Symptoms Of Arterial Occlusive Disease Research Articles

8:16 AM Abstract No. 14 - Radiofrequency wire for the recanalization of chronic arterial occlusions that have failed conventional endovascular techniques

Purpose Describe the technique and present the results of RF wire puncture for the recanalization of chronic arterial occlusions in symptomatic patients. Materials and Methods Between January and June 2012, 6 patients (5 male), age ranging from 58-72 years, presented with signs and symptoms of arterial occlusive disease. The lesions ranged from TASC C to D and were identified within the common iliac and superficial femoral artery. Despite multiple repeat attempts at recanalization using conventional endovascular techniques, the lesions were unable to be crossed. PowerWire RF wire (Baylis Medical, Canada) was advanced (via intra-luminal or subintimal approach) within a 5-Fr KMP catheter using a 10 mm snare (iliac lesions) or arterial wall calcification (femoral lesions) as a target. Pre-stent balloon angioplasty was followed by stent placement. If the RF wire puncture was inadequate, a new location was pursued. Clinical assessment along with targeted diagnostic and imaging follow up was performed at 30 days and then at 3, 6, and 12 months. Results All patients were successfully treated with RF wire after previous failed attempts at recanalization using different combinations of catheter/wire techniques. There were no complications. All patients improved clinically and imaging of the treated segment showed patency at 10 months mean follow-up. Conclusion RF wire is a safe alternative in the recanalization of chronic arterial occlusions when conventional techniques have failed and provides an endovascular solution for patients who would otherwise be forced into undergoing surgical repair.

Diagnostic Coronary Angiography in Patients with Peripheral Arterial Disease: A Sub‐study of the Coronary Artery Revascularization Prophylaxis Trial

Although patients in need of elective vascular surgery are often considered candidates for diagnostic coronary angiography, the safety of this invasive study has not been systematically studied in a large cohort of patients scheduled for an elective vascular operation. The goal of this sub-study of the Coronary Artery Revascularization Prophylaxis (CARP) trial was to assess the safety of coronary angiography in patients with peripheral vascular disease. The CARP trial tested the long-term benefit of coronary artery revascularization prior to elective vascular operations. Among those patients who underwent diagnostic coronary angiography during screening for the trial, the associated complications were determined at 24 hours following the diagnostic procedure. Over 5,000 patients were screened during a 4-year recruitment period at 18 major VA medical centers and the present cohort consists of 1,298 patients who underwent preoperative coronary angiography. Surgical indications for vascular surgery included an expanding aortic aneurysm (AAA) (n = 446; 34.4%) or arterial occlusive disease with either claudication (n = 457; 35.2%) or rest pain (n = 395; 30.4%). A total of 39 patients had a confirmed complication with a major complication identified in 17 patients (1.3%). Complication rates were higher in patients with arterial occlusive symptoms compared with expanding aneurysms (1.8% vs. 0.5%; P = 0.07) and were not dissimilar with femoral (2.8%) versus nonfemoral (4.7%) access sites (P = 0.42). Coronary angiography is safe in patients with peripheral arterial disease undergoing preoperative coronary angiography. The complication rate is higher in patients with symptoms of arterial occlusive disease.

Impaired fibrinolysis in young adults with arterial occlusive disease: The relationship with hyperinsulinism and smoking

Peripheral arterial occlusive disease is occasionally observed in young adults. In these patients thromboembolic events are a menace and life expectancy is reduced. We studied two fibrinolytic factors, tissue plasminogen activator (t-PA) and plasminogen activator inhibitor (PAW), possibly risk factors for an early onset of the disease or for complications, in 75 patients seen at the out-patient clinic with symptoms of arterial occlusive disease manifest before the age of 45 years and we compared them with an age and sex matched control group of 29 ambulant patients with minor surgical problems. In both groups we looked for a correlation with plasma insulin, C-peptide, body mass index, von Willebrand factor, and triglyceride levels, parameters of the insulin resistance syndrome, and smoking. In the patients with occlusive arterial disease PAI activity and t-PA antigen were both significantly higher, and t-PA activity significantly lower than in the control group. An unfavourable effect on the disease is surmised. In a subgroup of heavy smokers, PAI activity, body mass index and triglycerides were significantly higher than in light smokers (less than 30 000 cigarettes in their life) or non-smokers. This suggests that the high PAI-1-levels are, at least in our patient population, associated with smoking. A warning against smoking is warranted in atherosclerosis prone subjects, especially in members of affected families. Plasma insulin and C-peptide levels were not statistically different in the two groups, but the positive correlation of PAI activity with insulin and C-peptide levels, and a positive correlation with triglycerides and body mass index, suggest a relationship of peripheral atherosclerosis with the insulin resistance syndrome, a hitherto unnoticed association.

A prospective survey of risk factors in young adults with arterial occlusive disease

Few studies have presented a thorough analysis of young adults with symptoms of arterial occlusive disease. To learn more about the possible risk factors of vascular disease playing a role in these young patients, we have reviewed all patients of 45 years of age and younger with symptoms of arterial occlusive disease who had been referred to our department between 1978 and 1987. Thirty-seven patients (28 males and 9 females) were included in the study. The mean age at which the first symptoms occurred was 34 years. Most patients presented with chronic arterial obliterations of the lower extremities (31/37, 84%). In addition, 4 patients showed signs of ischaemic heart disease. A strongly positive family history of arteriosclerosis was obtained from 13 patients (35%). Hypertension was present in 7 patients (19%), diabetes in three (8%) and nicotine abuse was found in 27 patients (73%). Fifty-four percent of the patients (20/37) had undergone vascular reconstructive surgery, 19% (7/37) underwent transluminal dilatation, and 3 had had subsequent treatment of newly developed lesions. For this study, all patients were recalled to the outpatient clinic. A complete case history was taken followed by a physical examination and ECG. Laboratory examinations were performed to analyse parameters of: (a) coagulation; (b) fibrinolysis; (c) fat- and (d) methionine metabolism. Clear-cut laboratory abnormalities were found in 33 patients (33/37, 89%). Coagulation parameters were abnormal in 11 patients (30%) (protein S deficiency: 3 pts). Fibrinolysis was impaired in 15 patients (40%).(ABSTRACT TRUNCATED AT 250 WORDS)

Streptokinase as an adjunct to arterial surgery.

Twenty-four patients with symptoms of arterial occlusive disease were given streptokinase. Those with sudden onset of symptoms usually demonstrated intravascular thrombosis amenable to streptokinase-induced thrombinolysis. Those with gradual onset of arterial insufficiency had atherosclerotic occlusion for which streptokinase was of little benefit. Contraindications to streptokinase were (1) less than ten days postoperative, (2) severe hypertension, (3) liver disease, (4) recent cerebrovascular accident, and (5) blood dyscrasias. It was concluded that measurement of blood, fibrinogen, and thrombin clot time were necessary to control dosage; post-infusion arteriograms were necessary to control the result, and elective operation was sometimes necessary to correct the causative lesion. It was found helpful in (1) the poor-risk patient, (2) the patient with an active wound infection, (3) the patient whose thrombi are inaccessible, and (4) the complicated clinical situation in which operation would be hazardous.