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PubMed1993

[MR evaluation of common femoral arterial flow: age-related changes and characteristics in obstructive arterial disease of lower extremities].

Flow velocity measurements of the common femoral arteries in 60 lower extremities of 30 healthy subjects and 12 lower extremities of 7 patients with arteriosclerosis obliterans (ASO) were performed by means of magnetic resonance imaging with a use of presaturation bolus tracking (PBT) method. Our PBT method can provide both precise determination of flow velocity and evaluation of flow patterns within 30 minutes in the clinical setting. In phantom study, MR flow velocity had good correlation with actual flow velocity (r = 0.997). 30 healthy volunteers were classified into three groups; group I (20-40 years), group II (41-60 years) and group III (61-80 years). Starting time of acceleration (STA) were shortened as the age progressed. Peak reverse velocity (PRV), maximum deceleration rate (MDR), peak forward velocity/mean velocity ratio (PFV/MV) and pulsatility index (PI) were significantly decreased in group III as compared to group I and group II. Although intraluminal flow profile showed almost uniform during acceleration time on MR images, flow profile became disproportioned and reverse flow was observed in the medial portion during deceleration time. These characteristic hemodynamics were recognized in all healthy subjects regardless to the different age group. In ASO, STA was prolonged and PFV, PRV, Maximum acceleration rate, MDR, PFV/MV, PI, Vascular sectional area, flow volume were significantly decreased (p < 0.001) as compared to the control healthy group III. As the result we obtained marked characteristics such as flattening of curves and disappearance of reverse flow in MR flow waveform. On MR images, disproportion of intraluminal flow profile, decreased flow velocities during acceleration time and disappearance of reverse flow (11 of 12 extremities) during deceleration time were observed.

Adult↗

PubMed1998

Diabetic ulcers of the lower extremity: a review of comprehensive management.

The management of lower extremity diabetic ulceration exacts enormous emotional and economic costs from patients, their family members and caregivers, and society. A team approach to wound healing has proved effective, but efforts at prevention have been less successful. The etiology of lower extremity diabetic ulcers includes injury complicated by underlying neuropathy, ischemia, or both. Prevention of primary and recurrent ulcers can be increased through programs to educate patients and caregivers. Proper management begins with thorough assessment and continues with various forms of medical and surgical therapy, and timely referral to specialists when appropriate. The use of recombinant growth factors is becoming more widespread as more is learned about their essential role in wound healing. Monitoring the wound while it is being treated is as important as initial assessment. Across the United States and Canada, wound care clinics are being established to provide intensive care directed by specially trained multidisciplinary care teams. Less populated areas must rely on proper education of ET nurses, home care nurses, visiting nurses, podiatrists/chiropodists, and allied healthcare professionals. Challenges for the future include the development of protocols for comprehensive assessment and care, better methods of prevention, a greater understanding of the role of growth factors in wound healing, and optimizing wound care.

Diabetic Foot↗

PubMed1986

Trends in revascularization of the lower extremity.

Several trends are evident in revascularization of the lower extremity. Currently, few patients with severe leg ischemia undergo amputation without prior surgical or angioplasty attempts at revascularization. Percutaneous balloon angioplasty and thrombolytic therapy have had a definite but limited influence on the treatment of all patients with lower-limb arterial disease. Although pentoxifylline, a hemorrheologic agent, is being widely used, it has not changed the need for surgical intervention in patients with severe arterial disease. In the aggressive approach to save legs with severe popliteal-tibial disease, the use of femorotibial grafts is increasing. In situ saphenous vein grafting is becoming the operation of choice for infrapopliteal occlusive disease. For most patients with severe lower-extremity arterial occlusive disease, a properly selected and conducted operation remains the safest and most durable treatment.

Angioplasty, Balloon↗

PubMed1989

Influence of appropriate lower extremity orthotic management on ambulation, pain, and fatigue in a postpolio population.

A major functional problem for the postpolio patient is the loss of ambulation ability. A retrospective study of lower extremity orthotic management for ambulation was made of 104 subjects with histories of paralytic poliomyelitis who received treatment and evaluation in a postpolio clinic. Thirty-six patients (35%) had a remote history of a surgical arthrodesis of the ankle. Fifty-six subjects (54%) reported using lower extremity orthoses after the onset of their polio. At initial postpolio clinic evaluation 19 subjects (18%) were using lower extremity orthoses, and all of these patients had a remote history of orthotic use. After clinical evaluation, a new lower extremity orthosis was recommended for 37 subjects (36%). Nine of these patients had never used orthotic devices. New orthoses for a previously braced limb or an additional orthosis for a previously unbraced limb were prescribed more frequently in previously braced patients (28 of 56 vs 9 of 48, p less than 0.02). Seventy-two percent of subjects with ankle fusion required new orthoses; 19% of those without fusion required one (p less than 0.001). A questionnaire returned by 81 subjects (78%) indicated that appropriate orthotic prescription significantly improved the ability to walk, increased perceived walking safety, and reduced knee and overall pain (p = 0.04 to 0.008).

Adult↗

PubMed2003

Lower extremity muscle activities during cycling are influenced by load and frequency.

The purpose of this experiment was to investigate the effects of frequency and inertia on lower extremity muscle activities during cycling. Electromyographic (EMG) data of seven lower extremity muscles were collected. Sixteen subjects cycled at 250 W across different cadences (60, 80, and 100 rpm) with different loads (0, 0.5, 1.0, 1.5, and 2.0 kg) attached to distal end of their thighs. Load and cadence interactions were observed for the offset of the biceps femoris (BF), the active duration of the rectus femoris (RF), and the peak magnitudes of the vastus lateralis (VL) and the tibialis anterior (TA). Cadence effects were observed in the onset of the gluteus maximus (GM), RF, BF, VL, and TA; the offset of the GM, RF, BF, VL; the duration of the BF and TA; the peak magnitude of the RF and gastrocnemius (GAS); and the crank angle at which the peak magnitude was achieved of the BF, GAS, and soleus (SOL). Load effect was observed from the onset of RF and SOL, the offset of RF, the duration of SOL, and the peak magnitude of BF. These results indicate that inertial properties influence the lower extremity muscular activity in addition to the cadence effect.

Adult↗

PubMedDate not supplied

[The medical effect of magnetic-laser therapy in patients with diabetic angiopathies of the lower extremities].

Conventional antidiabetic therapy with insulin and sugar-lowering agents helps in achieving compensation of diabetes mellitus but fails to exert high effect on subjective and objective manifestations of diabetic microangiopathies of the lower extremities. A course of magnetic-laser therapy results in significant reduction of concentration of the lipid oxidation products as one of the pathogenetic mechanisms of diabetic microangiopathies, normalization of immunologic reactivity as well as attenuation of clinical manifestations of hemocirculatory disorders in the lower extremities and improvement of parameters of thermo- and rheovasography.

Adolescent↗

PubMed2004

Prooxidant-antioxidant balance in blood during the surgical treatment of obliterating arterial atherosclerosis in the lower extremities.

The chronic disorder of arterial circulation in the lower extremities due to the atherosclerotic injuries of the femoral-popliteal-tibial arteries was accompanied by the shift of the blood prooxidant-antioxidant balance towards more active free radical oxidation and by a depletion of antioxidant system. After restoring arterial blood flow in the ischemic lower extremities this balance was shifted towards more prominent lipid peroxidation processes. Such pattern of prooxidant-antioxidant balance changes implicates the development of strategies for its correction targeted on the reduction of lipid peroxidation activity and therefore on a tissue defense against the reperfusion injury.

Antioxidants↗

PubMedDate not supplied

Successful pharmacologic treatment of lower extremity ulcerations in 5 patients with chronic critical limb ischemia.

BACKGROUND: Ischemic ulcerations of the distal lower extremities are a manifestation of chronic critical limb ischemia. Without restoration of arterial flow, subsequent gangrene and limb loss can ensue. Unfortunately, revascularization is not always possible. METHODS: A literature search of MEDLINE was performed and a case series of 5 patients with lower extremity ischemic ulcerations is described. RESULTS AND CONCLUSION: Five patients with severe peripheral artery disease had nonhealing lower extremity ischemic ulcerations. Because 3 patients were not ideal candidates for percutaneous or surgical intervention, and 2 refused invasive therapy, they were treated with cilostazol. Between 7 and 24 weeks after beginning cilostazol therapy, the ulcerations healed in all 5 patients. Three of the patients experienced resolution of concurrent ischemic rest pain. One patient underwent a posttreatment noninvasive arterial study that documented improved large- and small-vessel perfusion. The antiplatelet, antithrombotic, and vasodilatory effects, in addition to possible unrecognized actions of cilostazol, appeared to promote wound healing in this small group of patients with chronic critical limb ischemia. When revascularization is not ideal therapy for ischemic ulcers, a pharmacologic approach with cilostazol might induce healing and obviate limb amputation.

Adult↗

PubMed2003

Risk factors associated with infection of lower extremity revascularization: analysis of 365 procedures performed at a teaching hospital.

Infection of arterial reconstructions is associated with high rates of mortality and limb loss despite optimal treatment. Lower extremity revascularization procedures performed at a teaching hospital were reviewed to identify risk factors associated with wound infection. Medical records, postoperative infection surveillance forms, and a computerized vascular registry for lower extremity revascularizations involving a common femoral or more distal artery during a 3-year period were reviewed. There were 335 bypass operations (184 femoral-distal, 36 popliteal-distal, 17 aortofemoral, 13 femorofemoral, 11 axillofemoral, 74 graft revisions) and 30 other vascular procedures (arterial thrombectomy or endarterectomy). Factors analyzed included age, gender, diabetes mellitus, dialysis dependence, malnutrition, obesity, ipsilateral foot ulcer or gangrene, separate admissions within the month preceding surgery, length of hospital stay before surgery, length of operation, wound hematoma requiring reoperation, vein or prosthetic grafts, or redo surgery. Risk factors commonly thought to increase wound infection following lower extremity revascularizations, such as diabetes, obesity, renal failure, redo surgery, and prosthetic grafts, did not predict this complication in this series. Given the correlation of operative time with infection, efforts to minimize operative time by "double-teaming" staff participation in teaching cases may decrease infection rates, although this is speculative. Vascular services should institute strategies to ensure that appropriate prophylactic antibiotics are administered in a timely fashion before lower extremity revascularizations.

Aged↗

PubMed2003

Lower extremity amputation episodes among persons with diabetes--New Mexico, 2000.

Lower extremity amputation (LEA) is one of the most disabling complications of diabetes. Lower extremity problems tend to recur among persons because of underlying complications, including the loss of "protective" sensation. To define the burden of LEA among persons with diabetes in New Mexico, the New Mexico Diabetes Prevention and Control Program (DPCP) analyzed data from the Hospital Inpatient Discharge Database (HIDD) and the Santa Fe Indian Hospital (SFIH) from 2000 by linking hospital discharges to persons to create "episodes" of LEA. This report summarizes the findings of that analysis, which indicated that the age-adjusted rate of LEA by episode was approximately 3.5 times higher for American Indians (AIs) (11.4 per 1,000 persons with diabetes) than for non-Hispanic whites (3.3). To address this disparity, DPCP is collaborating with the Indian Health Service (IHS) to determine the needs for foot-care resources and education in AI communities.

Adult↗

PubMedDate not supplied

Two-level disc herniation in the cervical and thoracic spine presenting with spastic paresis in the lower extremities without clinical symptoms or signs in the upper extremities.

BACKGROUND CONTEXT: There is no report in the literature of two-level disc herniation in the cervical and thoracic spine presenting with spastic paresis/paralysis exclusively in the bilateral lower extremities. PURPOSE: To identify the clinical characteristics of specific myelopathy resulting from C6-C7 disc herniation through a case with spastic paresis in the lower extremities without upper extremities symptoms due to separate disc herniation in the cervical and thoracic spine, which was surgically removed in two stages. STUDY DESIGN/SETTING: A case report. METHODS: A 48-year-old man developed a gait disturbance as well as weakness and numbness in the lower extremities. Thoracic magnetic resonance imaging (MRI) showed a T11-T12 disc herniation, which was removed under the surgical microscope through a minimally invasive posterior approach. He improved, but 2 months after surgery developed recurrent numbness and spasticity. On this occasion, no evidence of recurrence of the thoracic disc herniation could be identified, but cervical MRI demonstrated a compressed spinal cord at the C6-C7 level. The patient had no neurological findings in the upper extremities. The herniated disc at C6-C7 was removed under the surgical microscope with laminoplasty. RESULTS: The symptoms gradually improved after surgery. At the present time, 2 years and 9 months after the initial operation, the patient had a stable gait and was able to work. CONCLUSIONS: Our experience suggests that in the diagnosis of patients with spastic paresis and sensory disturbances in the lower extremities, spinal cord compression should be explored by imaging studies not only in the thoracic spine but also in the cervical spine, especially at the C6-C7 level, even if the symptoms and abnormal neurological findings are absent in the upper extremities.

Arm↗

PubMed2003

Sarcopenia: alternative definitions and associations with lower extremity function.

OBJECTIVES: To compare two sarcopenia definitions and examine the relationship between them and lower extremity function and other health related factors using data from the baseline examination of the Health Aging and Body Composition (Health ABC) Study. DESIGN: Observational cohort study. SETTING: Two U.S. communities in Memphis, Tennessee, and Pittsburgh, Pennsylvania. PARTICIPANTS: Participants were aged 70 to 79 (N=2984, 52% women, 41% black). MEASUREMENTS: Participants were assessed using dual energy x-ray absorptiometry and were classified as sarcopenic using two different approaches to adjust lean mass for body size: appendicular lean mass divided by height-squared (aLM/ht2) and appendicular lean mass adjusted for height and body fat mass (residuals). RESULTS: These methods differed substantially in the classification of individuals as being sarcopenic, especially those who were more obese. The former method was highly correlated with body mass index and identified fewer overweight or obese individuals as sarcopenic. In both men and women, none of the obese group would be considered sarcopenic using the aLM/ht2 method, compared with 11.5% of men and 21.0% of women using the residuals method. In men, both classifications of sarcopenia were associated with smoking, poorer health, lower activity, and impaired lower extremity function. Fewer associations with health factors were noted in women, but the classification based on both height and fat mass was more strongly associated with lower extremity functional limitations (odds ratio (OR)=0.9, 95% confidence interval (CI)=0.7-1.2 for low kg/ht2; OR=1.9, 95% CI=1.4-2.5 for lean mass adjusted for height and fat mass). CONCLUSION: These findings suggest that fat mass should be considered in estimating prevalence of sarcopenia in women and in overweight or obese individuals.

Absorptiometry, Photon↗

PubMedDate not supplied

A case of pelvic lipomatosis presenting with edema of the lower extremities.

We report a 29-year-old male with pelvic lipomatosis that presented with edema of the lower extremities. The patient visited our department because of the marked edema of the lower extremities with body weight gain. The pelvic region was generally radiolucent on plain abdominal radiogram. Excretory urogram and pelvic computed tomography scan revealed compression of the bladder by an adipose tissue mass. On lymphograms, lymph vessels were compressed from the inguinal area in the common iliac region. The edema of the lower extremities was thought to be caused by lymph vessel obstruction.

Adult↗

PubMed1976

Blood flow and venous distensibility in the upper and lower extremities of newborn infants.

The electrocapacitance plethysmograph was utilized to measure peripheral blood flow and venous distensibility in 17 newborn infants and 20 adults. Measurements were made in the upper and lower extremities in each subject under identical environmental conditions. Blood flow in the forearm and calf were found to be significantly higher in infants than adults. In infants there were no significant differences in the blood flow between the upper and lower extremities. In contrast, in the adults, the blood flow was significantly higher in the upper than in the lower extremities. Similarly, venous distensibility was observed to be higher in infants than in adults. While no significant differences were observed in the venous distensibility between the upper and lower extremities in infants, the venous distensibility was found to be higher in the forearm than in the leg in adults.

Adult↗

PubMed1999

Aortoiliac and lower extremity arteries: comparison of three-dimensional dynamic contrast-enhanced subtraction MR angiography and conventional angiography.

PURPOSE: To determine the clinical feasibility of three-dimensional dynamic contrast agent-enhanced subtraction magnetic resonance (MR) angiography in patients with symptoms of lower extremity ischemia. MATERIALS AND METHODS: Twenty-three patients suspected of having lower extremity ischemia underwent three-dimensional dynamic contrast-enhanced subtraction MR angiography of the aortoiliac arteries and arteries of the lower extremity. As the reference standard, conventional angiography was also performed. For data analysis, the arterial system was divided into 10 segments. Each segment was classified as normal, mildly stenosed, moderately stenosed, severely stenosed, or occluded. RESULTS: At conventional angiography, 83 stenosed segments (14 mildly stenosed, 16 moderately stenosed, 14 severely stenosed, and 39 occluded) were identified in a total of 423 segments. For the segments with more than mild stenosis, MR angiography was 97.1% sensitive and 99.2% specific. CONCLUSION: Three-dimensional dynamic contrast-enhanced subtraction MR angiography has high sensitivity and specificity. This technique is a noninvasive alternative to conventional angiography for screening patients suspected of having lower extremity ischemia.

Aged↗

PubMed2000

Utility of both muscle and fascia flaps in severe lower extremity trauma.

BACKGROUND: The evolving technology in trauma management today permits salvage of many severe lower extremity injuries previously even considered to be lethal. An essential component for any such treatment protocol must be adequate soft tissue coverage that often will use vascularized flaps. Traditionally, calf muscles have been used proximally and free flaps for the distal leg and foot. The reintroduction of reliable local fascia flaps has challenged this dictum, proving to be a simpler and yet versatile option. MATERIALS AND METHOD: The role of both muscle and fascia flaps in lower extremity injuries has been retrospectively reviewed from a 2-decade experience. Soft tissue deficits requiring some form of vascularized flap occurred in 160 limbs in 155 patients. The frequency of use of flap types, specific complications and benefits, effect of timing of wound closure, and rate of limb salvage were compared. RESULTS: Initial coverage after significant lower extremity trauma in these 160 limbs required 60 local muscle flaps, 50 local fascia flaps, and 74 free flaps. These flaps had been selected on a nonrandom basis according to wound location, its severity, and flap availability. Complications were directly related to the severity of injury, and for free flaps as a group (39%), although these were not independent variables. Local muscle (27%) or fascia flaps (30%) were similar with regard to this morbidity. Healing was more likely to be uneventful if coverage were accomplished during the acute period after injury, regardless of flap type. Muscle flaps were still used in two thirds of all cases, with the soleus muscle used as often for the distal leg as the mid-leg. Local fascia flaps were most valuable for smaller defects, especially in the distal leg or foot, and often as a reasonable alternative to a free flap. CONCLUSION: The traditional role of the gastrocnemius muscles for flap coverage of knee and proximal leg defects and the soleus muscle for the middle third of the leg was reaffirmed. The soleus muscle often also reached distal leg defects as could local fascia flaps, where classically, otherwise, a free flap would have been necessary. The largest or most severe wounds, irrespective of limb location, required free flap coverage. Local fascia flaps proved to be a valuable alternative.

Algorithms↗

PubMed2005

Determination of reference intervals for vibratory perception thresholds of the lower extremities in normal subjects.

The assessment of vibratory perception thresholds (VPTs) is important for evaluating human somatosensory functions and provides new aspects in clinical practice and research. However, there has been little information concerning determinants of the VPT in normal individuals, and there has been no investigation to determine the reference intervals for the lower extremities by vibrometers using appropriate statistical analysis. We determined reference intervals for the VPT in lower extremities of 377 healthy subjects (241 males, 136 females; ages 11-74 years) using Suzuki-Matsuoka vibrometer-5 according to the National Committee for Clinical Laboratory Standards guidelines. The VPT was measured at 12 points: ulnar styloids, patellae, medial and lateral malleoli and the tip of the great toes, dorsal aspect of the distal phalanx of the fifth toes. The effects of age, sex, height, weight, alcohol consumption, and smoking on the VPTs were also investigated. The VPTs of normal subjects increased significantly with age. The difference between the two sides was negligible for determining reference intervals of the VPT. The average VPT was higher in men than in women at the lateral malleolus, the great toe, the patella, and the ulnar styloid but not significantly different at the fifth toe or the medial malleolus. There were no significant differences in the VPTs among the four sites of the foot. The reference interval for the VPT of the lower extremity is less than 13 x 10(-2) G. The influence of body mass index, smoking, and alcohol consumption on the VPT was not significant. We provide the reference interval for the VPT of lower extremities in normal subjects. This information can serve as a basis for future clinical applications of VPT measurements.

Adolescent↗

PubMed1997

Evaluation of a training program for persons with SCI paraplegia using the Parastep 1 ambulation system: part 5. Lower extremity blood flow and hyperemic responses to occlusion are augmented by ambulation training.

OBJECTIVE: To test whether 12 weeks of exercise conditioning using functional neuromuscular stimulation (FNS) ambulation alters the resting lower extremity blood flow and hyperemic responses to vascular occlusion in subjects with paraplegia, and to determine whether an association exists between limb flow and lower extremity fat-free mass. DESIGN: Pretest, posttest. SETTING: Academic medical center. PARTICIPANTS: Subjects with chronic neurologically complete paraplegia. INTERVENTION: Thirty-two sessions of microprocessor-controlled ambulation using electrically stimulated contractions of lower extremity muscles and a rolling walker. OUTCOME MEASURES: Subjects underwent quantitative Doppler ultrasound examination of the common femoral artery (CFA) before and after training. End-diastolic arterial images and arterial flow-velocity profiles obtained at rest and after 5 minutes of suprasystolic thigh occlusion were computer-digitized for analysis of heart rate (HR), CFA peak systolic velocity (PSV), CFA cross-sectional area (CSA), flow velocity integral (FVI), pulse volume (PV), and CFA (arterial) inflow volume (AIV). RESULTS: Significant effects of training on CSA (p < .0001), FVI (p < .05), computed PV (p < .001), and computed AIV (p < .01) were observed. Resting HR was lower following training (p < .05). The change for resting PSV approached but did not reach significance (p = .083). Analysis of postocclusion PV and AIV showed significant effects for conditioning status (p values < .01), postcompression time (p values < .0001), and their interaction (p values < .01). At 1 minute after occlusion, the posttraining AIV response was 78.2% greater in absolute magnitude and 17.4% more robust when expressed as a percentage change from its resting value than before training. Significant correlations were found between thigh fat free mass and both AIV and PV (p values < .05). CONCLUSION: Exercise training using FNS ambulation increases the resting lower extremity AIV in individuals with paraplegia and augments the hyperemic response to vascular occlusion. Improved posttraining blood flow is attributable both to vascular structural changes and upregulation of vascular flow control mechanisms. Limb mass is associated with the volume of arterial blood flow.

Adult↗