improve the situation. Major efforts must also be focused on preventing vascular occlusive disease and diabetes.

Adult↗

PubMed2006

Prognostic ability of a good outcome to carpal tunnel release for decompression surgery in the lower extremity.

For years, patients who were treated successfully with carpal tunnel release were told there was nothing that could be done about their lower extremity symptoms. Now that lower extremity nerve decompression has been accepted as an option to treat appropriate patients, the authors looked for correlations between a successful outcome with carpal tunnel syndrome and its predictive value of success for lower extremity nerve decompression. Data from a recent study demonstrate that a good result from upper extremity peripheral nerve surgery predicts the outcome for lower extremity peripheral nerve surgery in 88% of patients, and is, therefore, information valuable for prognosis and clinical decision-making.

Animals↗

PubMed2000

Osseous overgrowth after post-traumatic amputation of the lower extremity in childhood.

Severe accidents in children may cause extreme destruction of the lower extremities. In some cases, there is no possibility to preserve the limbs. Initially, a weight-bearing stump cannot be achieved after amputation due to unstable local and soft tissue conditions. This critical situation is often complicated by one of the leading problems in the limb-deficient child - the development of osseous overgrowth. Bizarre overgrowth of the stump may lead to skin perforation, pressure ulcers, and difficulties with the prosthesis. Since 1993, we have been able to follow five pediatric and adolescent patients (2 years to 17 years old) with six post-traumatic amputations of the lower extremities. Four of these cases developed osseous overgrowth. One child treated with initial autologous stump-capping had excellent soft tissue conditions and no problems with the artificial limb. We also report on a case of bizarre and extensive new bone formation. We conclude that close follow-up visits after post-traumatic amputations in children are essential because of new bone formation which may endanger the soft tissue situation of the stump. Unfortunately, surgical revisions have to be performed quite often. To avoid several surgical corrections, an initial stump-capping with autologous material from the injured limb can be performed. Thus, the number of secondary procedures may be reduced drastically.

Adolescent↗

PubMedDate not supplied

Care of the elderly patient with lower extremity amputation.

BACKGROUND: The elderly patient with a lower extremity amputation (LEA) remains relatively common in most family medicine practices. LEA can be categorized into three major types: partial foot, transtibial amputation, and transfemoral amputation. Family physicians have not been well trained to provide care to these patients. METHODS: A literature review was performed using the key words "lower extremity amputation," "aged" and "rehabilitation." RESULTS AND CONCLUSIONS: Appropriate medical, surgical, and rehabilitative care can have a positive effect on the functional outcome for an elderly patient with a lower extremity amputation. The family physician can be instrumental in preparing the patient and family for surgery, providing psychological support, preventing and treating complications, managing comorbid illness, and assisting in rehabilitation. In addition, the family physician is primarily responsible for the daily care needs of these patients.

Age Factors↗

PubMed1995

Postoperative lower extremity bypass surveillance: beyond ankle arm blood pressures.

Surveillance is essential to the postoperative follow-up of lower extremity bypass grafts. Early, intermediate, and late thrombosis place the patient's limb at risk, so detection of problems before the graft fails is critical. Because contrast angiography is not routinely performed for surveillance, most vascular surgeons rely on history, physical examination, and noninvasive vascular studies (NVS) to assess perfusion to the lower extremity after bypass grafting. These NVS include ankle/brachial waveforms, blood pressures, and indexes before and after exercise. The purpose of this study is to report our findings with duplex color-flow ultrasonography (DCU) to examine lower extremity bypass grafts. According to our protocol, we monitor lower extremity grafts with ankle/brachial Doppler pressures, analogue waveforms, and lower extremity exercise when possible. These NVS are performed by nurses in the vascular laboratory before the patient is discharged from the hospital, at least twice during the first year, and then annually. DCU is also performed at least two times during the first year and then annually. If the study results are abnormal or if the patient has symptoms, testing is usually repeated. When abnormalities persist contrast angiography may be warranted. We have detected anatomic and hemodynamic changes in lower extremity bypasses by use of our protocol. By adding DCU to ankle/brachial blood pressures, we have identified aneurysmal dilation, diffuse atherosclerosis, focal narrowing, arteriovenous fistulas caused by unligated venous branches, retained venous valves, and disease progression proximal or distal to the graft.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Vessel Prosthesis↗

PubMed2005

Validation of a new lower-extremity motor coordination test.

OBJECTIVE: To determine the test-retest reliability and construct validity of a new lower-extremity motor coordination test, the Lower Extremity MOtor COordination Test (LEMOCOT). DESIGN: To test reliability, subjects with impairments in at least 1 lower extremity were evaluated twice by the same evaluator. To test construct validity, the LEMOCOT scores obtained from subjects who had had a stroke were correlated with physical, functional, cognitive, and perceptual tests. SETTING: Geriatric day hospital and functional intensive rehabilitation unit. PARTICIPANTS: In the reliability test, 29 people (mean age, 69.6y; range, 28-87y); in the construct validity, 144 people who recently had had a stroke. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: In addition to the LEMOCOT, the following measures were used for construct validity: the Fugl-Meyer Assessment (motor function), Berg Balance Scale, 5-m walking test, 2-minute walking test, Functional Autonomy Measurement System, Modified Mini-Mental State Examination, and Motor-Free Visual Perceptual Test. RESULTS: Intraclass correlation coefficients (ICCs) indicated that test-retest reliability is good (right-side ICC=.88; left-side ICC=.83). The construct validity of the LEMOCOT was demonstrated by obtaining high correlations with physical and functional tests ( r range, .62-.79; P <.001) and no correlations with cognitive ( r =.11, P =.20) or visual perceptual tests ( r =.15, P =.08) and by discriminating between subjects discharged to long-term care versus other living environments ( P <.001). CONCLUSIONS: The LEMOCOT is a simple lower-extremity motor coordination test that showed good test-retest reliability and construct validity. It can be used in clinical and research settings, specifically with people who have had a stroke. Other studies should be carried out to confirm its psychometric properties.

Adult↗

PubMed1996

Risk factors for lower extremity arterial disease in non-insulin-dependent diabetic persons.

The relationship of lower extremity arterial disease to the different risk factors for atherosclerosis in non-insulin-dependent (Type 2) diabetes mellitus is a matter of continuing investigation. The present study was conducted on a random sample of 193 non-insulin-dependent diabetic patients in order to compare the frequency and severity of some known risk factors for atherosclerosis among such persons with and without indications of lower extremity arterial disease. Conventional risk factors for atherosclerosis (smoking, existence of hypertension, total plasma cholesterol, HDL-cholesterol, and triglycerides) were assessed. In addition body mass index, waist-to-hip ratio, body fat mass, and albumin excretion were determined. Criteria for the presence of lower extremity arterial disease were an ankle brachial pressure index < 0.89 and/or the existence of intermittent claudication. Age, length of diabetes, and waist-to-hip ratio appeared to be factors significantly related to lower extremity arterial disease in most cases. Blood lipids, body mass index, HbA1 (except in males), smoking, and type of antidiabetic treatment were not significantly related to disease. The multivariate analysis confirmed the significant contribution of the duration of diabetes (p = 0.002), and waist-to-hip ratio (p = 0.024) and further showed a significant relation with triglycerides (p = 0.020). Thus, lower extremity arterial disease in non-insulin-dependent diabetes mellitus is significantly related to a long duration of diabetes and to central body fat distribution (but not to body mass index), as well as to triglyceride levels.

Aged↗

PubMed2006

The relation between pelvic varicose veins, chronic pelvic pain and lower extremity venous insufficiency in women.

PURPOSE: To determine the frequency of pelvic varicose veins with transvaginal ultrasound and associated lower extremity venous insufficiency with Doppler ultrasound in women with chronic pelvic pain of undetermined origin. MATERIALS AND METHODS: A total of 100 women with chronic pelvic pain of undetermined origin lasting more than 6 months were included in the study. The presence of anechogenic and non-pulsatile vascular structures demonstrating flow in Doppler ultrasound with a diameter > 5 mm in parauterine and paraovarian localizations was accepted as pelvic varicose veins. In all patients, lower extremity venous systems were examined with Doppler ultrasound to assess possible associated venous insufficiency. Chi-square test was used for statistical analysis. RESULTS: Pelvic varicose veins were discovered with transvaginal ultrasound in 30 of 100 patients. This association was shown to be statistically significant. Various degrees of associated lower extremity venous insufficiency were also discovered in 21 of these 30 patients. CONCLUSION: This study has shown that the presence of pelvic varicose veins in women with chronic pelvic pain is not infrequent, and in the majority of cases, they are associated with lower extremity venous insufficiency. Since the diagnosis of lower extremity venous insufficiency plays an important part in deciding the course of treatment, lower extremity Doppler ultrasound must be included in the evaluation when pelvic varicose veins are discovered.

Adult↗

PubMed1987

Radiographic analysis of the axial alignment of the lower extremity.

The axial alignment of the lower extremities of twenty-five normal male volunteers whose mean age was thirty years was studied using a standardized radiograph of the entire lower extremity. The extremities were found to be in a mean of 1.5 degrees (right) and 1.1 degrees (left) of varus angulation at the knee between the tibial and femoral mechanical axes. The transverse axis of the knee lacked a mean of 3.0 degrees (right) and 2.6 degrees (left) of being perpendicular to the mechanical axis of the tibia. The anatomical axis of the femur did not pass through the center of the knee.

Adult↗

PubMed2003

Major lower extremity amputation in an academic vascular center.

Major lower extremity amputations continue to be performed despite an aggressive policy of revascularization. Factors leading to amputation were analyzed to determine whether a reduction in the limb loss rate is possible. A retrospective analysis of a prospectively maintained vascular registry was performed to identify patients undergoing above-knee amputation (AKA), below-knee amputation (BKA), and lower extremity revascularization (LER) for limb salvage between January 1, 1999 and January 1, 2002. Patient demographics, comorbidities, insurance carriers, and indications for operative intervention were analyzed. Greater than one-half of all major lower extremity amputations are performed in patients who have failed attempts at revascularization or who are not candidates for LER due to anatomic factors. However, one-quarter of eventual amputees present very late to the vascular surgeon with extensive gangrene or infection that precludes limb salvage. Prompt patient referral and treatment may improve outcome in this group of patients. In our study, insurance issues did not appear to affect treatment. Renal failure continues to play a major role in limb loss.

Academic Medical Centers↗

PubMedDate not supplied

The impact of diabetes-related lower-extremity amputations in The Netherlands.

The purpose of this study is to identify the incidence of diabetes-related lower-extremity amputations in the Netherlands. We used discharge records from SIG Health Care Information for every hospitalization for a lower-extremity amputation in all hospitals in the Netherlands in 1992. Age- and gender-specific population figures and diagnosed cases of diabetes were obtained from the Central Bureau of Statistics. Age- and gender-adjusted amputation incidences were identified at four different levels (toe, foot, leg, and thigh). Multiple amputations were analyzed by the highest level. Of all lower-extremity amputations, 1,575 (47%) were in persons with diabetes mellitus. Age- and gender-adjusted lower-extremity amputation rates per 10,000 persons with diabetes by level were the following: toe 12.39, foot 2.42, leg 7.82, thigh 2.54, and total 25.17. People with diabetes were 20.3 times more likely to experience a lower-extremity amputation than people without diabetes. Males were at a significantly higher risk of experiencing an amputation than females. There was a significant increase in the age-specific incidence of amputations as age increased. The most common amputation procedure performed was the toe amputation. There was a significant increase in thigh amputations as age increased, indicating that as people get older they suffer higher levels of amputations. Although the incidence of lower-extremity amputations was lower than previous reports, they still have a serious impact on the health-care system in the Netherlands.

Adult↗

PubMed2001

[The course of pregnancy, delivery and puerperium in women with varices and thrombophlebitis of lower extremities, after application of low molecular weight heparins].

OBJECTIVES: Estimation of the long term prophylactic or therapeutic application of low molecular weight heparin (LMWH) on the platelets count, and incidence bleedings during pregnancy, delivery and puerperium in the women with varices of lower extremities and past thrombophlebitis of lower extremities. MATERIAL AND METHODS: 5212 pregnant, women in labour and in puerperium divided into 4 groups.; 142 women with varices and thrombophlebitis of lower extremities (group I); 10 with past thrombophlebitis of lower extremities (group II); 15 with thrombophlebitis in current pregnancy; 5045 without vascular complications (group IV--control). In group I during pregnancy compression therapy was applied (stockings) and low molecular weight heparins (LMWH) in course of puerperium. In group II during the 1st trimester of pregnancy and in labour the same heparin doses were administered, while the doses were increased in the 2nd and 3rd trimester. In group III, when thrombophlebitis was stated non-steroid anti-inflammatory drugs and LMWH were administered. In all cases treated with heparin both number of platelets and incidents of bleedings from genitourinary tract were observed. Presence of embolic complications was also noted. RESULTS: No cases of decrease platelets number or bleedings from genitourinary tract were observed in group I-III during administering of LMWH. In women in group II where prophylactic with LMWH was applied no incidences of recurrent thrombophlebitis during pregnancy and puerperium were observed. In group I-III all newborns were born in good condition and no complications were observed. Average blood loss during both labour and cesarean section, among women in group I-III was not significantly different comparing with control group. No incidences of pulmonary artery embolism or decrease number of platelets were observed. CONCLUSIONS: 1. The long term prophylactic or therapeutical administration of LMWH in the women with varices of lower extremities or thrombophlebitis has no influence on the platelets count and incidence of bleedings from genitourinary tract during pregnancy or increase of blood loss during labour and puerperium. 2. In the women with past thrombophlebitis of the lower extremities after application of LMWH during pregnancy there were no recurrence observed.

Adult↗

PubMedDate not supplied

Amputation of the lower extremity: an overview.

Amputation of the lower extremity may be traumatic or a necessary procedure to prevent further morbidity and possibly death in a patient. Advances have been made in the area of lower extremity amputation surgery and subsequent management. Prosthetic design has resulted in more lightweight, better fitting prostheses that more closely resemble the workings of a normal leg and foot. This results in a decrease in energy expenditure with walking and allows an increased activity level for amputees. This article addresses factors concerning phantom limb sensations and pain, prosthesis use and nursing considerations in rehabilitation.

Amputation, Surgical↗