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At least 1,387 records · Page 77Linked to original sources

PubMed1999

Duplex scanning alone is not sufficient imaging before secondary procedures after lower extremity reversed vein bypass graft.

PURPOSE: Duplex surveillance of lower extremity reversed vein bypass grafts (LERVG) is a means of identifying patients at risk for occlusion. The perceived accuracy of duplex scan as a means of identifying stenoses has led many surgeons to perform graft revision on the basis of duplex scan alone. This may result in missing additional lesions that are threatening patency. To assess the role of duplex scan as the sole imaging method before revision of LERVGs, we reviewed consecutive patients undergoing revisions who underwent preoperative arteriography after identification of duplex scan abnormalities. METHODS: Duplex scan results, operative reports, and preoperative arteriograms for patients undergoing LERVG revision from January 1990 to December 1997 were reviewed. A standard duplex scan surveillance protocol was followed, and attempts were made to survey the entire graft, including inflow and outflow. Duplex scan results were compared with the results of preoperative arteriograms and the operation performed to determine if all significant lesions were identified by means of duplex scan alone. RESULTS: Two hundred five LERVG revisions were performed. The 5-year assisted primary patency rate was 91%. In 119 cases (58%), arteriography did not contribute significantly to duplex scan findings. Arteriography significantly contributed to operative planning in 86 cases (42%). In 38 cases (19%), only a low-flow state was identified by means of duplex scan, and a correctable stenosis was identified by means of arteriography. In 48 cases (23%), additional significant lesions corrected at operation were identified by means of arteriography. These included 26 inflow, 16 graft, and 8 outflow lesions. Arteriography was most useful as a means of determining the revision procedure performed when there were inflow lesions (P <.05) or when the proximal anastomosis was to the profunda or superficial femoral arteries (P <.05). All frequently performed bypass graft configurations had some discrepancy between arteriographic and duplex scan findings. CONCLUSION: Available data do not permit prediction of which LERVG are immune from missed lesions in a duplex scan surveillance protocol. This suggests to us that arteriography is mandatory before LERVG revisions.

Aged↗

PubMed2000

Open saphenectomy complications following lower extremity revascularization.

A review of saphenectomy site complications following lower extremity revascularization was conducted. Leg incisions used for 133 consecutive infrainguinal bypass procedures were categorized by location. Patient and procedural risk factors were analyzed for risk of wound complications. Procedure, limb and patient outcome were reported via life table analysis. Incisional wound complications followed 32/133 procedures (24%), including 15 groin, eight saphenectomy, five distal and four vein/distal incisions. There were five grade I and three grade II saphenectomy complications. Only weight (body mass index) predicted the likelihood of wound complication (P < 0.05). The 6-month primary patency rate was 79% (mean follow-up 22 months). Four-year assisted primary patency, limb salvage and survival rates were 75, 87 and 57%, respectively. Most bypass-related wound complications (24/32, 75%) involve arterial access incisions. Incisional complications are related to body mass index. Only 6% of GS vein bypass procedures develop saphenectomy site complications. Limiting saphenectomy size may not significantly reduce incisional morbidity following bypass grafting.

Adult↗

PubMed2003

The role of the pediatric plastic surgeon in limb salvage surgery for osteosarcoma of the lower extremity.

Limb salvage for management of osteosarcoma of the lower extremity has become the mainstay of treatment for patients with malignant bony and soft tissue tumors. The knee has become a special area of concern for the reconstructive surgeon due to the high rate of wound complications and difficulties of soft tissue reconstruction. With the availability of new prosthetic implants, the advancement of surgical soft tissue techniques and introduction of adjuvant and neoadjuvant chemotherapy, resection and reconstruction has become the standard approach for patients presenting to St. Jude Children's Research Hospital. The pediatric plastic surgeon's role usually requires handling of wound complications in these reconstructive procedures. This article will discuss the authors' approach to dealing with wound complications in this difficult patient population and their interaction with the orthopedic oncologic service in obtaining primary resection and soft tissue coverage.

Adolescent↗

PubMed1982

Therapy for superficial telangiectasias of the lower extremities.

A practical treatment for superficial telangiectasias of the lower extremities of described that is a modification of sclerotherapy commonly used for the treatment of varicose veins. The key to our technique lies in the use of 32-gauge needles and precise injection of small amounts of sodium tetradecyl sulfate as sclerosant. The cosmetic results of our method are good and our patients are appreciative.

Adult↗

PubMed1987

Shortcomings of physical examination and impedance plethysmography in the diagnosis of lower extremity deep venous thrombosis.

Accuracy in the diagnosis of lower extremity deep venous thrombosis (DVT) by physical examination and impedance plethysmography (IPG) is reviewed. Physical examination proved unreliable in distinguishing patients with and without acute disease. Swelling in the leg was, however, more prevalent in patients with DVT. The sensitivity and specificity of IPG were less than those reported by other groups. Venography remains the most reliable diagnostic procedure in our institution.

Humans↗

PubMed2000

[Primary leiomyosarcoma of vascular origin in the groin causing lower extremity venous compression].

A soft tissue tumor causing left lower extremity swelling in a 43 years old female was detected in the left inguinal region and resection was performed at the Department of Cardiovascular Surgery of Semmelweis University of Medicine, Budapest. Histologic examination revealed primary leiomyosarcoma of vascular origin. On the base of this case attention is called to this rare disease, which has poor prognosis. Early diagnosis and complete resection plays key role in the treatment of leiomyosarcoma and may improve survival.

Adult↗

PubMed2001

Percutaneous interventions for lower extremity peripheral vascular disease.

Peripheral vascular disease of the lower extremities is an important cause of morbidity that affects up to 10 million people in the United States. The primary care physician can easily identify patients who are at risk for the disease with a questionnaire and a relatively simple test-the ankle brachial index. More than 70 percent of patients diagnosed with the disease remain stable or improve with conservative management. Those who do not improve may undergo contrast angiography or magnetic resonance angiography, which may be used in planning for surgery or percutaneous intervention. Surgical bypass is the gold standard for extensive vascular occlusive disease, but endovascular interventions, including percutaneous transluminal angioplasty and stent placement, are being used more frequently, particularly in patients with significant comorbid conditions.

Angiography↗

PubMedDate not supplied

[The pulmonary distress syndrome during acute arterial occlusion of the lower extremities].

After surgery for acute arterial occlusion in the lower extremities 59 patients have developed tachypnea, respiratory alkalosis and arterial hypoxemia. These symptoms persisted over the whole postoperative period. In 66% of dead patients pulmonary changes have been observed and only in 34% of patients who died suddenly the lungs were unaffected. Morphological changes in the lungs are most marked in long-standing ischemia and have the signs of the "shock lung" (adult respiratory distress syndrome). Pronounced changes in the respiratory function, acid-base balance, blood gas composition can account for a more severe course of the disease, deteriorate the prognosis, predetermine multiorgan failure in the early postoperative period.

Arterial Occlusive Diseases↗

PubMed1992

[Effect of indirect endolymphatic antibiotic therapy on clinical and immunological indicators in patients with erysipelas of the lower extremities].

Two groups of patients with erysipelas of the lower extremities underwent indirect endolymphatic therapy with bicillin-3 (58 patients) and routine penicillin therapy (79 patients). Comparative clinicoimmunological examinations in the two groups revealed that lymphotropic administration of the antibiotic had a more favourable effect on the disease process, as evidenced by more rapid reverse time courses of erysipelas clinical signs, less frequent incidence of early relapses and normalization of the majority of immunological parameters by the end of the treatment. For estimation of the anti-recurrence efficacy of the antibiotic therapy in the patients with erysipelas, it was recommended to use a specific scale based on the principles of the Wald successive alternative analysis.

Adult↗

PubMed1989

Myopathies of the lower extremities.

The myopathies that can manifest themselves within the lower extremity are reported here and can serve as a guideline for clinicians in the early diagnosis of these disabling conditions. The classification of these disease entities based on signs and symptoms is significant if correlated with the age of the patient at the time of onset, the evolution and course, and the type of familial inheritance. This article can also aid the practitioner in assessing and planning the course of treatment for a particular patient.

Acute Disease↗

PubMed1983

Percutaneous transluminal angioplasty in the treatment of ischemic disease of the lower extremity.

Symptoms of severe peripheral vascular disease in the lower extremity necessitate attempts to revascularize the limb. Patients refusing or unable to undergo direct arterial surgery may be candidates for percutaneous transluminal angioplasty. Combined with realistic goals regarding foot salvage, careful selection of patients for angioplasty may prevent unnecessary amputations and permit local surgical care of the foot. Restoration of pain-free ambulation can follow the procedure. The coordinated efforts of various specialists can now be directed toward treatment of previously unmanageable ischemic complications in the foot.

Aged↗

PubMed1982

[Surgical procedure in combined postthrombotic and varicose diseases of the lower extremities].

Combinations of the varicose and postthrombotic diseases of lower extremities were observed in 105 patients. Different kinds of operations are recommended according to phlebography data. Venectomy, subtotal subfascial ligation of the perforating veins and anastomoses are indicated in most cases. The individual approach to the choice of the operation volume enabled the authors to get good results in 70% of the operated patients. Repeated courses of the conservative therapy are indicated to all the patients after operations.

Adult↗

PubMed1981

Lower extremity fractures after spinal cord injury: a retrospective study.

Lower extremity fractures after spinal cord injury (SCI) are more common in paraplegic than in quadriplegic persons, probably due to their greater activity level. Most of the fractures are pathologic in osteoporotic bones and most occur without known trauma or are caused by trivial injury. Supracondylar or shaft fractures of the femur are most common. Although callus formation is usually fast, exuberant fracture healing may be delayed. The main management goal, maintenance of functional independence without complications of SCI, is best obtained by a nonsurgical approach with traction or well-padded cast followed by early joint mobilization.

Adolescent↗

PubMed1995

[Measurement of lower extremity length using computed tomography].

A new method for lower extremities length measurement in patients destined for surgical legalization is presented. It is based on a scan in investigational CT. Reference points are marked and the distance between them is calculated. The record is inclusive of synthetic, diminutive anterior-posterior image of the extremity along with the measurement. Since September 1990 to December 1993, 34 patient underwent this procedure. The advantage is sensitivity better than 1 mm, flexibility in choosing reference points, good reproducibility and little exposure to the radiation. The result is more precise and trustworthy then obtained with other radiological or clinical methods.

Humans↗

PubMed1994

The embryology of lower-extremity torsion.

The presence of torsional deformities in the lower extremities of otherwise normal children is based on a variety of developmental processes. With intrauterine maturation, both rotation and external compression of the extremities take place. These forces result in the normal molding and final position of the limbs. Torsion of the extremities is, thus, a normal embryological process. It is imperative for the treating physician to understand these factors in human development to decide which cases are significant deviations from normal torsion. Knowledge of the embryology and natural history of these conditions is a key to appropriate treatment of patients with torsional or angular malalignments.

Bone Diseases, Developmental↗

PubMed1998

[The treatment of acute thrombophlebitis in the varicose saphenous veins of the lower extremities].

682 patients underwent treatment for varicose veins of lower extremities (VVLE). 641 patients with thrombophlebitis of VVLE were operated: in 62.9% of patients urgent operation and in 37.1% delayed operation after conservative treatment were made. Operation procedure comprised removal of all thrombotic varicose veins and ligation of communicant veins. The treatment of acute thrombophlebitis affecting anatomically intact veins in 41 patients was conservative. Comparative evaluation of the results of treatment evidences, that active surgical policy is justified as it leads to a decrease of complication rate, shortening of hospital stay duration 2 times and reduction of disability period. Conservative treatment of acute thrombophlebitis in intact veins is advisable.

Acute Disease↗

PubMed1998

[Surgical treatment of an acute thrombophlebitis of the varicose veins of the lower extremities].

The operation for an acute thrombophlebitis of the lower extremities varicose veins was conducted in 45 patients in an acute period of complication (1st group); in 22--after the durable ambulatory conservative therapy (2nd group); in 18--hospitalized for the next aggravation of the superficial veins chronical recurrent thrombophlebitis (3d group). Complications after the operation have occurred in the 1st group in 4.4% patients, in the 2nd group--in 13.6%, in the 3d group--in 22.2%. The duration of treatment of patients in stationary have constituted on average accordingly 7.6, 9.3 and 23.5 days. In elderly patients, having severe concurrent diseases, the segmental phlebothrombectomy conduction is indicated.

Acute Disease↗

PubMed1989

Autonomic neuropathies affecting the lower extremities.

The autonomic nervous system is a diffuse network that is primarily under involuntary control. This article described the functional anatomy of the autonomic nervous system, which is essential in understanding the disease entities that affect the lower extremity. Autonomic dysfunction of the sympathetic system is primarily affected and includes those syndromes involving the sweat glands and the blood vessels. Abnormalities of autonomic function in the lower extremity in three prominent neuropathies has also been presented.

Autonomic Nervous System↗