- 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.
- 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.
- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- Clinical presentation of subclavian and innominate artery peripheral arterial disease (PAD) varies from hand claudication to cerebral hypoperfusion to distal embolization and digital ischemia. Upper ...
Clinical presentation of subclavian and innominate artery peripheral arterial disease (PAD) varies from hand claudication to cerebral hypoperfusion to distal embolization and digital ischemia. Upper extremity PAD could manifest as coronary steal or lower extremity claudication in patients who have had CABG or extra-anatomic axillary to femoral bypass. Physical examination is significant for weak pulses on an ipsilateral extremity, a systolic blood pressure difference of more than 10mmHg compared to contralateral extremity. Sometimes the affected hand may feel cool to touch, and in severe cases, digital ischemia has also been described. Often patients present during their sixth or seventh decades of life, and they have associated peripheral arterial disease risk factors such as smoking, diabetes mellitus, hyperlipidemia, hypertension, lower-extremity peripheral arterial artery disease, and less common inherited genetic disorders such as inflammatory or Takayasu arteritis.
- Extra-Anatomic Ascending Aorta to Abdominal Aorta Bypass in Takayasu Arteritis Patients with Mid-Aortic Syndrome. [Journal Article]
- KJKorean J Thorac Cardiovasc Surg 2017; 50(4):270-274
- CONCLUSIONS: An extra-anatomic ascending aorta to abdominal aorta bypass could be an effective treatment option for severe aortic steno-occlusive disease in patients with type II or III TA, with favorable early and long-term outcomes.
- Presentation, clinical features, and results of intervention in upper extremity fibromuscular dysplasia. [Multicenter Study]
- JVJ Vasc Surg 2017; 66(2):554-563
- CONCLUSIONS: Presenting symptoms for patients with UE FMD vary in severity from asymptomatic disease to digital ischemia. More than half of symptomatic limbs eventually require at least one invasive intervention for complete relief of symptoms.
- Factors Associated With Need for Revascularisation in Non-coronary Arterial Occlusive Lesions Secondary to Takayasu's Arteritis. [Journal Article]
- EJEur J Vasc Endovasc Surg 2017; 54(3):397-404
- CONCLUSIONS: Patients with TA who underwent interventions had higher ESR at the time of diagnosis; this factor and active smoking were associated with progression of the disease and worsening ischaemic symptoms despite medical therapy. Revascularisation procedures are effective at relieving symptoms; lifelong surveillance is necessary.
- Stromal vascular fraction cells for the treatment of critical limb ischemia: a pilot study. [Journal Article]
- JTJ Transl Med 2017 Jun 19; 15(1):143
- CONCLUSIONS: Results of this pilot study demonstrate that the multiple intramuscular SVF cell injections stimulate regeneration of injured tissue and are effective alternative to achieve therapeutic angiogenesis in CLI patients who are not eligible for conventional treatment. Trial registration number at ISRCTN registry, ISRCTN13001382. Retrospectively registered at 26/04/2017.
- Vascular TOS-Creating a Protocol and Sticking to It. [Review]
- DDiagnostics (Basel) 2017 Jun 10; 7(2)
- Thoracic Outlet Syndrome (TOS) describes a set of disorders that arise from compression of the neurovascular structures that exit the thorax and enter the upper extremity. This can present as one of ...
Thoracic Outlet Syndrome (TOS) describes a set of disorders that arise from compression of the neurovascular structures that exit the thorax and enter the upper extremity. This can present as one of three subtypes: neurogenic, venous, or arterial. The objective of this section is to outline our current practice at a single, high-volume institution for venous and arterial TOS. VTOS: Patients who present within two weeks of acute deep vein thrombosis (DVT) are treated with anticoagulation, venography, and thrombolysis. Those who present later are treated with a transaxillary first rib resection, then a two-week post-operative venoplasty. All patients are anticoagulated for 2 weeks after the post-operative venogram. Those with recurrent thrombosis or residual subclavian vein stenosis undergo repeat thrombolysis or venoplasty, respectively. ATOS: In patients with acute limb ischemia, we proceed with thrombolysis or open thrombectomy if there is evidence of prolonged ischemia. We then perform a staged transaxillary first rib resection followed by reconstruction of the subclavian artery. Patients who present with claudication undergo routine arterial duplex and CT angiogram to determine the pathology of the subclavian artery. They then undergo decompression and subclavian artery repair in a similar staged manner.
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- [Efficacy of transforaminal endoscopic nerve root decompression in the treatment of degenerative lumbar spinal stenosis]. [Journal Article]
- BDBeijing Da Xue Xue Bao Yi Xue Ban 2017 Apr 18; 49(2):252-255
- CONCLUSIONS: We can apply transforaminal endoscopic decompression for the patients of lumbar spinal stenosis who have unilateral nerve root irritation. Patients with transforaminal endoscopic decompression can get less surgical trauma, quick recovery and obtain good short-term outcome.