Peripheral Artery Diseases

2017 ◽  
Author(s):  
Mark A Creager
Keyword(s):  
Arterial Occlusion ◽  
Limb Ischemia ◽  
Common Femoral Artery ◽  
Thromboangiitis Obliterans ◽  
Raynaud Phenomenon ◽  
Critical Ischemia ◽  
Peripheral Arterial Diseases ◽  
Peripheral Arterial ◽  
The Right ◽  
Peripheral Artery Diseases

Peripheral arterial diseases (PADs) compromise blood flow to the limbs. Common causes of arterial obstruction include atherosclerosis, thrombus, embolism, vasculitis, arterial entrapment, adventitial cysts, fibromuscular dysplasia, arterial dissection, trauma, and vasospasm. The most frequently encountered cause of PAD is peripheral atherosclerosis. This chapter considers its epidemiology and risk factors, as well as its diagnosis, including clinical presentation and noninvasive diagnostic tests. This chapter also discusses acute arterial occlusion, atheroembolism, popliteal artery entrapment, thromboangiitis obliterans, and acrocyanosis, as well as the etiology, diagnosis, and treatment of Raynaud phenomenon. The chapter contains 4 tables and 7 figures. Tables describe the Fontaine classification and clinical categories of chronic limb ischemia, provide examples of leg segmental pressure measurements in a patient with calf claudication and foot pain, and summarize secondary causes of Raynaud phenomenon. Figures include a photograph of an ischemic foot demonstrating dependent rubor, measurement of the ankle:brachial index, ultrasonography of a stenosis of the right common femoral artery, magnetic resonance angiograms of patients with calf claudication, arteriograms of critical ischemia of the foot and of disabling claudication of the leg, and ischemia of the toes caused by atheroemboli. This chapter contains 80 references.

Peripheral Artery Diseases

2012 ◽  
Author(s):  
Mark A Creager
Keyword(s):  
Arterial Occlusion ◽  
Limb Ischemia ◽  
Common Femoral Artery ◽  
Thromboangiitis Obliterans ◽  
Raynaud Phenomenon ◽  
Critical Ischemia ◽  
Peripheral Arterial Diseases ◽  
Peripheral Arterial ◽  
The Right ◽  
Peripheral Artery Diseases

Peripheral arterial diseases (PADs) compromise blood flow to the limbs. Common causes of arterial obstruction include atherosclerosis, thrombus, embolism, vasculitis, arterial entrapment, adventitial cysts, fibromuscular dysplasia, arterial dissection, trauma, and vasospasm. The most frequently encountered cause of PAD is peripheral atherosclerosis. This chapter considers its epidemiology and risk factors, as well as its diagnosis, including clinical presentation and noninvasive diagnostic tests. This chapter also discusses acute arterial occlusion, atheroembolism, popliteal artery entrapment, thromboangiitis obliterans, and acrocyanosis, as well as the etiology, diagnosis, and treatment of Raynaud phenomenon. Tables describe the Fontaine classification and clinical categories of chronic limb ischemia, provide examples of leg segmental pressure measurements in a patient with calf claudication and foot pain, and summarize secondary causes of Raynaud phenomenon. Figures include a photograph of an ischemic foot demonstrating dependent rubor, measurement of the ankle:brachial index, ultrasonography of a stenosis of the right common femoral artery, magnetic resonance angiograms of patients with calf claudication, arteriograms of critical ischemia of the foot and of disabling claudication of the leg, and ischemia of the toes caused by atheroemboli. This review contains 4 highly rendered figures, 7 tables, and 80 references.

Peripheral Artery Diseases

2017 ◽  
Author(s):  
Mark A Creager
Keyword(s):  
Arterial Occlusion ◽  
Limb Ischemia ◽  
Common Femoral Artery ◽  
Thromboangiitis Obliterans ◽  
Raynaud Phenomenon ◽  
Critical Ischemia ◽  
Peripheral Arterial Diseases ◽  
Peripheral Arterial ◽  
The Right ◽  
Peripheral Artery Diseases

Peripheral arterial diseases (PADs) compromise blood flow to the limbs. Common causes of arterial obstruction include atherosclerosis, thrombus, embolism, vasculitis, arterial entrapment, adventitial cysts, fibromuscular dysplasia, arterial dissection, trauma, and vasospasm. The most frequently encountered cause of PAD is peripheral atherosclerosis. This chapter considers its epidemiology and risk factors, as well as its diagnosis, including clinical presentation and noninvasive diagnostic tests. This chapter also discusses acute arterial occlusion, atheroembolism, popliteal artery entrapment, thromboangiitis obliterans, and acrocyanosis, as well as the etiology, diagnosis, and treatment of Raynaud phenomenon. The chapter contains 4 tables and 7 figures. Tables describe the Fontaine classification and clinical categories of chronic limb ischemia, provide examples of leg segmental pressure measurements in a patient with calf claudication and foot pain, and summarize secondary causes of Raynaud phenomenon. Figures include a photograph of an ischemic foot demonstrating dependent rubor, measurement of the ankle:brachial index, ultrasonography of a stenosis of the right common femoral artery, magnetic resonance angiograms of patients with calf claudication, arteriograms of critical ischemia of the foot and of disabling claudication of the leg, and ischemia of the toes caused by atheroemboli. This chapter contains 80 references.

scholarly journals Influence of non-conventional risk factors on peripheral arterial diseases

2020 ◽  
pp. 113-118
Author(s):  
A. A. Lyzikov ◽  
Y. K. Kulikovich ◽  
T. M. Sharshakova ◽  
D. B. Kulikovich
Keyword(s):  
Risk Factors ◽  
Depression Scale ◽  
Peripheral Artery ◽  
Critical Ischemia ◽  
Peripheral Arterial Diseases ◽  
Reactive Anxiety ◽  
Artery Disease ◽  
Peripheral Arterial ◽  
Peripheral Artery Diseases ◽  
Conventional Risk Factors

Objective: to study the effect of non-conventional risk factors on the progression of peripheral artery diseases.Material and methods. The study involved 250 patients (76.8 % men (192 patients) and 23.2 % women (58 patients)). The non-conventional risk factors among the patients were identified using the «Hospital Anxiety and Depression Scale» (HADS), «Scales for assessing the level of reactive and personal anxiety» (Ch. D. Spilberger, Yu. L. Khanin). The degree of chronic arterial insufficiency was determined in accordance with the classification of Pokrovsky-Fontaine (1985). The statistical analysis of the obtained data was performed by means of the «Statistica» 8.0 program, using the Pearson χ2 criterion. Differences between the groups were considered statistically significant at p < 0.05.Results. A high prevalence rate of personal (95.2% of the patients) and reactive (91.6 % of the patients) anxiety has been revealed among patients with peripheral artery disease. Higher levels of personal and reactive anxiety have been found among patients with critical ischemia threatened by limb loss (group 3) (46.0 (41.0; 50.0); 47.0 (43.0; 51.0), respectively) compared with the values in groups 1 and 2 of the patients.

scholarly journals Catastrophic Coronavirus Disease COVID Infection Leading to Gangrene of Foot in Peripartum Women

2021 ◽  
Vol 11 (9) ◽  
Author(s):  
Chandan Noel Vincent ◽  
S Elango ◽  
Dinakar Rai ◽  
Sujith Kumar ◽  
Ajay Sivakumar
Keyword(s):  
Respiratory Failure ◽  
Limb Ischemia ◽  
Common Femoral Artery ◽  
Third Trimester ◽  
Distal Limb ◽  
Catheter Directed Thrombolysis ◽  
Ct Angiogram ◽  
Severe Infections ◽  
The Right

Introduction:Pregnancy is a physiologically hypercoagulable state and a coronavirus disease 2019 (COVID-19) infection adds to this burden by accentuating the coagulopathy. We report two cases of severe peri-partum COVID infection leading to extremity gangrene secondary to a pro-thrombotic coagulopathy. Case Report:A 37-year-old lady, day-2 postpartum, was brought with severe COVID infection & and respiratory failure. She developed progressive gangrene of the foot. A computed tomography (CT) angiogram confirmed the presence of thrombosis of the left external iliac & and common femoral artery. She was managed with catheter- directed thrombolysis and fasciotomy. The dry gangrene of the foot was managed with a Boyd’s amputation. At 1-year follow-up, she is ambulant with a healthy stump. Case Two: A 34-year-old lady, 36 weeks of gestation, presented with fulminant COVID infection with respiratory failure and pulmonary embolus. The lady developed gangrene of the B/L toes. A CT angiogram revealed thrombosis below the popliteal trifurcation in both limbs along with segmental pulmonary thrombo-embolism involving the right lung and multiple splenic infarcts. She succumbed to the overwhelming infection and sepsis. Discussion:The pathogenesis of coagulopathy in pregnant COVID patients is attributed to the hypercoagulable effect, which leads to thrombo-embolisms and limb ischemia following a cytokine storm syndrome in severe infections. To date, this is the first experience detailing distal limb gangrene in fulminant COVID infection in peri-partum women. Although, cases have been reported on distal limb gangrene in severe COVID infection among non-pregnant individuals. Conclusion:A multidisciplinary team must manage COVID infections in the third trimester. A prompt recognition of any forms of lethal coagulopathy and vigilant treatment will prevent loss of life. Keywords:Coronavirus diseaseCOVID, foot gangrene, pregnancy, coagulopathy.

Claudication as an ‘Orphan Disease’: Rationale and Goals of Drug Therapy for Peripheral Arterial Disease

1996 ◽  
Vol 1 (1) ◽  
pp. 37-42 ◽  
Author(s):  
Alan T Hirsch
Keyword(s):  
Peripheral Arterial Disease ◽  
Disease Progression ◽  
Critical Role ◽  
Ankle Brachial Index ◽  
Arterial Occlusion ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Current Data ◽  
History Of ◽  
Peripheral Arterial

Patients with peripheral arterial disease are often perceived to suffer from a disorder whose pathogenesis and symptoms are not amenable to drug therapies. This clinical misperception remains prevalent despite an abundance of data suggesting that diverse pharmacotherapies may modulate the natural history of this disease. Patients with chronic limb arterial occlusive disease suffer from a disease that is characterized by: (1) a prolonged asymptomatic state that can be identified by simple physical examination and confirmed by measurement of the ankle brachial index; (2) a multi-year period of symptomatic claudication; and (3) a variable rate of progression to critical limb ischemia or acute arterial occlusion. This stage-dependent disease progression is mediated via the dynamic, but as yet incompletely understood, interaction of factors that elicit endothelial dysfunction, atherogenesis, and thrombosis. Current data suggest that each of these contributory disease processes can be modulated by extant pharmacotherapies. Additionally, many novel pharmacotherapeutic agents that are currently under investigation may further improve the ability of clinicians to modulate these fundamental biologic processes. Pharmacologic therapies should be targeted to decrease the rate of limb arterial disease progression, to improve limiting symptoms, and to prolong life. Symptoms of claudication can be objectively assessed via both exercise testing and disease-specific questionnaires. The presence of lower extremity atherosclerotic disease is predictive of the presence of coronary heart disease and a foreshortened five-year survival. Current data suggest that clinical investigations should be able to effectively stratify this relative risk via use of both clinical variables (e.g., age, diabetes mellitus, tobacco use, etc.) or by measurement of the ankle brachial index (ABI). The role of the physician is to decrease suffering and to prolong life. Judicious administration of medical therapies can play a critical role in helping the vascular practitioner accomplish these goals.

scholarly journals PROTECTIVE FACTORS AGAINST DEPRESSION IN PATIENTS WITH PERIPHERAL ARTERIAL DISEASE WITH CRITICAL LIMB ISCHEMIA

2017 ◽  
Vol 64 (4) ◽  
pp. 296-299
Author(s):  
Liliana Veronica Diaconescu ◽  
◽  
Ion Diaconescu ◽  
Keyword(s):  
Social Support ◽  
Peripheral Arterial Disease ◽  
Coping Strategies ◽  
Depression Scale ◽  
Limb Ischemia ◽  
Psychosocial Interventions ◽  
Arterial Disease ◽  
Active Coping ◽  
Critical Ischemia ◽  
Peripheral Arterial

Introduction. The aim of the study was to assess the extent to which psychosocial factors (social support and coping strategies) may have a protective role against depression in patients with peripheral arterial disease (PAD). Methods. The design of the study was transversal and included 37 patients with PAD with critical ischemia (32 men, 5 women, mean age = 62.41). They were administered Center for Epidemiologic Studies Depression Scale, Duke-UNC Functional Social Support Questionnaire and COPE inventory. Results. Depressive symptoms were found at 28.6% of the patients. There were low scores of perceived social support at 32.4% of the patients. Depression correlated (p<.001) positively with mental disengagement (r=.791), denial (r=.672), behavioral disengagement (r=.760), restraint (r=.075) and negatively with social support (r= -.879) and positive reinterpretation (r=-.844), active coping (r=-.776), use of emotional support (r=-.624). Discussion. PAD patients experience depression. Is highlighted the buffer role of social support and of active coping strategies in facing a chronic disease. Conclusions. Recognition and evaluation for depression in patients with PAD followed by identifying psychosocial interventions may be useful in improving outcomes of these patients.

scholarly journals Cystic Adventitial Disease of the Common Femoral Artery: A Rare-Case Report

2022 ◽  
Vol 8 ◽  
Author(s):  
Qilong Wang ◽  
Zhihua Cheng ◽  
Liang Tang ◽  
Qi Wang ◽  
Ping Zhang ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Limb Ischemia ◽  
Common Femoral Artery ◽  
Acute Limb Ischemia ◽  
Appropriate Treatment ◽  
Contrast Enhanced ◽  
Rare Case Report ◽  
The Right ◽  
Enhanced Computed Tomography

Herein, we report the case of a 59-year-old man with intermittent claudication of ~100 m, who complained of resting pain in his lower right extremity. A pelvic, contrast-enhanced, computed tomography scan showed the presence of cystic density in the lower segment of the right common femoral artery. Faced with the risk of acute limb ischemia, we navigated a challenging diagnostic procedure to choose an appropriate treatment for him. Additionally, we performed a pathological investigation of the excised common femoral artery following the excision bypass. On postoperative day 5, the patient was discharged from the hospital. During the 2-year follow-up, no new cysts were discovered, and the patient had favorable prognosis.

scholarly journals The vascular armamentarium explored-the ultimate goal achieved

2020 ◽  
Vol 7 (5) ◽  
pp. 1637
Author(s):  
Manoj Prabakar Ravichandran ◽  
Subrammaniyan Rathinavelpandian ◽  
Marunraj Gnanasekaran ◽  
Saravanan Balachandran
Keyword(s):  
Skin Grafting ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Vascular Surgeon ◽  
Interventional Radiological Procedure ◽  
Catheter Directed Thrombolysis ◽  
Split Skin Grafting ◽  
Peripheral Arterial ◽  
The Right ◽  
Split Skin

Peripheral arterial disease is one of the commonest causes for a limb being amputated most often, we present this case of medium vessel vasculitis with chronic threatening limb ischemia to make a note of our attempt to save her limb by multiple modalities which included medical management with steroids, immunosuppressants, pulsed cyclophosphamide, interventional radiological procedure of catheter directed thrombolysis with urokinase, surgical procedures like bypass, split skin grafting and minor amputations, implemented novel modalities like hyperbaric oxygen therapy. By exploring the armamentarium available, involving a multidisciplinary team which included vascular surgeon, rheumatologist, intervention radiologist, plastic surgeon, physiotherapist and aptly using the right modality at the right time we were able to ultimately achieve our goal of limb salvage.

scholarly journals Ultrasound-guided puncture reduces bleeding-associated complications, regardless of calcified plaque, after endovascular treatment of femoropopliteal lesions, especially using the antegrade procedure: A single-center study

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248416
Author(s):  
Kentaro Fukuda ◽  
Shinya Okazaki ◽  
Masayuki Shiozaki ◽  
Iwao Okai ◽  
Akihisa Nishino ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Limb Ischemia ◽  
Common Femoral Artery ◽  
Arterial Disease ◽  
Ultrasound Guided ◽  
Calcified Plaque ◽  
The Common ◽  
Ultrasound Guided Puncture ◽  
Peripheral Arterial ◽  
Guided Puncture

Background A common complication of endovascular treatment for femoropopliteal lesions is bleeding at the vascular access site. Although risk factors of bleeding-associated complications at the approach site have been reported, the results have been inconclusive. Hence, this study aimed to assess the predictors of bleeding-associated complications at the approach site in patients undergoing endovascular treatment for femoropopliteal lesions. Methods This retrospective, single-center, observational study included consecutive patients who underwent endovascular treatment (n = 366, 75% male, 72.4±9.9 year) for peripheral arterial disease with claudication and critical limb ischemia in our hospital from January 2010 to December 2017. We divided the patients into bleeding and non-bleeding groups, depending on whether bleeding-associated complications occurred at the approach site. Bleeding-associated complications were defined according to the Bleeding Academic Research Consortium criteria types 2, 3, and 5. Results Altogether, 366 endovascular treatment procedures and 404 arterial accesses were performed for femoropopliteal lesions in 335 peripheral arterial disease patients with claudication and 69 critical limb ischemia patients. We recorded 35 postprocedural bleeding-associated complications at the approach site (9%), all of which were hematomas. The predictors of increased bleeding-associated complications were age ≥ 80 years (bleeding vs. non-bleeding group, 43% vs. 25%, p<0.05) and antegrade cannulation of the common femoral artery (48% vs. 69%, p<0.05). Ultrasound-guided puncture reduced bleeding-associated complications (odds ratio, 0.28; 95% confidence interval, 0.004–0.21; p<0.05). In contrast, there was no significant difference in puncture site calcification between the groups (bleeding vs. non-bleeding groups, 29% vs. 21%, p = 0.29). Conclusion Ultrasound-guided puncture is associated with a decrease in bleeding-associated complications at the approach site, regardless of the presence of calcified plaque. It is particularly effective and should be more actively used in patients aged ≥80 years and for antegrade cannulation of the common femoral artery.

scholarly journals Is There a Risk Factor More Responsible for Disaster?

2015 ◽  
Vol 61 (3) ◽  
pp. 245-247
Author(s):  
Carasca Cosmin ◽  
Muresan Vasile Adrian ◽  
Tilea Ioan ◽  
Magdas Annamaria ◽  
Carasca Emilian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Peripheral Arterial Disease ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Risk Level ◽  
Critical Ischemia ◽  
Medium Risk ◽  
Peripheral Arterial

Abstract Background: Risk factors for peripheral arterial disease are generally the same as those responsible for the ischemic heart disease and in both cases are overlapping risk factors involved in the etiology of atherosclerosis, such as smoking, dyslipidemia, diabetes and hypertension. Case report: We present a case of a 61 years old male, whose ischemic peripheral symptoms began in 2003, at the age of 49, presenting as a Leriche syndrome. The patient was subjected to first revascularization procedure consisting in aortic-bifemoral grafting in the same year. General examination revealed no risk factors except smoking. Only a year after, he returns with critical right lower limb ischemia due to bypass thrombosis, therefore two thrombectomies were performed followed by a right side femoro-popliteal bypassing with Dacron prosthesis. The patient’s condition was good until 2008 when a femoro-popliteal bypass using inverted autologus saphenous vein was imposed due to occlusion of the previous graft. In 2013 the patient was readmitted to hospital with left lower limb critical ischemia. A femoro-popliteal bypass was performed, followed by two thrombectomies and the amputation of the left thigh. Up to this date, the patient kept smoking. Discussions: Although our patient has a low/medium risk level of atherosclerosis by Framingham score and a minimum Prevent III score, all the surgical revascularization procedures were not able to avoid the amputation. Conclusions: There are enough reasons to believe that smoking as a single risk factor can strongly influence the unfavorable progression to amputation in patients with peripheral arterial disease.

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