- "Mesenteric steal" physiology as a cause of claudication and chronic mesenteric ischemia. [Journal Article]
- AVAnn Vasc Surg 2018 May 16
- Aortoiliac occlusive disease (AOID) results in varying degrees of pelvic and lower extremity arterial insufficiency. Treatment approach has evolved and endovascular therapies are being successfully r...
Aortoiliac occlusive disease (AOID) results in varying degrees of pelvic and lower extremity arterial insufficiency. Treatment approach has evolved and endovascular therapies are being successfully reported for high-grade lesion. However, Trans Atlantic Inter-Society Consensus (TASC) D often necessitates open revascularization. Disease limited to the infrarenal segment does not typically affect intestinal perfusion in the absence of visceral aortic or mesenteric vessel involvement. Chronic mesenteric ischemia most commonly occurs due to atherosclerotic disease of two or three of the mesenteric vessels. The marginal artery of Drummond is an important component of the collateral network that allows for continued intestinal perfusion. We report a case of short-segment subtotal infrarenal aortic occlusion, proximal to the inferior mesenteric artery (IMA) in the absence of significant mesenteric disease. The patient had resultant lifestyle limiting claudication and chronic mesenteric ischemia. Angiographic evaluation demonstrated "mesenteric steal" physiology with retrograde flow via the arc of Riolan and IMA to perfuse the aortoiliac circulation. Successful endovascular recanalization with a balloon expandable covered stent was achieved, resolving the arterial insufficiency in both the mesenteric and lower extremity vascular beds. The patient denied any symptoms on postoperative day one and at one month follow-up.
- Medical Management of Functional Impairment in Peripheral Artery Disease: A Review. [Review]
- PCProg Cardiovasc Dis 2018 Mar 28
- Lower extremity peripheral artery disease (PAD) now affects 200 million people worldwide and is a major cause of disability. Cilostazol is the only Federal Drug Administration approved medication for...
Lower extremity peripheral artery disease (PAD) now affects 200 million people worldwide and is a major cause of disability. Cilostazol is the only Federal Drug Administration approved medication for PAD-related ischemic symptoms that is recommended by clinical practice guidelines. Supervised treadmill exercise significantly improves treadmill walking performance in PAD. Recent evidence shows that home-based exercise interventions that include occasional medical center visits and incorporate behavioral change techniques also significantly improve walking endurance in PAD. Upper and lower extremity ergometry (cycling) also improve walking ability in PAD. A recent decision by the Center for Medicaid and Medicare Services to cover supervised exercise for people with symptomatic PAD will increase access to exercise for the large number of people disabled by PAD.
- Incidence and predictors of clinical peripheral artery disease in asymptomatic persons with a low ankle-brachial index. [Journal Article]
- JMJ Med Screen 2018 Jan 01; :969141318773782
- Objective To determine the occurrence of clinical peripheral artery disease in a cohort of middle-aged and older persons who, though they initially had no symptoms of peripheral artery disease, had b...
Objective To determine the occurrence of clinical peripheral artery disease in a cohort of middle-aged and older persons who, though they initially had no symptoms of peripheral artery disease, had blood pressure levels in the arteries of their ankles and feet that were at least 10% lower than those in the arteries of their arms. Methods We analyzed data obtained in the Multi-Ethnic Study of Atherosclerosis, in which lower and upper extremity blood pressures were assessed in over 6000 Americans aged 45-84 and the ratio of these (the ankle-brachial index) was calculated. During a median follow-up of 13 years, the incidence of symptomatic peripheral artery disease (identified through annual questionnaires, review of hospital records, and notations of peripheral artery disease found in data obtained from the Center for Medicare Services) was compared between persons whose ankle-brachial index was ⩽9 and persons with higher ankle-brachial index values. Results The incidence of clinical peripheral artery disease was 23.0 per 1000 person-years among the 172 participants whose baseline ankle-brachial index was <0.9, compared with 2.0 per 1000 person-years in those with a higher ratio. The incidence of clinical peripheral artery disease rose steadily with decreasing ankle-brachial index below 0.9. The excess risk associated with a low ankle-brachial index was present in persons with and without the other measured risk factors for peripheral artery disease (cigarette smoking, hyperten sion, diabetes, and obesity). Conclusions Even in persons asymptomatic for peripheral artery disease, those with a low ankle-brachial index are at an appreciable risk of the development of manifestations of peripheral arterial insufficiency.
- Functional Popliteal Artery Entrapment Syndrome. [Journal Article]
- RPRev Port Cir Cardiotorac Vasc 2017 Jul-Dec; 24(3-4):183
- CONCLUSIONS: Continuous popliteal artery compression leads to its progressive fibrosis, which may cause thrombosis or post-stenotic aneurysmal dilation. Treatment should be performed as soon as possible as to avoid this course and the eventual necessity of interposition or bypass grafting. Futhermore, late intervention worsens the interposition/ bypass grafting prognosis5. In this sense, the possibility of this diagnosis should be considered in a young patient presenting with intermittent claudication. Diagnostic tests are often decisive for differential diagnosis and to establish the disease subtype and intervention strategy. In most patients, a culprit muscular or tendinous anomaly is detected before surgery, however, in some individuals, especially physically active ones, compression results from muscular hypertrophy.
- Stand-alone lateral lumbar interbody fusion for the treatment of symptomatic adjacent segment degeneration following previous lumbar fusion. [Journal Article]
- SJSpine J 2018 Apr 18
- CONCLUSIONS: Stand-alone LLIF is a safe and effective approach with low morbidity and acceptable complication rates for patients with symptomatic ASD following a previous lumbar fusion.
- The burden and characteristics of peripheral arterial disease in patients undergoing amputation in Korle Bu Teaching Hospital, Accra, Ghana. [Journal Article]
- GMGhana Med J 2017; 51(3):108-114
- CONCLUSIONS: There is a high prevalence of PAD among patients undergoing lower extremity amputation at the KBTH. The majority of PAD patients presented with moderate to severe PAD. Instituting measures to identify and control risk factors of PAD may reduce this high burden.
- Assessment of extracellular matrix-related biomarkers in patients with lower extremity artery disease. [Journal Article]
- JVJ Vasc Surg 2018 Mar 31
- CONCLUSIONS: We propose noninvasive candidate biomarkers with the ability to be clinically useful across the LEAD spectrum.
- [Revision of Schatzker type Ⅵ tibial plateau fracture failure focus on the recovery of lower limb alignment]. [Journal Article]
- ZWZhonghua Wai Ke Za Zhi 2018 Mar 01; 56(3):189-195
- Objective: To explore the influence of the lower extremity abnormal alignment and the joint surface, and to explore the surgical skills. Methods: Twenty-two cases of tibial plateau Schatzker Ⅵ frac...
Objective: To explore the influence of the lower extremity abnormal alignment and the joint surface, and to explore the surgical skills. Methods: Twenty-two cases of tibial plateau Schatzker Ⅵ fracture internal fixation failure revision from January 2012 to January 2017 in Department of Orthopedics, Shanghai 10(th) Hospital.One year follow-up after initial surgery to make sure of failure.Three-dimensional CT scan, radiography, infection index, gait analysis, knee joint ROM, femur tibia angle, tibial plateau tibial shaft angle and posterior slope if tibial plateau were observed. The medial approach and bi-planer osteotoma were used.Autogenous iliac bone graft, postoperative fast recovery channel were used.Follow-up point included preoperative and postoperative 7 days, 6 weeks, 3 months, and 6 months.Obvervational index included double lower limbs radiography, knee society score(KSS), complications such as infection, skin necrosis, joint main passive activity, double lower limbs alignment the last follow-up SF-36 scale.Rate was compared by χ(2) test, measurement data using paired sample t test.Correlation was analyzed by Pearson correlation regression testing. Results: Twenty-two patients received follow-up.KSS, more than 21 cases were benign, with good gait.One case was poor, with claudication gait.Not skin necrosis, no deep infection cases, 1 case get blisters 2 days postoperatively, and disappear after 5 days with detumescence and cold therapy.Whether restoring force line affect the KSS significantly(χ(2)=22.000, P=0.000). Knee joint ROM, SF-36 score, KSS and lower limb alignment were improved significantly. In different individual the articular surface and anatomical angle recovered greatly but the posterior slope angle was quite difference which has no correlation with KSS and SF-36 scale(P>0.01). Conclusions: Revision of Schatzker type Ⅵ tibial plateau fracture failure should focus on the recovery of lower limb alignment.moderate overcorrect bone cutting and joint surface height can bring benefits to the postoperative knee function.Revision surgery patients have greater psychological pressure, more early psychological intervention is necessary.
- Active smoking in claudicants undergoing lower extremity bypass predicts decreased graft patency and worse overall survival. [Journal Article]
- JVJ Vasc Surg 2018 Mar 06
- CONCLUSIONS: Despite the fact that smokers are younger and have fewer comorbidities than nonsmokers, active smoking at the time of LEB for claudication is associated with decreased long-term patency and decreased overall survival. Surgeons should consider smoking an important risk factor for worse LEB outcomes in smokers compared with nonsmokers.
New Search Next
- Contrast-induced encephalopathy after percutaneous peripheral intervention. [Journal Article]
- TKTurk Kardiyol Dern Ars 2018; 46(2):140-142
- Contrast-induced encephalopathy (CIE) is a rare complication of angiography. Presently reported is the case of a patient diagnosed with CIE following peripheral angioplasty with the non-ionic contras...
Contrast-induced encephalopathy (CIE) is a rare complication of angiography. Presently reported is the case of a patient diagnosed with CIE following peripheral angioplasty with the non-ionic contrast agent, iohexol. A 66-year-old male patient described intermittent claudication and peripheral arterial disease was suspected. Lower extremity angiography was performed, and following dilation of a 7.0x150-mm balloon, a 9.0x57-mm stent was placed in the lesioned vessel. The patient subsequently developed confusion and cortical blindness, and a seizure occurred 1 hour after the procedure. An emergency cerebral computed tomography scan did not reveal any signs of intracerebral hemorrhage. The neurological symptoms disappeared within 24 hours after hydration and sedative medication. CIE was diagnosed based on the patient`s clinical course findings and cerebral imaging.