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ischaemic limb pain

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https://www.readbyqxmd.com/read/29776002/the-chaos-of-hospitalisation-for-patients-with-critical-limb-ischaemia-approaching-major-amputation
#1
Susan Monaro, Sandra West, Jana Pinkova, Janice Gullick
AIMS AND OBJECTIVES: To illuminate the hospital experience for patients and families when major amputation has been advised for critical limb ischaemia (CLI). BACKGROUND: CLI creates significant burden to the health system and the family, particularly as the person with CLI approaches amputation. Major amputation is often offered as a late intervention for CLI in response to the marked deterioration of an ischaemic limb, and functional decline from reduced mobility, intractable pain, infection and/or toxaemia...
May 18, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29701411/true-brachial-artery-aneurysm-after-arteriovenous-fistula-for-hemodialysis-case-report
#2
Tiago Soares, Ricardo Castro-Ferreira, João Rocha Neves, Marina Neto, Joel Sousa, José Pedro Pinto, Luis Gamas, Alfredo Cerqueira, Sérgio Sampaio, José Fernando Teixeira
INTRODUCTION: Brachial artery aneurysms are relatively uncommon and generally due to infectious, post-traumatic or iatrogenic etiology. They seem to affect 4.5% of arteriovenous fistula. The usual manifestation is an accidental finding of a pulsatile, painless, and asymptomatic mass. Complications include sac thrombosis, thromboembolic ischaemic events, and disruption with profuse bleeding. METHODS: The aim of this study is to present a case of true brachial artery aneurysm in end-stage renal disease patient after arteriovenous fistula creation...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
https://www.readbyqxmd.com/read/29429146/graft-type-for-femoro-popliteal-bypass-surgery
#3
REVIEW
Graeme K Ambler, Christopher P Twine
BACKGROUND: Femoro-popliteal bypass is implemented to save limbs that might otherwise require amputation, in patients with ischaemic rest pain or tissue loss; and to improve walking distance in patients with severe life-limiting claudication. Contemporary practice involves grafts using autologous vein, polytetrafluoroethylene (PTFE) or Dacron as a bypass conduit. This is the second update of a Cochrane review first published in 1999 and last updated in 2010. OBJECTIVES: To assess the effects of bypass graft type in the treatment of stenosis or occlusion of the femoro-popliteal arterial segment, for above- and below-knee femoro-popliteal bypass grafts...
February 11, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29273390/outcomes-of-patients-with-critical-limb-ischaemia-in-the-euclid-trial
#4
Lars Norgren, Manesh R Patel, William R Hiatt, Daniel M Wojdyla, F Gerry R Fowkes, Iris Baumgartner, Kenneth W Mahaffey, Jeffrey S Berger, W Schuyler Jones, Brian G Katona, Peter Held, Juuso I Blomster, Frank W Rockhold, Martin Björck
OBJECTIVES: Critical limb ischaemia (CLI) implies an increased risk of cardiovascular morbidity and mortality, and the optimal antithrombotic treatment is not established. DESIGN, MATERIALS, METHODS: The EUCLID trial investigated the effect of monotherapy with ticagrelor versus clopidogrel in 13,885 patients with peripheral artery disease (PAD); the primary endpoint was cardiovascular death, myocardial infarction, or ischaemic stroke. Patients planned for revascularisation or amputation within 3 months, were excluded...
January 2018: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28905042/social-demographic-and-clinical-characteristics-of-patients-suffering-from-peripheral-vascular-disease-treated-surgically-compared-to-patients-treated-with-endovascular-angioplasty
#5
Renata Piotrkowska, Marek Dobosz, Janina Książek, Grzegorz Halena
INTRODUCTION: Atherosclerosis is the most common cause of chronic lower limb ischaemia. Many factors that have a crucial influence on the development of the disease, its course and prognosis have been identified. The risk factors seem to be subject to interventions due to their susceptibility to changes. It is important to increase the engagement of doctors and nurses performing the screening oriented on risk factors, medical consultation regarding giving up smoking, changing the diet and undertaking physical activity...
2017: Archives of Medical Sciences. Atherosclerotic Diseases
https://www.readbyqxmd.com/read/28835456/systematic-review-of-pharmacological-therapies-for-the-management-of-ischaemic-pain-in-patients-with-non-reconstructable-critical-limb-ischaemia
#6
REVIEW
Áine Ní Laoire, Fliss E M Murtagh
BACKGROUND: Critical limb ischaemia (CLI) is a severe manifestation of peripheral arterial disease, characterised by chronic ischaemic rest pain, ulcers or gangrene. Management of ischaemic pain is challenging in patients with no options for revascularisation and optimal pharmacological therapies have not been established. OBJECTIVES: To identify and evaluate the effectiveness of pharmacological therapies to treat ischaemic pain secondary to non-reconstructable CLI...
August 23, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28746752/immunotherapy-for-diabetic-amyotrophy
#7
REVIEW
Yee Cheun Chan, Yew Long Lo, Edwin Sy Chan
BACKGROUND: People with diabetes mellitus (DM) sometimes present with acute or subacute, progressive, asymmetrical pain and weakness of the proximal lower limb muscles. The various names for the condition include diabetic amyotrophy, diabetic lumbosacral radiculoplexus neuropathies, diabetic femoral neuropathy or Bruns-Garland syndrome. Some studies suggest that diabetic amyotrophy may be an immune-mediated inflammatory microvasculitis causing ischaemic damage of the nerves. Immunotherapies would therefore be expected to be beneficial...
July 26, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28526046/balloon-versus-stenting-in-severe-ischaemia-of-the-leg-3-basil-3-study-protocol-for-a-randomised-controlled-trial
#8
RANDOMIZED CONTROLLED TRIAL
Benjamin D Hunt, Matthew A Popplewell, Huw Davies, Lewis Meecham, Hugh Jarrett, Gareth Bate, Margaret Grant, Smitaa Patel, Catherine Hewitt, Lazaros Andronis, Jonathan J Deeks, Andrew Bradbury
BACKGROUND: Severe limb ischaemia (SLI) is defined as the presence of rest pain and/or tissue loss secondary to lower extremity atherosclerotic peripheral arterial disease. The superficial femoral and popliteal arteries are the most commonly diseased vessels in such patients and are being increasingly treated using endovascular revascularisation techniques. However, it is currently unknown whether drug-eluting stents and drug-coated balloons confer additional clinical benefits over more established techniques using plain balloons and bare metal stents, or whether they represent a cost-effective use of NHS resources...
May 19, 2017: Trials
https://www.readbyqxmd.com/read/28340289/remote-ischaemic-conditioning-decreases-blood-flow-and-improves-oxygen-extraction-in-patients-with-early-complex-regional-pain-syndrome
#9
T Hegelmaier, N Kumowski, T Mainka, J Vollert, O Goertz, M Lehnhardt, P K Zahn, C Maier, J Kolbenschlag
BACKGROUND: Remote ischaemic conditioning (RIC) is the cyclic application of non-damaging ischaemia leading to an increased tissue perfusion, among others triggered by NO (monoxide). Complex regional pain syndrome (CRPS) is known to have vascular alterations such as increased blood shunting and decreased NO blood-levels, which in turn lead to decreased tissue perfusion. We therefore hypothesized that RIC could improve tissue perfusion in CRPS. METHOD: In this proof-of-concept study, RIC was applied in the following groups: in 21 patients with early CRPS with a clinical history less than a year, in 20 age/sex-matched controls and in 12 patients with unilateral nerve lesions via a tourniquet on the unaffected/non-dominant upper limb...
March 24, 2017: European Journal of Pain: EJP
https://www.readbyqxmd.com/read/27959471/lumbar-sympathectomy-techniques-for-critical-lower-limb-ischaemia-due-to-non-reconstructable-peripheral-arterial-disease
#10
REVIEW
Veena Kl Karanth, Tulasi Kota Karanth, Laxminarayan Karanth
BACKGROUND: Critical lower limb ischaemia (CLI) is a manifestation of peripheral arterial disease (PAD) that is seen in patients with typical chronic ischaemic rest pain or patients with ischaemic skin lesions - ulcers or gangrene - for longer than 2 weeks. Critical lower limb ischaemia is the most severe form of PAD, and interventions to improve arterial perfusion become necessary. Although surgical bypass has been the gold standard for revascularisation, the extent or the site of disease may be such that the artery cannot be reconstructed or bypassed...
December 13, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27919605/not-all-patients-with-critical-limb-ischaemia-require-revascularisation
#11
T B Santema, R M Stoekenbroek, J van Loon, M J W Koelemay, D T Ubbink
OBJECTIVES: International guidelines recommend revascularisation as the preferred treatment for patients with critical limb ischaemia (CLI). Most contemporary research focuses on the outcome of invasive procedures for CLI, but little is known about the outcome of conservative management. Amputation free survival (AFS) and overall survival (OS) was investigated in patients with CLI who did or did not receive revascularisation, and characteristics associated with clinical outcomes were explored...
March 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/27623758/ankle-brachial-index-for-the-diagnosis-of-lower-limb-peripheral-arterial-disease
#12
REVIEW
Fay Crawford, Karen Welch, Alina Andras, Francesca M Chappell
BACKGROUND: Peripheral arterial disease (PAD) of the lower limb is common, with prevalence of both symptomatic and asymptomatic disease estimated at 13% in the over 50 age group. Symptomatic PAD affects about 5% of individuals in Western populations between the ages of 55 and 74 years. The most common initial symptom of PAD is muscle pain on exercise that is relieved by rest and is attributed to reduced lower limb blood flow due to atherosclerotic disease (intermittent claudication). The ankle brachial index (ABI) is widely used by a variety of healthcare professionals, including specialist nurses, physicians, surgeons and podiatrists working in primary and secondary care settings, to assess signs and symptoms of PAD...
September 14, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27428501/adaptation-of-external-counterpulsation-based-on-individual-shear-rate-therapy-improves-endothelial-function-and-claudication-distance-in-peripheral-artery-disease
#13
Eva-Elina Buschmann, Michele Brix, Lulu Li, Janke Doreen, Andreas Zietzer, Meijing Li, Ivo Buschmann, Philipp Hillmeister
BACKGROUND: External counterpulsation therapy enhances blood flow and was shown to improve endothelial function and quality of life in coronary artery disease patients. However, high pressures of up to 300 mmHg may lead to malperfusion of the ischaemic limb. To improve the clinical outcome of patients with peripheral artery disease (PAD), we adjusted external counterpulsation and developed a novel non-invasive approach termed individual shear rate therapy (ISRT). PATIENTS AND METHODS: In the present study, 14 patients with a Fontaine stage IIb and femoral-popliteal PAD underwent 30 hours of ISRT over 5 weeks...
2016: VASA. Zeitschrift Für Gefässkrankheiten
https://www.readbyqxmd.com/read/27032310/-the-use-of-intermittent-pneumatic-compression-for-critical-limb-ischaemia-without-vascular-surgery-reconstruction
#14
Ingrid L Feuerhake, Eskild W Henneberg, Annette Høgh
Patients with critical limb ischaemia, without possibility for vascular surgery reconstruction, are a high selected population with a wide scale occurrence of co-morbidity and mortality. We outline the use of intermittent pneumatic compression (IPC) to these patients. Impact on both wound healing and cost-effectiveness concerning IPC use are recently shown. The overriding purpose of IPC use is to decrease the frequency of major and to lower the extent of ischaemic rest pain. IPC equipment is currently available around the country, but is not often used on the indication critical limb ischaemia...
March 14, 2016: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/26927956/collagen-implant-with-gentamicin-sulphate-as-an-option-to-treat-a-neuroischaemic-diabetic-foot-ulcer-case-report
#15
C E Costa Almeida
INTRODUCTION: The ischaemic diabetic foot is associated with a faster evolving atherosclerosis affecting preferentially the bellow knee arteries. This distal ischemia associated with a wide distribution of multiple stenosis and occlusions throughout lower limb arteries, makes revascularization very hard or even impossible. This represents a major factor responsible for non-healing diabetic foot ulcer. In these cases all efforts should be made to find treatment alternatives that can promote ulcer healing...
2016: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/26739146/bypass-versus-angio-plasty-in-severe-ischaemia-of-the-leg-2-basil-2-trial-study-protocol-for-a-randomised-controlled-trial
#16
RANDOMIZED CONTROLLED TRIAL
Matthew A Popplewell, Huw Davies, Hugh Jarrett, Gareth Bate, Margaret Grant, Smitaa Patel, Samir Mehta, Lazaros Andronis, Tracy Roberts, Jon Deeks, Andrew Bradbury
BACKGROUND: Severe limb ischaemia is defined by ischaemic rest/night pain, tissue loss, or both, secondary to arterial insufficiency and is increasingly caused by infra-popliteal (below the knee) disease, mainly as a result of the increasing worldwide prevalence of diabetes. Currently, it is unknown whether vein bypass surgery or the best endovascular treatment (angioplasty or stenting) represents the optimal revascularisation strategy in terms of amputation-free survival, overall survival, relief of symptoms, quality of life and cost-effective use of health care resources...
January 6, 2016: Trials
https://www.readbyqxmd.com/read/25870474/balneotherapy-in-treatment-of-spastic-upper-limb-after-stroke
#17
Tatjana Erceg-Rukavina, Mihajlo Stefanovski
INTRODUCTION: After stroke, spasticity is often the main problem that prevents functional recovery. Pain occurs in up to 70% of patients during the first year post-stroke. MATERIALS AND METHODS: A total of 70 patients (30 female and 45 male) mean age (65.67) participated in prospective, controlled study. INCLUSION CRITERIA: ischaemic stroke, developed spasticity of upper limb, post-stroke interval <6 months. EXCLUSION CRITERIA: contraindications for balneotherapy and inability to follow commands...
February 2015: Medical Archives
https://www.readbyqxmd.com/read/25751556/neurological-complications-of-vascular-access
#18
Christopher P Gibbons
Neurological problems are common in patients undergoing haemodialysis. Over 60% of patients will suffer from symptoms of underlying polyneuropathy due to uraemia or diabetes. Others will have subclinical disease demonstrable by nerve conduction studies. Nerve injury following haemodialysis access surgery is underreported. However, sensory nerve lesions are probably common after most vascular access procedures but are rarely debilitating. Nerve compression syndromes such as carpal tunnel and ulnar compression syndromes are common, especially in patients who have been on dialysis for some years and at least some of these are related to or exacerbated by the access...
2015: Journal of Vascular Access
https://www.readbyqxmd.com/read/25525690/local-intramuscular-transplantation-of-autologous-mononuclear-cells-for-critical-lower-limb-ischaemia
#19
REVIEW
Kasra Moazzami, Bobak Moazzami, Aria Roohi, Saharnaz Nedjat, Elena Dolmatova
BACKGROUND: Peripheral arterial disease is a major health problem, and in about 1% to 2% of patients the disease progresses to critical limb ischaemia (CLI). In a substantial number of patients with CLI, no effective treatment option other than amputation is available and around a quarter of these patients will require a major amputation during the following year. This is an update of the review first published in 2011. OBJECTIVES: To determine the effectiveness and safety of local intramuscular transplantation of autologous adult bone marrow mononuclear cells (BMMNCs) as a treatment for critical limb ischaemia (CLI)...
2014: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/25442472/-phlegmasia-cerulea-dolens
#20
C Zeboulon, M Amy de la Bretèque, P Bilan, C Sin, J-F Linder, B Dakhil, M-L Sigal, E Mahé
BACKGROUND: Herein we report a case of phlegmasia cerulea dolens, a form of venous thrombosis complicated by arterial ischaemia. PATIENTS AND METHODS: A 69-year-old man presented a bilateral trophic condition of the lower limbs that had appeared 3 weeks earlier. The patient had a history of metastatic urothelial bladder carcinoma and arteritis. Clinical examination revealed right leg ulcers with massive bilateral oedema of the lower limbs, cyanosis and local ischaemia...
November 2014: Annales de Dermatologie et de Vénéréologie
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