[Critical observations on the etiology and principles of a conservative therapy of peripheral vascular diseases].
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Humans↗
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Results for “VASCULAR DISEASES PERIPHERAL”
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[The function and anatomy of peripheral vascular diseases].
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Humans↗
[Symptomatology in peripheral vascular diseases].
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Peripheral Vascular Diseases↗
Lower limb deep venous flow in patients with peripheral vascular disease.
PURPOSE: A prospective controlled study was undertaken to determine how peripheral vascular disease (PVD) influences flow in the deep veins of the leg. METHODS: Eighty-nine patients with peripheral vascular disease and 35 age-matched control subjects were studied. The popliteal vein diameter and flow velocity were measured at rest by means of color duplex ultrasound scanning, and these measurements were compared with the ankle-brachial pressure index. For 23 subjects, measurements were also performed during reactive hyperemia and then repeated after venous return from the foot was prevented by an ankle cuff. RESULTS: There was a significant correlation between the ankle-brachial pressure index and the popliteal vein diameter (r = 0.35, P <.001) but a negative correlation between the ankle-brachial pressure index and venous flow velocity among patients with PVD (r = -0.24, P =.002). In PVD patients the diameter decreased further in reactive hyperemia, whereas it increased in control subjects ( P <.001). Preventing venous return from the foot in PVD patients led to diameter increase at rest and abolished the reduction in diameter caused by reactive hyperemia. Despite the reduction in diameter during reactive hyperemia, flow velocity increased less in patients with PVD than it did in control subjects (P =.01). CONCLUSION: Chronic tissue ischemia results in constriction of the popliteal vein. This appears to be an active process related to the washout of humoral factors from ischemic tissues distally, which leads to an increase in flow velocity. The latter may confer some protection against the deep vein thrombosis that would otherwise tend to occur with low venous flow rates.
Adult↗
Arterial occlusion in patients with peripheral vascular disease treated with platinum-based regimens for lung cancer.
BACKGROUND: Patients with cancer may be hypercoagulable, and smoking can cause both lung cancer and peripheral vascular disease. Cisplatin-based chemotherapy has been reported to cause a variety of vascular side effects. CASE REPORTS: Five patients with bronchogenic carcinoma and peripheral vascular disease developed acute arterial occlusion soon after receiving a combination of cisplatin or carboplatin plus etoposide. All these patients had risk factors for atherosclerosis and three of them had preexisting known peripheral vascular disease. CONCLUSIONS: The occurrence of acute arterial occlusion soon after initiation of chemotherapy suggests that it might have been a complication of this therapy. Hence, caution should be exercised when using platinum-based (and other?) chemotherapy in patients with known moderate or severe peripheral vascular disease.
Aged↗
A study of platelet fibronectin immunofluorescence in peripheral vascular disease and diabetes mellitus.
Platelets hyperaggregability and hypersecretion fibronectin (Fn) are known to occur in peripheral vascular disease (PVD) and diabetes mellitus (DM) with microangiopathy. To determine whether an increase in platelet membrane bound Fn constitutes to hyperaggregability of platelets, washed platelets from normal subjects and from patients with peripheral vascular disease and patients with diabetes mellitus were examined for the presence of fibronectin (Fn) by means of fluorescein linked antibody to Fn. Platelets from peripheral vascular disease and diabetes mellitus patients tended to aggregate during preparation and apparently exhibited greater fluorescence in platelet "smears" than was observed in smears from controls. In contrast, when washed platelet "smears" were prepared from platelet preparations containing iloprost, an analogue of prostacyclin, platelet aggregates did not form and the 'excess' of fluorescence disappeared from all the three groups. When platelets were stained for Fn fluorescence in suspensions, no fluorescence was observed on the surface of platelets from peripheral vascular disease and diabetes mellitus patients or controls. On stimulation with thrombin washed platelet suspension showed fluorescence for Fn. Platelet activation leads to Fn appearing on platelet surface but this effect cannot be quantified by optical fluorescence microscopy.
Adult↗
The prevalence, detection, and epidemiological correlates of peripheral vascular disease: a comparison of diabetic and non-diabetic subjects in an English community.
A cross-sectional study was performed to investigate the distribution, methods of detection, and potential risk factors for peripheral vascular disease in a diabetic population with comparison to an age and sex matched non-diabetic group. The population came from a geographically defined area consisting of 10 general practices (total list size 97,034) and covered rural and urban districts of East Dorset. Peripheral vascular disease was defined as an ankle/brachial Doppler pressure ratio of 0.9 or less. Of the diabetic subjects reviewed, 864 were classified as having Type 2 diabetes and 213 Type 1 diabetes. The prevalence of peripheral vascular disease in Type 1 diabetes was 8.7% (95% CI 4.9-12.5) and in Type 2 diabetes 23.5% (95% CI 20.5-26.5), which after adjusting for age was not significantly different (odds ratio 1.5, 95% CI 0.8-2.7, p = 0.18). There was no difference in the frequency of symptomatic peripheral vascular disease or the site of occlusion between diabetic and non-diabetic subjects with peripheral vascular disease. Age, cerebrovascular disease, coronary artery disease, glucose, body mass index, and cholesterol in Type 2 diabetes and age and proteinuria in Type 1 diabetes were significant predictors of peripheral vascular disease. In the non-diabetic group, age and cigarettes smoked were significant variables. These findings suggest that clinical features of peripheral vascular disease in diabetic and non-diabetic subjects are similar but risk determinants may be different.
Adult↗
Patterns of oxygen consumption during exercise testing in peripheral vascular disease.
Exercise testing on a treadmill was performed in 15 patients with peripheral vascular disease to determine the pattern of oxygen consumption during exercise. A plateau in the oxygen consumption over the final 90 s of exercise was used as a criterion for maximal effort and only 4 out of 15 (27%) obtained a plateau of oxygen consumption compared to 20 out of 26 (77%) normal subjects (chi 2 7.9, p less than 0.005). These findings may account for the limited value of exercise testing in detecting coronary artery disease in patients with peripheral vascular disease.
Adult↗
Role of Gritti-Stokes amputation in peripheral vascular disease.
The perigenicula lower limb amputations performed for peripheral vascular disease in Nottingham between April 1987 and September 1992 were reviewed. Of the 434 amputations, 173 were below-knee amputations (BKA), 144 Gritti-Stokes amputations (GSA) and 117 above-knee amputations (AKA). The 30-day mortality was significantly greater for AKA patients than either GSA or BKA patients. There was no difference in mortality within 30 days of amputation between GSA and BKA. Re-amputation rate to a more proximal level was significantly higher in BKA compared with GSA. Mobility after prosthetic rehabilitation was assessed using the Stanmore grading. A greater number of patients achieved mobility grade III and above in the GSA and BKA groups when compared with the AKA group, but there was no significant difference between GSA and BKA groups. At follow-up, a median of 23 months after amputation, there was a tendency for more patients to have given up using their limb prosthesis in the GSA group than either the BKA or AKA groups. However, there remained no significant difference between the BKA and GSA groups in the numbers of patients who remained successfully rehabilitated to Stanmore grade III or above. When a BKA is not possible, GSA offers a better prospect for rehabilitation compared with AKA in patients with occlusive arterial disease.
Adult↗
Standards for evaluating results of interventional therapy for peripheral vascular disease.
Uniform standards for evaluating and reporting the results of therapeutic interventions for peripheral vascular disease are clearly needed. They are already established for vascular surgery, as represented by several reports by SVS/ISCVS committees, but they are not always followed by vascular surgeons and have been largely ignored by other vascular interventionists. In this article, the major problematic reporting practices are discussed and illustrated, and 14 recommendations are advanced to deal with them. They are intended to provide precise definitions, objective criteria of success or failure, standardized severity gradation schemes for peripheral vascular disease and its risk factors, and proper procedures for reporting the outcome of all forms of therapeutic intervention. Until these or some other agreed upon reporting standards are accepted and followed, the literature on peripheral vascular disease and its management will continue to be a source of confusion rather than enlightenment.
Angioplasty, Balloon↗
Peripheral vascular disease--the geriatrician's tale.
One hundred and twenty four elderly patients with peripheral vascular disease were seen by a geriatrician over a period of just under 4 years. Half of them presented with critical ischaemia and had not been previously known to have peripheral vascular disease. Two-thirds were shown to have bilateral disease; 14.5% of the series developed manifestations of the condition during the course of acute systemic illnesses and in 5 cases this was almost certainly, and in several more probably, due to haemodynamic crises. A third were dead within 3 months and so far a further 18.5% are known to have died within 2 y of first encounter. Of those who survived 3 months, at least 37% required treatment for persistent rest pain or had skin ulceration or necrosis, or had developed gangrene or come to amputation. Only 5 patients, after investigation, underwent successful limb salvage procedures. Peripheral vascular disease in old people is common, is likely to continue to be so, carries a dismal prognosis, and appears on the evidence presented here to be under-suspected until an advanced stage in the disease. Those dealing with the aged must be constantly on the alert for it since it calls for scrupulous care of the feet and for especial vigilance during acute systemic illness.
Acute Disease↗
Neuropathy in peripheral vascular disease; it bearing on diabetic neuropathy.
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Diabetic Neuropathies↗
Free-tissue transfer in patients with peripheral vascular disease: a 10-year experience.
Advances in free-tissue transfer have allowed for lower limb salvage in patients with significant peripheral vascular disease and limb-threatening soft-tissue wounds. The authors retrospectively reviewed their 10-year experience with free flaps for limb salvage in patients with peripheral vascular disease to assess postoperative complication rates and long-term functional outcome. They identified all patients undergoing free-tissue transfer with significant peripheral vascular disease and otherwise unreconstructible soft-tissue defects. Charts were reviewed for perioperative and long-term outcome. Parameters studied included perioperative morbidity and mortality, flap success, bypass graft patency, ambulatory results, and long-term limb and patient survival. Survival data were analyzed using life-table analysis, Kaplan-Meier survival analysis, and Cox testing. A total of 79 flaps were examined in 75 patients with peripheral vascular disease from July of 1990 to November of 1999. All patients would have required a major amputation had free-tissue transfer not been performed. Mean age was 60 years, average hospital stay was 32 days, and perioperative mortality was 5 percent. Within the first 30 days after operation, there were four cases of primary flap loss, and another two were lost as the result of bypass graft failure (8 percent); five of these cases resulted in amputation. There were no primary flap failures after 30 days. Follow-up ranged to 91 months (mean, 24 months). During this time, another 14 limbs were lost, most commonly because of progressive gangrene and/or infection in sites remote from the still-viable free flap. Using Kaplan-Meier survival analysis, 5-year flap survival was 77 percent, limb salvage 63 percent, and patient survival 67 percent. Sixty-six percent of patients were able to ambulate independently with the use of their reconstructed limb at least 1 year after hospital discharge, although some of these later went on to amputation. Free-tissue transfer for lower extremity reconstruction can be performed with acceptable morbidity and mortality in patients with peripheral vascular disease. Flap loss is low, and limb salvage, ambulation, and long-term survival rates in these patients are excellent.
Follow-Up Studies↗
Sensitivity and specificity of QTc dispersion for identification of risk of cardiac death in patients with peripheral vascular disease.
OBJECTIVE: To determine whether QTc dispersion, which is easily obtained from a standard electrocardiogram, can predict those patients with peripheral vascular disease who will subsequently suffer a cardiac death, despite having no cardiac symptoms or signs. DESIGN: Patients with peripheral vascular disease were followed up for five years after they had had coronary angiography, radionuclide ventriculography, and their QTc dispersion calculated from their 12 lead electrocardiogram. SUBJECTS: 49 such patients were then divided into three groups: survivors (34), cardiac death (12), and non-cardiac death (3). MAIN OUTCOME MEASURE: Survival. RESULTS: The mean (SD; range) ejection fractions were similar in all three groups: survivors 45.9 (11.0; 27.0-52.0), cardiac death 44.0 (7.90; 28.5-59.0), and non-cardiac death 45.3 (4.55; 39.0-50.0). QTc dispersion was significantly prolonged in the cardiac death group compared with in the survivors (86.3(23.9; 41.0-139) v 56.5 (25.4; 25.0-164); P = 0.002). A QTc dispersion > or = 60 ms had a 92% sensitivity and 81% specificity in predicting cardiac death, QTc dispersion in patients with diffuse coronary artery disease was significantly (P < 0.05) greater than in those with no disease or disease affecting one, two, or three vessels. CONCLUSIONS: There is a strong link between QTc dispersion and cardiac death in patients with peripheral vascular disease. QTc dispersion may therefore be a cheap and non-invasive way of assessing the risk of cardiac death in patients with peripheral vascular disease.
Aged↗
Transluminal atherectomy for occlusive peripheral vascular disease.
Sixty-one patients with occlusive peripheral vascular disease were treated with transluminal atherectomy, a catheter-mediated technique for removal of atheroma. The technique was performed using 7Fr, 9Fr or 11Fr atherectomy catheters. Mean percent diameter stenosis was reduced from 71 to 23%, by removal of 831 atheromatous specimens in 949 passes of the cutting element through 136 stenoses in 61 patients. All specimens removed were sent for histopathologic examination to determine the components of the atheroma removed, which differed for specimens removed from original vs restenotic lesions. Percent stenosis was reduced to less than 45% in 118 of 136 stenoses (87%). Complications included 1 thrombus, which resolved after intraarterial infusion of streptokinase and 1 probable distal embolization without sequelae. Three angiographic dissections occurred without impairment of blood flow. There were no instances of acute occlusion, vascular spasm or vessel perforation. Six-month follow-up angiography was performed showing that patients who had a residual stenosis less than 30% after initial atherectomy had a lower restenosis rate (18%) than patients with initial residual stenoses greater than 30% (52%); this result demonstrated the importance of performing more complete atherectomy. Transluminal atherectomy appears to be an effective, predictable and safe method for removing occlusive atheromatous deposits from peripheral arteries.
Angioplasty, Balloon↗
Is erectile dysfunction predictive of peripheral vascular disease?
The association between erectile dysfunction (ED) and peripheral vascular disease (PVD) among men was examined in the Integrated Healthcare Information Services National Managed Care Benchmark Database (IHCIS). The IHCIS is a fully de-identified, Health Insurance Portability and Accountability Act compliant database and includes complete medical histories for more than 17 million managed-care lives; data from more than 30 US health plans, covering seven census regions; and patient demographics, including morbidity, age and gender. A total of 12 825 ED patients and an equal number of male patients without ED were included in the retrospective cohort study. Logistic regression analyses were performed to assess the adjusted risk of PVD that accounted for age at ED diagnosis, smoking, obesity and medications including angiotensin converting enzyme (ACE) inhibitors, beta blockers and statins. The cohort of men with ED were observed to have a 75% increase in risk for PVD (odds ratio (OR) = 1.75, 95% confidence interval (CI) = 1.06, 2.90) after adjusting for age at ED diagnosis, smoking, obesity and use of ACE inhibitors, beta blockers and statins. Some evidence of a possible trend towards increased risk was detected by age group. After controlling for the aforementioned covariates and compared to men aged 30-39 years, it was noted that patients aged 40-44 years were 2.1 times more likely to develop PVD (OR = 2.07, 95% CI = 0.89, 4.81), 45-49-year-old men were also more than twice as likely to have PVD (OR = 2.32, 95% CI = 1.03, 5.22), and 50-55-year-old patients had a three-fold increased risk of developing PVD (OR = 3.00, 95% CI = 1.40, 6.43). The results of this study indicate that ED may serve as a marker for PVD. The risk becomes more pronounced with increasing age, indicating the need for cardiologists and internists to monitor ED patients who may not necessarily present with cardiovascular symptoms.
Adult↗
Clinical update on pentoxifylline therapy for diabetes-induced peripheral vascular disease.
OBJECTIVE: To introduce readers to the use of pentoxifylline for diabetes-induced peripheral vascular disease. The article provides background on the pathophysiology of diabetic foot ulcers as well as a review of the literature on the therapeutic use of pentoxifylline for treating this disorder. DATA SOURCES: A MEDLINE search was used to identify pertinent literature, including review articles and case reports. Key index terms included pentoxifylline, diabetic foot ulcer, neuropathy, peripheral vascular disease, and intermittent claudication DATA EXTRACTION: Basic pharmacologic data regarding absorption, distribution, metabolism, and excretion were reported in normal subjects as well as in patients with renal impairment. Open and controlled clinical trials also were analyzed; subjective symptoms were reported. The economic implications also were reported. The pharmacist's role in patient education is discussed. DATA SYNTHESIS: Pentoxifylline 800 mg/d was found to be effective in improving the symptoms in patients with noninsulin-dependent diabetes mellitus, including improvement in walking distance, paresthesia, skin temperature, and subjective overall response. In nondiabetic patients, statistically significant differences in leg-ulcer healing were found between the treatment and placebo groups. Case reports illustrated healing times, which ranged from two weeks to six months. Pentoxifylline use in both insulin-dependent and noninsulin-dependent patients was assessed in clinical trials, with improvement of symptoms in both patient types. CONCLUSIONS: Studies show that pentoxifylline is an alternative to vascular surgery in the management of peripheral vascular disease in diabetic patients, particularly in those with chronic ulceration of the lower extremities that does not heal despite other optimal treatment regimens, including cessation of smoking, maintenance of normoglycemia, elimination of vasoconstrictive drugs, correctly fitted shoes, and appropriate would care. Pentoxifylline therapy may provide an appropriate, economical treatment modality by reducing the need for hospitalization and vascular surgery.
Clinical Trials as Topic↗
Altered low density lipoproteins in peripheral vascular disease patients.
Several studies have shown that peripheral vascular disease (PVD) patients have abnormal lipoproteins. The mechanism whereby this abnormal lipid metabolism influences arterial occlusive disease in these PVD patients is not known. In the present study we found that low density lipoproteins (LDL) obtained from PVD patients have lower affinity to B receptor of normal fibroblasts compared to LDL obtained from control subjects. The nanograms of 125I LDL bound per milligram of B receptor was 254 +/- 19 for LDL from control subjects, 152 +/- 12 for LDL from PVD without diabetes, and 108 +/- 8 for PVD with diabetes (P less than 0.01). Further, the preincubation of LDL obtained from PVD patients with pentoxifylline (xanthine derivative used for PVD) increased the binding affinity of the LDL to B receptor sites from 107 +/- 9 to 210 +/- 34 (P less than 0.01). There was no significant difference in the binding properties of LDL with fibroblasts either from PVD patients (254 +/- 19) or control subjects (267 +/- 22) (P greater than 0.5), thereby suggesting that the number of receptor sites may be the same in both types of fibroblasts. From these results it can be concluded that defect in the metabolism of LDL may promote arterial occlusive disease seen in the PVD patients.
Aged↗