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PubMed2002

Lower extremity performance is associated with daily life physical activity in individuals with and without peripheral arterial disease.

OBJECTIVES: To determine whether persons with poorer lower extremity functioning have reduced physical activity levels. DESIGN: Cross-sectional. SETTING: Three Chicago-area medical centers. PARTICIPANTS: Two hundred twenty-five people with lower extremity peripheral arterial disease (PAD) and 121 individuals without PAD. MEASUREMENTS: The summary performance score (SPS) was determined for all participants. The SPS combines data on walking velocity, time for five repeated chair rises, and standing balance. Each test is scored on a 0 to 4 scale (4 = best). Scores are summed to create the SPS (0-12 scale, 12 = best). All participants wore a vertical accelerometer for 7 days to measure physical activity. RESULTS: The SPS was associated linearly with 7-day physical activity levels of participants with (P< .0001) and without PAD (P< .0001). This relationship was maintained even after restricting analyses to subsets of participants who reported that they could walk a quarter of a mile and up and down stairs without difficulty (P< .001) and were able to walk for 6-minutes without stopping (P< .001). In multiple linear regression analyses, the SPS was associated with physical activity in participants with (P< .01) and without PAD (P< .001), adjusting for age, sex, race, comorbidities, ankle brachial index, neuropathy, and leg symptoms. CONCLUSION: In people with and without PAD who have impaired lower extremity performance, reduced physical activity levels may contribute to subsequent disability. Future study is needed to determine whether interventions to increase physical activity can prevent functional decline in persons with a low SPS.

Activities of Daily Living↗

PubMed2002

Declining-dose study of reteplase treatment for lower extremity arterial occlusions.

PURPOSE: To prospectively determine the technical success and complication rates of three different reteplase dosing regimens during catheter-directed arterial thrombolysis. MATERIALS AND METHODS: Prospective data were obtained from three groups of patients who underwent lower extremity arterial thrombolysis with three different regimens of reteplase: 0.5 U/h, 0.25 U/h, and 0.125 U/h. A total of 101 thrombosed lower extremity arterial occlusions in 87 patients were treated. A subtherapeutic intravenous heparin dose of 400-500 U/h was administered. All limbs were viable at presentation. Thrombolytic success was defined as 95% thrombolysis of the occluded artery or graft with restored distal antegrade flow. Thirty-day mortality and amputation rates were calculated. Bleeding complications and need for transfusions were recorded. Laboratory values recorded included fibrinogen level, platelet count, hematocrit level, hemoglobin level, and prothrombin time. RESULTS: Thrombolytic success was achieved in 86.7% of patients in the 0.5-U/h dose group, 83.8% of patients in the 0.25-U/h dose group, and 85.3% of patients in the 0.125-U/h dose group. The major bleeding and transfusion rates were 13.3% in the 0.5-U/h dose group, 5.4% in the 0.25-U/h dose group, and 2.9% in the 0.125-U/h dose group. The 30-day amputation-free survival rates were 90% in the 0.5-U/h dose group, 97.3% in the 0.25-U/h dose group, and 94.1% in the 0.125-U/h dose group. Pre- and postprocedural fibrinogen levels and the fibrinogen nadir were not statistically different between the groups. No differences in total infusion times were found between the 0.5-U/h dose and 0.25-U/h dose groups. However, the infusion time in the 0.125-U/h dose group was significantly longer than in the other two groups (42 h vs 30 h; P <.05). CONCLUSION: All dosing regimens were equally effective in the treatment of acute lower extremity occlusions. The infusion times were longer with the 0.125-U/h dose. Significantly fewer major bleeding complications were encountered with the 0.25-U/h and 0.125-U/h dose regimens than with the 0.5-U/h dose regimen.

Aged↗

PubMed2004

[The potential of conservative therapy and surgical treatment of microcirculatory distress in chronic venous insufficiency of the lower extremities in a stage of trophic disorders].

The present work describes the results of an all-round examination and treatment of 120 patients suffering from different forms of chronic venous insufficiency (CVI) of the lower extremities with trophic disorders of soft tissues. Of these, varicosis was present in 91 (75.8%) patients and postthrombotic disease - in 29 (24.2%), patients. Hemomicrocireulation was examined by laser Doppler flow-metry. Assessment was made of the functional activity of neutrophilic granulocytes of the microcirculatory bed. The data were obtained indicating the decrease of skin perfusion and activation of neutrophils in the hemomicrocirculatory bed of the involved extremity at venous outflow decompensation. Of the 120 persons, conservative treatment was provided to 23 patients, in 45 patients, the conservative measures represented a stage in the preoperative preparation. Ninety-seven patients were operated on. The studies of hemomicrocirculation carried out at different times after treatment have demonstrated that conservative treatment produces a beneficial effect on hemomicrocirculatory disorders in the lower extremities of patients with CVI. However, the effects of conservative therapy are unstable and not long-lasting. Surgical correction of the venous outflow in patients with decompensated forms of CVI of the lower extremities leads to a stable improvement of the functional parameters of microcirculation.

Adult↗

PubMed1989

[The significance of vascular surgery treatment of complications following percutaneous transluminal angioplasty of the lower extremities].

In 147 patients suffering from arterial occlusive disease of the lower extremities 162 PTAs of the iliac, femoral and popliteal arteries were performed. Thirteen complications occurred in 12 patients, while surgical intervention was necessary in seven cases (4.3%). Hematoma at the site of the arterial puncture were the most frequent complications, requiring acute surgical intervention (n = 3). In two patients, acute vascular occlusion after PTA required bypass operation and thrombendarteriectomy, respectively. In one patient, presenting with an iliac stenosis, PTA was performed using a transaxillar approach and was complicated by an axillar hematoma due to the ruptur of the arteria subscapularis. Furthermore, one patient with an extended hematoma of the abdominal wall required surgical intervention. The results presented indicate that PTA of the lower extremities for treatment of arterial occlusive disease is a procedure with low risk. Complications, which require acute operative therapy, can be treated mostly successful by small surgical interventions.

Angioplasty, Balloon↗

PubMed1996

[Results of kinesis therapy in patients with diabetic macroangiopathy of the lower extremities].

In 30 patients with diabetes type II and macroangiopathy of lower extremities, physical training was applied. This treatment was carried on in our Clinic for average 4 weeks. The following methods were applied: individual exercises of legs once or twice daily for 30-minutes, training in brine swimming pool for 30 minutes every-day, treatment walks with proportioning effort. Value of physical effort was not more than 30-40% max. pulse rate. The examination was performed before and after the programme of treatment. The examination included the following parameters: subjective test on cycloergometer, examination of blood flow velocity by Doppler method and biochemical examination of glycaemia and lipidemia. We found improvement in intermittent claudication distance, significant subjective improvement in velocity of blood flow in lower extremities. In our opinion physical vascular training is a valuable method of mono-operative treatment of vascular disease of legs in diabetic patients.

Adult↗

PubMed2003

Laser treatment with a 1064-nm laser for lower extremity class I-III veins employing variable spots and pulse width parameters.

BACKGROUND: The long-pulsed 1064-nm Nd:YAG laser (employing varying spot sizes, pulse widths, and fluences) has gained popularity for treating lower extremity blue and red vessels that are less than 4 mm in diameter. OBJECTIVE: To evaluate the efficacy of high-power 50-ms 1064 Nd:YAG laser in the treatment of class I-III lower extremity vessels. METHODS: Ten female patients (mean age of 39 years) had a 5-cm2 area of veins measuring 0.2 to 3 mm in diameter treated with up to three treatment sessions using a new 1064 Nd:YAG laser, with the end point being 100% vessel clearing after three treatments. Red vessels were treated with a spot size of 1.5 mm, a fluence of 400 to 600 J/cm2, a pulse width of 30 to 50 ms; blue vessels of 1 to 3 mm were treated with a spot size of 3 mm, a fluence of 250 to 370 J/cm2, and a pulse width of 50 to 60 ms. Macrophotographic imaging evaluations by blinded observers using a quartile scale and a patient satisfaction scale were employed to evaluate results. RESULTS: At month 3 after the final treatment session, 20% of all vessel types had 50% to 75% improvement. Equal clearing was noted for blue and red vessels. At month 6, 80% of patients had a greater than 75% clearing. Ninety percent of patients were highly satisfied with the treatment results at 6 months. CONCLUSION: By varying spot size, fluence, and pulse duration, a long-wavelength 1064-nm Nd:YAG laser can achieve excellent results for treating both blue and red lower extremity vessels that are less than 3 mm in diameter.

Adult↗

PubMed2006

Effect of brisk walking in 1 or 2 daily bouts and moderate resistance training on lower-extremity muscle strength, balance, and walking performance in women who recently went through menopause: a randomized, controlled trial.

BACKGROUND AND PURPOSE: Menopause may induce a phase of rapid decreases in bone mineral density, aerobic fitness, muscle strength, and balance, especially in sedentary women. The purpose of this study was to examine the effects and feasibility of an exercise program of 1 or 2 bouts of walking and resistance training on lower-extremity muscle strength (the force-generating capacity of muscle), balance, and walking performance in women who recently went through menopause. SUBJECTS AND METHODS: The subjects were 134 women who recently went through menopause. The study was a 15-week, randomized, controlled trial with continuous and fractionated exercise groups. The outcomes assessed were lower-extremity muscle strength, balance, and walking time over 2 km. Feasibility was assessed by questionnaires, interviews, and training logs. RESULTS: One hundred twenty-eight women completed the study. Adherence to the study protocol was 92%. Both continuous and fractionated exercise groups improved equally in lower-extremity muscle strength and walking time but not in balance. Almost 70% of the subjects considered the program to be feasible. Two daily walking sessions caused fewer lower-extremity problems than did continuous walking. DISCUSSION AND CONCLUSION: Brisk walking combined with moderate resistance training is feasible and effective. Fractionating the walking into 2 daily sessions is more feasible than continuous walking.

Exercise↗

PubMed2003

Improvement in lower-extremity peripheral arterial disease by nocturnal hemodialysis.

A 42-year-old man with end-stage renal disease (ESRD) was referred for conversion to nocturnal hemodialysis (NHD) therapy from conventional hemodialysis (CHD) therapy because of refractory intermittent claudication secondary to peripheral arterial disease (PAD). The patient was initiated on CHD therapy in 1976 and subsequently had undergone two unsuccessful renal transplantations. While on CHD therapy, his clinical course was complicated by worsening vascular and soft-tissue calcification. Extensive dystrophic soft-tissue calcification was noted bilaterally in his hands, lower extremities, and sacral region, requiring surgical excision. Lower-extremity arterial Doppler scans documented vascular calcification and a pronounced decrease in peripheral arterial flow bilaterally. After conversion to NHD therapy (7.5 h/session five times weekly), the patient became symptom free and had significant clinical improvements in (1) hemodynamics, measured by clinic blood pressure and two-dimensional echocardiography, (2) biochemical profile, and (3) a sustained improvement in arterial Doppler flow measured by duplex Doppler ultrasound. We conclude that NHD was able to improve lower-extremity PAD in our patient. Further observational and interventional studies are required to investigate the therapeutic potential of NHD for the treatment of PAD in patients with ESRD.

Adult↗

PubMed1986

Long-term hemodynamic and clinical sequelae of lower extremity deep vein thrombosis.

Forty-seven patients with phlebographically confirmed lower extremity deep vein thrombosis (DVT) were reexamined 5 to 10 years (mean, 7 years) after the thrombotic event. Clinical symptoms were recorded and the following noninvasive venous vascular laboratory tests were performed: Doppler examination to determine venous valve competence and photoplethysmography to measure ambulatory venous pressure and venous recovery time. Twenty-eight control subjects underwent similar examination. Although only 10 of 47 patients (21%) were asymptomatic, venous ulceration had developed in only two patients. The symptomatic patients had varying degrees of edema, pigmentation, and varicosities. Eighty-three percent of DVT patients had abnormal vascular laboratory findings. Both the severity of clinical symptoms and the magnitude of the hemodynamic abnormalities generally correlated with the extent of the initial thrombus. However, only 47% of patients whose initial thrombus appeared limited to the calf were asymptomatic, and only 25% of this group had normal venous hemodynamic findings. This study indicates that 5 to 10 years after lower extremity DVT 80% of patients will have both symptoms and abnormal venous hemodynamics regardless of the initial site of the thrombosis.

Female↗

PubMed2000

Age differences and changes in midline-crossing inhibition in the lower extremities.

BACKGROUND: The effects of crossing the body midline on the lower extremities of individuals 65 years of age and older was investigated. METHODS: The subjects were 10 individuals 65-79 years of age, 10 individuals 80 years and older, and 10 individuals 20-35 years. The total testing phase consisted of 2 sets of 30 trials per leg on 2 days. The subjects performed trials that involved movements ipsilaterally, contralaterally, and directly in front of the anterior superior iliac crest of the leg being tested. Reaction time and movement time scores were recorded. RESULTS: Individuals 65 years of age and older were found to exhibit slower reaction times to movements in a contralateral direction when compared with movements made in the ipsilateral direction whereas individuals 80 years of age and older were also found to exhibit slower reaction times to movements in a contralateral direction when compared with movements made in the midline and ipsilateral direction. CONCLUSIONS: These findings indicate that the effects of midline-crossing inhibition on the lower extremities reemerge in individuals 65 years and older, whereas in early development this effect disappears by 8 or 9 years of age.

Adult↗

PubMed1995

Bilateral lower extremity US in the patient with unilateral symptoms of deep venous thrombosis: assessment of need.

PURPOSE: To assess the need for bilateral ultrasound (US) evaluation for lower extremity deep venous thrombosis (DVT) regardless of predisposing factors in patients with unilateral symptoms. MATERIALS AND METHODS: Two hundred six patients with unilateral lower extremity symptoms suggestive of DVT were evaluated prospectively for predisposing factors and symptoms. Bilateral examinations were performed in all patients, and the prevalences of US-diagnosed DVT in symptomatic and in asymptomatic extremities were determined. RESULTS: Thirty-seven of the 206 patients had DVT in the symptomatic extremity. Twenty-five of these 37 patients had predisposing factors. No DVT was found in any asymptomatic extremity. Because compression US has a sensitivity and a specificity of greater than 90% for the diagnosis of DVT, these results were statistically significant (P < .001). CONCLUSION: Regardless of predisposing factors, US screening for DVT in the lower extremities should be limited to the symptomatic extremity in patients with unilateral symptoms. This would decrease scanning time and cost without a decline in the DVT detection rate.

Adolescent↗

PubMedDate not supplied

Increasing hamstring flexibility decreases lower extremity overuse injuries in military basic trainees.

The purpose of this intervention study was to prove that increasing flexibility of the hamstring musculotendinous unit would decrease the number of lower extremity overuse injuries that occur in military infantry basic trainees. Two different companies going through basic training at the same time were used. Hamstring flexibility was checked at the beginning and at the end of the 13-week infantry basic training course. The control company (N = 148) proceeded through normal basic training. The intervention company (N = 150) followed the same program but added three hamstring stretching sessions to their already scheduled fitness program. All subsequent lower extremity overuse injuries were recorded through the troop medical clinic. Hamstring flexibility increased significantly in the intervention group compared with the control group. The number of injuries was also significantly lower in the intervention group. Forty-three injuries occurred in the control group for an incidence rate of 29.1%, compared with 25 injuries in the intervention group for an incidence rate of 16.7%. Thus, in this study, the number of lower extremity overuse injuries was significantly lower infantry basic trainees with increased hamstring flexibility.

Adult↗

PubMed1990

Effects and limitations of pentoxifylline therapy in various stages of peripheral vascular disease of the lower extremity.

One hundred one patients with peripheral vascular disease of the lower extremity were entered into a study of the efficacy of oral pentoxifylline to determine if the response to therapy varied with the severity of disease. Ninety-three patients were evaluated before and after 8 weeks of therapy with pentoxifylline, while 8 did not complete the entire course due to adverse drug reactions. Resting and post-stress ankle/arm Doppler indices (AAIs) were measured and, in those patients who could walk on a treadmill, treadmill walking distances were measured. Patients were classified according to pretreatment clinical and treadmill measurements and according to pretreatment resting AAIs. Resting and post-stress AAIs, as well as treadmill walking distances, increased in patients with moderately severe claudication. Patients in this group responded better to therapy than did patients with rest pain or ischemic ulcers, severe claudication, or mild claudication. Patients with a pretreatment resting AAI greater than or equal to 0.5 responded better than those with an AAI less than 0.5. Only 5% of patients reported satisfaction with the results of treatment. These results support the findings that pentoxifylline may be useful only in selected patients with moderately severe peripheral vascular disease of the lower extremity and may not be useful in those with severe or mild disease.

Diabetes Complications↗

PubMedDate not supplied

Cryogenic neuroablation for the treatment of lower extremity neuromas.

A prospective study testing the efficacy of cryosurgery on lower extremity neuromas was performed. Thirty-one neuromas in 20 patients were percutaneously denervated using a Westco Neurostat-III cryoneedle. All patients were surgical candidates who had failed prior conservative treatment. Patient evaluation consisted of a 10-point visual analog scale (VAS) that was administered pre- and postoperatively. Periodic evaluation with the VAS and patient satisfaction was conducted for a 1-year period following the procedure. Immediately after the procedure, all patients reported complete relief of pain and were permitted to return to full activity. Two weeks after the index procedure, patients were categorized into one of three groups: those who remained completely pain free (38.7%), those who had reduced pain (45.2%), and those who had reverted to preprocedure pain levels (16.1%). The pain score of those patients who had reduced pain decreased from a mean of 8.5+/-0.4 preprocedure to 3.5+/-0.4 (p < .002). All five patients with no improvement had previous local neurectomies. Even though fewer than 40% of the patients had complete pain relief, an overwhelming 90% stated they would have the procedure performed again. Cryogenic neuroablation appears to be a viable treatment option for patients with lower extremity neuromas. The success rate is similar to surgical excision with little to no disability period and high patient satisfaction.

Adult↗

PubMed1999

Functional outcome of individuals with traumatic brain injury and lower extremity deep venous thrombosis.

OBJECTIVE: To determine the impact of acute lower extremity (LE) deep venous thrombosis (DVT) on functional outcome after traumatic brain injury (TBI). SETTING: Tertiary university medical center rehabilitation unit. SUBJECTS: Ninety-two TBI rehabilitation patients (46 patients with DVT and 46 patients without DVT). Forty-six TBI patients with a diagnosis of LE DVT were 1:1 matched with non-DVT TBI patients. Matching criteria included: primary diagnosis of TBI, admission Functional Independence Measure (FIM), Glasgow Coma Scale (GCS), and age. OUTCOME MEASURES: FIM (admission, discharge, change, and efficiency), FIM subscores (activities of daily living [ADL], mobility, cognition), length of stay ([LOS] acute and rehabilitation), and discharge living disposition. DESIGN: Cohort study utilizing prospectively collected data. DVT diagnoses were made upon rehabilitation admission using color flow duplex Doppler ultrasonography. Descriptive statistics were run on demographic variables. Analyses of variance (ANOVAs) were performed on the sample with regard to outcome measures, including FIM scores, FIM subscores, and LOS (acute and rehabilitation). RESULTS: No significant between-group differences were found concerning LOS, rehabilitation costs, FIM total, or FIM subgroup scores. Chi-squared analyses revealed significant differences between groups with regard to discharge living disposition (chi(2) = 4.7, P <.03). CONCLUSION: Lower extremity DVT does not appear to interfere with functional outcome after TBI. The data suggest that this patient population is appropriate for admission or continued participation in acute inpatient rehabilitation, despite the presence of LE DVT.

Activities of Daily Living↗

PubMed1985

The role of free-tissue transfers in lower-extremity reconstruction.

Eighty-five free flaps were performed in 76 patients for defects in the lower extremity. A new classification of lower-extremity defects was devised to help define the role of free-tissue transfers: group 1, soft-tissue defects; group 2, soft-tissue and bone loss less than 8 cm; group 3, massive soft-tissue and bone loss greater than 8 cm; and group 4, bone defect only. Each group was further divided into clean (A) and infected (B) wounds. Our overall results include resolution of the presenting problem in 82 percent; there were 17 flap losses (20 percent), persistent osteomyelitis in 8, and 10 amputations. This review has prompted us to limit our indications for limb salvage, particularly in group 3B, in patients with compound injuries that include loss of plantar sensation, and in patients with large segments of infected bone.

Adolescent↗

PubMed2003

[Clinical manifestations and characteristics of vascular bed involvement in atherosclerosis of lower extremities in patients with type 2 diabetes].

Clinical manifestations of arterial insufficiency and characteristics of vascular damage were compared in 68 patients (54 men, 14 women, mean age 64.5+/-1.1 years) with atherosclerosis of arteries of lower extremities including 40 patients with type 2 diabetes. Color duplex scanning was used for assessment of severity of vascular wall involvement. Ankle blood pressure was measured by Doppler technique with calculation of ankle-brachial index. Atherosclerosis of arteries of lower extremities in patients with diabetes manifested clinically as neuropathy while intermittent claudication was more characteristic of patients without diabetes. Severity of medial calcinosis and vascular wall rigidity were related to duration of diabetes. Ankle-brachial index in patients with diabetes was 20-30% and 1.5-2 times higher compared with those without diabetes with similar occlusive and nonocclusive changes of arteries of lower extremities, respectively. Color duplex scanning did not reveal differences between patients with and without diabetes in frequency of large multiple atherosclerotic plaques in abdominal aorta, iliac, popliteal arteries.

Aged↗

PubMed1999

Health status in veterans undergoing noninvasive lower extremity arterial evaluation.

The health status of outpatients (n = 299) undergoing lower extremity arterial Doppler studies (LES) in a Veterans Affairs Medical Center-based vascular laboratory was assessed from 9/95 through 6/96 using the SF-36 Health Survey. The purpose of this study was to compare health status of these outpatients to national norms and to determine whether Doppler-derived ankle/brachial indices (ABI) correlated with the eight health concepts measured by the SF-36 Health Survey. Physical functioning (PF), role limitations by physical illness (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role limitations by emotional illness (RE), and mental health (MH) were more impaired in study patients (65.9 +/- 9.6 years of age) undergoing LES than national norms for males >/=65 years old (P < 0.0001). In fact, each health concept was below the 25th percentile of the national norms. PF was 33.4 +/- 22.4 for outpatients compared to the national norm of 65.8 +/- 28.3. Physical functioning was the only SF-36 health concept defined above which correlated with lowest ABI (r = 0.15; P = 0.012), adjusting for age but not comorbidities. Veterans undergoing only carotid duplex during the study period (n = 169) were compared to the veterans undergoing only LES (n = 251) during the study. PF, RP, BP, GH, VT, SF, and RE were significantly more impaired in those undergoing only LES compared with carotid duplex (P < 0.05). Veteran outpatients referred to a vascular laboratory have broad-based and profound impairments in health status. In addition, only physical functioning correlated with ABI, a measure of lower extremity arterial disease severity.

Aged↗