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PubMed1991

Serum lipoprotein (a) levels in men with peripheral vascular disease.

The authors quantified serum lipoprotein (a) (Lp) (a) by enzymo-immuno-analysis in 86 outpatient men suffering peripheral vascular disease (PVD) and in 53 age-matched healthy men. They further measured serum cholesterol, serum triglycerides, low density lipoproteins-cholesterol, high density lipoproteins (HDL)-cholesterol and serum apolipoprotein B. Serum triglycerides were significantly increased in patients with PVD versus controls (148 +/- 8 and 114 +/- 7 mg/dL, mean +/- SEM). HDL-cholesterol levels were significantly lower in patients versus controls (36 +/- 1 and 43 +/- 2 mg/dL, respectively). Serum Lp(a) levels in patients with PVD were 20 +/- 2 mg/dL, whereas in controls they were 16 +/- 3 (p: NS). Serum Lp(a) concentrations were identical in smoker and nonsmoker patients. There was no correlation between Lp(a) concentration and the other lipid parameters. Conversely, as occurs in coronary heart disease and in cerebrovascular disease, Lp(a) does not seem to be a marker for PVD, although a trend toward a higher mean levels was found.

Adult↗
PubMed1989

Reducing blood cholesterol levels in patients with peripheral vascular disease: dietitian or diet fact sheet?

A randomized trial was performed to test the hypothesis that, among patients with peripheral vascular disease, no difference is achieved in the magnitude of the reduction in blood cholesterol levels as a result of advice which is provided by a dietitian and that which is provided by a diet fact sheet. Fifty-nine patients were allocated at random either to a "dietitian" group (n = 31) or to a "diet fact sheet" group (n = 28). Dietary advice which was provided by a dietitian involved two personal interviews; the diet fact sheet was prepared by the NSW Department of Health. Twenty-two and 23 members of each group, respectively, returned for follow-up at three months. The mean cholesterol level fell by 8.5% among the "dietitian" group but only by 1.9% among the "diet fact sheet" group. The difference of 0.47 mmol/L in the total cholesterol level reduction between the two groups was statistically significant (P = 0.02; 95% confidence interval, -0.88 to -0.07 mmol/L). It appears that individual advice which is provided by a dietitian is more successful in leading to a reduction in blood cholesterol levels than is the administration of a diet fact sheet, even though this particular diet fact sheet appears to be excellent and is used widely. In view of the large numbers of patients and of persons in the population as a whole who would benefit from a reduction in blood cholesterol levels, and the expense of individual advice to be provided by a dietitian, explorations of cost-effective methods of providing dietary advice are needed.

Aged↗
PubMed1990

Clinical, blood gas, and lactate changes in the course of the treatment of peripheral vascular disease with a hemodialysate.

In a double-blind comparison with placebo, treatment with a hemodialysate (Solcoseryl) in severe peripheral vascular disease (PVD) resulted in a distinct improvement in symptomatology and clinically observed pathology. Initially depressed ApO2 was normalized with a corresponding increase in AO2 saturation, an increase in A-V pO2 difference, and reduction of elevated blood lactate levels. Correction of disturbed O2 diffusion is postulated to explain these observations. The mechanism proposed may be operative in lung-to-blood, blood-to-tissue, within-tissue and within-cell aspects of oxygen transport under pathologic conditions.

Actihaemyl↗
PubMed1950

Dehydrogenated alkaloids of ergot in treatment of peripheral vascular diseases.

The dihydrogenated alkaloids of ergot, dihydroergocornine (DHO 180) and an equal mixture of dihydroergocornine, dihydroergocristine and dihydroergokryptine known as CCK 179 have been found to be therapeutic adjuncts in the medical treatment of peripheral vascular diseases. Their action is primarily that of adrenergic blockage, although depression of the brain stem is to be considered. The mixture of alkaloids (CCK 179) was found to be more effective than a single alkaloid, dihydroergocornine (DHO 180). A greater number of patients were benefited, relief of symptoms was greater and the dosage easier to establish. A favorable therapeutic response of clinical significance with the mixture was obtained in approximately 60 per cent of all cases investigated. It was of greater benefit in the organic occlusive diseases, where a larger percentage of favorable responses was obtained than in the purely vasospastic disorders. Orally and subcutaneously, CCK 179 exhibited vasodilating properties which compared favorably with paravertebral and peripheral nerve block, reflex heat, alcohol and sympathectomy. Surface temperatures were elevated, oscillometric readings increased and tolerance to cold increased in a statistically significant number of cases. Effects of sympathectomies were frequently enhanced. Following subcutaneous administration, increased surface temperatures of the extremities of one to two hours' duration were obtained in 90 per cent of all cases.Paresthesias, nocturnal cramps and intermittent claudication were improved. A sense of well-being was occasionally exhibited. Blood pressure and pulse rates were rarely affected. Blood pressure was lowered in normotensive patients, but was rarely changed in hypertensive patients. Symptoms of overdosage appeared after two to three months of continuous therapy. These were manifested by lowered surface temperatures, decreased tolerance to cold, return of intermittent claudication and occasionally by vague general discomfort. These symptoms disappeared on cessation of therapy. Improvement frequently followed. In only one case was there an immediate reaction. Following subcutaneous administration of CCK, blood pressure and pulse rate increased and oscillometric readings and surface temperatures decreased. Frequent courses of therapy with interruptions were necessary for maintenance of improvement.

Alkaloids↗
PubMed2002

Ethnicity and peripheral vascular disease.

There are well-documented differences in the prevalence of coronary artery disease and carotid disease between caucasians, Afro-Caribbeans and Indo-Asians. Very little data are available on ethnic differences in peripheral vascular disease (PVD). To investigate this further, we surveyed 200 consecutive patients attending the vascular surgery service at a city centre hospital serving a multiethnic patient catchment population. All patients had proven PVD, with an ankle brachial pressure index of less than 0.8. Within this cohort, Afro-Caribbeans presented more frequently with PVD compared with the proportion of this ethnic group in the local population (p = 0.013), with a greater proportion with diabetes mellitus than in the other two ethnic groups. There did not appear to be a significant difference between the ethnic groups in any of the other established risk factors or associations (i.e. treated hypertension, smoking, previous history of ischaemic heart disease, atrial fibrillation, previous history of cerebrovascular accident or transient ischaemic attack) with PVD. As with coronary artery disease and carotid disease, there are ethnic differences in the prevalence of PVD, and the underlying risk factors, between caucasians, Afro-Caribbeans and Indo-Asians. Furthermore, patients of Afro-Caribbean origin present more frequently with symptomatic PVD than do either caucasians or Indo-Asians.

Aged↗
PubMed1998

Altered surface myoelectric signals in peripheral vascular disease: correlations with muscle fiber composition.

Conduction velocity (CV) and median frequency (MDF) during tetanic electrical stimulation of the tibialis anterior muscle were evaluated in patients with uncomplicated peripheral arterial occlusive disease. Results were analyzed with respect to biopsy determination of diameter and proportion of types 1 and 2 muscles fibers. Initial MDF and CV correlated positively with type 2, but not type 1 fiber diameter. Initial MDF was reduced bilaterally in patients with unilateral peripheral arterial occlusive disease as compared to normal subjects, indicating that chronic ischemia alone cannot explain the altered myoelectric signal. Physical training increased pain-free walking distance and raised initial MDF, though CV remained unchanged. Fatigue indices were highly interrelated, but showed no correlation with any of the other evaluation variables. Thus, initial MDF, a correlate of type 2 muscle fiber distribution in chronically ischemic tibialis anterior muscles, is altered in peripheral vascular disease. However, muscle ischemia alone cannot explain all aspects of this abnormality.

Aged↗
PubMed2000

Paraplegia after epidural anesthesia in a patient with peripheral vascular disease: case report and review of the literature with a description of an original technique for hematoma evacuation.

Epidural hematoma after epidural anesthesia is a rare and uncommon complication in patients with peripheral vascular disease who require perioperative anticoagulation therapy. A low index of suspicion makes its diagnosis difficult and often delayed. Treatment usually involves extensive laminectomy, increasing the chances for patient complications. In this article, the authors report a case of epidural hematoma with secondary paraplegia after epidural anesthesia. Also described is an original technique for evacuating the epidural space.

Aged↗
PubMed1987

Use of a gamma camera for measuring limb blood flow in peripheral vascular disease.

A method for measuring limb blood flow during reactive hyperaemia is described. Pneumatic cuffs inflated to 300 mmHg are used to isolate the blood in the limbs from the rest of the circulation. The remaining blood is labelled with technetium. The increase in radioactivity in the limb following release of the cuffs is measured using a gamma camera. The mean rate of flow of blood to the limb (in ml (100 ml)-1 tissue min-1) is derived from the graph of radioactivity versus time and from the radioactivity in a sample of venous blood. The results of measurements carried out in patients with peripheral vascular disease (30 limbs) and normal controls (24 limbs) are presented. Repeated studies in 10 subjects (20 limbs) showed the method to be highly reproducible at high and low flow rates (r = 0.99). Case studies illustrating the use of the method as a screening test for peripheral vascular disease and to monitor the effects of treatment are presented.

Aged↗
PubMed1998

Prostaglandin E1 in peripheral vascular disease: a PET study of muscular blood flow.

BACKGROUND: Increase of blood flow in the ischaemic leg is believed to represent the main action of prostaglandin E1 (PGE1) in the therapy of peripheral vascular disease (PVD). There is no reliable data in man concerning the amount of increase in muscular blood flow (MBF) of the calf, and the difference between intra-arterial and intravenous application. PATIENTS AND METHODS: We conducted a positron emission tomography (PET) study of MBF with 15O-water as flow tracer. Fifteen patients with PVD and three healthy volunteers were given 5 micrograms PGE1 intra-arterially over 50 min; PET scans were taken at 0, 25 and 50 min. Additionally, eight of the patients were investigated during an intravenous infusion of 40 micrograms PGE1 over 120 min; PET scans were taken at 0, 30, 60 and 120 min. RESULTS: Increase of muscular blood flow by intra-arterial PGE1 averaged 80%. A steal phenomenon was not observed. The amount of flow enhancement depended on whether or not the femoral artery was patent. During intravenous PGE1, muscular blood flow remained unchanged. CONCLUSIONS: In man, the pharmacodynamic profile of intra-arterial PGE1 differs clearly from intravenous PGE1. The flow-enhancing property is lost during metabolization in the lung. Since no difference exists between the therapeutic efficacy of intraarterial and intravenous PGE1, the impact on muscular blood flow is not as important as suggested previously.

Adult↗
PubMed1991

Transmetatarsal amputation in patients with peripheral vascular disease.

Transmetatarsal amputation has the reputation of being an operation with a poor healing rate, and less than a 50% success rate had recently been reported. The outcome of this amputation in patients with peripheral vascular disease has been retrospectively studied in this paper by examining 34 transmetatarsal amputations performed over a 5-year period. Twelve patients had had previous toe amputations and 22 were diabetic with an overall healing rate of 68%. There was no significant difference in the success rate between diabetics and non-diabetics. One patient died in the postoperative period, giving an early post-operative mortality of 3%. Revision of failed transmetatarsal below-knee amputation resulted in healing in seven patients out of nine, suggesting that it does not compromise later amputation at a higher level. Healing did not appear to be influenced by factors such as sympathectomy, previous arterial reconstruction or peripheral pulses. Transmetatarsal amputation provides patients who have a short life expectancy with a durable functional stump which is prosthesis free.

Adult↗
PubMed1982

Smoking, ignorance, and peripheral vascular disease.

The effect of the surgeon's advice to give up smoking was studied in a group of 43 patients with peripheral vascular disease (PVD), using blood carboxyhemoglobin levels to detect deception. Only seven of 40 patients (17.5%) actually stopped smoking, but the remainder appeared fairly honest in reporting their continued habits. Few patients were aware of the possible harmful effect of smoking on the peripheral arteries. The 43 patients with PVD who smoked had significantly higher carboxyhemoglobin levels than a group of 25 smokers without PVD although their cigarette consumption was the same. This suggests that carboxyhemoglobin levels may provide a better indication of the risk of smoking than overall cigarette consumption alone in the development of PVD.

Adult↗
PubMed1984

Prolonged infusion of prostacyclin in patients with advanced stages of peripheral vascular disease: a placebo-controlled cross-over study.

Twelve patients (age 33-77 years, mean age 68.4 years) with peripheral vascular disease (PVD) stage III-IV received continuous intravenous infusions of 5 ng prostacyclin (PGI2)/kg/min and physiological saline for 7 days. The administration was randomized and double-blind with an interval of 7 days between the infusions. During PGI2 infusion systolic blood pressure fell significantly from 147.8 +/- 4.8 mm Hg to 140.6 +/- 4.0 mm Hg (P less than 0.01) and returned to 144.5 +/- 4.9 mm Hg post infusion. Transcutaneous pO2 (tcpO2) measured on the instep of the affected limb increased significantly by 8.9 +/- 3.8 Torr during PGI2 infusion and remained elevated during the subsequent week. A significant reduction of pain was observed from the 5th day of PGI2 infusion, lasting for at least the following observation period. Platelet cAMP increased from 18.8 +/- 1.5 pmol/10(8) platelets to 24.7 +/- 1.6 pmol/10(8) platelets on the 3rd day of PGI2 infusion (P less than 0.01). Spontaneous platelet aggregation was also significantly reduced during PGI2 infusion. However, 7 days after the infusion thromboxane B2 (TXB2) in plasma and spontaneous platelet aggregation significantly increased in comparison with the preinfusion values, indicating a rebound phenomenon. The clinical outcome was favorable in 9 of 12 patients, was unchanged in two patients, while progressing to limb amputation in one patient.

Adult↗
PubMed1997

Fasting total plasma homocysteine and atherosclerotic peripheral vascular disease.

Fasting total plasma homocysteine levels were measured by rapid ion-exchange chromatography in 100 patients with symptomatic atherosclerotic peripheral vascular disease (PVD) and 100 age and sex-matched control subjects. Demographic data, biochemistry, hematology, and lipid fractions were measured in both groups, and clinical and vascular laboratory disease parameters were recorded for the patient group. Patients with hyperhomocysteinemia (defined as those with fasting homocysteine values exceeding the 90th percentile of the control range) were compared to patients with normal homocysteine with respect to the above parameters. Total fasting homocysteine concentrations were significantly higher in the patient group (28.8 +/- 14.9 mumol/l) than in the control subjects (20.3 +/- 11.3 mumol/l; p < 0.001). Homocysteine levels were also higher in males than in females in both the control and the patient groups. Homocysteine correlates positively only with age in the healthy controls (r = 0.291; p < 0.005) but not with other standard risk factors. Multivariate analysis of the biochemical risk factors confirmed that total plasma homocysteine concentration is an independent risk factor for PVD (p < 0.001). Hyperhomocysteinemia is not associated with vitamin B12 or folate deficiency states. Vitamin B12 concentration was 591 +/- 313 ng/l in the control group, and 682 +/- 405 ng/l in the patient group (p = NS). Serum folate concentration was lower in the controls (7.2 +/- 2.3 micrograms/l) than in the patients (8.3 +/- 2.0 micrograms/l, p < 0.001). Mild hyperhomocysteinemia was detected in 27% of the patients. Patients with hyperhomocysteinemia has a four-fold increase in risk of PVD relative to patients with a normal homocysteine level. There is no significant difference between the two groups with respect to patient demographics, biochemical risk factors, and disease pattern and severity.

Adult↗
PubMed1976

Relationship of plasma uric acid to plasma lipids and lipoproteins in subjects with peripheral vascular disease.

Hyperuricaemia and hyperlipidaemia (elevated fasting plasma cholesterol or triglycerides) were frequently found in 219 males and 63 females with peripheral vascular disease (PVD). The subjects were divided into sexes and the uric acid, cholesterol and triglyceride concentration adjusted for the effects of age and obesity by multiple regression analysis. Followig this no significant relationship was found between uric acid and cholesterol or triglyceride. When the males with PVD were divided into lipoprotein types it was found that those who were normo-lipoproteinaemics or who had type IV hyperlipoproteinaemia (HLP) had a significantly higher mean uric acid level. The other types had a mean uric acid concentration similar to that found in 25 healthy normolipoproteinaemic males. The discrepancy between this result and the lack of correlation between uric acid and triglyceride noted above is presumably due to the complex effects of age and obesity. In the females no significant increase in the mean uric acid concentration was found in any of the lipoprotein groups.

Body Weight↗
PubMed1990

Forefoot transcutaneous oxygen tension at different leg positions in patients with peripheral vascular disease.

Transcutaneous oxygen tension (TcPo2) was measured on the forefoot of 150 limbs of 128 patients with different stages of peripheral vascular disease (PVD) and on 36 limbs of 18 healthy subjects in the sitting and supine position. The diagnostic value of TcPo2 measurements was tested and compared with indirect toe pressure measurements. TcPo2 measured in the supine position gives the best diagnostic discrimination between healthy controls and patients with PVD and between patients with different degrees of PVD. The median TcPo2 in patients with PVD and rest pain (severe PVD), patients with PVD without rest pain (moderate PVD) and control subjects was 12 mmHg (range 0-61), 50 mmHg (range 0-86), and 60 mmHg (range 35-78), respectively. In the supine position, 95% of the patients with severe PVD had TcPo2 values below 40 mmHg, as opposed to 28% of the patients with moderate PVD and 8% of the control subjects. TcPo2 below 40 mmHg measured on the forefoot in the supine position suggests severe ischaemia. The diagnostic value of TcPo2 measurement is comparable with that of toe systolic pressure measurement. As a diagnostic and quantitative non-invasive method of evaluating patients suspected of PVD, TcPo2 measurement is ideal as it is easy to perform, and does not cause discomfort.

Adult↗
PubMed2006

[The meaning of caring from the viewpoint of patients with wounds due to peripheral vascular disease].

This qualitative study describes the meaning of Caring from the viewpoint of the patient with chronic wounds due to peripheral vascular disease (PVD). Because the meaning of Caring can not be understood independent from the life context of the persons involved, the following questions have been formulated: 1) What influence does living with chronic wounds have on the everyday life of the patient? 2) What is the meaning of Caring for patients with chronic wounds? To answer these questions, qualitative research methods according to Mayring were chosen. A convenience sample of twelve patients, seven women and five men, with ages ranging from 69 to 86 years (median 77 years), were interviewed from April to November 2002. Data were analyzed according to Mayring (2000) through content analysis. The results show that the everyday life of the patient is strongly influenced by the effects of having chronic wounds. Patients view their lives with chronic wounds, the effects on their day to day life and the support from health professionals and family caregivers as a whole. Patients differentiate between Caring from Health professionals and Caring from family caregivers. Caring from health professionals is described primarily in the context of treatments and support situations. Caring from family caregivers is experienced as a part of the everyday life. Patients assume that healthcare professionals have the needed expertise, knowledge and skills. They hope, however, to be valued and respected and describe these characteristics as "kind and nice". When patients experience these attitudes from the nurses they feel they are taken seriously and are cared for. This is a requirement to enable or empower patients to understand and implement their treatment regimen. Caring must always be an element of nursing care and determines the standard of the quality of the patient-nurse relationship.

Activities of Daily Living↗