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At least 37 records · Page 2Linked to original sources
PubMed1990

Chronic cocaine treatment enhances the responsiveness of the left anterior descending coronary artery and the femoral artery to vasoactive substances.

The mechanism by which cocaine produces sudden cardiac death has not been elucidated, but clinical evidence indicates that it may be due to a direct or indirect action on coronary vessels. The present study was designed to compare the responses of the isolated left anterior descending (LAD) coronary artery and femoral artery taken from untreated dogs with the response of these vessels taken from dogs administered cocaine (1 mg/kg i.v.) daily for 4 weeks. The actions of norepinephrine, U-46619 (a thromboxane A2 analog) and serotonin (5-HT) were evaluated. The direct vascular action of cocaine was also determined. Morphology of the blood vessels was evaluated by scanning electron microscopy. Chronic cocaine treatment significantly increased the sensitivity and maximum response of the femoral artery to norepinephrine, U-46619 and 5-HT. The sensitivity of the LAD coronary artery to U-46619 and 5-HT and the maximum response to U-46619 and 5-HT were also enhanced. Vasoconstriction produced by cocaine was not dose dependent and only occurred at high concentrations (10(-5)-10(-4) M). Morphology of the vessels was evaluated by scanning electron microscopy. Femoral arteries from cocaine-treated dogs exhibited loss of endothelial integrity, areas of excessive endothelial cell sloughing and thrombus formation. LAD coronary arteries exhibited only areas of enhanced endothelial cell sloughing. The results of this study indicate that the femoral artery and the LAD coronary artery are more sensitive to endogenous vasoactive substances after chronic cocaine use, which may result in enhanced peripheral vasoconstriction and cardiac ischemia. Morphological results demonstrate femoral arterial thrombosis associated with cocaine use.

15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5↗
PubMedDate not supplied

Arterial injuries from femoral artery cannulation with port access cardiac surgery.

Although minimally invasive (MI) cardiac surgery reduces blood loss, hospital stay, and recovery time, some MI approaches require femoral arterial cannulation, which introduces a heretofore unknown risk of femoral arterial injury. This study was performed to examine the risk of femoral arterial injury after Port Access MI cardiac surgery (PA-MICS) with femoral cannulation. Data were prospectively obtained on 739 consecutive patients who had PA-MICS with femoral cannulation between June 1996 and April 2000, identifying any patient with new (<30 days postoperative) arterial insufficiency from the cannulation site. Patient characteristics (gender, age, height, weight, body surface area, smoking, peripheral vascular disease, diabetes) and operative variables (cannula size, cross-clamp time) were examined with univariate and multivariate analysis to identify risk factors for arterial injury. Injuries were defined and classified by radiologic and intraoperative assessment, and follow-up was obtained by patient examination and from the medical records. Femoral arterial occlusion (FAC) occurred in 0.68% (5/739) of patients (4 women, 1 man; age range 26-74 years). The risk of femoral injury was higher in women: 1.31% vs 0.23% (p = 0.07). One patient had intraoperative limb ischemia from iliofemoral dissection and was treated by axillopopliteal bypass. Four patients presented postoperatively with claudication. Three of these had iliofemoral arterial occlusion or localized iliofemoral dissection and were treated with iliofemoral bypass, and 1 patient had localized femoral artery stenosis treated by angioplasty. With a mean follow-up of 17.8 months (range 13-26 months) limb salvage was achieved in all patients. Secondary or tertiary interventions were required in 40% (2/5), both in patients with iliofemoral occlusion, and 1 patient (20% of femoral injuries, 0.135% of overall series) has chronic graft occlusion and long-term claudication. The risk of arterial injury after femoral arterial cannulation and perfusion for Port Access surgery was low (0.68%). This risk is increased in women and is unpredictable. Initial vascular repair has a significant failure rate, and secondary interventions are often necessary. Although the femoral cannulation and perfusion technique is safe overall, the risk must be clearly recognized.

Adult↗
PubMed1986

Extensive endarterectomy of the aorta, common and external iliac arteries, and common femoral arteries by a modified Le Veen method.

It has been 8 years since Le Veen et al. described a new method of disobliteration of the distal aorta and iliac arteries. Since then no further reports have appeared in the literature. During the past 2 1/2 years we have treated 23 patients with severe ischemia of the lower limbs, caused in most cases by severe and multilevel arterial occlusions (types II and III), which included the infrarenal aorta, common and external iliac arteries, and common femoral arteries, with the method of Le Veen et al. with some modifications in the technique. A satisfactory revascularization was obtained in all patients. Similarly, there were no operative deaths or morbidity and no early or late arterial occlusions. We conclude that this method of arterial disobliteration has certain advantages over the much more widely used bypass grafting, deserves an extensive trial, and could in the future become a well-accepted procedure to treat extensive occlusions of the distal aorta, common and external iliac arteries, and common femoral arteries.

Aged↗
PubMed1993

Endothelium in the aorta and ilio-femoral arteries proximal to femoral arteriovenous fistulae in rabbits.

The endothelium and underlying internal elastic lamina of the aorta and ilio-femoral arteries from 15 rabbits with femoral arteriovenous fistulae (2 to 92 days postoperatively) and 3 rabbits with control femoral arteriotomies were examined using the en face technique and scanning electron microscopy. The rapidity of development of the tears in the internal elastic lamina of the muscular ilio-femoral arteries was greater than in fistulae involving the elastic common carotid artery. The elastic tissue tears appeared to have a predilection for certain anatomical regions possibly related to regions of specific hemodynamic stress. A few tears were observed in the aorta near the origin of the renal arteries. Initially the elastic tissue tears in the afferent ilio-femoral arteries were longitudinally orientated and the endothelium overlying the elastic tissue tears soon exhibited increased cell density relatively restricted to the floor of the tears. This cellular pattern was similar to that in the carotid-jugular fistulae. With time the endothelium assumed a more conventional morphology.

Animals↗
PubMed1995

[Effect of the frequency of neuromuscular electric stimulation of the leg on femoral arterial blood flow].

In a previous work we have demonstrated that the transcutaneous neuromuscular electrical stimulation of the muscles of the leg in the human increases largely the arterial femoral blood flow. This elevated flow is stable during the stimulation. The present work deals with the influence of the frequency of the stimulation on the level of this hyperaemia. The neuromuscular electrical stimulation is applied to the internal and external branches of the sciatic nerve in order to stimulate the whole muscles of the leg and the foot. The stimulus is yielded by a Compex stimulator for seven minutes with frequencies in random order between 3 and 15 Hz. The intensity of the current (mean: 31 mA) is set up at such a level to increase blood flow by at least 100% at 5 Hz. The femoral arterial flow velocity and the pulsatility index are assessed during the last minute of the stimulation by a duplex ultrasound method. The peripheral vascular resistance is calculated on the base of the femoral blood flow and the mean arterial pressure. Seven healthy volunteers are studied (6 males and one female, aged 26.9 years, +/- 6.9). The haemodynamic variables are recorded at rest (table I). We observe a linear increase of the blood flow with increasing frequencies of stimulation (181% of the rest value at 3 Hz and 276% at 9 Hz) (fig. 1).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Carotid artery reconstruction using superficial femoral arterial grafts.

The indications, consequences, and value of resection of the carotid artery as part of an extended neck dissection has been discussed for many years. Many of the earlier reports have focused on the sequelae of carotid artery ligation and tests to predict patient tolerance for the procedure. Efforts to reconstruct the carotid artery have been limited primarily to vein grafts. The authors report on 11 cases of reconstruction of the carotid artery using the patient's superficial femoral artery. The femoral artery itself is reconstructed using a Gore-Tex graft. Free autografts of the superficial femoral artery in the carotid location have been found to be an excellent size match, mechanically stronger than a vein graft, and tolerant of bacterial contamination. Arteriography in 1 case with 14 months' follow-up demonstrates long-term patency.

Blood Vessel Prosthesis↗
PubMed2002

Transcatheter thrombolysis with high-dose bolus tissue plasminogen activator in iatrogenic arterial occlusion after femoral arterial catheterization.

PURPOSE: To assess the efficacy of percutaneous local thrombolysis with high-dose bolus recombinant tissue plasminogen activator (rt-PA) in patients with acute limb ischemia due to arterial thrombosis after cardiac catheterization. METHODS: We treated eight patients (7 men; mean age 56 years) with thrombotic occlusion of both the common femoral artery (CFA) and external iliac artery (EIA) in six patients and of the CFA only in two patients. Two 5 mg boluses of rt-PA were injected into the proximal clot through a 5 Fr end-hole catheter and subsequently two additional boluses of 5 mg rt-PA were given through a catheter with multiple side-holes. In case of a significant amount of residual thrombus, a continuous infusion of 2.5 mg/hr of rt-PA was started. RESULTS: Successful lysis was achieved in all patients. The mean duration of lysis was 2 hr 41 min. The mean total amount of rt-PA delivered was 23.16 mg. In four patients unmasked flow-limited dissections confined to the CFA were managed by prolonged balloon dilatation, while in the remaining four patients with extension of the dissection to the external iliac artery one or two Easy Wallstents were implanted. There was prompt relief of lower limb ischemic symptoms and signs in all patients. Two groin hematomas were conservatively treated. Clinical and color Doppler flow imaging follow-up with a mean duration of 15 months, showed no reappearance of ischemic symptoms or development of restenosis in any of the patients. One patient died 6 months after thrombolysis. CONCLUSIONS: Transcatheter thrombolysis with high-dose bolus rt-PA is a safe and effective treatment in patients with iatrogenic arterial occlusion after femoral catheterization. Underlying dissections should be treated by prolonged balloon dilatation but stent implantation is often required.

Angiography↗
PubMed1985

Eversion endarterectomy of the superficial femoral artery and end-to-side anastomosis to the deep femoral artery. An alternative to extended profundoplasty.

The success of aortofemoral reconstruction in patients with superficial femoral artery occlusion depends on the restoration of a satisfactory pulsatile flow to the deep femoral artery. In 18 patients with multilevel disease, widespread involvement of the deep femoral artery, and poor distal outflow, we performed an eversion endarterectomy of the proximal segment of the superficial femoral artery and constructed an end-to-side anastomosis between this segment and the distal deep femoral artery. In 10 patients, the reconstruction was performed after thrombectomy of the occluded aortofemoral graft, and in 8 the two reconstructions were simultaneous. The actuarial patency rate was 93.5 percent at 1 year and 75.2 percent at 5 years. Four late femorodistal bypasses were performed that gave an actuarial limb salvage rate of 68.8 percent at 1 year and 61.6 percent at 5 years. In selected cases, this technique is a valid alternative to an extended profundoplasty or to a femorodistal bypass.

Aged↗
PubMedDate not supplied

Selective non-operative management of pseudoaneurysms and arteriovenous fistulae complicating femoral artery catheterization.

Femoral arterial pseudoaneurysms or arteriovenous fistulae may sometimes complicate percutaneous femoral artery catheterization procedures. Most surgeons recommend prompt operative repair because of the unfavorable natural history of pseudoaneurysms or arteriovenous fistulae secondary to violent or accidental arterial trauma. However, the natural history of catheterization-induced pseudoaneurysms and arteriovenous fistulae has not been well documented. Accordingly, we prospectively studied the natural history of 22 pseudoaneurysms, 8 arteriovenous fistulae, and 3 combined lesions, identified by duplex scan in 32 patients following trans-femoral cardiac, peripheral vascular, or vascular access arterial catheterization procedures. Angiographic procedures were performed with the use of 5-8F introducer sheaths. A femoral artery complication was significantly more likely to result from coronary balloon angioplasty (9/304; 3.0%) than from diagnostic cardiac catheterization (21/2476; 0.8%) (p less than 0.003; chi square). Fourteen patients (13 pseudoaneurysms, 1 combined pseudoaneurysm/fistulae) underwent surgical repair. Pain and/or enlarging hematoma resulted in repair within two days of the diagnosis in 8 patients. The need for chronic anticoagulation prompted elective repair in 2 patients. A pseudoaneurysm was repaired in one patient five days following catheterization when it became painful. In three stable patients, asymptomatic pseudoaneurysms were repaired electively during another surgical procedure. There were no operative deaths. One patients (7%) developed a wound infection postoperatively. Eighteen patients (19 arterial lesions: 9 pseudoaneurysms, 8 arteriovenous fistulae, 2 combined pseudoaneurysms/arteriovenous fistulae) with improving symptoms and stable physical signs were followed by serial clinical evaluation and duplex scans. Seventeen of 19 (89%) of these lesions resolved spontaneously within 5-90 days (mean 30.7 days).(ABSTRACT TRUNCATED AT 250 WORDS)

Aneurysm↗
PubMed2001

Obtaining a superficial femoral artery graft in adolescents and children with the deep femoral artery transposition.

A new technique to obtain a segment of the superficial femoral artery as an arterial conduit in young patients while an unobstructed peripheral blood flow is maintained by superficial femoral artery-deep femoral artery transposition is illustrated with two clinical examples. The explanted arterial autograft requires no replacement by another graft and provides a conduit of up to 10 cm in length. Excellent results were achieved in both patients at 1 year. This technique is recommended instead of saphenous vein conduits in very young patients because of the risk for late vein degeneration.

Adolescent↗
PubMed2004

Prospective randomized study on reversed saphenous vein infrapopliteal bypass to treat limb-threatening ischemia: common femoral artery versus superficial femoral or popliteal and tibial arteries as inflow.

PURPOSE: Use of inflow sources distal to the common femoral artery (CFA) for bypass to infrapopliteal arteries is a compromise measure when the length of the vein is not adequate. The purpose of this study was to compare the clinical outcome of vein infrapopliteal bypass arising from the CFA and from the distal superficial femoral or popliteal and tibial arteries in patients with limb-threatening ischemia. METHODS: Over 13 years, 160 vein infrapopliteal vein bypass procedures (160 patients) were randomized into 2 groups, 80 with inflow arising from the CFA (group 1) and 80 with inflow from below the CFA (group 2). Patency and limb salvage rates were assessed with the Kaplan-Meier method. All patients underwent graft surveillance at discharge and at 30 days and 6 months after surgery, then every 6 months thereafter. Follow-up ranged from 30 days to 127 months (mean, 49 months). RESULTS: Groups were similar with regard to age, sex, and most atherosclerotic risk factors. Gangrene as an indication for surgery was statistically more frequent in group 1 (73.7% vs 48.7%; P = .002), whereas nonhealing ulcer and rest pain were statistically more frequent in group 2 (respectively, 51.2% vs 25%; P = .001 and 46.2% vs 28.7%; P = .03). No patients died during the perioperative (30 days) period. At 1, 3, and 5 years patency and limb salvage rates were comparable between groups, tending toward significance for the 5-year primary patency rate (73% vs 57%; P = .08). CONCLUSIONS: In the absence of significant proximal disease, infrapopliteal revascularization arising distal to the CFA can ensure patency and limb salvage rates statistically similar to those with use of the CFA. Moreover, procedures arising distal to the CFA required fewer graft revisions to maintain patency of failing grafts.

Aged↗
PubMed1998

Stent-grafts in the superficial femoral artery.

Superficial femoral artery disease is still cumbersome to treat. While percutaneous transluminal angioplasty (PTA) and stent replacement are well established treatment modalities for occlusive iliac or renal artery diseases, less favorable results are obtained with these techniques in the superficial femoral artery. Bypass surgery with the use of an autologous vein still gives the best results. A less invasive alternative is therefore desirable. The use of stent-grafts seems promising as it combines the technology of a less invasive endovascular treatment with the advantages of creating an anatomical endoprosthetic smooth conduit. This article gives an overview of the different types of stent-grafts and their clinical applications.

Aneurysm↗