Vascular Disease Of Lower Limbs Research Articles

ELSO Interim Guidelines for Venoarterial Extracorporeal Membrane Oxygenation in Adult Cardiac Patients.

ELSO Interim Guidelines for Venoarterial Extracorporeal Membrane Oxygenation in Adult Cardiac Patients.

Dysregulations of MicroRNA and Gene Expression in Chronic Venous Disease.

Chronic venous disease (CVD) is a vascular disease of lower limbs with high prevalence worldwide. Pathologic features include varicose veins, venous valves dysfunction and skin ulceration resulting from dysfunction of cell proliferation, apoptosis and angiogenesis. These processes are partly regulated by microRNA (miRNA)-dependent modulation of gene expression, pointing to miRNA as a potentially important target in diagnosis and therapy of CVD progression. The aim of the study was to analyze alterations of miRNA and gene expression in CVD, as well as to identify miRNA-mediated changes in gene expression and their potential link to CVD development. Using next generation sequencing, miRNA and gene expression profiles in peripheral blood mononuclear cells of subjects with CVD in relation to healthy controls were studied. Thirty-one miRNAs and 62 genes were recognized as potential biomarkers of CVD using DESeq2, Uninformative Variable Elimination by Partial Least Squares (UVE-PLS) and ROC (Receiver Operating Characteristics) methods. Regulatory interactions between potential biomarker miRNAs and genes were projected. Functional analysis of microRNA-regulated genes revealed terms closely related to cardiovascular diseases and risk factors. The study shed new light on miRNA-dependent regulatory mechanisms involved in the pathology of CVD. MicroRNAs and genes proposed as CVD biomarkers may be used to develop new diagnostic and therapeutic methods.

Clinical analysis for patients with diabetic foot among multiple centers in China

To explore the clinical characteristics, risk factors and factors affecting the severity of the disease in patients with diabetic foot at the current stage through a multi-center cross-sectional survey. Methods: Clinical data of 326 patients with diabetic foot (205 males and 121 females) from 13 general hospitals nationwide were collected from October to November 2017 using a unified clinical data collection table. The clinical characteristics were analyzed, and the influential factors for severe diabetic foot were analyzed by logistic regression analysis. Results: Among 326 patients with diabetic foot, 68.4% of the patients were more than 60 years old, and 60.1% of the patients received primary or junior high school education; 96.3% of the patients developed Type 2 diabetes; 80.1% of patients had glycated hemoglobin (HbA1c)≥7%; 60.1% of patients suffered dyslipidemia. Improper wearing of footwear (38.5%) is the main cause of diabetic foot. Diabetic neuropathy (76.7%), diabetic retinopathy (62.3%) and lower limb vascular disease (57.4%) were the most common complications. Logistic regression analysis showed that diabetic nephropathy, diabetic lower extremity vascular disease, and HbA1c levels were independent risk factors for severe diabetic foot, and receiving foot care education can be regarded as a protective factor. Conclusion: The diabetic foot occurs mostly in male patients, and Type 2 diabetes with older age, lower education level, poor glycemic control and dyslipidemia are the risk factors. Diabetic nephropathy, diabetic lower extremity vascular disease, HbA1c, and receiving foot care education are independent influential factors for the severity of diabetic foot.

Extravascular findings during upper limb computed tomographic angiography focusing on undiagnosed malignancy.

BACKGROUNDComputer tomography angiography (CTA) has been an established method for diagnostic vascular disease of lower limbs. Recently, the method is widely used for diagnosis of vascular pathologies in the upper limbs too. It also has increased the possibilities of this scans being reviewed by no specially trained radiologists. This increases the risk of incidental non vascular findings to be missed or misinterpreted. The study is focusing in the frequency of extravascular incidental finding (EVIF) and highlights the importance for both the reporting radiologist and the referring physician recognizing the frequency of EVIFs.AIMTo analyse the frequency of EVIF identified on computed angiography (CT) of the upper limb.METHODSA total of 1383 CT angiographic studies of the peripheral arterial system were performed between August 2015 and August 2017. All upper limb CTAs (n = 79) were retrospectively reviewed for the presence of non-vascular incidental findings within the chest, abdomen/pelvis, musculoskeletal system or head and neck. These EVIFs were subsequently grouped into 3 categories based on clinical significance. EVIFs of immediate clinical relevance were included in category A, findings considered indeterminate but most likely benign were placed in category B, while incidental findings of no clinical significance were included in category C.RESULTSComplete imaging datasets were available in 74/79 (93.7%). Patient demographics included 39 (52.7%) females and 35 (47.2%) males with a mean age of 59 ± 19.5 years (range 19-93 years). A total of 153 EVIFs were reported in 52 patients (70.3%). Of these, 44 EVIFs (28.7%) were found in the chest, 83 (54.2%) in the abdomen, 14 (9.2%) in the musculoskeletal system and 9 (5.8%) in the head and neck. Thirteen EVIFs (8.4%) identified in 11 patients were noted to be of immediate clinical significance (Category A), 50 EVIFs (32.3%) were identified in 20 patients and were considered indeterminate but most likely benign, while the remaining 91 EVIFs (59.5%) identified in 21 patients were determined to be of no clinical significance (Category C). One index case of malignancy (1.3%) and four cases of new disseminated metastatic disease (5.4%) were identified.CONCLUSIONOur study of upper limb CTA examinations demonstrated a frequency of 8.4% for extravascular incidental findings of immediate clinical significance. We highlight the importance for both the reporting radiologist and the referring physician of the need to recognize the frequency with which EVIFs are identified in the upper limb peripheral arterial system and of the necessity for further clinical and imaging work-up.

Application of resistant exercise combined with Buerger exercise in patients with diabetic foot

Objective To investigate the application of resistive exercise combined with Buerger exercise in lower extremity vascular disease of type 2 diabetes mellitus. Methods According to the order of admission, 120 type 2 diabetes mellitus patients with lower extremity vascular disease were randomly divided into resistance exercise group, Buerger exercise group and combined exercise group, with 40 cases in each group.The resistance exercise group was given resistance exercise, the Buerger exercise group was given Buerger exercise, and the combined exercise group was given resistance exercise combined with Buerger movement.The changes of self-inductance, ABI and DAWV of the three groups were observed. Results The clinical symptoms of the three groups were significantly reduced (the resistance exercise group: markedly effective in 10 cases, effective in 14 cases; the Burger exercise group: markedly effective in 15 cases, effective in 17 cases; the combined exercise group: markedly effective in 22 cases, effective in 13 cases), the effective rate of the combined exercise group was higher than that of the resistance exercise group and Buerger exercise group(the resistance exercise group: 60.0%; the Burger exercise group: 80.0%; the combined exercise group: 87.5%, χ2=11.333, P<0.05). The ABI of the three groups were higher than those before treatment, and the ABI ratio of the combined exercise group[(0.933±0.113)]was higher than that of the resistance exercise group[(0.866±0.112)] and the Buerger exercise group[(0.888±0.111)](t=1.796, 2.663, all P<0.05). The DAWV of the three groups increased compared with those before treatment, and the DAWV of the combined exercise group[(7.023±0.535)cm/s]was higher than that of the resistance exercise group[(6.633±0.552)cm/s]and the Buerger exercise group[(6.772±0.435)cm/s](t=2.302, 3.209, all P<0.05). Conclusion Resistant exercise combined with Buerger exercise is helpful to improve the blood flow velocity and blood flow in the lower extremity vessel of patients with diabetic lower limb vascular disease, and can improve the self-sensitization symptoms of peripheral neuropathy in patients. Key words: Diabetes mellitus, type 2; Diabetic angiopathies; Lower extremity; Exercise therapy; Blood flow velocity

Analysis of risk factors that affect type 2 diabetic arrhythmia

Objective To investigate risk factors that affect type 2 diabetic cardiac arrhythmia. Methods Clinical data of 292 diabetic patients who were performed examination of low limb vascular were analyzed retrospectively. Based on electrocardiogram, the patients were divided into cardiac arrhythmia group and non-cardiac arrhythmia group with case-control study, and the clinical data and evaluation indexes of lower extremity vascular disease were compared between two groups. Results Data comparison between two groups indicated age [(59±14)years vs (54±12)years], symptoms of low limbs [40.7% vs 29.0%] had statistical significance (P 0.05). Age, gender, history of high blood pressure, symptoms of low limbs, and heat- controlled laser Doppler were analyzed with multiple logistic regression, which indicated that age was risk factor of type 2 diabetic arrhythmia. Conclusions Age is correlated with type 2 diabetic arrhythmia, and evaluation indexes of lower limb vascular disease have no significant correlation with type 2 diabetic arrhythmia. Key words: Diabetes mellitus, type 2/CO; Arrhythmias, cardiac/CO; Risk factors

Fibrinolytic effects of peroneal nerve stimulation in patients with lower limb vascular disease.

Patients with lower limb vascular disease are at an increased risk of thrombotic events. Tissue plasminogen activator (t-PA) and plasminogen activator inhibitor 1 (PAI-1) are important components of the fibrinolytic system, responsible for clot lysis. This study aimed to establish whether peroneal nerve stimulation (PNS) could promote fibrinolysis within a cohort of vascular patients. Ethical approval was obtained for this prospective case-controlled study. Patients were randomly assigned to active stimulation or control groups. Arterial flow measurements and venous blood samples were taken bilaterally at baseline and following 45 min of PNS. ELISA analysis for plasma t-PA and PAI-1 was performed utilizing commercially available kits. Statistical analysis evaluated the changes in t-PA and PAI-1 levels from baseline for the active (device active), passive (contralateral limb) and control limbs (inactive device applied).Seventy-seven participants were recruited: 30 claudicants (25 active and five controls), 25 patients postoperative infra-inguinal bypass grafts (19 active and six controls) and 22 patients with varicose veins (17 active and five controls). t-PA levels reduced significantly in all groups; however, intergroup analysis demonstrated no statistically significant difference when comparing the active, passive and control limbs (P = 0.079). PAI-1 levels decreased by 16.2% (34.0 ng/ml, SD 52.2) in the active limbs but only 3.6% (11.4 ng/ml, SD 47.4) and 2.6% (2.7 ng/ml, SD 21.3) in the passive and control limbs, respectively (intergroup analysis P < 0.001). No relationship between changes in flow and plasma of t-PA and PAI-1 were demonstrated. Peroneal nerve stimulation may augment fibrinolysis by decreasing plasma levels of PAI-1 levels in patients with lower limb arterial and venous disease.

Multiple Atherectomy and Patch Plasty in Diffuse Atherosclerotic Peripheral Vascular Disease: Our Experience

Background: Peripheral vascular disease of lower limbs is a debilitating condition with a significant proportion of patients having diffuse, long segment atherosclerosis. This study emphasizes the role of surgery in this group of patients. Materials and Methods: Eighty patients (95 legs) met the inclusion criteria for this study and were followed prospectively. Patients with Rutherford Class IV–VI were taken. Operative findings (type of operation, number of patches, total length of patches, etc.) were recorded. Subsequently, in postoperative period, they were evaluated for improvement in clinical (Rutherford) class, appearance of distal pulsations, ulcer healing, primary patency rates, freedom from amputation, and associated complications at 1, 3, 6, 12, 18, and 24 months. Results: Sustained clinical treatment efficacy according to Rutherford was 82% at 12 months and 59% at 24 months. Amputation-free survival rate was 86% at 12 months and 74% at 24 months. Until 24 months, 17 legs were amputated (18%) and 10 (10.5%) target limbs were revascularized through femoral embolectomy. At 2 years, cumulative femoral artery patency was 88%, whereas cumulative popliteal artery patency was 71%. Conclusion: The present series evaluated patients with the most advanced form of critical leg ischemia with a high rate of leg salvage with this procedure. Multiple atherectomy with patch plasty does offers hope to such patients and can become part of armamentarium of a vascular surgeon.

Abstract 239: Stem Cell Therapy Improves Critical Limb Ischemia

Introduction: The journey from single cell to complex being is attributable to stem cells role. Adult stem cells originate during ontogeny &amp; persist in specialized niches within organs. Asymmetric division of each stem cell during differentiation produces : one daughter stem cell &amp; one daughter transit amplifying/intermediate cell having migratory properties. Forced migration of hematopoietic stem/progenitor cells (HSPC) from bone marrow into peripheral blood is called mobilization. Accumulating evidence suggests that attenuation of the chemokine stromal derived factor-1(SDF-1)-CXCR4 axis that plays a pivotal role in retention of HSPC in bone marrow (BM) results in the release of these cells from the BM into peripheral blood. Recently, adult cells have been genetically reprogrammed to an embryonic stem cell like state. Induced pluripotent stem cells (IPSCs) were similar to human embryonic stem cells in morphology, proliferative capacity, expression of cell surface antigens, &amp; gene expression. Treatment of ischemic vascular disease of lower limbs remains a significant challenge. Unfortunately, if medical &amp; surgical salvage procedures fail, amputation is an unavoidable result for those patients. Aim of Work: (Hypothesis) To assess the application of implantation of autologous stem/progenitor cell in the treatment of chronic limb ischemia &amp; to evaluate the safety, efficacy &amp; feasibility of this novel therapeutic approach. Methods: A total of 24 patients with chronic limb ischemia not eligible for arterial reconstruction or endovascular procedures were enrolled &amp; randomized (1:1) to either the implanted group or the control group. Control group: Conventional medical therapy in the form of anti platelet therapy &amp; vasodilators. Implanted group: Subcutaneous injection of 300μ g/day of recombinant human granulocyte colony stimulating factor (G-CSF) for 5 days to mobilize stem/progenitor cells from BM. Total leucocytic count is measured daily to follow up successful mobilization of bone marrow mononuclear cells (BMMNCs). Stem cell Harvesting After 5 days peripheral blood mononuclear cells (PBMNCs) were harvested using a cell separator. Samples from apheresis products are subjected to TLC measurement &amp; immunophenotypic characterization of CD34+ cells by flow cytometry. The collected PBMNCs were implanted by multiple intramuscular injections into ischemic limbs. Results: There was significant increase in pain free walking distance &amp; ankle/brachial index (ABI) &amp; significant decreased rest pain. Effectiveness was documented by : reduced number of amputation, increase ABI &amp; improvement of the quality of life in therapeutic group compared to control group. Conclusion: The novel therapeutic approach of PBMNCs implantation in patients with chronic limb ischemia is safe, feasible &amp; effective in decreasing co-morbidity &amp; rate of amputation. Safety was manifested by absence of complications during G-CSF therapy or during harvesting &amp; injection of the stem cells. Recommendations: 1- Future studies on larger number of patients &amp; longer follow up. 2- Controlled studies using different methods &amp; different cell population (PBMNCs, BMMNCs or MSCs) to compare the outcome of each. 3-Studing the role of endothelial progenitor cell dysfunction in different ischemic diseases to develop successful gene therapy.

Incidence and risk factors of the vascular disease in lower limbs of patients with type 2 diabetes

Objective To investigate the incidence and the risk factors of the vascular disease in lower limbs of patients with type 2 diabetes(T2DM).Methods To retrospectively analyze 318 cases with T2DM patients.All the patients were checked on both lower limbs by color ultrasonic Doppler.The differences of ordinary and biochemical indicators between PVD group and non-PVD group were compared.Results There were 67.2％ (205/318) patients who had vascular disease in lower limbs with type 2 diabetes.Age,course of disease,HbAlC,TC,TG,SBP,DBP and BMI in PVD group were significantly higher than those in non-PVD group( P ＜ 0.01 ).Conclusion There was higher incidence of the vascular disease in lower limbs of patients with type 2 diabetes.And the independent risk factors were hypertension,hyperglycemia,hyperlipemia.It could help to prevent the development of lower limb blood vessel pathological changes in DM patients by controlling the levels of blood pressure,lipid and blood sugar strictly. Key words: Diabetas,type 2; Vascular disease in lower limbs; Risk factors; Ultrasonic doppler

Lower Limb Vascular Disease in Diabetic Patients:: A Study with Calf Compression Contrast-enhanced Magnetic Resonance Angiography at 3.0 Tesla

To retrospectively analyze the significance of 3.0-T contrast-enhanced (CE) magnetic resonance angiography (MRA) with calf compression in the lower limbs of diabetic patients with peripheral vascular disease. Sixty-one type 2 diabetes patients underwent both MRA and digital subtraction angiography (DSA) within 1 week. The patients were divided into two groups: one with (pressure) and one without (conventional) calf compression during MRA. Two radiologists evaluated the quality of MRA images and compared the two groups. Cohen's kappa statistic was used to determine the concordance between MRA and DSA. Image quality in the calf and foot was better in the group with calf pressure than the conventional group without applied pressure (P = .001 [calf], 0.008 [foot]). Significantly more runoff vessels in the calf were detected with MRA than with DSA (P = .0043 [conventional], 0.0031 [pressure]). The kappa values were 0.928 in the conventional group and 0.979 in the pressure group, but in the conventional group, the diagnostic accuracy of CE-MRA was lower than that of DSA (P = .002). Diagnostic accuracy in the pressure group was significantly higher than that in the conventional group (P = .009). The overall sensitivity and specificity for >50% stenosis or occlusion was 93.8% and 98.5%, respectively, in the conventional group and 98.7% and 99.6%, respectively, in the pressure group. With calf compression, venous overlap (P = .0396, .0425) and deep vein overlap (P = .022, .022) were significantly reduced in the leg and foot. Calf compression with 3.0-T CE-MRA was convenient and practical and could improve image quality and diagnostic accuracy in diabetic patients with peripheral vascular disease by reducing venous overlap.

Clinical study on chronic complications in diabetic patients

Objective To investigate the chronic complications of diabetes-related conditions and associated risk factors. Methods Clinical data of 738 diabetic patients with chronic complications were retrospectively analyzed.The patients age,duration,glycosylated hemoglobin levels,smoking and family history,body mass index,systolic blood pressure,diastolic blood pressure,triglycerides,cholesterol,high density lipoprotein,low-density lipoprotein-related risk factors etc were analyzed. Results The diabetic patients with chronic complications,was neuropathy,diabetes,eye disease and diabetic nephropathy accounted for the top three,followed by the lower limb vascular disease,cardiovascular disease and cerebrovascular disease.The relevant factors analysis revealed that influential factors had relationship with il1 ness course,age,drinking alcohol,blood pressure and blood-fat Conclusion There were many reasons for diabetic chronic complications,blood sugar.blood pressure,blood lipid should be actively controlled,and regular health education should be requested. Key words: Diabetes mellitus; Diabetes complications; Factor analysis,statistical

Interventional therapy combined with multifactorial intervention in diabetes with lower-limb vascular disease

The effect of interventional therapy combined with multifactorial intervention on critical limb ischemia in patients with diabetes mellitus was investigated. The patency rate and limb salvage rate were followed up. Interventional therapy is effective in treating diabetic foot with critical limb ischemia. Multifactorial intervention was helpful for reducing amputation. Key words: Diabetes; Peripheral vascular disease; Interventional therapy

Association of serum matrix metalloproteinase-9 levels and C-reactive protein with peripheral vascular disease of lower limbs in type 2 diabetes mellitus

Serum matrix metalloproteinase-9 (MMP-9), hypersensitive C-reactive protein (hsCRP) and other clinical parameters were measured in patients with types 2 diabetes mellitu (with or without angiopathy of lower limbs). The serum levels of MMP-9 and hsCRP were higher in type 2 diabetic patients and those with angiopathy by Doppler ultrasonography than those in normal controls. The change of serum MMP-9 was positively correlated with the level of hsCRP. The extent of angiopathy was correlated positively with both hsCRP and MMP-9. Key words: Matrix metalloproteinase-9; C-reactive protein; Diabetes mellitus, type 2; Angiopathy

A colour atlas of extra-anatomic bypass for lower limb vascular disease. J. Chamberlain. 265 × 195 mm. Pp. 64. Illustrated. 1988. London: Wolfe Medical Publications Ltd. £19.00

A colour atlas of extra-anatomic bypass for lower limb vascular disease. J. Chamberlain. 265 × 195 mm. Pp. 64. Illustrated. 1988. London: Wolfe Medical Publications Ltd. £19.00

In vivo femoropopliteal arterial wall compliance in subjects with and without lower limb vascular disease

Objective: The purpose of this study was to further the development of a compliant vascular graft with a preliminary assessment of the elastic properties of the femoropopliteal artery in subjects with and without lower limb peripheral vascular disease. Methods: This prospective controlled study was set in a university department of surgery. Using an ultrasound scan wall tracking system with the simultaneous measurement of brachial blood pressure, measurements of femoropopliteal artery wall motion were undertaken in 11 patients with peripheral vascular disease (group 1), in 11 older control subjects who were matched for blood pressure, age, and sex (group 2), and in 12 younger control subjects (group 3). Diametrical compliance and stiffness index were determined for the common femoral artery, the proximal superficial femoral artery, the distal superficial femoral artery (DSFA), and the midgenicular popliteal artery. Results: All the arterial segments in group 1 showed a trend towards increased stiffness and less compliance than the group 2, age-matched control vessels, with significantly lower distensibility noted at the common femoral artery (mean compliance of 6.2% vs 14.1% mm Hg –1 × 10 –2, respectively; P < .05) and the DSFA (mean compliance of 2.2% vs 1.9% mm Hg –1 × 10 –2, respectively; P < .05). The popliteal artery segment in group 3 proved to be more compliant and less stiff than did the same vessel in group 2 (8.5% vs 4.7% mm Hg –1 × 10 –2, respectively; P < .01). In all three study groups, the DSFA was consistently noted to be the least distensible vessel segment. Conclusion: Lower limb peripheral vascular disease is associated with a reduction in femoropopliteal artery elasticity. Age alone appears to have a minimal effect on the compliance of the proximal half of the femoropopliteal segment. The elastic properties of the femoropopliteal vessel are subject to marked variation along its course. To minimize compliance mismatch, the degree of elasticity engineered into a vascular graft must reflect that observed in vivo. (J Vasc Surg 1999;30:936-45.)

Epidural spinal cord stimulation for treatment of chronic pain—some predictors of success. A 15-year experience

BACKGROUND We have used epidural spinal cord stimulation (SCS) for pain control for the past 15 years. An analysis of our series of 235 patients has clarified the value of specific prognostic parameters in the prediction of successful SCS. METHODS Patients were followed up for periods ranging from 6 months to 15 years with a mean follow-up of 66 months. The mean age of the 150 men and 85 women in the study was 51.4 years. Indications for SCS included failed back syndrome (114 patients), peripheral vascular disease (39 patients), peripheral neuropathy (30 patients), multiple sclerosis (13 patients), reflex sympathetic dystrophy (13 patients), and other etiologies of chronic intractable pain (26 patients). RESULTS One hundred and eighty-nine patients received permanent devices; 111 (59%) of these patients continue to receive satisfactory pain relief. Pain attributable to failed back syndrome, reflex sympathetic dystrophy, peripheral vascular disease of lower limbs, multiple sclerosis, and peripheral neuropathy responded favorably to spinal cord stimulation. In contrast, paraplegic pain, cauda equina syndrome, stump pain, phantom limb pain, and primary bone and joint disease pain did not respond as well. Cases of cauda equina injury had promising initial pain relief, but gradually declined after a few years. After long-term follow-up, 47 of the 111 successfully implanted patients were gainfully employed, compared with 22 patients before implantation. The successful patients reported improvements in daily living as well as a decrease in analgesic usage. Multipolar stimulation systems were significantly more reliable ( p < 0.001) than unipolar systems. Complications included hardware malfunction, electrode displacement, infection, and tolerance. CONCLUSION Aside from etiologies of pain syndromes as a prognostic factor, we have identified other parameters of success. In patients who have undergone previous surgical procedures, the shorter the duration of time to implantation, the greater the rate of success ( p < 0.001). The diagnosis of failed back syndrome must be considered a confounding factor in our analysis. Those patients whose pain did not follow a surgical procedure had better responses to SCS than patients who had multiple surgical procedures prior to their first implant. The advent of multipolar systems has significantly improved clinical reliability over unipolar systems. Age, sex, and laterality of pain did not prove to be of significance.

Evaluation of the Pullback Atherectomy Catheter in the treatment of lower limb vascular disease

Evaluation of the Pullback Atherectomy Catheter in the treatment of lower limb vascular disease

Evaluation of the Pullback Atherectomy Catheter in the Treatment of Lower Limb Vascular Disease

To evaluate prospectively the Pullback Atherectomy Catheter (PAC) in terms of its technical success and 1-year patency in the treatment of lower limb vascular disease.M ETHODS: Thirty-nine PAC procedures were performed in 34 patients to treat atherosclerotic disease (occlusive in 51%) of the femoropopliteal arteries, including four cases of graft neointimal hyperplasia and three dissection flaps. Follow-up was by ankle-brachial indices at 24 hr and 1 month, and arteriography at 6 and 12 months. Technical success was achieved in 38 of 39 procedures (97.4%). There was a reduction in mean stenosis from 89.4% to 12.1%, but 69.2% of procedures required additional balloon dilatation to achieve an adequate arterial lumen. Complications followed 15.4% of procedures, a third of which required surgery. The PAC is an easy and relatively safe catheter to use, but does not provide a satisfactory arterial lumen without additional percutaneous transluminal angioplasty (PTA). It proved to be effective, however, in the treatment of graft neointimal hyperplasia and in the resection of obstructive intimal flaps following PTA.

Occlusive vascular disease of lower limbs: diagnosis, amputation surgery and rehabilitation. A review of the Burke experience.

This review is concerned with the epidemiology of lower limb amputations, frequency and results of limbsaving procedures and the contemporary management of dysvascular amputees. National data showed no decline in the number and rates of amputations from 1981-1985, but the frequency of bypass surgery increased indicating that the problem of peripheral arterial occlusive disease is far from being resolved. Femoral/popliteal bypasses are performed twice as often as aorto/ileac procedures but failure rates are high. Based on observations of 238 amputees we noted that femoral/popliteal bypasses had the highest failure rate, particularly when performed as a last limbsaving effort. A laudable trend of preserving the knee was noted but poor stump conditions were the most important factors influencing the length of hospital stay (average 51 days). The amputee rehabilitation process is discussed along with a description of contemporary prosthetic technology. The cost effectiveness of state of the art devices for the older dysvascular amputee is questioned. The cost of amputation and rehabilitation is enormous, especially when preceded by unsuccessful arterial reconstruction. The loss of a leg is, of course, a major disaster for every individual and therefore limbsaving efforts and amputation techniques must be refined and the rehabilitation effort optimized.