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Lower limb claudication

R J Cong, J F Liu, Y Jiang, Duolikun Dilixiati, X D Hou, L P Zheng
Objective: To explore the influence of the lower extremity abnormal alignment and the joint surface, and to explore the surgical skills. Methods: Twenty-two cases of tibial plateau Schatzker Ⅵ fracture internal fixation failure revision from January 2012 to January 2017 in Department of Orthopedics, Shanghai 10(th) Hospital.One year follow-up after initial surgery to make sure of failure.Three-dimensional CT scan, radiography, infection index, gait analysis, knee joint ROM, femur tibia angle, tibial plateau tibial shaft angle and posterior slope if tibial plateau were observed...
March 1, 2018: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Sean C Maguire, Christina A Fleming, Gavin O'Brien, Gerald McGreal
BACKGROUND: Lumbar sympthectomy (LS) was traditionally performed for intermittent claudication but is now eclipsed by revascularisation for that indication. However, it retains a role in the management of critical limb ischaemia and other conditions causing lower limb pain with or without ischaemia. We report the role of LS in modern surgical practice when revascularisation and pain management options have been exhausted. METHODS: A medical chart review was performed on all patients who underwent LS in our unit from 2005 to 2016 (inclusive)...
March 7, 2018: Irish Journal of Medical Science
Sevan Komshian, Thomas W Cheng, Alik Farber, Marc L Schermerhorn, Jeffrey A Kalish, Denis Rybin, Douglas W Jones, Jeffrey J Siracuse
OBJECTIVE: Retrograde popliteal artery (RPA) access to treat superficial femoral artery and popliteal artery disease is an option when treatment through common femoral artery (CFA) access is not possible. Our goal was to compare the safety and efficacy of RPA access with CFA access for treatment of femoral and popliteal artery lesions. METHODS: The Vascular Quality Initiative was queried for all patients undergoing RPA access from 2010 to 2016 for symptomatic peripheral arterial disease...
March 1, 2018: Journal of Vascular Surgery
Fadi Saab, Michael R Jaff, Larry J Diaz-Sandoval, Gwennan D Engen, Theresa N McGoff, George Adams, Ashraf Al-Dadah, Philip P Goodney, Farhan Khawaja, Jihad A Mustapha
PURPOSE: To present the chronic total occlusion (CTO) crossing approach based on plaque cap morphology (CTOP) classification system and assess its ability to predict successful lesion crossing. METHODS: A retrospective analysis was conducted of imaging and procedure data from 114 consecutive symptomatic patients (mean age 69±11 years; 84 men) with claudication (Rutherford category 3) or critical limb ischemia (Rutherford category 4-6) who underwent endovascular interventions for 142 CTOs...
February 1, 2018: Journal of Endovascular Therapy
Samuel Fernández, Juan Carlos Parodi, Fabián Moscovich, Camilo Pulmari
BACKGROUND: Medical treatment of disabling intermittent claudication or critical limb threatening ischemia causing rest pain often fails or has partial response. METHODS: In this pilot study thirty-six patients (12 females) affected by disabling intermittent claudication or rest pain of the lower extremities were exposed to a daily 3 L water intake for up to six weeks. Cutaneous foot temperature, ankle/brachial index, time and distance of claudication and pain intensity were recorded before and at the completion of the hydration period...
February 23, 2018: Annals of Vascular Surgery
Dereck L Salisbury, Rebecca Jl Brown, Ulf G Bronas, Laura N Kirk, Diane Treat-Jacobson
Peripheral artery disease (PAD) is a manifestation of generalized atherosclerosis which results in hemodynamic compromise of oxygen and substrate delivery to the lower extremity skeletal muscles. Hemodynamic assessments are vital in PAD diagnosis and in the evaluation of strategies aimed at treating claudication (i.e. exercise training, revascularization, and pharmacological agents). Venous occlusion plethysmography (VOP) is a century-old, non-invasive technique used to quantify limb blood flow and has been used to evaluate hemodynamic compromise in patients with PAD...
February 1, 2018: Vascular Medicine
Victor Aboyans, Marie-Antoinette Sevestre, Ileana Désormais, Philippe Lacroix, Gerry Fowkes, Michael H Criqui
It is estimated that more than 200 million individuals are affected by lower extremity artery disease (LEAD) worldwide. This prevalence has increased between 2000 and 2010 by 25%, especially in low/middle income countries. In France, about one million people are affected by this condition. Almost two-thirds of patients with LEAD are asymptomatic. This explains the interest of the measurement of the ankle-brachial index (ABI), an objective and harmless diagnostic tool. An ABI≤0.90 is considered as diagnostic for LEAD...
February 12, 2018: La Presse Médicale
Peta Ellen Tehan, Alex Louise Barwick, Mathew Sebastian, Vivienne Helaine Chuter
The postexercise ankle-brachial index (ABI) is recommended in patients with normal resting ABI when peripheral artery disease (PAD) is suspected. The aims of this study were to determine the comparative diagnostic accuracy of the resting and postexercise ABI for detecting PAD, and, the effect of the presence of diabetes on these. Three methods of interpretation currently in use were also investigated: a reduction in postexercise ABI by >20% compared to resting ABI, an ABI value of ≤0.90 postexercise, or a reduction in systolic ankle pressure of >30 mmHg postexercise...
February 1, 2018: Vascular Medicine
Noritsuna Nakajima, Toshikazu Tani, Katsuhito Kiyasu, Masashi Kumon, Shinichirou Taniguchi, Ryuichi Takemasa, Nobuaki Tadokoro, Kazuya Nishida, Masahiko Ikeuchi
BACKGROUND: Repetitive electrical nerve stimulation of the lower limb may improve neurogenic claudication in patients with lumbar spinal stenosis (LSS) as originally described by Tamaki et al. We tested if this neuromodulation technique affects the F-wave conduction on both sides to explore the underlying physiologic mechanisms. METHODS: We studied a total of 26 LSS patients, assigning 16 to a study group receiving repetitive tibial nerve stimulation at the ankle (RTNS) on one leg, and 10 to a group without RTNS...
January 15, 2018: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Xu Lan, Jie Gao, Jian-Zhong Xu, Xue-Mei Liu
OBJECTIVE: To investigate the imaging characteristic and operation outcome of ossification of ligamentum flavum with lumbar spinal stenosis. METHODS: January 2013 to January 2016, 9 patients with ossification of ligamentum flavum with lumbar spinal stenosis were treated, included 5 males and 4 females, aged from 51 to 63 years old with an average of 57 years old. All patients complained intermittent claudication and radiating pain at lower limb. The pathologic change regions examined by CT or MRI were as follows:2 cases in L₄,₅ and L₅S₁, 5 in L̀,̀, and 2 in L₅S₁...
February 25, 2017: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
Pouria Parsa, Anthony Rios, Lisa N Anderson, John F Eidt, Dennis Gable, Brad Grimsley
Giant cell arteritis is a large- and medium-vessel vasculitis that has been described as a systemic disease process with disseminated vessel involvement. Advances in vascular imaging techniques have demonstrated that involvement of the large vessels of the upper and lower limbs may be more prevalent than was once thought, although the clinical implications of this are unknown. Isolated lower extremity claudication without systemic or classic cranial symptoms, especially as a primary manifestation of giant cell arteritis, is rare...
September 2017: Journal of Vascular Surgery Cases and Innovative Techniques
Pierre Abraham, Christophe Colas-Ribas, Isabelle Signolet, Myriam Ammi, Mathieu Feuilloy, Jean Picquet, Samir Henni
BACKGROUND: Exercise transcutaneous oximetry (Ex-tcPO2) is used to argue for the vascular origin of lower limb pain, especially at the proximal level, where the diagnosis of peripheral artery disease can be difficult. This study analyzed the principal indications, mean results, and limitations of Ex-tcPO2, as well as the relationship between the annual number of Ex-tcPO2 tests and internal iliac artery (IIA) revascularizations.Methods and Results:Data from our first 15 years' experience (3,631 patients, 5,080 tests) with Ex-tcPO2 were analyzed retrospectively using the minimal value of the decrease from rest of oxygen pressure (DROPmin)...
January 18, 2018: Circulation Journal: Official Journal of the Japanese Circulation Society
S Henni, Y W Semporé, T Le Meliner, N Ouedraogo, J-F Hamel, P Abraham
BACKGROUND: Transcutaneous oxygen pressure (tcpO2) reliability is blunted by an unpredictable transcutaneous gradient through the skin. We hypothesized that the "Decrease from Rest of Oxygen pressure (DROP: subtraction of limb-changes from chest-changes from the respective starting values) would show a good to excellent reliability during Exercise -tcpO2 investigations. METHODS: In three different experiments we tested: The intra-test variability at the peripheral level (Experiment A: 32 patients, 16 at each location), at the chest level (Experiment B: 45 patients) and the test-retest reproducibility within 3 months (Experiment C: 67 patients)...
January 8, 2018: Microvascular Research
Katriina Heikkila, David C Mitchell, Ian M Loftus, Amundeep S Johal, Sam Waton, David A Cromwell
Background -The availability and diversity of lower limb revascularisation procedures have increased in England in the past decade. We investigated whether these developments in care have translated to improvements in patient pathways and outcomes. Methods -Individual-patient records from Hospital Episode Statistics (HES) were used to identify 103 934 patients who underwent endovascular (angioplasty) or surgical (endarterectomy, profundaplasty or bypass) lower limb revascularisation for infrainguinal peripheral artery disease (PAD) in England between January 2006 and December 2015...
January 9, 2018: Circulation
Natalie Ly Ngu, James Lisik, Dinesh Varma, Gerard S Goh
INTRODUCTION: Percutaneous transluminal angioplasty (PTA) and surgical bypass (BYP) are treatment options for symptomatic peripheral arterial disease (PAD). PTA and BYP have different clinical outcomes and cost implications. This paper aims to compare hospital-related costs of PTA and BYP for PAD of the lower limbs in an Australian health service. METHODS: A retrospective cost analysis using clinical and financial data from an urban, tertiary hospital was performed...
January 5, 2018: Journal of Medical Imaging and Radiation Oncology
Risha Lane, Amy Harwood, Lorna Watson, Gillian C Leng
BACKGROUND: Exercise programmes are a relatively inexpensive, low-risk option compared with other, more invasive therapies for treatment of leg pain on walking (intermittent claudication (IC)). This is the fourth update of a review first published in 1998. OBJECTIVES: Our goal was to determine whether an exercise programme was effective in alleviating symptoms and increasing walking treadmill distances and walking times in people with intermittent claudication. Secondary objectives were to determine whether exercise was effective in preventing deterioration of underlying disease, reducing cardiovascular events, and improving quality of life...
December 26, 2017: Cochrane Database of Systematic Reviews
Ryan S Cousins, David J Dexter, Sadaf S Ahanchi, Brandon C Cain, Obie M Powell, Sarah B Ongstad, Niraj M Parikh, Jean M Panneton
OBJECTIVE: The objective of this study was to determine the natural progression of popliteal artery aneurysms (PAAs) and clinical variables associated with their accelerated growth. METHODS: Retrospective chart review of 224 patients with encounters between January 2008 and May 2016 and with at least one PAA was conducted. From this group, 65 asymptomatic patients had either unilateral (n = 43) or bilateral (n = 22) PAAs that were observed for at least 1 year of medical management before intervention...
December 22, 2017: Journal of Vascular Surgery
S Keisin Wang, Gary W Lemmon, Natalie A Drucker, Raghu L Motaganahalli, Michael C Dalsing, Ashley R Gutwein, Brian W Gray, Michael P Murphy
OBJECTIVE: Acute limb ischemia (ALI) in infants poses a challenge to the clinician secondary to poor operative outcomes, limb loss risk, and lifelong morbidity. This retrospective study reviewed a 10-year institutional experience with the nonoperative management of ALI in infants. METHODS: Infants (aged ≤12 months) diagnosed with ALI by duplex ultrasound and treated with initial nonoperative management at a tertiary care children's hospital were identified through vascular laboratory arterial duplex ultrasound records and International Classification of Diseases and Current Procedural Terminology codes associated with ALI...
December 7, 2017: Journal of Vascular Surgery
Hou-Jen Chen, Trisha L Roy, Graham A Wright
BACKGROUND: Previously, a theoretical model based on microvascular physiology was established to facilitate the interpretation of calf perfusion dynamics recorded by arterial spin labeling (ASL). PURPOSE: To investigate the clinical relevance of novel perfusion indices by comparing them to the symptoms, response to revascularization, and short-term functional outcome in patients with peripheral arterial disease (PAD). STUDY TYPE: Prospective cohort study...
November 28, 2017: Journal of Magnetic Resonance Imaging: JMRI
Ryan A Becker, Kim Cluff, Nithyanandhi Duraisamy, George P Casale, Iraklis I Pipinos
BACKGROUND: Peripheral artery disease (PAD) is a vascular disease caused by atherosclerosis, resulting in decreased blood flow to the lower extremities. The ankle-brachial index (ABI) is a standard PAD diagnostic test but only identifies reduced blood flow based on blood pressure differences. The early signs of PAD manifest themselves not only at a clinical level but also at an elemental and biochemical level. However, the biochemical and elemental alterations to PAD muscle are not well understood...
December 2017: Journal of Surgical Research
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