1/59. Vascular reconstruction in Buerger's disease.In 23 of 148 patients with Buerger's disease, it was possible to undertake 27 arterial reconstructive procedures: bypass in 22 and thrombo-endarterectomy in 5. In a follow-up of 10 months to 8 years, the overall patency rate was 26 per cent. The long term patency rate of bypass grafting was good in obstruction of main vessels, but unsatisfactory with multiple occlusions. Bypass grafting was preferred to thromboendarterectomy. To obtain long term patency of revascularaized segments, complete abstinence from tobacco is absolutely essential. The preparatory manoeuvres for antogenous venous graft should be as atraumatic as possible. A functional diagnosis is indispensable when considering operative indications and for follow-up study of patients with peripheral arterial occlusive disease.- - - - - - - - - - ranking = 1keywords = peripheral (Clic here for more details about this article) |
2/59. Major vascular surgery in a patient with sickle cell disease.We report a patient with homozygous sickle cell disease who underwent femoropopliteal bypass for claudication on walking 10m. Isotope studies showed a blood flow in his left femoral artery of only 0.808 ml. 100ml.min-1. The potential problems of sickle cell disease combined with peripheral vascular disease were probably reduced in this patient because he had an increased fetal haemoglobin level of 13%. Despite the femoral artery being clamped for 100 min, no sickling crisis occurred.- - - - - - - - - - ranking = 1keywords = peripheral (Clic here for more details about this article) |
3/59. Spontaneous popliteal artery dissection: a case report and review of the literature.Spontaneous arterial dissection of a peripheral artery involving an extremity is a rare event. We report a case of atraumatic, nonaneurysmal dissection of the popliteal artery that occurred in a 62-year-old man who was admitted with progressive right lower-extremity claudication. Preoperative arteriography was suggestive of arterial dissection, and surgical treatment was undertaken before irreversible ischemia developed. Intraoperatively, a dissection of the popliteal artery was observed, and the patient underwent femoral-popliteal bypass grafting with the ipsilateral, greater saphenous vein and the popliteal artery was ligated distal to the dissection. Spontaneous dissection limited to the popliteal artery has not previously been reported in the literature. Successful management depends on consideration of the diagnosis, particularly when other, more common diseases have been excluded.- - - - - - - - - - ranking = 1keywords = peripheral (Clic here for more details about this article) |
4/59. Thermal biofeedback for claudication in diabetes: a literature review and case study.temperature biofeedback (TBFB) is designed to alter cutaneous temperature in treated extremities by providing information corresponding to minor temperature fluctuations in the context of therapeutic structure and reinforcement. Toe TBFB may improve vascular flow and walking tolerance in patients with peripheral vascular disease. This case study documents improved walking in a diabetes patient with lower extremity complications, and suggests TBFB might increase lower extremity temperature and blood flow volume pulse in uncomplicated diabetes. ankle-brachial index (ABI) and walking function were assessed in a 60-year-old woman with type 2 diabetes and intermittent claudication, before and after five sessions of TBFB applied to the ventral surface of the great toe. Toe temperature increased during feedback phases but not during baseline phases. Improvements were seen in ankle-brachial index, walking distance, walking speed, and stair climbing. This case indicates the need for extended and controlled study of TBFB for improved vascular and ambulatory function in diabetic claudication.- - - - - - - - - - ranking = 1keywords = peripheral (Clic here for more details about this article) |
5/59. Relieving intermittent claudication: a nursing approach.peripheral arterial disease affects at least 10% of adults older than 70 years. risk factors such as diabetes, hypertension, hyperlipidemia, history of smoking, and genetics increase the incidence of the disease. intermittent claudication, experienced as calf pain or cramping, is the primary symptom in patients with lower-extremity peripheral arterial disease. patients with claudication are unable to walk even moderate distances. As a result, they often lead lives that are profoundly restricted. Medical therapeutic options available for patients with intermittent claudication are limited to a small number of medications and walking exercise rehabilitation. walking exercise training can significantly increase ability and decrease calf discomfort for many patients. nurses can have a major impact on improving the quality of life of patients with claudication, not only by seeking referrals to established institutional walking exercise programs, but also by helping patients in the community develop a personalized walking program. In this article, a nursing plan of care including short-term and long-term goals is addressed. A case study will illustrate the effectiveness and improved quality of life that an individualized program of walking exercise had for one community-based client.- - - - - - - - - - ranking = 10962.72029781keywords = peripheral arterial disease, arterial disease, peripheral (Clic here for more details about this article) |
6/59. Covered stent to exclude intravascular thrombus.PURPOSE: To describe the utility of stent-graft implantation to avoid distal embolization from a large thrombus-containing lesion. CASE REPORT: A 67-year-old man was evaluated for recent onset of disabling left leg claudication. angiography disclosed a mobile lobular mass occluding the left common iliac artery; irregular staining suggested an atherothrombotic lesion. Through a percutaneous ipsilateral access and an 8-F sheath, a balloon-expandable Jostent peripheral stent-graft was positioned with the distal edge immediately proximal to the internal iliac artery ostium. A prominent "waist" at the center of the balloon confirmed entrapment of the thrombotic mass. Completion angiography showed an optimal result with no residual stenosis or evidence of distal embolization. At 6-month follow-up, the patient was asymptomatic with angiographically documented luminal patency and no evidence of in-stent stenosis. CONCLUSIONS: Stent-graft implantation appears a viable treatment alternative for thrombus-containing lesions, particularly when the thrombotic material is localized or is in a large vessel.- - - - - - - - - - ranking = 1keywords = peripheral (Clic here for more details about this article) |
7/59. Risk factor assessment for patients with peripheral arterial disease.peripheral arterial disease is a chronic condition that affects a significant proportion of the adult population. Treatment is often prolonged and may be painful, with a slow rate of healing. However, current evidence to support risk-factor assessment highlights the role of the nurse in encouraging lifestyle modification, leading to an improvement in the patient's quality of life.- - - - - - - - - - ranking = 41016.902880603keywords = peripheral arterial disease, arterial disease, peripheral (Clic here for more details about this article) |
8/59. intermittent claudication unmasking underlying Fabry's disease.In a 53-year-old woman, admitted to our Department with leg pain, peripheral arterial occlusive disease (PAOD) was diagnosed. The absence of cardiovascular risk factors in this middle-aged woman, the unexplained burning pain during both effort and rest of the lower extremities mimicking severe ischemia, decreased sweating and cold induced Raynaud's phenomenon raised the suspicion of an underlying predisposing disease. The coexistence of painful acroparesthesias, angiokeratomas, left ventricular hypertrophy (LVH), corneal opacities and lenticular lesions suggested the diagnosis of Fabry's disease, which was confirmed by low serum levels of a-galactosidase-A activity. This case, presented with intermittent claudication due to generalized atherosclerosis, is quite unusual, since Fabry's disease rarely produces symptoms in female carriers.- - - - - - - - - - ranking = 1keywords = peripheral (Clic here for more details about this article) |
9/59. Improvement in lower-extremity peripheral arterial disease by nocturnal hemodialysis.A 42-year-old man with end-stage renal disease (ESRD) was referred for conversion to nocturnal hemodialysis (NHD) therapy from conventional hemodialysis (CHD) therapy because of refractory intermittent claudication secondary to peripheral arterial disease (PAD). The patient was initiated on CHD therapy in 1976 and subsequently had undergone two unsuccessful renal transplantations. While on CHD therapy, his clinical course was complicated by worsening vascular and soft-tissue calcification. Extensive dystrophic soft-tissue calcification was noted bilaterally in his hands, lower extremities, and sacral region, requiring surgical excision. Lower-extremity arterial Doppler scans documented vascular calcification and a pronounced decrease in peripheral arterial flow bilaterally. After conversion to NHD therapy (7.5 h/session five times weekly), the patient became symptom free and had significant clinical improvements in (1) hemodynamics, measured by clinic blood pressure and two-dimensional echocardiography, (2) biochemical profile, and (3) a sustained improvement in arterial Doppler flow measured by duplex Doppler ultrasound. We conclude that NHD was able to improve lower-extremity PAD in our patient. Further observational and interventional studies are required to investigate the therapeutic potential of NHD for the treatment of PAD in patients with ESRD.- - - - - - - - - - ranking = 50091.304304655keywords = peripheral arterial disease, arterial disease, peripheral (Clic here for more details about this article) |
10/59. Percutaneous transluminal angioplasty against arteriosclerosis obliterans in dialysis patients.The incidence of peripheral arteriosclerosis is on the increase in chronic hemodialysis patients. Recently, the intervention (IV) treatment is conducted to deal with this problem. IV was performed in 4 dialysis patients against the complication of arteriosclerosis obliterans (ASO) but the result was unsuccessful in 3 of them. These 3 failure cases were investigated to find the problems associated with percutaneous transluminal angioplasty (PTA). Cases 1, 2 and 3 had intermittent claudication while case 4 had gangrenous toes as the major complaint. The symptoms in these cases were attributable to 90-100% stenosis and occlusion of superficial femoral artery, bilateral iliac arteries, bilateral superficial femoral-popliteal artery, branch of right iliac artery and left iliac artery region, respectively. IV was successful in case 1 but failed in cases 2 and 4 because the catheter itself did not go through due to the severe stenosis of vessel or the procedure of forcefully dilating the vessel caused dispersion of minute thrombi. In case 3, acute myocardial infarction occurred at 10 h after successful IV, resulting in sudden death. In view of the extent of invasion, IV is a treatment method selected against ASO in dialysis patients. However, the method has a high risk of causing thrombus formation, vessel rupture and organ failure. In this regard, it is advisable to evaluate the systemic condition and conduct IV if the extent of stenosis is mild.- - - - - - - - - - ranking = 1keywords = peripheral (Clic here for more details about this article) |
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