Management Of Peripheral Vascular Disease Research Articles

Management of Peripheral Vascular Disease with the Simpson Atherocath

Management of Peripheral Vascular Disease with the Simpson Atherocath

The Role of Lasers in the Management of Peripheral Vascular Disease

Although it has been almost twenty-five years since the first studies of McGuff et al, who employed the laser for atheroablation, problems still require resolution. The various laser wavelengths from ultraviolet through visible to infrared have been employed for atheroablation. The laser's greatest appeal and the most spectacular results have been in reopening channels in totally occluded vessels. The laser's greatest problem has been damage of the arterial wall and even perforation. The purpose of this presentation is to clarify the present status of available lasers for the treatment of peripheral vascular disease of the lower extremities. To this end, the initial experience with angioscopically guided laser-assisted angioplasty with a new hybrid laser probe is reported.

Angioplasty in peripheral vascular disease.

Percutaneous revascularization as an alternative to surgery in the management of peripheral vascular disease was first described in 1964 but gained little acceptance.' In 1974 the development of a doublelumen balloon catheter by Gruntzig and others made the technique a much more practical and effective one that has subsequently gained widespread acceptance.2 At first it was used in the peripheral arteries but soon extended to the renal and coronary arteries. In the 12 years since its introduction the technology of balloon catheters and the associated equipment has improved considerably. This in addition to the experience gained by radiologists has allowed the scope and range of angioplasty to be extended so that many more lesions can now be safely and effectively treated. Angioplasty techniques can be applied to such diverse lesions as branch stenoses of a renal artery or a distal tibial stenosis as well as to aortic and pulmonary valve stenosis. In this article the role of percutaneous transluminal angioplasty (PTA) in peripheral vascular disease only will be examined.

Book Review: Diagnosis and Management of Peripheral Vascular Disease

Book Review: Diagnosis and Management of Peripheral Vascular Disease

Evaluation of Surgical Patients with Peripheral Vascular Disease

The diagnosis and management of peripheral vascular disease as it relates to patients undergoing other types of major surgical procedures are considered in this article.

Diagnosis and Management of Peripheral Vascular Disease

Books on vascular surgery are popping up all over. The ground is ripe, for suddenly a large number of part-time and full-time surgeons are devoting an increasing part of their practice to vascular reconstruction. Clearly, they want guidance in this new field, and this book, like several others that have recently appeared, is multiauthored and written to provide practical guidance. One of the several advantages of this book is its excellent section on noninvasive techniques and angiography. The book is most useful for residents, general surgeons who perform occasional vascular surgery, and practicing vascular surgeons. However, because it is well organized and concise, medical students will find it a readable source for clinical information. It is not intended for the serious student of cardiovascular pathophysiology, as it is devoid of basic science references. However, this weakness clarifies the book's purpose and makes it a strong practical clinical text. The illustrations

Diagnosis and Management of Peripheral Vascular Disease.

Diagnosis and Management of Peripheral Vascular Disease.

Percutaneous transluminal angioplasty as an adjunct to the surgical management of peripheral vascular disease.

Percutaneous transluminal angioplasty (PTA) was performed as an adjunct to an operation in 43 patients with peripheral arterial insufficiency. This represents 26% of patients undergoing PTA over the past 44 months. In 23 patients PTA was done in conjunction with planned vascular reconstruction. It was successful in all 23 patients, and patency of the vascular graft was maintained in 22 patients during a mean follow-up period of nine months. Fourteen patients had PTA after operation. It was successful in 13 of them, and vascular patency was maintained in all 13 during a mean follow-up period of four months. Six patients had PTA prior to a distal amputation or a skin graft. All healed promptly. The overall initial success rate of PTA was 98%, the complication rate was 2%, with a late failure rate of 2%. It is concluded that PTA is a valuable adjunct to vascular surgery to improve inflow or outflow for bypass grafts, to reduce the extent of the operation in poor risk patients, to facilitate the healing of distal amputations, and to manage late graft stenosis.

Progress in the Management of Peripheral Vascular Disease

A search of the recent literature reveals a number of significant advances in peripheral vascular surgery. However, today's surgeon continues to find him self battling a disease process he does not understand with diagnostic tools which need improvement. The purpose of this paper is to outline progress in three areas; 1) diagnosis, 2) pathophysiology and 3) surgical therapy. The advances in diagnostic techniques have focused on three questions—(1) what is the nature of the vascular lesion so that an appropriate operation can be designed, (2) what is the status of the disease post-operatively, and (3) in the unreconstructable limb, what amputation may be successfully performed? The second section deals with our increasing knowledge of the underlying disease—atherosclerosis—and its modification through pharmacology. The final section is devoted to improvements in surgical therapy, from pre operative management to the technical details of the operation and post operative care. Concurrently, new ideas in graft preparation and new graft developments are discussed.

Percutaneous transluminal angioplasty: an angiographer's viewpoint.

We outline the present role of angioplasty in the management of peripheral vascular disease and its application to other portions of the arterial and venous systems; we summarize several large series, including our own, which encompass more than 4,000 cases; and we discuss the pathophysiology of balloon dilation techniques and the criteria for patient selection. With appropriate patient selection, initial (90%) and long-term (85%) patency results are now comparable with surgical techniques when the iliac arteries are involved. Treatment of femoropopliteal disease is slightly less successful but is indicated in appropriate patients. We present the role of angioplasty in conjunction with grafting procedures and in the management of renal vascular hypertension, and we review the potential complications (2% to 3%), adjunctive medical management, and areas for further investigation.

Points: Non-surgical management of peripheral vascular disease

Points: Non-surgical management of peripheral vascular disease

Non-surgical management of peripheral vascular disease

Non-surgical management of peripheral vascular disease

Non-surgical management of peripheral vascular disease.

Non-surgical management of peripheral vascular disease.

Non-surgical management of peripheral vascular disease

Non-surgical management of peripheral vascular disease

Non-surgical management of peripheral vascular disease

Non-surgical management of peripheral vascular disease

Correction: Non-surgical management of peripheral vascular disease: a review

Correction: Non-surgical management of peripheral vascular disease: a review

Treatment of vasospastic disease with prostaglandin E1.

Prostaglandin E1, a vasodilator and potent inhibitor of platelet aggregation, was administered to 26 patients with severe vasospastic disease of the hands. Patients tolerated infusions well and reported appreciable symptomatic improvement. Five of eight ischaemic ulcers healed in six weeks. Non-invasive studies of blood flow were used to observe haemodynamic changes during and after infusions. The Doppler-derived radial artery pulsatility index fell from 8.8 +/- 0.6 to 4.6 +/0 0.5 (mean +/- SEM), indicating hand vasodilatation. This fall was maintained 24 hours after infusion (5.9 +/- 0.9), but the index had returned to normal values at two weeks. The amplitude of finger pulse volume recordings increased (5.6 +/- 0.7 mm to 23.8 +/- 3.4 mm) and was raised two and six weeks after infusion (13.5 +/- 2.1 mm). Hand temperature measured by infrared radiometry also increased (27.4 +/- 0.7 degrees C to 31.2 +/- 1.2 degrees C). Intensity of digital vasospasm induced by cold water challenge was not objectively affected by prostaglandin E1 despite an increased finger temperature after infusion. Nevertheless, patients reported less frequent and severe attacks. Prostaglandin E1 given by central venous infusion is a safe new vasoactive agent that can produce appreciable symptomatic improvement by increasing digital perfusion, which may last for several weeks after treatment. Further study will define its mode of action and its place in the management of peripheral vascular disease.

Non-surgical management of peripheral vascular disease: a review.

Although the outlook for a pronounced improvement in the ischaemic limb that cannot be surgically treated remains bleak, cessation of smoking, encouragement of exercise, and the withdrawal of vasoconstricting agents may give some symptomatic relief. There is little evidence that vasodilators or antiplatelet agents have much to offer.

Investigation and management of peripheral vascular disease.

Investigation and management of peripheral vascular disease.

Value of the ultrasonic flow detector in the management of peripheral vascular disease

Summary A transcutaneous ultrasonic flow detector was employed to determine arterial and venous flow in patients with peripheral vascular disease at Walter Reed General Hospital. The flow detector provided useful information not obtainable by the usual clinical means and its use often avoided the necessity of angiography. Information on the quality of peripheral arterial flow was particularly useful in patients in whom distal pulses were lacking because of low systemic pressure, early postoperative shivering and vasoconstriction, peripheral edema, and proximal occlusive arterial lesions. The flow detector allowed determination of the patency of venous repairs, aided in the diagnosis of deep vein thrombosis and valvular incompetency, and was useful in the diagnosis and management of arteriovenous malformations. Further evaluation is warranted.