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At least 1,063 records · Page 59Linked to original sources
PubMed1995

Thrombolysis of lower extremity embolic occlusions: a study of the results of the STAR Registry.

PURPOSE: To evaluate thrombolysis as primary therapy for lower extremity embolic occlusions. MATERIALS AND METHODS: Forty-five of 306 consecutive cases of lower extremity arterial occlusions treated with urokinase and registered in the Society of Cardiovascular and Interventional Radiology Transluminal Angioplasty and Revascularization Registry were believed on the basis of clinical and angiographic findings to be due to emboli. RESULTS: Comorbidity included atrial fibrillation in 50%, previous myocardial infarction in 40%, and a cerebrovascular event in 35%. Thirty-two (71%) limbs were viable, 12 (27%) were threatened, and one had irreversible ischemia. Mean symptom duration was 8.6 days. Average occlusion length was 17 cm. The distribution of emboli was 4% aortoiliac, 65% femoropopliteal, 24% tibial, and 7% graft. Major complications occurred in eight of 45 patients (18%). The technical success rate was 69%, with a 1- and 2-year primary patency of 79% for initially successful intraarterial thrombolyses. CONCLUSION: Thrombolysis of embolic occlusions is successful in most cases. Limb salvage and survival rates are similar to historical reports for surgical embolectomy.

Adult↗
PubMed2005

Function of skin grafts in children following acquired amputation of the lower extremity.

BACKGROUND: Investigators have recommended aggressive use of skin-grafting in order to preserve length and proximal joint function following an acquired amputation in children. However, there is little objective evidence to either support or refute that recommendation. METHODS: We performed a retrospective review of the cases of all children for whom a skin graft had been applied to the residual limb following an acquired lower-extremity amputation at our Limb Deficiency Clinic between 1984 and 2002. Skin graft dysfunction, defined as breakdown, contracture, and/or pain, was considered to be clinically relevant if it required the child to discontinue use of the prosthesis for any period of time or if it required revision surgery to facilitate continued prosthetic fitting. RESULTS: Twenty-three children (mean age at amputation, 4.4 years) with a total of thirty-one acquired lower-extremity amputations had been treated with skin-grafting. At a mean of 6.3 years after the operation, sixteen (52%) of the thirty-one extremities had had no episodes of skin graft dysfunction. The remaining fifteen extremities (48%) had had clinically relevant skin graft dysfunction (breakdown in thirteen and contracture and pain in one extremity each). Nine of the ten extensive skin grafts underwent clinically relevant breakdown, as did thirteen of the twenty-four grafts that were located distally on the residual limb. Subsequent surgical revision of the residual limb because of inadequate function of the skin graft was performed on seven extremities (23%), with revision to a more proximal limb-segment level required in five. CONCLUSIONS: Focal skin-grafting (involving < or = 25% of the surface area) of partial-thickness soft-tissue defects in order to optimize the length of the residual limb at the time of an amputation is an effective option for children with an acquired lower-extremity amputation. Limited skin-grafting (involving 26% to 50% of the surface area) is more likely to result in skin graft breakdown, particularly when it is done distally. Extensive skin-grafting, while technically possible, frequently requires revision and rarely results in an optimally functioning limb. Alternative treatment strategies should be considered for extremities that would require extensive, distal skin-grafting.

Adolescent↗
PubMed1989

Lower extremity telescopic orthosis for immediate fitting in paraplegia.

For initial gait training with the paraplegic patient, a lower extremity telescoping orthosis has been developed. This brace eliminates the time-consuming fabrication, considerable weight, and cumbersome use of conventional knee-ankle-foot orthoses and is easily adjustable to a wide range of patients. Particularly during the early phase of rehabilitation, this brace offers significant advantages to the patient with lower extremity disabilities.

Braces↗
PubMed1957

Surgical treatment for poliomyelitis paralysis; principles of reconstruction of the lower extremities.

In surgical procedures for the improvement of function in lower extremities paralyzed by poliomyelitis, even the best that can be done will fall far short of normal function. But choosing and carrying out the operation best suited to the paralytic situation of the patient and to the kinds of function that will benefit him most, often can make the patients more self-sufficient, can make improvements that enable him to walk farther with less fatigue, to balance without support, to walk without grotesque limping, or that sometimes permit discarding a brace. Sometimes improving his ability to carry out even seemingly minor tasks of personal care is a definite positive service which to the patient is a boon.

Humans↗
PubMed2004

The magnetic attraction of lower extremity external fixators in an MRI suite.

OBJECTIVES: To determine the magnetic attraction of 10 currently available lower extremity external fixators in the MRI suite and to test fixators with minimal or no magnetic attraction for the presence of temperature elevation during a 30-minute MRI scan. DESIGN: Consecutive testing of selected tibial external fixation models in an identical manner. SETTING: Level 1 trauma center. CONSTRUCTS: Ten commercially available external fixators used for lower extremity injuries applied to saw bone tibia. INTERVENTION: External fixators suspended in testing apparatus were placed at three locations in the MRI suite for magnetic testing. Fixators with minimal attraction were scanned for 30 minutes. MAIN OUTCOME MEASUREMENTS: Magnetic attraction was measured with a digital scale, and temperature measurements were obtained with a digital thermometer and thermocouple. RESULTS: The Ilizarov with carbon fiber rings, Richards Hex-Fix, and Large Synthes External Fixator had <1 kg of magnetic attraction at all three locations. No component of these fixators experienced >2 degrees of temperature elevation after a 30-minute MRI scan. The EBI Dynafix with Ankle Clamp, EBI Dynafix, and EBI Dynafix Hybrid along with the Hoffman II, Hoffman II Hybrid, Ilizarov with stainless steel rings, and Synthes Hybrid had >1 kg of magnetic attraction at all three locations. CONCLUSIONS: Many commercially available external fixators have components and spring clamps that have significant magnetic attraction to the MRI scanner. Fixators that have <1 kg of attraction do not experience significant heating during MRI.

Equipment Design↗
PubMed2003

Endovascular management of venous thrombotic and occlusive diseases of the lower extremities.

Acute complications of deep vein thrombosis (DVT) of the lower extremities include pulmonary embolism and venous ischemia. Delayed complications include a spectrum of debilitating symptoms referred to as postthrombotic syndrome (PST). Anticoagulation therapy is recognized as the mainstay of therapy in acute DVT. However, there are few data to suggest any major beneficial effect on PTS, which is thought to be mediated by valve damage and/or occlusive chronic thrombus and venous scarring. Endovascular catheter-directed thrombolysis techniques with pharmacologic thrombolytic agents, used alone or in combination with mechanical thrombectomy devices, have been proven highly effective in clearing acute DVT, which may allow the preservation of venous valve function and prevention of subsequent venous occlusive disease. Definitive management of underlying anatomic occlusive abnormalities can also be undertaken.

Arterial Occlusive Diseases↗
PubMedDate not supplied

Lower-extremity arterial disease in diabetes mellitus due to chronic pancreatitis.

OBJECTIVE: To determine the prevalence of lower-extremity arterial disease and the sites of arterial obstruction in patients with pancreatic diabetes. PATIENTS AND METHODS: The retrospective study included 83 patients with diabetes due to chronic pancreatitis (age [m +/- SD] 54.5 +/- 9.5 yr, diabetes duration 9.7 +/- 7.4 yr) and 83 patients with idiopathic diabetes were carefully matched for sex, age, diabetes duration and treatment. They were screened for arteriopathy by segmental blood pressures and Doppler ultrasound, and for cardiovascular risk factors. The arterial lesions were classified as proximal (above-knee), distal (below-knee), and combined (both above- and below-knee). RESULTS: Lower extremity arterial disease occurred in 25.3% of pancreatitis patients and in 14.5% of idiopathic diabetes patients (p = 0.08). The sites of obstruction in both groups were similar; proximal obstruction: 4 vs 4 cases; distal: 10 vs 5 cases, combined: 7 vs 3 cases. The prevalence of arteriopathy increased with age and diabetes duration in both groups (p < 0.01). Total cholesterol, LDL cholesterol and apolipoprotein B were lower in the pancreatitis patients (p < 0.01); 92% of these were smokers vs 62% of idiopathic diabetes patients (p < 0.001). CONCLUSIONS: Arteriopathy, assessed by non-invasive tests, has the same prevalence and distribution in chronic pancreatitis and idiopathic diabetes patients, despite their different vascular risk factor profiles. This emphasizes the role of chronic hyperglycaemia and its duration in the pathogenesis of macroangiopathy in diabetic patients.

Aged↗
PubMed2003

Statin use and leg functioning in patients with and without lower-extremity peripheral arterial disease.

BACKGROUND: We determined whether statin use (versus nonuse) is associated with superior lower-extremity functioning independently of cholesterol levels and other confounders in patients with and without peripheral arterial disease. METHODS AND RESULTS: Participants included 392 men and women with an ankle brachial index (ABI) <0.90 and 249 with ABI 0.90 to 1.50. Functional outcomes included 6-minute walk distance and 4-meter walking velocity. A summary performance score combined performance in walking speed, standing balance, and time for 5 repeated chair rises into an ordinal score ranging from 0 to 12 (12=best). Adjusting for age, sex, ABI, comorbidities, education level, medical insurance status, cholesterol, and other confounders, participants taking statins had better 6-minute walk performance (1276 versus 1218 feet, P=0.045), faster walking velocity (0.93 versus 0.89 m/s, P=0.006), and a higher summary performance score (10.2 versus 9.4, P<0.001) than participants not taking statins. Positive associations were attenuated slightly after additional adjustment for C-reactive protein level but remained statistically significant for walking velocity and the summary performance score. We did not find significant associations between lower-extremity functioning and aspirin, ACE inhibitors, vasodilators, or beta-blockers. CONCLUSIONS: Statin use is associated with superior leg functioning compared with no statin use, independent of cholesterol levels and other potential confounders. These data suggest that non-cholesterol-lowering properties of statins may favorably influence functioning in persons with and without peripheral arterial disease.

Adrenergic beta-Antagonists↗
PubMed2002

The significance of lower extremity peripheral arterial disease.

The role of the cardiologist is expanding and involves the management of patients with lower extremity atherosclerotic occlusive arterial disease. Peripheral arterial disease (PAD) remains an underdiagnosed and undertreated disease. The purpose of this review is to educate the clinician on the significance of lower extremity atherosclerotic occlusive arterial disease. Pathophysiology and anatomy are briefly reviewed. The definition of PAD is based upon both anatomic and functional considerations. Risk factors for PAD include traditional atherosclerotic risk factors. There is a considerable overlap between coronary and cerebrovascular diseases and PAD. Diagnosis is made mainly by history and physical examination. Noninvasive and invasive tests help diagnosis and localize disease. Expanded therapies to improve outcomes include lifestyle changes, medical treatment, interventional cardiovascular procedures, or surgical intervention.

Arterial Occlusive Diseases↗
PubMed2003

Comparison of procedural outcomes after lower extremity reversed vein grafting and secondary surgical revision.

OBJECTIVE: Many lower extremity vein graft procedures require revision. Although morbidity associated with revision procedures is assumed minimal, this has not been previously quantified and may be underestimated. In this study, patient outcome after initial vein graft procedures and revisions are compared. METHODS: Records for all patients undergoing vein graft revision from January 1995 to August 2002 were reviewed for operation time, estimated blood loss, blood transfusion, hospital length of stay, perioperative complications, and functional status at discharge and at 2-month follow-up. Revisions were compared with the original operation and by revision type. RESULTS: One hundred sixty-five vein graft revisions were performed in 137 patients. In comparison with the initial bypass procedure, mean operation time (3.35 +/- 1.41 hours vs 2.58 +/- 1.04 hours; P <.001), estimated blood loss (272.4 +/- 249.9 mL vs 174.8 +/- 140.8 mL; P <.001), hospital length of stay (10.15 +/- 4.85 days vs 7.05 +/- 5.14; P <.001), and overall complication rate (35.8% vs 22.4%; P =.015) were significantly less for revision procedures. Revision of more than one site on the graft resulted in longer operation time (P =.003) and estimated blood loss (P <.001), but similar complication rates (P = NS), compared with revision at only one site. Revisions that involved only the graft resulted in decreased hospital length of stay compared with revisions involving extension to native inflow or outflow vessels (P <.02). Return to preoperative ambulatory status at discharge was 71% after initial operation, and was 92% after revision (P <.001). Return to independent living at discharge was 66% after the initial operation, and was 80% after revision (P <.01). CONCLUSIONS: Operative revisions were better tolerated than initial vein graft procedures, but are still major procedures. Hospital length of stay is longer for patients undergoing proximal or distal extension of the graft to native vessels and in patients who are not ambulatory and living independently at discharge. Patients undergoing vein graft revision should be counseled about potential morbidity.

Aged↗
PubMed1987

Evaluation of the usefulness of enzymatic diagnosis of myocardial infarction in patients with acute arterial occlusion of the lower extremities.

The serum activities of aspartate aminotransferase, lactate dehydrogenase, creatine kinase and estimated creatine kinase isoenzyme MB (CK-B) were investigated in 12 patients before and after revascularization of ischaemic lower extremities. All patients suffered from sudden lower limb arterial occlusion and underwent embolectomy through a small arteriotomy in the groin. The median serum activity of all four enzymes was elevated before surgery and further increased during the first 24-48 h after revascularization. Median serum activity of aspartate aminotransferase, creatine kinase and lactate dehydrogenase were continuously elevated 7 days after the operation. A high relative CK-B activity coincided in one patient with the development of electrocardiographic evidence of acute myocardial infarction. It is concluded that any of these four enzymes should be used with caution in the diagnosis of acute myocardial infarction before, during or after operation in patients who have sustained prolonged ischaemia of the lower extremities.

Acute Disease↗
PubMed2002

Influence of lower extremity strength of healthy older adults on the outcome of an induced trip.

OBJECTIVES: To determine whether decreased lower extremity strength contributes to trip-related falls in older adults. DESIGN: A cross-sectional sample of older adults were safety-harnessed and tripped while walking using a concealed, mechanical obstacle. Lower extremity strength was compared between trip outcome groups. SETTING: A biomechanics research laboratory. PARTICIPANTS: Seventy-nine healthy, community-dwelling adults aged 65 and older (50 women). MEASUREMENTS: Ankle, knee, and hip flexion and extension strength were measured isometrically and isokinetically. Measured strengths were subjected to a factor analysis. Strength factor scores were compared between those who recovered from the trip and those who fell by three previously identified mechanisms: during-step, after-step, and elevating-response falls. RESULTS: Seven common factors, one associated with each direction of exertion at each joint and one with the time rate of moment increase, explained 88% of the variance in measured strength. The during-step (n=5) fallers were significantly stronger in the ankle extension (plantarflexion), knee flexion, overall extension, and total strength factors than those who successfully recovered using a similar, lowering strategy (n=26). The elevating-response faller (n=1) was stronger in the plantarflexion and overall extension factors than most of those who recovered using a similar, elevating strategy (n=11). Two of three after-step fallers were among the weakest subjects tested. CONCLUSION: Weak older adults and the strongest older adults may be at greater risk of falling from a trip, although by different mechanisms. High strength may increase the likelihood of a during-step or elevating-response fall; decreased strength may increase the likelihood of an after-step fall.

Accidental Falls↗
PubMedDate not supplied

[The late results in the surgical treatment of patients with arteriosclerosis obliterans of the arteries of the lower extremities].

Long-term outcomes of surgical treatment were examined in 157 patients with atherosclerosis obliterans of lower extremity arteries. Complications of an atherosclerotic process are a basic cause of death in the patients in the long-term postoperative period. More than half (53.7%) the deaths were due to coronary heart disease. In a group of patients in whom coronary heart disease was not diagnosed prior to surgery, death from myocardial infarction was observed in 20.4% of cases during 5 years. Hypokinetic hemodynamics is a poor predictor of survival of patients with lower extremity artery atherosclerotic occlusions.

Adult↗
PubMed1990

[Diagnosis of diabetic macroangiopathy of the lower extremities using rheography].

Rheography (impedance plethysmography) makes it possible to differentiate the normal condition of arteries of the lower extremity from functional and organic affections. The examination of a group of 325 patients with diabetes mellitus revealed that without the use of rheography, i.e. when relying only on examination of the lower extremities by palpation, the presence of macroangiopathy would escape attention in 46% of the affected subjects. Macroangiopathy of an organic character was found significantly more frequently in type 2 (NIDDM) (35%) than in type 1 (IDDM) (9%; p less than 0.03). Its incidence increased in both types of diabetes with the duration of the disease. Moreover it was significantly associated with hyperlipoproteinaemia. The assembled results drew attention to the great diagnostic value of rheography. It permits also to document objectively the effect of treatment focused on macroangiopathy.

Adolescent↗
PubMed1977

Scintiscanning in venous thrombosis of the lower extremities.

Venous scintiscanning was performed once or serially in 252 patients in whom deep vein thrombosis of the lower extremities was suspected, representing a total of 494 limbs examined and 1,266 venous scintiscans performed. When controlled with roentgenologic contrast phlebography, the diagnostic accuracy rate of the isotopic method was 94.4 per cent, which increased up to 98.5 per cent when the thrombotic process was located in a major vein of the upper thigh or pelvis. There were 5.6 per cent false-positive and no false-negative diagnoses. The parameters that we have considered to be the most significant for the accurate interpretation of venous scintiscanning of the lower extremities are mentioned. Venous scintiscanning is a safe, simple and highly reliable method for the study of deep venous thrombotic disease of the lower extremitites.

Collateral Circulation↗
PubMed2001

The effect of energy restriction, walking, and exercise on lower extremity lean body mass in obese women with osteoarthritis of the knee.

Two hundred and twenty-eight Japanese women, aged 45-69 years, with osteoarthritis of the knee (knee OA) and a body mass index of greater than 26.4 self-selected one of the following interventions: (1) a nonsteroidal anti-inflammatory drug (NSAID) alone (NA group; n = 52), (2) the NSAID with nonweight-bearing exercises (NE; n = 49), (3) the NSAID combined with walking (NW; n = 35), (4) an energy restriction diet plus the NSAID (ND; n = 29), (5) the diet combined with the NSAID and strengthening exercises (NDE; n = 37), or (6) the diet combined with the NSAID and walking (NDW; n = 26). Body weight and lower extremity lean body mass (L-LBM), assessed with segmental bioelectrical impedance, were measured at the outset and at 8 weeks in the six therapy groups. Interval changes in L-LBM and L-LBM per body weight (L-LBM/weight) were compared among the six groups at the conclusion. The Lequesne index can index of severity of osteoarthritis of the knee at the final assessment, compared with that at the initial assessment, was significantly decreased in the NE group, but not in the NW or the NA groups (P = 0.023). There was a significant increase in the L-LBM/weight in the NE group, but not in the NA or NW groups (P = 0.002 between NE and NA; P = 0.019 between NE and NW). There was a significant reduction in the Lequesne index in the NDE group in comparison with the ND and NDW groups (P = 0.0001 between NDE and ND; P = 0.0001 between NDE and NDW). There was a significant increase in L-LBM/weight in the NDE group, but not in the NDW or the ND groups (P = 0.011). Adjunctive therapy with nonweight-bearing lower extremity exercises appears to be more efficacious for prevention of lower extremity loss of muscle mass than adjunctive therapy with walking for obese women with knee OA.

Aged↗
PubMed1985

Stump fractures in lower extremity amputees.

A series of 23 above-knee and below-knee amputees who sustained an ipsilateral lower extremity fracture was qualitatively evaluated with respect to the nature of the injuries sustained, associated problems, and results of fracture treatment. The overall incidence of these fractures was 3% in a population of lower-extremity amputees. The stump fractures encountered were distal femur fractures and fractures about the hip. More than one fourth of these fractures had an initially missed or 'delayed' diagnosis. Most femur fractures were successfully treated by nonoperative means, and most of the hip fractures were treated operatively. The final rehabilitated status of the dysvascular amputees was the poorest: one half of those who were previous household ambulators remained wheelchair confined postinjury.

Amputation Stumps↗