SEARCH · PubMed Health

Results for “Lower Extremity”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 685 records · Page 38Linked to original sources

PubMed2002

Glycemia (or, in women, estimated glucose disposal rate) predict lower extremity arterial disease events in type 1 diabetes.

The purpose of this study was to determine the predictors of lower extremity arterial disease (LEAD) events in a type 1 diabetes population. Data are from the Pittsburgh Epidemiology of Diabetes Complications Study of childhood onset type 1 diabetes. At baseline, the study population had a mean age 28 (range, 8 to 47) years and duration 19 (range, 7 to 37) years. LEAD events, assessed by questionnaire or clinical examination, were defined as claudication (Rose questionnaire), foot ulceration, or lower extremity amputation. Estimated glucose disposal rate (eGDR), a measure of insulin resistance, was calculated from glycosylated hemoglobin (HbA(1)), waist-to-hip ratio (WHR), and hypertension using an equation previously validated with hyperinsulinemic euglycemic clamp studies. There were incident LEAD events in 70 of 586 subjects during 10 years follow-up, giving an incidence density of 1.3 events/100 person-years. Incidence did not differ by gender. Major predictors of LEAD events were diabetes duration, low-density lipoprotein-cholesterol (LDL-C), heart rate, eGDR, log albumin excretion rate (AER), systolic blood pressure (SBP), hypertension, proliferative retinopathy, distal symmetric polyneuropathy, and overt nephropathy (each P <.001). HbA(1), low ankle brachial index (ABI) (<0.9), and a high ankle brachial difference (ABD) (SBP > or = 75 mm Hg) also predicted LEAD events. Cox modeling suggested that duration (P <.001), HbA(1) (P <.001), hypertension (P =.006), log albumin excretion rate (P =.011), and heart rate (P =.028) predicted events independently. The overall model with HbA(1) and hypertension was significantly better than with eGDR, while the alternate models in men were similar. In women, the model with eGDR showed a significantly better fit. Glycemia, insulin resistance, hypertension and renal disease are powerful predictors of symptomatic lower extremity arterial disease in type 1 diabetes.

Adolescent↗

PubMed2006

Knee deformity in congenital longitudinal deficiencies of the lower extremity.

UNLABELLED: The knee has various pathologic appearances in patients with congenital longitudinal deformities of the lower extremities. Radiographs from 39 patients with unilateral longitudinal congenital deficiencies of the lower extremities were analyzed to describe epiphyseal and metaphyseal configurations and position of the epiphyseal plate. We defined 22 radiographic parameters of the femur and tibia, calculated the mean values, and compared the parameters of the affected knee with the unaffected knee for patients in different age groups. In the femur, we observed hypoplasia of the lateral condyle in width and height. In the tibia, the lateral condylar hypoplasia was manifest primarily by lateral horizontal deficiency. Age group comparisons showed no horizontal epiphyseal deficiencies in the older patients, but there was persistence of vertical epiphyseal deficiencies. Bony deformities in congenital longitudinal deficiencies mainly were attributable to dysplasia of the lateral epiphysis in the distal femur and proximal tibia, whereas positions of the epiphyseal plate had varying physiologic values. LEVEL OF EVIDENCE: Diagnostic study, Level II. See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗

PubMed2005

Back pain and decline in lower extremity physical function among community-dwelling older persons.

BACKGROUND: Little is known regarding the longitudinal effects of back pain on physical function among older persons. We sought to determine whether back pain leading to activity restriction (i.e., restricting back pain) is associated with decline in lower extremity physical function among community-dwelling older persons. METHODS: In this prospective study with an 18-month follow-up period, participants (N = 659) were aged 70 years or older and independent in bathing, dressing, transferring, and walking at baseline. Restricting back pain, defined as staying in bed for at least one-half day or cutting down on one's usual activities due to back pain, was ascertained during monthly telephone interviews. Lower extremity physical function was assessed using three timed, performance-based tests (rapid gait, chair stands, and foot taps) at baseline and 18 months. Decline in lower extremity physical function was defined as an increase in timed scores on these tests between the baseline and 18-month assessments. RESULTS: The mean (standard deviation) number of months with restricting back pain was 1.3 (2.3); 364 (55%) participants reported 0 months, 209 (32%) reported 1-3 months, and 86 (13%) reported 4 or more months. After adjustment for baseline performance score and other covariates, the number of months with restricting back pain was independently associated with worsening rapid gait (p <.001), chair stand (p =.030), and foot tap (p <.001) performance. The deleterious effects of the "exposure" were limited to participants with 4 months of restricting back pain. CONCLUSIONS: Restricting back pain is independently associated with decline in lower extremity physical function among community-dwelling older persons. Treatment of restricting back pain may help to decrease functional decline in this population.

Aged↗

PubMed1994

The role of free tissue transfer following oncologic resection in the lower extremity.

The current treatment of extremity sarcomas is multimodal, consisting of limb-sparing surgery, adjuvant radiotherapy, and/or chemotherapy. This approach has decreased the need for amputations and increased the demand for coverage of large composite defects. To date, the role of microsurgery in lower extremity reconstruction after oncologic resection has not been well defined. This study reviews a single center's experience with free tissue transfer for reconstruction of the lower extremity after oncologic resection. Fifty-nine free flaps were performed in 57 patients over a 5-year period. Forty-six patients (78%) underwent primary reconstruction and 35 patients (61%) received adjuvant therapy. Overall flap success rate was 96.6%. Most flaps were soft-tissue types including musculocutaneous (78%), skin only (11%), and muscle plus skin graft (4%). Osteocutaneous flaps were uncommon. There were major complications in 12% and minor complications in 7%. This study demonstrates that free tissue transfer for lower extremity reconstruction following oncologic resection has a high success rate that is similar to other free flap applications. It has become an integral part of lower extremity sarcoma management. Free flaps permit uninterrupted adjuvant therapy and enhance the efficacy of limb salvage surgery.

Adult↗

PubMed1992

Neurovascular lower extremity complications of the lithotomy position.

The lithotomy position is commonly used during the performance of a variety of abdominal and pelvic operations. Previous publications reporting complications with these operations have been largely anecdotal. We report our experience with eight patients over the past four years who have suffered serious lower extremity complications following operations in which the lithotomy position was used. The average time in the lithotomy position for our patients was 7.4 hours (range: 3.7-12 hours). The mean interval between the original operation and the secondary operation to treat the lower extremity complication was 18.9 hours (range: 2-51 hours). The average hospital length of stay for these patients, 38.4 days (range: 11-119 days), was often prolonged as a direct result of their limb complication. Serious lower extremity complications may result from operations in which the lithotomy position is used. To prevent such complications, strict attention should be paid to the positioning of the limbs in the operating room and the time in the lithotomy position should be minimized. Perioperative monitoring of the lower extremity circulation and compartment pressures are essential in these patients since early detection and treatment of these complications is the only way to prevent permanent limb injury.

Abdomen↗

PubMed2004

Magnetic resonance angiography versus duplex arteriography in patients undergoing lower extremity revascularization: which is the best replacement for contrast arteriography?

OBJECTIVE: In an effort to explore alternatives to contrast material-enhanced arteriography, we compared magnetic resonance angiography (MRA) and duplex arteriography (DA) with contrast arteriography (CA) for defining anatomic features in patients undergoing lower extremity revascularization. METHODS: From August 1, 2001, to August 1, 2002, 61 consecutive inpatients (64 limbs) with chronic lower extremity ischemia underwent CA, MRA, and DA before undergoing lower extremity revascularization procedures. The reports of these tests and images were compared prospectively, and the differences in the iliac, femoropopliteal, and infrapopliteal segments were noted. The vessels were classified as mildly diseased (<50%), moderately diseased (50%-70%), severely diseased (71%-99%), or occluded. The studies and treatment plans based on these data were compared. RESULTS: Mean patient age was 76 +/- 10 years (SD). Indications for the procedures included gangrene (43%), ischemic ulcer (28%), rest pain (19%), severe claudication (9%), and failing bypass (1%). During this period 35 patients were ineligible for the protocol, because they could not undergo MRA (n=27) or angiography (n=8). Of the total 192 segments in the 64 patients (iliac, femoropopliteal, tibial), 17% were not able to be fully assessed with DA, and 7% with MRA. Disagreements with CA and DA were found in the iliac, femoropopliteal, and tibial segments in 0%, 7%, and 14% of cases, respectively, and between CA and MRA in 10%, 26%, and 42% of cases, respectively. Two of 9 differences (22%) between DA and CA were thought to be clinically significant, and 28 of 45 differences (62%) between MRA and CA were thought to be clinically significant. CONCLUSIONS: A review of the data obtained in this series indicates that MRA does not yet seem to yield adequate data, at least in this highly selected population at our institution. When severe calcification is identified, CA may be necessary in patients undergoing DA.

Aged↗

PubMedDate not supplied

Ultrasonographic screening for arterial occlusive disease in the pelvis and lower extremities.

PURPOSE: To evaluate the accuracy of pulsed Doppler ultrasound (PDUS) and color Doppler ultrasound (CDUS) for the screening of arterial occlusive disease in the pelvis and lower extremities. METHODS: We studied 52 patients with intermittent claudication or lower extremity "coolness." Pulsed Doppler waveforms were measured in the inguinal and popliteal regions and were classified according to their pattern. Patients with abnormal waveforms underwent subsequent CDUS evaluation from the aortic bifurcation to the popliteal arteries. All patients also underwent conventional angiography. RESULTS: All stenoses (> 50%) and occlusions on angiography were detected by PDUS. The combination of PDUS and CDUS allowed detection of 78.0% of stenotic lesions (> 50% narrowing) and 96.6% of occlusive lesions in the iliofemoral regions and in 100% of stenotic lesions (> 50% narrowing) and occlusive lesions in the femoropopliteal regions. PDUS required approximately 3 min. About more 5 min are required when CDUS was added. CONCLUSION: Combined PDUS and CDUS appears to be a rapid, highly sensitive means of screening for arterial occlusive disease in the pelvis and lower extremities.

Angiography↗

PubMed2003

Progression of lower-extremity disability in older women with diabetes: the Women's Health and Aging Study.

OBJECTIVE: Older patients with diabetes are more likely to have a higher prevalence of multiple risk factors for physical disability, as a result of diabetic complications. We evaluated the pace of decline in lower-extremity function and the risk for progression of disability in older women with diabetes. RESEARCH DESIGN AND METHODS: We conducted a 3-year longitudinal cohort study of a random sample of 729 physically impaired older women (age > or =65 years) living in the community (Baltimore, MD). Diabetes was ascertained by standard criteria. Self-reported functional status and objective performance measures were assessed at baseline and over six semiannual follow-up visits. RESULTS: The baseline prevalence of diabetes was 14.4%. After adjustment for age and compared with women without diabetes, those with diabetes had an RR of 1.8 (95% CI 1.3-2.5) for incident mobility disability and 1.6 (1.2-2.1) for incident activity of daily living disability. The increased incidence of new disability associated with diabetes was paralleled by a greater decline in objective measures of lower-extremity function. Adjustment for multiple risk factors for disability did not significantly attenuate the risk for disability associated with diabetes. CONCLUSIONS: In older patients, impaired lower-extremity function is a long-term diabetic complication. Comprehensive assessment of older diabetic patients should include a standardized evaluation of lower-extremity performance.

Activities of Daily Living↗

PubMed2006

Atherosclerosis obliterans of the lower extremities in Thai patients.

BACKGROUND: Major limbs loss and high mortality rate were observed in the management of Thai patients with atherosclerosis obliterans (ASO) of the lower extremities. These were the results of delayed diagnosis and treatment together with the associated morbidities. There is a lack of information of this disease resulting in a lack of knowledge and awareness of this problem among general practitioners in Thailand. OBJECTIVES: The purposes of this study were (1) to identify the prevalence of this disease in a tertiary care hospital, (2) to enumerate the risk factors and comorbidities, (3) to identify clinical characteristics of the disease and (4) to evaluate the outcomes of treatment. MATERIAL AND METHOD: A prospective study ofpatients with ASO of the lower extremities was carried out between January 2000 and December 2004. Patients having clinical manifestations of chronic and acute arterial occlusion with the absence of ankle pulse were included in the present study. Evidence of atheromatous plaque by angiography, operative finding, and histopathology of arterial wall from amputated specimens were used to confirm the diagnosis. The selection of surgical treatments for this disease such as revascularization, major amputation, minor amputation and debridement depended on the severity of limb ischaemia, the status of distal artery and the patients' general condition. The risk factors, comorbidities, clinical manifestations, site of arterial occlusion, severity of ischaemia, types of surgical treatment and outcomes of management were analyzed. RESULTS: Four hundred and fourteen consecutive patients with ASO were diagnosed in the present study with a prevalence of 1.02:1,000. Femoro-popliteal arterial segment was the most common site (221 cases, 53.4%) of the affected arteries. Diabetes mellitus (253 cases, 61. 1%) was the most common risk factor of ASO followed by hypertension (217 cases, 52.4%), smoking (195 cases, 47.1%) and hyperlipidemia (172 cases, 41.5%). Ischaemic heart disease (108 cases, 26.1%) was the most common comorbidity of ASO followed by major stroke (56 cases, 13.5%) and chronic renal failure (20 cases, 4.8%). Patients with ASO presented mostly as chronic manifestations (385 cases, 93%) or with limb-threatening condition (326 cases, 78.7%). The clinical manifestations were ischaemic ulcer and/or digital gangrene (251cases, 60.6%), rest pain (182 cases, 44.0%) incapacitating claudication (62 cases, 15.0%) and acute ischaemic pain (29 cases, 7.0%). One hundred and thirty eight (33.3%) patients had significant lower limb infection at the time of admission. One hundred and seventy one (41.3%) patients underwent revascularization procedures as the major primary treatments to salvage the limbs. The success rate of limb salvage after revascularization was 76.6% (13 1/171). Major amputation after revascularization was 16. 9%(29/ 171). Perioperative mortality rate of revascularization procedure was 8.2 %(14/171). Major amputation was required as the primary treatment due to infective (18.4%, 76/414) and ischaemic process (6.5%, 27/414). The mortality rate of primary major amputation for infection and ischaemia were 19.7%(15/76) and 25.9%(7/2 7) respectively. The total mortality rate in the present study was 11.3% (47/414). The common causes of death were sepsis and ischaemic heart disease. CONCLUSION: ASO of the lower extremities is one of the major problems for national health care causing major limb loss and death. Arterial bypass surgery was the most effective treatment for limb salvage. Management of this disease at the terminal stage causes high morbidity and mortality. Hence, early detection of this disease and correction of the risk factors should be the most effective strategy to improve the overall outcome of the management of this complicated problem.

Adult↗

PubMed2000

Strategic considerations on the configuration of free flaps and their vascular pedicles combined with Ilizarov distraction in the lower extremity.

For the injury of the lower leg associated with both bone and soft-tissue defect, the combined free flap and the Ilizarov distraction method were described as a useful treatment modality. During the procedure of distraction, however, revisions were frequently needed to change the pin position or to change the flap configuration. In case of flap ischemia, distraction should be delayed or abandoned. Then, a vascularized bone transfer might be necessary. To avoid these complications and achieve safe distraction, the configuration of the flap with its vascular pedicle should be carefully planned in terms of the future bony lengthening procedures and the concomitant soft-tissue changes of the lower leg. According to the response of local tissue to the distraction process, the lower limb can be divided into four compartments (active mobile, passive mobile, receptive, and restrictive). The configuration of the transferred free flap with its vascular pedicle can be classified into five types. To minimize the undue forces to the vascular pedicle and reduce the possibility of vascular compromise, the transferred free flap should have the configuration that its vascular pedicle lies in the territory of the mobile compartment. In performing free-tissue transfer combined with the Ilizarov method in the lower extremity, the configuration of the flap with its vascular pedicle should be carefully planned, and the characteristics of lower leg tissue should be kept in mind during the distraction.

Adult↗

PubMed2000

Occlusive arterial diseases of the upper and lower extremities found in workers occupationally exposed to vibrating tools.

Hand-arm vibration syndrome (HAVS) is primarily a disorder of the fingers and hands. However, in some cases, vibration-exposed workers are observed to have also episodic blanching of the hands and feet. In latter cases, arteriographies of both the upper and lower extremities are necessary to diagnose the background arterial disorders. In this study, eight HAVS subjects with such disorders were examined by arteriography for differential diagnosis in cases of workers' accident compensation. In three HAVS cases with thromboangiitis obliterans, the arteriographic examination revealed obstructive changes in the palm and forearm as well as three below-knee lesions in the lower extremities. In five HAVS cases with arteriosclerosis obliterans, obstruction kinking or coiling, stenosis and/or tapering-off of the proper digital arteries were observed together with two below-knee lesions and three high lesions in the lower extremities. From the viewpoint of occupational health, palpation of superficial arteries of both the upper and lower extremities should be routinely performed during both pre-placement and periodic medical examinations for workers exposed to vibrating tools for early detection and/or prevention of any worsening of the background disorders.

Adult↗

PubMed1985

Mechanical and physiological responses to lower extremity loading during running.

Fifteen highly trained men performed treadmill running at 12 km X h-1 to determine the effect of lower extremity loading on measures for seven temporal and kinematic descriptors of the running cycle, the mechanical work done on the lower extremity, oxygen consumption (VO2) and heart rate. Five load conditions (no added load and loads of 0.50 kg and 1.00 kg added to either the thighs or feet) were examined. The results demonstrated that VO2 and heart rate increased as load was increased on both the thighs and feet. All changes were statistically significant except for the heart rate changes due to thigh loading. The increases in VO2 due to foot loading--approximately 7.2% per kg of load--were nearly twice as great as those due to thigh loading. The results also demonstrated that 1.00 kg added to the feet produced small but significant increases in stride length (1.4 cm), swing time (9 ms), and flight time (6 ms) and a decrease in peak ankle velocity (0.23 m X s-1). No other load condition resulted in significant changes in any of the temporal and kinematic variables. The results for mechanical work demonstrated that significant increases in the work done on the leg were produced by the loading but that these increases were limited to the loaded segments. Consistent with the data for oxygen consumption and heart rate, mechanical work was increased to a greater extent by foot loading than by thigh loading. It was concluded from these results that the increased physiological demand was directly related to the mechanical work increases, which in turn were attributed to the increased inertia of the loaded segments rather than modifications in the kinematics of the lower extremity movements.

Adult↗

PubMed1998

[A case of hypertrophic cranial pachymeningitis associated with intramedullary lesion developed seizure marching from right lower extremity].

A case of hypertrophic cranial pachymeningitis associated with intramedullary lesion was reported. A 57-year-old male presented with the symptoms of Jacksonian seizure and weakness of right lower extremity. Neurological examination showed weakness and muscular atrophy of right lower extremity (MMT 1-2) and hyperreflexia. Superficial sensation and position sense were normal, however cortical sensory disturbance was recognized in his right lower extremity. MRI revealed diffuse dural thickening with gadolinium enhancement in the left convexity and hyperintense lesion in the bilateral (left dominant) frontal to parietal lobe on T2 weighted image. Magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) showed occlusion of the superior sagittal sinus. Histological examination revealed extensive fibrous tissue with lymphocytes infiltration around the vessels. The cause of the intramedullary lesion in this patient may have been related to the occlusion of superior sagittal sinus, due to thickening dura mater and influence of inflammation.

Angiography, Digital Subtraction↗

PubMed1996

Vascular reconstruction for limb salvage in sarcoma of the lower extremity.

OBJECTIVES: To examine the patency and limb-salvage characteristics of vascular reconstruction in patients with sarcomas of the lower extremity who had been treated with limb-preserving resection and to examine patient survival during a long follow-up period. DESIGN: Retrospective cohort study. SETTING: University hospital, tertiary referral center. PATIENTS: From 1984 to 1992, 14 patients underwent limb-preserving resection of sarcomas in the proximal lower extremity, with 20 vascular reconstructions performed. OUTCOME MEASURES: Color Doppler scans documented patency of the vascular reconstructions. Clinical evaluation included functional results in terms of limb movement and quality of life. Local tumor control and systemic recurrence were examined by repeated radiologic examination. Overall survival as well as time and cause of death were assessed. RESULTS: A total of 13 patients had patent vascular grafts, while the venous graft became occluded in 1 patient. Limb function was rated as excellent or good in 9 patients, as fair in 3, as poor in 1, and could not be clinically estimated in 1. Postoperative thrombosis of the venous graft was detected in 3 patients and was effectively managed by thrombectomy in 2. Three patients underwent reoperation because of hematoma or complications caused by local infection. The tumor endoprosthesis had to be replaced in 3 patients. During follow-up periods that ranged from 15 to 132 months (mean, 55 months), 4 patients died. In all of these patients the cause of death was systemic recurrence in the lung. Two additional patients developed pulmonary metastases, but at the time of this report, they were still alive as long as 132 months after operative resection or chemotherapy. No local recurrence was found. CONCLUSION: Limb-preserving resection of sarcoma of the lower extremity can be performed with satisfactory function of the limb maintained, even if it becomes necessary to resect the femoral vessels. Autologous venous graft for vascular reconstruction is the treatment of choice. In spite of the high incidence of metastases, considerable long-term survival is possible.

Adolescent↗

PubMed2000

Lower-extremity revascularisation without preoperative contrast arteriography in 185 cases: lessons learned with duplex ultrasound arterial mapping.

PURPOSE: we have previously reported our experience with lower-extremity duplex-ultrasound arterial mapping (DUAM) compared to contrast arteriography (CA) to predict lower-extremity bypass sites. The present study evaluates arterial revascularisation procedures for chronic limb ischaemia based on DUAM. MATERIALS AND METHODS: from January 1998 to July 1999, 195 patients (128 men, 67 women) underwent 211 lower-extremity revascularisation procedures based on DUAM. Indications for surgery were tissue loss, severe claudication, rest pain and popliteal aneurysm in 57%, 25%, 14% and 4% of the limbs, respectively. The mean age was 72+/-12 years and risk factors such as diabetes, hypertension, tobacco use, coronary artery and end-stage renal disease were present in 53%, 58%, 53%, 50% and 12% of the patients, respectively. Previous revascularisation procedures had been performed in 23% of the limbs. Preoperative evaluation consisted of DUAM alone (185) or of a combination of DUAM and CA (29 limbs). CA was deemed necessary due to a combination of technical difficulties that jeopardized adequate sonographic imaging and presence of disadvantaged run-off for medico-legal reasons. DUAM consisted of direct imaging of all major arteries from the distal aorta to the pedal circulation. Optimal inflow and outflow bypass anastomotic sites were selected according to a diagram based on DUAM. Adequacy of the inflow was additionally assessed by common-femoral-artery waveform and confirmed by intraoperative pressure measurements. Post-bypass CA was obtained to verify patency of the run-off. RESULTS: DUAM procedure time averaged 75+/-26 min. For patients who underwent only DUAM, the distal anastomosis was to the popliteal artery in 91 cases and to tibial or pedal arteries in 58 cases. Distal anastomosis was proximal to a significant lesion in two cases that required jump grafts. Cumulative patency rates at 1 and 3 months for popliteal bypasses were 96% and 90%, and for infrapopliteal bypasses 90% and 83%, respectively. Inflow procedures to the femoral artery, patch and balloon angioplasties accounted for the remaining 40 cases. Four primary amputations were performed after CA confirmed DUAM findings. CONCLUSIONS: contrary to general belief, these data show that high-quality arterial ultrasonography represents a safe alternative to preoperative CA, even for infrapopliteal bypasses. This non-invasive approach may be especially useful for patients with contrast allergy or impaired renal function.

Adult↗

PubMed1989

Lower extremity fractures: relationship to reaction time and coordination time.

The purpose of this study was to examine the possible relationship between delayed reaction time and slow coordination time as a contributing factor to lower extremity fracture. A simple reaction time tester and hand coordination tester were used to assess the relative times of reaction and coordination. Subjects were also questioned concerning their daily activity levels. A definite relationship was observed to exist between the times recorded and lower extremity fractures: subjects with lower extremity fractures exhibited delayed reaction times and longer coordination times. Moreover, shorter reaction times and coordination times were seen in those subjects who reported higher activity levels. Statistical analysis was performed on selected data which show an association of fracture with reaction time.

Adolescent↗

PubMed1993

Surgery for chronic lower extremity ischemia in patients eighty or more years of age: operative results and assessment of postoperative independence.

PURPOSE: Revascularization for chronic lower extremity ischemia (CLEI) in patients 80 or more years of age is controversial. High operative mortality, short remaining life span, and nonambulatory nursing home existence are cited as frequent outcomes in this patient group. Despite these considerations we have maintained an aggressive policy of lower extremity revascularization in functional and potentially functional patients 80 or more years of age with limb-threatening ischemia or claudication sufficient to threaten their independence. METHODS: The records of all patients 80 or more years of age who underwent lower extremity revascularization for CLEI from 1981 through 1991 were reviewed. Patients were evaluated for surgical indication, perioperative mortality, late survival, graft patency, and limb salvage. In addition, the patient's preoperative and postoperative independence determined by living situation (home versus nursing home) and ambulatory status were examined. RESULTS: During the period reviewed 88 patients 80 or more years of age underwent 95 arterial reconstructions for CLEI; 95% for limb salvage and 5% for short-distance claudication. There were 81 (85%) infrainguinal bypasses and 14 (15%) extra-anatomic bypasses, 5 of which also included a simultaneously placed infrainguinal bypass. The perioperative mortality rate was 6%. Mean hospitalization was 18 days (range 6 to 62). The 1- and 3-year primary graft patency rates were 88% and 66%, limb salvage rates 94% and 91%, and patient survival rates 73% and 51%, respectively. One year after operation 88% of patients were ambulatory, 85% were living at home, and 80% were both living at home and ambulatory. At 3 years these results were 86%, 76%, and 71%, respectively. Of the patients living at home and ambulatory before operation, 100% and 84% of survivors were still living at home and ambulatory 1 and 3 years after operation. Of patients living at home who had late graft occlusions, 67% required amputation and subsequent nursing home placement. CONCLUSION: Although survival in this group is predictably lower than that of age-matched control subjects, octogenarians have satisfactory 1- and 3-year graft patency, limb salvage, and functional results. Revascularization for CLEI in patients 80 or more years of age is appropriate and results in maintenance of independent living in a large majority.

Activities of Daily Living↗

PubMed1999

Lower extremity revascularization without contrast arteriography: a prospective study of operation based upon duplex mapping.

This study prospectively assessed the results of lower extremity surgical revascularization, which was performed on the basis of duplex arterial mapping in selected patients without preoperative contrast arteriography. Criteria were developed for patient selection. Among 158 patients requiring surgery for lower extremity ischemia over a 24-month period, 24 (15%) were selected for operation without current preoperative arteriography. Aorto-iliac and infrainguinal duplex arterial mapping were performed in an laboratory that was accredited by the Intersocietal Commission for Accreditation of Vascular Laboratories. Indications for surgery were minor gangrene (11), rest pain (7), or claudication (6). Operations included femoropopliteal bypass (14), femoral endarterectomy (9) and femoral-femoral bypass (1). Mean length of stay was 4.5 +/- 2.0 days. Ankle-brachial index improved from 0.49 +/- 0.12 to 0.80 +/- 0.15 (P < 0.05). Primary patency was 91.7 +/- 9.4% and assisted primary patency was 100% at 18 months. There was no graft occlusion or limb loss. Mean follow-up was 16.7 +/- 7.0 months. These preliminary data support the safety and durability of duplex-guided lower extremity surgical revascularization without arteriography in selected cases. Success in a broader application of this approach requires the continuing development of patient selection criteria.

Angiography↗