- [Epidemiology of lower extremity artery disease]. [Journal Article]
- PMPresse Med 2018 Feb 12
- It is estimated that more than 200 million individuals are affected by lower extremity artery disease (LEAD) worldwide. This prevalence has increased between 2000 and 2010 by 25%, especially in low/m...
It is estimated that more than 200 million individuals are affected by lower extremity artery disease (LEAD) worldwide. This prevalence has increased between 2000 and 2010 by 25%, especially in low/middle income countries. In France, about one million people are affected by this condition. Almost two-thirds of patients with LEAD are asymptomatic. This explains the interest of the measurement of the ankle-brachial index (ABI), an objective and harmless diagnostic tool. An ABI≤0.90 is considered as diagnostic for LEAD. The detection of symptomatic LEAD requires standardized questionnaires identifying intermittent claudication. Epidemiological studies on chronic limb-threatening ischemia (CLTI) - the most severe presentation of the disease - are scarce: the prevalence is estimated around 0.5-2.0% after the age of 40, mostly affecting elderly people. Similar to other atherosclerotic diseases, the risk factors are multiple (genetic factors, traditional risk factors, metabolic and inflammatory factors, socioeconomic factors), with different weighs of association as compared to coronary artery diseases. Due to their high prevalence and strength of association, cigarette smoking and hypertension are the most frequent purveyors of this disease in population. Diabetes mellitus is a strong risk factor, and its increasing prevalence contributes to the global epidemics of LEAD. In claudicants, the 5-year amputation risk is estimated at 5%, increasing to 25% at one year in case of CLTI. However, the main risk is related to general cardiovascular events. It is estimated that patients with LEAD present concomitantly coronary and cerebrovascular disease in respectively 50% and 20% of cases. The non-cardiovascular mortality, especially related to cancer, is also higher than in general population. Overall, the control of traditional risk factors has a beneficial effect both for the limb and general prognosis.
- [Vascular rehabilitation in lower-extremity artery disease in 2017]. [Journal Article]
- PMPresse Med 2018 Jan 26
- The vascular rehabilitation is an effective treatment for patients with an intermittent claudication linked to lower-extremity artery disease. This treatment increases the claudication distance of 18...
The vascular rehabilitation is an effective treatment for patients with an intermittent claudication linked to lower-extremity artery disease. This treatment increases the claudication distance of 180% with the Gardner's protocol (30 to 60 minutes of walking at least 3 times a week, walking until appearance of a mild pain) and allows also to control the vascular risk factors. This treatment is not enough prescribed for many reasons and often requires a hospitalization in a rehabilitation centre.
- Femoral artery pseudoaneurysm due to a gunshot injury. [Journal Article]
- JPJ Pak Med Assoc 2018; 68(1):130-132
- Femoral artery pseudoaneurysms are commonly iatrogenic due to increasing use of the artery for arterial interventions. Other reasons of pseudoaneurysm formation are intravenous drug use and penetrati...
Femoral artery pseudoaneurysms are commonly iatrogenic due to increasing use of the artery for arterial interventions. Other reasons of pseudoaneurysm formation are intravenous drug use and penetrating trauma. Here, we have discussed the management strategy of a femoral artery pseuodoaneursym and the modalities for preventing the misdiagnoses of the pseudoaneurysm in the emergency department. A 50-year-old male patient was referred to our emergency department (ED) with claudication and severe local swelling. Ten days earlier, he had been referred to another ED immediately after a gunshot injury to the left inguinal zone. Duplex ultrasound and CT angiography of the left lower extremity revealed a 4 cm sac of pseudoaneurysm on the distal part of posterofemoral branch of deep femoral artery and a 9*10 cm haematoma on the posteromedial part of pseudoaneurysm. The patient underwent open repair surgery due to co-existing large haematoma and risk of infection. The patient was discharged after three days hospitalization. Pain, extremity oedema, pulsatile mass, femoral bruit, palpable thrill, and compressive neuropathy should alert the physician to possible femoral artery pseudoaneurysm. Duplex ultrasound and CT angiography are important diagnostic steps to reveal a possible life-threatening vascular injury.
- Achilles tendon elasticity decreases with intermittent claudication in patients by Acoustic Radiation Force Impulse Imaging (ARFI). [Journal Article]
- JPJ Pak Med Assoc 2018; 68(1):16-20
- CONCLUSIONS: The elasticity of healthy tendon decreased with intermittent claudication in patients.
- Real-life adaptations in walking patterns in patients with established peripheral arterial disease assessed using a global positioning system in the community: a cohort study. [Journal Article]
- CPClin Physiol Funct Imaging 2018 Jan 24
- CONCLUSIONS: Given the reported symptom progression, we advocate early intervention (e.g. exercise interventions) combined with frequent patient monitoring in attempts to maintain or improve walking ability.
- A modified activity protocol for claudication. [Journal Article]
- JCJ Cardiovasc Surg (Torino) 2018 Jan 23
- CONCLUSIONS: In the Veteran population, the use of a monitored step tracking device such as the FitBit® is a potentially effective strategy to improve walking distance in claudicators particularly in those with mild symptoms. Additional investigation is needed to determine which patients will benefit most from this walking protocol.
- Isolated lower extremity vasculitis leading to progressive critical limb ischemia. [Journal Article]
- JVJ Vasc Surg Cases Innov Tech 2017; 3(3):119-122
- Giant cell arteritis is a large- and medium-vessel vasculitis that has been described as a systemic disease process with disseminated vessel involvement. Advances in vascular imaging techniques have ...
Giant cell arteritis is a large- and medium-vessel vasculitis that has been described as a systemic disease process with disseminated vessel involvement. Advances in vascular imaging techniques have demonstrated that involvement of the large vessels of the upper and lower limbs may be more prevalent than was once thought, although the clinical implications of this are unknown. Isolated lower extremity claudication without systemic or classic cranial symptoms, especially as a primary manifestation of giant cell arteritis, is rare. We present the case of a patient with isolated bilateral limb claudication that rapidly progressed to critical limb ischemia requiring urgent surgical intervention after steroid therapy. Our patient has consented to the publication of this report.
- Acute aortoiliac occlusive disease during percutaneous transluminal angioplasty in the setting of ST-elevation myocardial infarction: a case report. [Journal Article]
- JMJ Med Case Rep 2018 Jan 11; 12(1):6
- CONCLUSIONS: The presence of significant peripheral vascular disease, significant cardiac risk factors, and/or difficulty accessing the femoral artery should caution a transfemoral approach during percutaneous transluminal angiography. This approach may precipitate aortoiliac occlusion and/or thromboembolism to the lower extremities. We encourage interventional cardiologists to (1) take extra caution when manipulating the wire and catheter and (2) strongly consider using a transradial approach in such patients.
- Exercise transcutaneous oximetry significantly modifies the diagnostic hypotheses and impacts scheduled investigations or treatments of patients with exertional limb pain. [Journal Article]
- EJEur J Intern Med 2018 Jan 03
- CONCLUSIONS: Ex-TcPO2 in patients with exertional limb pain is applicable in various vascular institutions, and significantly modifies the diagnostic hypotheses and impacts scheduled investigations or treatments of patients with exertional limb pain.
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- Nursing review section of Surgical Neurology International: Part 1 lumbar disc disease. [Review]
- SNSurg Neurol Int 2017; 8:301
- CONCLUSIONS: Familiarity with symptoms, neurological signs, and radiographic presentations for patients with lumbar disc disease is critical for nurses. Here, we review the important factors nurses should know to better recognize, triage, and treat patients with lumbar disc disease.