Form Of Peripheral Vascular Disease Research Articles

Chronic Limb-Threatening Ischemia: Management Updates and Common Questions

Chronic limb-threatening ischemia (CLTI) is an advanced form of peripheral vascular disease with high rates of morbidity and mortality. Patients often present with claudication, impaired walking, and ischemic pain. Screening for CLTI and peripheral arterial disease is recommended with ankle-brachial indexing. To prevent progression to CLTI, family medicine physicians can intervene with lifestyle modification of hyperlipidemia, obesity, smoking, and encouraging well-rounded high-fiber diets. OMT can be useful in increasing lower-extremity circulation and collateral-vessel development. If refractive to optimized medical management and lifestyle modification, surgical intervention is required. Regardless of intervention, CLTI maintains a high rate of morbidity and mortality, with halting progression being the primary objective.

Intestinal thromboangiitis obliterans: a case report

BackgroundThromboangiitis obliterans or Buerger’s disease is a form of peripheral vascular disease in young male smokers. The involvement of the intestine occurs in only about 2% of the cases, when they may present as acute abdomen due to mesenteric ischemia. The uncommonness of the condition makes it a less suspected differential diagnosis, leading to a delay in appropriate management, thereby increasing chances of morbidity or mortality. Cessation of smoking is known to stall the disease progression including visceral involvement, but may not always be the case as happened in the case being presented.Case presentationOur Indian Hindu male patient, a known smoker, presented with diffuse abdominal pain along with bouts of vomiting and loose motions. He had a prior history of amputation of the right foot, 4 years before. At presentation he had abdominal distension with diffuse tenderness and guarding. An omental band attached to the tip of the appendix was discovered at the initial exploration along with dilated proximal bowel loops, for which a release of the omental band along with appendectomy was done. He developed an enterocutaneous fistula on the 6th postoperative day for which he had to be reexplored, and multiple jejunal perforations were found. Segmental jejunal resection and a Roux-en-Y gastrojejunostomy with distal ileostomy were done along with a feeding jejunostomy. The patient however again had feculent discharge from the wound for which a third exploration was done. The gastrojejunostomy and feeding jejunostomy sites were leaky, both of which were repaired primarily. The patient developed septicemia which progressed to refractory septic shock, and he ultimately succumbed to his illness on the 23rd postoperative day of the index surgery.ConclusionAcute abdomen in a young man who is a chronic smoker and having an antecedent history of amputation of some part of an extremity for a nontraumatic cause should raise the suspicion of Buerger’s disease of the intestine. Although it is a progressive disease and the situation has already progressed by the time intestinal symptoms manifest, early detection may give some scope of salvage and decrease the morbidity and mortality.

Impact of diabetes on mortality in peripheral artery disease: a meta‐analysis

There are accumulating studies showing the association between diabetes and all-cause mortality in peripheral vascular disease. However, the results in these studies are conflicting regarding the impact of diabetes on outcome. Diabetes is associated with increased risk of mortality in peripheral artery disease. Using MEDLINE and Scopus, we searched for studies published before January 2016. Additionally, studies were identified by manual search of references of original articles or review studies on this topic. Of the 1072 initially identified records, 21 studies with 15,857 patients were included in the final analysis. Diabetes was associated with a statistically significant increased risk of all-cause mortality (odds ratio: 1.89, 95% confidence interval: 1.51-2.35, P < 0.001), without detected publication bias (Egger bias = 0.75, P = 0.631). The stronger effect on outcome was obtained in patients with critical limb ischemia (odds ratio: 2.38, 95% confidence interval: 1.22-4.63, P < 0.001) as the most severe form of peripheral vascular disease. Diabetes is associated with an increased risk of mortality in peripheral vascular disease, and the effect is even more pronounced in patients with critical limb ischemia.

L-Alanyl-Glutamine Preoperative Infusion in Patients with Critical Limb Ischemia Subjected to Distal Revascularization Reduces Tissue Damage and Protects from Oxidative Stress

Critical limb ischemia (CLI) is the most severe form of peripheral vascular disease where there is inadequate blood flow to a limb. Our aim was to examine the effects of preoperative infusion of l-alanyl-glutamine (l-Ala-Gln) during the ischemic period and during the first 30 minutes following blood reflow in patients with CLI who are undergoing distal femoral artery bypass surgery. Thirty-two patients with CLI were alternately allocated to group 1 (saline) or group 2 (l-Ala-Gln). Saline (1000 mL) or L-Ala-Gln 250 mL plus 750 mL of saline were infused intravenously over a 3-hour period prior to surgery. Samples (muscle and blood) were collected at the beginning of the surgical procedure, at the end of ischemia, and at 15 and 30 minutes after reperfusion. l-Ala-Gln induced elevation in glutathione (GSH) muscle concentrations while promoting reduction in thiobarbituric acid reactive substance concentrations, demonstrating enhancement of antioxidant capacity and protection from lipid peroxidation. Decreases in LDH, lactate, and glucose blood concentrations in l-Ala-Gln-treated patients suggest increased glucose utilization by muscle and peripheral tissues. Reduction in creatine phosphokinase blood concentrations may reflect smaller muscle cell damage in l-Ala-Gln-treated patients. l-Ala-Gln pretreatment reduces muscle cell damage and enhances antioxidant capacity in patients with CLI.

Extremitätenerhalt für den diabetischen Fuß

Lower-extremity amputation (LEA) is a common complication among patients with diabetes. This study tests the effects of a structured disease management program for the diabetic foot (DF) aiming to reduce the number of LEA. DESIGN, METHODS: In a prospective study design we investigate patients with DF in a system of outpatient treatment, acute in-patient care and rehabilitative treatment. Subjects were recruited since January 1(st), 2000, with the latest admission being December 31, 2004. All study participants undergo a five-year follow-up observation period. The University of Texas Wound Classification System (UT) of foot ulcers serves as basis of the documentation and analysis. We evaluated numbers of LEA, rates of ulcer healing and underlying forms of peripheral vascular disease. We report the results of the first patient group completing the two-year follow-up examination. In 2000, 102 subjects with new foot ulcers were consecutively included into the study. 68.6% were men, the mean age of the study population was 68.1 +/- 11.4 years and the mean diabetes duration was 19.4 +/- 10.3 years. After two years, 68 patients can still be examined. Altogether, 22 patients (21.6%) died, and 12 (11.8%) dropped out for various reasons. At the point of discharge from the clinics 35.3% of the ulcers had healed and another 44.1% were in UT grade 1. After two years, a complete healing could still be determined with 51 patients (50.0% of the cohort of the original 102 patients, or 75.0% of the subjects reaching the two-year follow-up). 10 subjects (9.8% or 14.5%) were in the UT grade 1. Eight diabetics underwent major amputation (MA) during the two-year examination period (amputation rate 7.8%). The primary objective of the study, a significant reduction of MA with DF patients, has been achieved. The ulcer healing rates are comparable to the reports of leading centers.

Clinical uses of prostaglandins in anaesthesia and intensive care medicine

Summary Our knowledge of the therapeutic use of prostaglandins has increased dramatically in recent years. As clinical experience and familiarity with these agents grows, and is guided by properly conducted clinical trials, the true place of prostaglandins in clinical practice will become apparent. Unfortunately, much of the use of prostanoids today is based on uncontrolled studies and clinical impressions. Currently, the major roles for prostaglandins are in obstetric practice, in the treatment of ductus-dependent congenital heart disease, in the interim treatment of primary pulmonary hypertension, in acute post-CPB right ventricular afterload mismatch or right ventricular failure, and possibly in some forms of peripheral vascular disease.

Clinical appraisal of a new adrenergic blocking agent: effect of regitine on digital blood flow in normal subjects and patients with peripheral arterial diseases.

By means of venous occlusion digital plethysmography, the authors have evaluated the peripheral vasodilating effect on normal and diseased arterioles of a new adrenergic blocking agent, Regitine, 2-[-( m -Hydroxy-N- p -tolylanilino)-methyl]-2-imidazoline. Results have been compared with the results of similar studies using Priscoline and indirect body heating to produce vasodilation. The effect of palrenteral Regitine on pulse and blood pressure has been noted as well as the clinical results obtained when this drug was used orally for the treatment of certain forms of peripheral vascular disease.

Evaluation of sympathectomy in arteriosclerotic peripheral vascular disease.

In terms of incidence and morbidity arteriosclerosis constitutes the most important form of peripheral vascular disease and consequently deserves the most serious consideration. However, until relatively recently the prevailing attitude characterizing the therapeutic approach to this problem was almost fatalistic. Among the more important factors which have contributed to this point of view are the concept that arteriosclerosis is an inevitable consequence of aging, and therefore an irreversible process, and the general belief that sympathectomy was indicated only in peripheral vascular disturbances characterized by vasospastic phenomena with little or no organic component. With the encouraging results which followed the cautious extension of this procedure in selected cases of this disease greater interest was aroused in the potential benefits of this form of therapy. During the past decade numerous reports have appeared attesting to the value of this procedure in obliterative vascular sclerosis and reflecting a more hopeful outlook in therapy.

Lumbar sympathectomy in peripheral vascular disease.

THE AMOUNT of arterial obstruction which results from any peripheral vascular disease is the sum of the anatomic obstruction in the diseased blood vessel plus the constriction resulting from vasomotor impulses. These impulses may be thought of as those which are normally present producing normal vascular tone and those which are present because of abnormal reflexes. Such reflexes may arise in the area of disease in the blood vessels and, after passing through efferent and afferent loops contained within the sympathetic nervous system, return to the same vascular bed to produce abnormal vasoconstriction. Sympathectomy was early used in those forms of peripheral vascular disease in which there is a large vasospastic element. The first indication for such surgical treatment was considered to be Raynaud's disease and scleroderma. More recently the operative procedure has been used with greater acceptance in peripheral vascular conditions in which the amount of vasomotor tone, depending

ETIOLOGY OF THROMBOANGIITIS OBLITERANS

The etiology of thromboangiitis obliterans has been obscure ever since the first differentiation by Buerger between this condition and other forms of peripheral vascular disease. Impressed by the inflammatory type of lesions seen in the blood vessels, Buerger¹regarded the disease as an infection, but all the clinical evidence indicates that this conception is incorrect. Goodman²agrees that thromboangiitis obliterans is an infectious disease and holds that an attenuated virus of typhus is responsible for it.³Kaunitz⁴suggests that chronic ergot poisoning from eating infected rye foods causes the disease, and recently Thompson⁵has claimed that fungous infection (dermatophytosis) is the causative agent. The occurrence of the disease in smokers has been commented on by several writers. Erb⁶in 1904 stated that smoking was an important contributing cause of this condition. Lilienthal⁷noted this relationship in 1914, and Willy.Meyer⁸in 1920 expressed

THE NEUROCIRCULATORY CLINIC; A SUMMARY OF ITS ACTIVITIES

Article1 December 1939THE NEUROCIRCULATORY CLINIC; A SUMMARY OF ITS ACTIVITIESI. PERIPHERAL VASCULAR DISEASE*G. DE TAKATS, WM. C. BECK, EUNICE A. ROTHG. DE TAKATSSearch for more papers by this author, WM. C. BECKSearch for more papers by this author, EUNICE A. ROTHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-13-6-957 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptINTRODUCTIONNo single form of therapy is equally applicable and efficacious in all forms of peripheral vascular disease. It is obvious that the physical therapist, the internist and the surgeon will strive to extend their sphere of activity in such a borderline field. This may not always be to the best interest of the patient. An approach to the solution of this difficulty seemed to be the establishment of a special clinic in which men from different departments group themselves around a problem which is neither medical nor surgical. It may have dermatologic, neurologic, ophthalmologic and orthopedic ramifications. The decision...Bibliography1. WHIPPLE AO: Studies in splenopathy, Jr. Am. Med. Assoc., 1936, cvii, 1775. CrossrefGoogle Scholar2. RAVDIN JS: Personal communication. Google Scholar3. DE TAKATS G: Acute arterial occlusions of the extremities, Am. Jr. Surg., 1936, xxxiii, 60-67. CrossrefGoogle Scholar4. DE TAKATS G: Vascular anomalies of the extremities, Surg., Gynec. and Obst., 1932, lv, 227. Google Scholar5. DE TAKATS G: Analysis of results following sympathectomy for peripheral vascular disease, Am. Jr. Surg. (In press.) Google Scholar6. ROSS PJ: The recognition of structural changes in the arteries in Raynaud's disease, St. Barth. Hosp. Rep., 1935, cxviii, 121. Google Scholar7. 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PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byDie arteriellen Durchblutungsst�rungen der unteren Extremit�tDiagnosis and Management of Peripheral Vascular DiseaseDiagnosis and treatment of acral gangreneThe vasodilating action of various therapeutic procedures which are used in the treatment of peripheral vascular disease 1 December 1939Volume 13, Issue 6Page: 957-979KeywordsHospital medicineOrthopedicsPeripheral vascular diseaseSurgeonsSurgery ePublished: 1 December 2008 Issue Published: 1 December 1939 PDF downloadLoading ...

THROMBO-ANGIITIS OBLITERANS

For many years after 1879, when von Winiwarter 1 first described peculiar type of endarteritis, endophlebitis and gangrene of the feet, little attention was paid to this form of peripheral vascular disease. Weiss 2 and von Manteuffel 3 contributed studies of the pathologic process, but it was left for Buerger 4 to give a detailed account of all aspects of the entity from both the clinical and the pathologic standpoint. He was the first to point out the thrombotic and inflammatory nature of the process, the involvement of veins as well as of arteries and the characteristic clinical phenomena. He incorporated all these concepts in the name which he gave to the disease, thrombo-angiitis obliterans. An extensive literature now exists on many phases of this malady. However, little is known concerning the fate and especially the mode of death of patients with this condition. Usually only transient phases of