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PubMed1996

[Current methods in the diagnosis of deep venous thrombosis of the lower limbs].

The diagnosis of lower limb deep vein thrombosis requires to use of complementary diagnostic tests. For a long time phlebography has been the only reliable examination and is always regarded as the gold standard by many people. In recent years, non invasive diagnostic modalities have been developed. Most significantly scintigraphy, plethysmography, color Doppler ultrasound and MR imaging. MRI is as reliable as venography but, at the present time, it is time-consuming and far less available than the other modalities. Scintigraphy and plethysmography may be useful but are less accurate and yield a somewhat higher rate of false positive and negative examinations. Color Doppler ultrasound has proved its effectiveness and is currently recommended as the diagnostic modality of choice. Venography is still a significant diagnostic tool for questionable cases or for technically inadequate Doppler ultrasound examinations.

Diagnostic Imaging↗

PubMed1994

[Mechanisms, epidemiology and clinical evaluation of venous insufficiency of the lower limbs].

Chronic venous insufficiency of the lower limbs is a frequent disorder that has costly repercussions for society as a whole. It is important to distinguish between abnormality of venous function and its most frequent causes, which are sequelae of deep venous thrombosis and varices of the lower limbs. Chronic venous insufficiency manifests by functional symptoms, based on the heavy leg syndrome, which is very frequent but not specific, and on objective distal signs that are highly specific. Both prognosis and cost of the disorder are based on such objective signs, cutaneous and subcutaneous complications of stasis and of venous hypertension, ranging from simple ochre dermatitis to recurring ulcers and ankylosis of the ankle. Dermo- and hypodermatitis and ulcers complicate less than 10% of chronic venous insufficiency but are responsible for most of the cost involved, two-thirds of which is linked to invalidity. Clinical grades of chronic venous insufficiency have been established, which should facilitate standardisation and comparison of epidemiological, pathophysiological and therapeutic data. Diagnosis of chronic venous insufficiency is by clinical examination, while etiological investigation should most often be done by technical investigation.

Chronic Disease↗

PubMed2002

[Surgical approach in plastic of shortened lower limb].

OBJECTIVE: To introduce a new surgical approach to rectify the shortened lower limbs. METHODS: From March 1985 to October 2000, 288 cases of shortened lower limbs were treated and reviewed. Closed fracture at the metaphysis was made by a self-made "needle saw", and then the "multiple-plane and double-track elongation instrument" was adopted to elongate the fractured bone. There were totally 161 cases of male and 127 cases of female included, with average age 21.3 years old, ranging from 12 to 29 years old, among which there were 268 cases elongated at the proximal metaphysis of the tibia, 16 cases at the distal femur and 4 cases at the distal tibia. All of the cases were followed up for 6 to 8 months before clinical evaluation. RESULTS: The lower limbs in 288 cases were elongated for 3.0 to 11.5 cm in 24 to 96 days, averaging 47 days, which fulfilled pre-operative plan. In the second week after the operation, new calculus and periosteum formed obviously in the gap between the fractured parts, and in 6 to 8 months bone union was observed at the fractured site in all cases. There was no nerve or blood vessel injury, or non-union of the metaphysis fracture. The function of the manipulated knee joints and ankle joints recovered well. CONCLUSION: It is a practical and safe surgical option to rectify the shortened lower limbs by closed fracture at the metaphysis, followed by elongation of the fractured bone, without any complication such as non-union or atrophy of manipulated bone, and with no need of internal fixation or bone grafting.

Adolescent↗

PubMed1998

Prostaglandin E1 from the tip of an intraaortic balloon catheter for lower limb ischemia.

A method to treat lower limb ischemia associated with the insertion of an intraaortic balloon catheter is herein reported. A low dose of prostaglandin E1 was administered into the descending aorta continuously from the tip of the intraaortic balloon catheter. Immediately after the administration of prostaglandin E1 in patients whose lower limbs were ischemic due to obstruction with the catheter, the peripheral circulation of the ischemic limbs recovered with minimal changes in the systemic arterial blood pressure. This method is simple and noninvasive and was found to induce a satisfactory effect.

Alprostadil↗

PubMed1992

[Truncal blocks of the lower limb].

Plexus nerve blocks of the lower limb have been described for many years but were seldom used until recently. Postoperative analgesia is one of the main indications of these blocks. The blockade of both lumbar and sciatic plexuses is required for most of the surgical procedures performed on the proximal part of the lower limb. Nerve stimulators account for less difficulties to perform such blocks and results are more reliable. Several pharmacokinetic studies have documented that toxic thresholds of plasma concentrations of local anaesthetics are not reached with the doses commonly injected. Many different techniques and landmarks have been described providing several alternatives to perform these blocks according to the type and the localisation of the surgical procedure. Extensive indications are reported for day case surgery or patients at risk.

Ankle↗

PubMed2005

Deep venous thrombosis: withholding anticoagulation therapy after negative complete lower limb US findings.

PURPOSE: To establish the safety of withholding anticoagulation therapy after negative findings at a complete lower limb ultrasonographic (US) examination of the symptomatic leg for suspected deep venous thrombosis (DVT). MATERIALS AND METHODS: Regional ethics committee approval and patient consent were obtained. A total of 542 consecutive ambulatory patients presented to the emergency department and were prospectively recruited from April 2001 to May 2003. Of these patients, 16 were excluded, and radiology residents and sonographers performed a complete lower limb US examination by means of compression and Doppler US in 526 patients. Patients with negative US findings received no anticoagulation therapy, and they were observed for occurrence of any thromboembolic event for 3 months. Patients with progressive or new symptoms that were indicative of thromboembolism within the follow-up period underwent objective testing with US, computed tomographic (CT) pulmonary angiography, or both. RESULTS: There were 413 patients (78.5%) with US findings that were negative for DVT and 113 patients (21.5%) with findings that were positive. There were 64 patients (56.6%) with DVT isolated to the calf and 49 (43.4%) with proximal DVT. Of the 413 patients with negative initial US findings, 16 (3.9%) underwent a second US examination for new or progressive symptoms of DVT, one patient (0.25%) underwent CT pulmonary angiography for suspected pulmonary embolism, and one patient (0.25%) underwent both US and CT pulmonary angiography during the 3-month follow-up period. One of these patients (0.24%; 95% confidence interval: 0.01%, 1.3%) developed pulmonary embolism, which was diagnosed with CT pulmonary angiography. DVT was not diagnosed in any patient, and no patient died during follow-up. The negative predictive value of a complete single lower limb US examination to exclude clinically important DVT is 99.6% (95% confidence interval: 98.4%, 99.9%). CONCLUSION: A single negative complete lower limb US examination is sufficient to exclude clinically important DVT, and it is safe to withhold anticoagulation therapy after negative complete lower limb US findings were obtained in patients suspected of having symptomatic lower limb DVT. New or progressive symptoms require further objective imaging.

Angiography↗

PubMed2002

Lower limb venous insufficiency and tobacco smoking: a case-control study.

At the present time, no study has yet clearly established whether tobacco smoking is a risk factor of lower limb venous insufficiency. This case-control study was initiated in France to determine the possible etiologic relation between tobacco smoking and lower limb venous insufficiency. A total of 1,806 cases suffering from lower limb venous insufficiency, recruited by 460 general practitioners between April 1997 and April 1998, were matched by age and gender to 1,806 controls. Data were collected on the physical examination, medical reason for consulting, current treatments, smoking habits, and known risk factors of lower limb venous insufficiency. Conditional logistic regression for the statistical analyses was performed. Known risk factors of lower limb venous insufficiency were confirmed in the overall model: family history of venous insufficiency (odds ratio (OR) = 7.7), frequent (OR = 1.4) or regular (OR = 2.7) prolonged standing at work, heat exposure (OR = 2.0), low physical activity (OR = 1.6), and (for women) more than four pregnancies (OR = 3.4). Multivariate analysis adjusted for other risk factors showed that lower limb venous insufficiency is significantly associated with tobacco smoking (OR = 1.7 for 10-19 cigarettes/day and OR = 2.4 for 20 cigarettes/day or more; p < 0.001). These results suggest that smoking is significantly associated with lower limb venous insufficiency, in accordance with biologic data and physiopathologic mechanisms.

Adult↗

PubMed1989

[Analysis of subjective symptoms of coldness and numbness in the upper and lower limbs among patients with vibration syndrome].

Coldness and numbness of the lower limbs in patients with vibration syndrome were studied in correlation with the frequency of attacks of vibration-induced white finger (VWF), coldness and numbness of the upper limbs, and awakening at night due to numbness of the arm. Subjects were 229 patients aged 50-69 years without disease other than vibration syndrome who had mainly operated chain saws. The present study showed that patients with more frequent VWF attacks had a higher prevalence and frequency of coldness in the fingers, awakening at night due to numbness of the arm, and coldness and numbness in the legs. Particularly patients having almost daily attacks of VWF had a high prevalence of these symptoms. Positive correlation was observed in prevalence and frequency between coldness of the fingers and that of the legs, and between coldness and numbness in the legs. The prevalence of VWF, numbness and coldness of the fingers, and coldness of the legs was higher the longer the total chain saw operating period. The present findings suggest that patients with severe circulatory disturbances in the upper limbs have severe circulatory disturbance in the lower limbs. Further studies on circulatory disturbances in the lower limbs are indicated, and their mechanism involved should be also pursued from the pathogenetic point of view.

Aged↗

PubMed2000

Experimental investigation and biomechanical analysis of lower limb movements for clutch pedal operation.

Lower limb movements for clutch-pedal operations were investigated and the influence of four parameters (seat height, pedal travel, pedal travel inclination, pedal resistance) was studied using a multi-adjustable experimental seat. Fifteen subjects participated in the experiment: five short females, five average height males and five tall males. A biomechanical model has been proposed to explain how pedal force direction could be controlled. The experimental observations show that the lower limb movement of clutch pedal operation is mainly guided by the geometric constraints imposed by the task and its environment, especially during the depression phase. The results support the hypothesis that movements obey the principle of minimum work and minimum discomfort. Furthermore, it seems that a functional segmentation exists between the distal joint (ankle) and the proximal joints (knee and hip), thus simplifying the control problem, which is due to the redundancy of the human body. It appears that the depression movement is controlled by proprioceptive feedback related to foot displacement and pedal force, from the fact that the deceleration duration during the depression phase increases with the pedal resistance and pedal travel. The minimum pedal resistance and pedal travel are discussed.

Adult↗

PubMed2004

Degloving injuries of the lower limb.

OBJECTIVE: To identify the pattern of degloving injuries of the lower limb to help in designing a management protocol for such injuries. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Plastic and Reconstructive Surgery, Hayatabad Medical Complex, Peshawar over a period of 3 years from September 1998 to August 2001. SUBJECTS AND METHODS: Fifty patients with degloving injuries of the lower limb were included, type, cause, extent and location of degloving injury was identified in all of them. RESULTS: Majority of the patients were males (74%) with a median age of 14 years. The most common cause of trauma was roadside accidents (96%). Left lower limb involvement was more common (72%). Sixty-six per cent of the cases sustained trauma to the leg. The type of degloving injury observed more frequently was open degloving in 94% of the patients. Fifty one percent patients had proximally attached degloved skin. CONCLUSION: The pattern of degloving injuries of the lower limb emerging from this study will help clinicians to identify the pattern of these injuries and develop a management protocol.

Adolescent↗

PubMed1993

Quality of life following lower limb amputation for peripheral arterial disease.

Lower limb amputations for peripheral arterial disease are performed predominantly on an elderly population with poor social support and concomitant medical problems. The effect of amputations on the quality of life of this population has not been properly assessed. The quality of life of 149 amputees from one hospital was evaluated using the Nottingham Health Profile and compared to that of a control group matched for age and sex. One hundred and thirty (87%) amputees and 115 (77%) controls responded to the questionnaire. Amputees reported significantly more problems with mobility, social isolation, lethargy, pain, sleep and emotional disturbance than controls (p < 0.001). However, mobility was the only significant independent factor after matched logistic regression analysis (p < 0.001). The differences in social isolation and emotional distress lost their significance after adjustment for mobility. The overall quality of life following lower limb amputation for peripheral arterial disease is poor, but much of this is secondary to restricted mobility. Rehabilitation following amputation should therefore focus on attempts to improve mobility.

Activities of Daily Living↗

PubMed1996

Optimal duration of oral anticoagulant therapy following deep vein thrombosis of lower limbs.

Deep vein thrombosis of the lower limbs is usually treated with an initial course of heparin or low-molecular-weight heparin associated with oral anticoagulants which are started simultaneously, thereby allowing heparin to be stopped after 4-7 days. Although consensus conferences have proposed a uniform duration of oral anticoagulant therapy of 3 months, great uncertainties remain as to the optimal treatment duration in an individual patient. Two large-scale studies have recently demonstrated that short treatment durations (4 weeks or 6 weeks, respectively) are associated with about two-fold higher rates of thromboembolic recurrences over follow-up periods of 1-2 years compared with longer treatment durations (3 months or 6 months, respectively). However, because treatment duration is also a major determinant of the hemorrhagic risk on oral anticoagulants, it is essential to balance the protective effect of these agents against their bleeding risk. This paper reviews the literature on the antithrombotic effects and hemorrhagic risks of different durations of oral anticoagulant therapy following lower limb deep vein thrombosis and suggests tentative recommendations which range from a short anticoagulant course of 4 weeks in a patient with a low risk of thromboembolic recurrence and a high hemorrhagic risk (e.g. postoperative distal vein thrombosis) to 6 months or more in a patient with a low hemorrhagic risk and a high risk of thromboembolic recurrence (e.g. idiopathic proximal vein thrombosis in a patient with inherited thrombophilia or malignancy).

Anticoagulants↗

PubMed1992

Capillary recruitment and pain relief on leg dependency in patients with severe lower limb ischemia.

BACKGROUND: Patients suffering from severe lower limb ischemia may experience pain relief on leg dependency despite the fact that dependency normally results in arteriolar vasoconstriction. To clarify this possible paradox, skin microcirculation of the limb was investigated in 75 patients with different stages of lower limb ischemia and in 12 asymptomatic subjects. METHODS AND RESULTS: Using nailfold capillary video microscopy, red blood cell-perfused capillary density and diameter and red blood cell velocity were assessed in supine and sitting positions. Capillary density increased by changing from the supine to the sitting position, especially in patients with limb-threatening ischemia (showing a 4.5-fold increase versus a 1.5-fold increase in asymptomatic subjects). In subjects without or with mild ischemia, capillary perfusion was two to four times lower in the sitting than in the supine position. In patients with limb-threatening ischemia, perfusion was strongly reduced, being slightly higher in the sitting position. Patients with relief of pain while sitting did not always have a higher capillary perfusion but did have a higher capillary density in the sitting position. CONCLUSIONS: The arteriolar postural vasoconstrictive mechanism at the nutritive level is still intact in subjects without or with mild ischemia but not in patients with severe ischemia. Capillary recruitment rather than disturbed arteriolar vasoconstriction could explain why patients with severe leg ischemia prefer leg dependency.

Adult↗

PubMed1992

Frequency of long-term lower limb ischemia associated with intraaortic balloon pump use.

Lower limb ischemia is a frequent complication of intraaortic balloon pump (IABP) use. The incidence and risk factors for acute ischemia have been well-defined, but little is known about long-term ischemic complications. This prospective study evaluated the incidence, nature, progression and predisposing factors for long-term lower limb ischemia in 151 patients who were previously treated with the IABP. These persons were interviewed and their lower extremities examined 12 to 20 months after undergoing IABP counterpulsation. Limb ischemia, characterized primarily by ipsilateral discomfort and diminished pulses, occurred in 18% of those evaluated. Evidence of ischemia worsened over time in 14%. Logistic regression analysis, which was based on variables found to be significant in bivariate analysis, revealed that the occurrence of limb ischemia acutely, cardiogenic shock as an indication for IABP insertion, and smoking (at the time of hospitalization or having quit < 10 years previously) were risk factors for long-term lower limb ischemia. The adjusted odds ratio for acute limb ischemia was 8.89 (95% confidence interval 2.80 to 28.21), for cardiogenic shock 3.59 (95% confidence interval 1.01 to 12.75), and for smoking 2.87 (95% confidence interval 1.10 to 7.46). Increasing numbers of patients are undergoing IABP counterpulsation and a greater proportion of these are surviving their acute event and resuming active lives. It is essential to recognize that detrimental consequences of this device can persist long after hospitalization.

Adult↗

PubMed1992

Comparison of the efficacy of digital subtraction and film-screen angiography of the lower limb: prospective study in 50 patients.

We prospectively compared current digital subtraction angiography (DSA) with conventional film-screen angiography (FSA) of the lower limb for evaluation of areas of arterial stenosis and degree of arterial visualization. Fifty patients had both DSA and FSA of a single lower limb. Specific anatomic sites (examiner-selected sites) throughout the lower limb were marked on each film by an experienced angiographer (examiner). These sites consisted of the common femoral, superficial femoral, popliteal, anterior tibial, posterior tibial, peroneal, and dorsalis pedis arteries and bypass grafts, when present. The films were then reviewed blindly by two different experienced angiographers (observers). All sites were graded for the degree of arterial narrowing based on a standard scale (grade 1 = normal, grade 5 = occluded) that also included grading for nonvisualization (grade 6). Each observer also selected the most stenotic site in each anatomic area (observer-selected sites). The data were analyzed for the entire lower limb and at specific anatomic sites. DSA sites were judged to be slightly more narrowed (p less than .05) in the superficial femoral artery by both observers and in the common femoral artery, bypass graft, and overall by a single observer. No other significant differences were found in grade of stenosis or vessel visualization for examiner-selected sites. For observer-selected sites, observers agreed on the location of the most stenotic site 76% of the time for FSA and 69% of the time for DSA. No significant difference was found in grade of stenosis or vessel visualization for either observer for the entire lower limb or at specific anatomic sites. These findings were present when all sites chosen were considered and when there was agreement between sites chosen on FSA and DSA for each observer. In conclusion, optimal-quality FSA and DSA produced virtually equivalent results for angiography of the lower limb for both grade of stenosis/occlusion and vessel visualization.

Angiography↗

PubMed1996

Prostacyclin and thromboxane A2 synthesis are increased in acute lower limb ischaemia.

Prostacyclin (PGI2) and thromboxane A2 (TXA2) play an important role in the pathophysiology of various cardiovascular diseases. The balance between PGI2 and TXA2 regulates the interaction between platelets and the vessel wall in vivo. In this study we measured PGI2 and TXA2 synthesis by analysing their urinary index metabolites 2,3-dinor-6-keto-PGF1 alpha and 11-dehydro-TXB2, respectively, in acute (10 patients) and chronic (10 patients) lower limb ischaemia. Both PGI2 and TXA2 synthesis were increased about two-fold in patients with acute lower limb ischaemia compared to chronic lower limb ischaemia. However, the PGI2/TXA2 ratio was more or less the same in acute and chronic lower limb ischaemia. In patients with acute lower limb ischaemia caused by thrombotic occlusion, PGI2 and TXA2 formation were about two times higher than in patients with acute lower limb ischaemia caused by embolic occlusion. Elevation of PGI2 and TXA2 synthesis in acute lower limb ischaemia may reflect increased platelet-vascular wall interactions without changing the PGI2/TXA2 ratio.

6-Ketoprostaglandin F1 alpha↗

PubMed1994

[Use of vazaprostan in the treatment of multifocal peripheral obliterating lesions of arteries of the lower limbs].

Vazaprostan was prescribed to 13 patients with the lower limbs obliterating atherosclerosis and the coronary arteries atherosclerotic lesion (first group) and in 17--with obliterating atherosclerosis and endarteritis of the lower limbs vessels (second group). The treatment was found to be effective one in all of the patients of the first group and in 13--of the second. The authors consider vazaprostan application to be expedient in patients with the lower limbs obliterating lesions as a supplement to operative intervention and also in coincidence of this pathology with the ischemic heart disease.

Aged↗

PubMed1991

[Percutaneous ascending phlebography in acute thrombosis of the deep veins of the lower limbs].

The author describes a method for percutaneous ascending phlebography of the lower limbs which was conducted in 258 patients: he performed 315 ascending phlebographies (the examination was unilateral in 201 and bilateral in 57 patients). Nonocclusive and occlusive venous thromboses of the deep veins of the lower limbs were revealed in 225 patients. In 23% of the examined patients abnormalities were not found in the veins of the lower limbs, in 10 cases the examination was not carried out to the end for various reasons. The method allows the location of the lesion and the character of phlebothrombosis to be determined, its important merit consists in the possibility of contrast study of the sural veins which were demonstrated in 93.5% of patients with nonocclusive thromboses and in the absence of changes in the veins. Percutaneous ascending phlebography of the lower limbs is a highly effective, mildly injurious, and relatively safe method of examination, which meets all conditions of emergency angiography and provides the possibility of repeating the examination through the same approach.

Adult↗