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PubMed1978

A new surgical approach to extensive arterial occlusion of lower extremity--femoro-popliteal open endarterectomy with arteriovenous shunt.

A revascularized surgery for extensive arterial occlusive lesions of the lower extremities, namely open endarterectomy of the occluded femoro-popliteal artery with arteriovenous shunt, was devised. The procedure is specially indicated to the extensive arterial occlusion of the lower extremity for which the conventional reconstructive vascular surgery is not applicable. The patency of the reconstructed femoro-popliteal arteries are ensured by virture of an arteriovenous shunt and newly developed collaterals from the reopened genicular network is expected to provide effective blood flow to peripheral parts. From 1967 to 1975, this procedure was applied to 59 extremities in 53 patients, all of whom had extensive arterial occlusion from the femoral artery to the periphery with impending ulcer and severe rest pain. Fourty-five out of 59 extremities had remarkable improvement of the ischemic symptoms and signs at the time of discharge. Long-term effectiveness was shown in 34 out of 59 extremities or 58 per cent.

Arterial Occlusive Diseases↗

PubMed1990

[Ultrasonic examination in secondary lymphedema of the lower extremities].

The article deals with the results of ultrasonic examination (USE) of 39 patients with secondary edema of the lower extremities. The authors developed a USE method which yields objective data characterizing changes of the structure, thickness, boundaries, and firmness of the soft tissues in lymphedema of the lower extremities of various severity. It was established that lymphostasis produced a characteristic ultrasonic pattern, which, as claimed by the author, may be used in differential diagnosis of lymphatic and venous edema of the extremities.

Adult↗

PubMed2005

Clinical and economic outcomes of oral linezolid versus intravenous vancomycin in the treatment of MRSA-complicated, lower-extremity skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus.

BACKGROUND: Resistant bacteria often complicate the management of skin and soft tissue infections of the lower extremities. This open-label study compared oral linezolid and intravenous vancomycin for management of complicated skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus (MRSA). METHODS: Patients aged 18 years or older with proven MRSA-related complicated skin and soft-tissue infections requiring surgical intervention were randomized to receive oral linezolid (n=30) or intravenous vancomycin (n=30) for 7 to 21 days. Clinical and microbiological outcomes, duration of hospitalization and drug treatment, and outpatient charges were determined. RESULTS: Linezolid was associated with greater rates of clinical cure and improvement (P=.015), a 3-day shorter median length of stay (P=.003), and reduced outpatient charges (P<.001). Vancomycin therapy was associated with more treatment failures and subsequent lower-extremity amputations (P=.011). CONCLUSIONS: Clinical outcomes were significantly better with linezolid than with vancomycin. Additionally, linezolid was associated with reduced length of stay and outpatient charges.

Acetamides↗

PubMed1989

Phentolamine for enhanced visualization of distal arteries in lower extremity arteriography.

To augment visualization of the distal arteries, phentolamine was administered to 83 patients (164 limbs) undergoing lower extremity arteriography. Arterial visualization was graded into three classes and skin temperatures were recorded. Phentolamine provided very good visualization of the distal arterial bed in 95% of limbs. A strong correlation was observed between the temperature rise of the feet and the class of arterial visualization. No side effects were recorded. The use of phentolamine in lower extremity arteriography is recommended.

Angiography↗

PubMed1990

Refinements in lower extremity free flap surgery.

This chapter recommends numerous factors that are significant refinements in approach and execution of lower extremity free flaps. I encourage a clear conceptual separation between the two essential phases of successful reconstruction of problem wounds: wound preparation and flap transfer. I have found that antibiotic beads maintain the sterility of temporary bony dead space. Due emphasis should be given to preparation of the surgeon, patient, and wound, allowing a nonemergency approach to lower extremity free flap coverage. The surgeon needs to be familiar with a variety of flaps beyond the usual workhorse group. Also, attention should be paid to perioperative warmth and hydration, and vessels affected by posttraumatic vessel disease must be avoided. A positive attitude toward the use of vein grafts whenever necessary is important. I also favor careful planning of the exact size and shape of the flap and length of the vessels along with use of a widely spatulated technique of end-to-side anastomoses.

Anti-Bacterial Agents↗

PubMed1988

Lower-extremity venous thrombosis: comparison of venography, impedance plethysmography, and intravenous manometry.

This study was undertaken to compare impedance plethysmography with lower-extremity venography and venous manometry in the diagnosis of acute deep venous thrombosis (DVT) of the lower extremity. Ninety-six extremities were studied. In this population, in which the prevalence of acute DVT was 43.8%, plethysmography had a sensitivity of 86.8% and a specificity of 72.0%. The predictive value of abnormal findings at plethysmography was 70.2%, and the predictive value of normal findings at plethysmography was 87.8%. Venous manometry was performed successfully in 89 extremities. A statistically significant difference was shown in the mean intravenous pressure between patients with and without acute DVT. However, there was considerable overlap between the two populations, limiting the predictive value of impedance plethysmography in any given patient.

Adult↗

PubMedDate not supplied

[The storage and preparation of autologous plasma for transfusions to patients with arteriosclerosis obliterans of the vessels of the lower extremities].

An investigation of the regimen of storage and sorption of plasma in patients with obliterating atherosclerosis of lower extremity vessels has shown that the optimum regimen of storage of plasma is freezing (with addition of 1 thousand of heparin units per 100 ml of plasma) at t = -20 degrees C followed by thawing at t = +6(+/- 2) degrees C in running water before sorption. The optimal sorbent for sorption of plasma of patients with obliterating atherosclerosis of lower extremity vessels is "Actilen" charcoal. The optimal method of sorption is sorption after thawing the plasma. The sufficient degree of plasma purification can be reached in the ratio sorbent/sorbate for charcoal "Actilen" equal to 1:100 and a single perfusion of plasma through the column.

Arteriosclerosis Obliterans↗

PubMed1994

Distribution of acute lower extremity deep venous thrombosis in symptomatic and asymptomatic patients: imaging implications.

The ability of noninvasive imaging modalities to diagnose lower extremity DVT depends, in part, on the anatomic location of the thrombus. To define the pattern of thrombus formation in symptomatic and asymptomatic high-risk patient populations, 172 consecutive lower extremity venograms were submitted to blinded, retrospective interpretation. Acute DVT was present in 59 venograms (34 symptomatic and 25 asymptomatic patients). Among symptomatic patients with acute DVT, 26 of 34 (76%) patients had an above-knee thrombus and only eight of 34 (24%) patients had a thrombus isolated to the calf. In comparison, only three of 25 (12%) asymptomatic patients with DVT had an above-knee thrombus and 22 of 25 (88%) patients had a thrombus isolated to the calf veins (most involving only one venous segment). Failure to examine the calf veins, particularly in asymptomatic patients, would result in missing at least half of patients with DVT. Alternatively, since all cases of iliac vein DVT extended into the femoropopliteal segment, failure to visualize the iliac veins is unlikely to miss patients with DVT. Our results suggest merit to routine examination of the deep femoral, anterior tibial, and particularly the soleal (but not the gastrocnemius) veins and also to use of an imaging technique to detect congenital duplications of the superficial femoral and popliteal veins.

Female↗

PubMed2004

Incidence of lower-extremity amputation in American Indians: the Strong Heart Study.

OBJECTIVE: To define incidence and predictors of nontraumatic lower-extremity amputation (LEA) in a diverse cohort of American Indians with diabetes. RESEARCH DESIGN AND METHODS: The Strong Heart Study is a study of cardiovascular disease and its risk factors in 13 American-Indian communities. Data on the presence/absence of amputations were collected at each of three serial examinations (1989-1992, 1993-1995, and 1997-1999) by direct examination of the lower extremity. The logistic regression model was used to quantify the relationship between risk of LEA and potential risk factors, including diabetes duration, HbA(1c), peripheral arterial disease, and renal function. RESULTS: Of the 1,974 individuals with diabetes and without prevalent LEA at baseline, 87 (4.4%) experienced an LEA during 8 years of follow-up, and a total of 157 anatomical sites were amputated among these individuals. Amputation of toes was most common, followed by below-the-knee and above-the-knee amputations. Age-adjusted odds of LEA were higher among individuals with unfavorable combinations of risk factors, such as albuminuria and elevated HbA(1c). Multivariable modeling indicated that male sex, renal dysfunction, high ankle-brachial index, longer duration of diabetes, less than a high school education, increasing systolic blood pressure, and HbA(1c) predicted LEA risk. CONCLUSIONS: The 8-year cumulative incidence of LEA in American Indians with diabetes is 4.4%, with marked differences in risk by sex, educational attainment, renal function, and glycemic control.

Amputation, Surgical↗

PubMed1980

Pedalator assessment of occlusive arterial disease of the lower extremities.

Use of the Pedalator instead of the treadmill in the assessment of occlusive arterial disease of the lower extremities has been evaluated. The following aspects were assessed: (1) The effect on the cardiovascular system in terms of brachial arterial pressure, pulse rate, and oxygen consumption (VO2) during exercise in 5 health volunteers; (2) emg activity of the tibialis anterior and gastrocnemius muscles during exercise in the same 5 volunteers; and (3) postexercise ankle pressure changes in 10 subjects with angiographically proven occlusive arterial diseases of the lower extremities. For comparable degrees of VO2, the changes in brachial arterial pressure and pulse rate were similar. However, the maximum workload and effect on the cardiovascular system with the Pedalator were self-limiting. The emg acticity of tibialis anterior and gastrocnemius muscles was greater with the Pedalator. Average exercise time required to produce calf pain was 5 minutes with the Pedalator and 2.8 minutes with the treadmill. When the systolic pressure indexes before and after exercise was compared in 3 groups of limbs (11 with complete, 8 with partial, and 1 with no occlusion), both forms of exercise produced a significant degree of reduction in the systolic pressure index in all limbs except the normal one. The Pedalator exercise was associated with less elevation of brachial arterial pressure. Therefore, the Pedalator should be used whenever the least elevation of brachial arterial pressure is desirable during the assessment of occlusive arterial disease.

Arterial Occlusive Diseases↗

PubMed2006

Preliminary examination to determine the suitable contrast material injection protocol for CT angiography of the pelvis and lower extremities with a multidetector row helical scanner.

PURPOSE: The aim of this study was to determine the best of three protocols for the depiction of arteries in the pelvis and lower extremities by computed tomographic angiography (CTA) with a multidetector row helical scanner. MATERIALS AND METHODS: CTA was performed in five asymptomatic volunteers using a four-channel multidetector row helical scanner. Low-osmolar iodinated contrast material was injected at the flow rate of 3 ml/s using three protocols: 100 ml of 300 mg I/ml, 150 ml of 300 mg I/ml, and 100 ml of 350 mg I/ml. The CT number of opacified blood was measured at six levels. Three doctors independently assessed the degree of depiction of arteries on CTA images without knowing the protocol using a 3-point scale. RESULTS: CT numbers at the level of the popliteal artery on the protocol of 150 ml of 300 mg I/ml were significantly greater than the others. The mean score for the depiction of trifurcation on the protocol of 150 ml of 300 mg I/ml was significantly greater than those in the others. CONCLUSION: The protocol of 150 ml of 300 mg I/ml was the best for depicting arteries in the pelvis and lower extremities by CTA.

Adult↗

PubMed1978

Thrombophlebitis of the lower extremities and ABO blood type.

Of 86 medical patients with a hospital discharge diagnosis of thrombophlebitis of the lower extremity, 70 (81%) were of blood type A,B, or AB (non-O). Of the 344 reference patients matched for age, sex, and country, 187 (54%) were of non-O blood type. The estimate of risk ratio of non-O blood type patients to O blood type patients was 3.7 with 90% confidence limits 2.3 and 6.0. The association between non-O blood type and thrombophlebitis of the lower extremity was strongest among the younger patients and women.

ABO Blood-Group System↗

PubMed1988

Lower extremity vasospasm associated with ischemic neuropathy, dermal fibrosis, and digital gangrene in a patient with carcinoid syndrome.

Bilateral lower extremity vasospasm associated with severe pain and hyperesthesias in the legs, and digital gangrene in both feet developed in a 50-year-old man with carcinoid syndrome. Nifedipine and chemical lumbar sympathectomy were partially effective in relieving the vasospasm. Electromyographic findings were consistent with ischemic neuropathy. A skin biopsy specimen showed striking dermal fibrosis. Serotonin and other vasoconstrictor substances released from the tumor may be responsible for the vasospasm, the dermal sclerosis, and the ischemic neuropathy. The early use of lumbar sympathectomy in patients with lower extremity vasospasm may prevent these irreversible ischemic complications.

Bronchial Neoplasms↗

PubMed1980

Lower extremity replant--a preliminary report.

The amputated lower right extremity of an 11-year-old girl, severed 10 cm above the knee, was reimplanted on New Year's Eve, 1978. Three skin grafting procedures were required. Seven months later, all wounds healed. There was callus formation at the fracture site and soft tissue contracture at the amputation level. The patient is up and about on a partial weight-bearing brace with a molded foam shoe to protect her foot. There is excellent circulation in the entire lower extremity. At 6 months postinjury, cable sural nerve grafts for sciatic nerve repair were done elsewhere. This will be the subject of a subsequent report.

Amputation, Traumatic↗

PubMed2000

A descriptive system for lower extremity evaluation in children: data for the newborn infant.

An efficient and practical system for examination of the lower extremities in newborn infants and children is presented. Measurements of hip rotation and abduction are performed in a supine position. During examination, the foot is held in passive correction or induced weight-bearing position to compare the tibia, forefoot, and hindfoot alignment. Thirty-six newborn infants were examined randomly to establish standard measurements for newborns. The only statistically significant difference between male and female infants occurred in hip abduction and internal and external rotation of the hips during extension. This method of examination of the lower extremity in newborn infants is useful for routine evaluation in all children.

Ankle Joint↗

PubMed1989

[The effect of hemosorption on clinical symptoms of ischemia of the lower extremities, heart and brain].

Sixty-eight hemosorptions were carried out in 55 patients with atherosclerotic lesions of the lower extremity vessels. Hemosorption efficacy was evaluated by biochemical methods, clinical manifestations of ischemia of the legs, heart and brain. It was established that hemosorption proved highly efficient in the complex treatment of obliterative lesions of the lower extremity vessels, particularly, in the II-III stages of the disease.

Adult↗

PubMed2004

Influence of transmetatarsal amputation in patients requiring lower extremity distal revascularization.

When a transmetatarsal amputation (TMA) is required, successful long-term limb salvage is questioned. We evaluated the influence of TMA on limb salvage in patients undergoing lower extremity revascularization. Patients who had distal bypasses extending to the infrapopliteal arterial tree and adjunctive TMA were retrospectively reviewed. Limb salvage was determined with life-table analysis. Twenty-four patients (29 limbs) were evaluated: 15 male and 9 female. Average age was 64.2 years old. Gangrene was the indication for bypass and TMA in 25 (86.2%) patients. Seven limbs were lost to follow-up. Nine of the remaining 22 limbs required below-knee (8) or above-knee (1) amputations, seven limbs within the first 3 months. In the group of patients who had major amputations within the first 3 months, graft thrombosis was the cause of leg amputation in six (85.7%) cases. No significant predictors of early major amputation were identified. Limb salvage was 62 per cent at 1 year in the TMA group. In comparison, among historical controls requiring distal revascularization and no adjunctive toe or foot amputations, limb salvage was 76.5 per cent (P = NS). Long-term limb salvage is dependent on successful lower extremity revascularization. Requirement for TMA should not influence the decision for limb salvage.

Amputation, Surgical↗

PubMedDate not supplied

Lower extremity deep venous thrombosis: vascular laboratory quality assurance without correlation between ultrasound and venography.

Venography is rarely available for comparison with ultrasonography (US) as a means for quality assurance (QA) in the detection of lower extremity venous thrombosis. New QA methods must be implemented. We compared results of multiple serial studies performed in the same extremity as a QA indicator. From a 3-year sample of close to 9,000 venous tests, we obtained a subset of 44 patients who had 331 tests in 71 lower extremities throughout the years. A positive or negative study preceded or followed by another positive or negative study was considered as a confirmed study. A negative or positive study not preceded or followed by a negative or positive study was considered as unconfirmed. Explanations were then sought to explain unconfirmed results. There were 169 (51%) and 124 (37%) confirmed positive and negative studies, respectively, and 13 (4%) and 25 (8%) unconfirmed positive and negative studies, respectively. Of the 13 unconfirmed positive tests, 2 were preceded by negative tests, 3 were preceded and followed by negative tests, and 8 were followed by negative tests. Of these 13 tests, 4 documented extensive venous thrombosis. Of the 25 unconfirmed negative tests, 11 followed treatment for venous thrombosis, 6 had recurrent thrombosis with intermittent lysis, and 8 were followed by positive tests. Considering the low probability of extensive thrombosis being a false-positive test, positive predictive value was 95% (173/182). Excluding 11 negative tests following treatment for venous thrombosis, negative predictive value was 90% (124/138) and accuracy was 93% (297/320). US versus US and literature US versus venography comparisons of these statistics were similar.

Female↗