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ischaemic limb pain

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
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
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
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
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
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
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
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
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
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
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
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
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
Elnaz Vahidi, Delaram Shakoor, Mohamad Aghaie Meybodi, Morteza Saeedi
BACKGROUND: Numerous drugs have been proposed to alleviate ischaemic limb pain, but none have been successful in relieving ischaemic pain thoroughly and rapidly. OBJECTIVE: To compare the effectiveness of intravenous lidocaine and intravenous morphine in decreasing pain in patients with critical limb ischaemia. METHODS: A randomised double-blind controlled trial was performed in 63 patients with critical limb ischaemia recruited from the emergency department between October 2012 and December 2013; 23 patients were excluded and the remainder were randomly divided into two groups of 20 patients...
July 2015: Emergency Medicine Journal: EMJ
James Donaldson, Behrooz Haddad, Wasim S Khan
Acute compartment syndrome (ACS) is a surgical emergency warranting prompt evaluation and treatment. It can occur with any elevation in interstitial pressure in a closed osseo-fascial compartment. Resultant ischaemic damage may be irreversible within six hours and can result in long-term morbidity and even death. The diagnosis is largely clinical with the classical description of 'pain out of proportion to the injury'. Compartment pressure monitors can be a helpful adjunct where the diagnosis is in doubt. Initial treatment is with the removal of any constricting dressings or casts, avoiding hypotension and optimizing tissue perfusion by keeping the limb at heart level...
2014: Open Orthopaedics Journal
Giovanni De Caridi, Mafalda Massara, Antonio David, Massimiliano Giardina, Michele La Spada, Francesco Stilo, Francesco Spinelli, Raffaele Grande, Lucia Butrico, Stefano de Franciscis, Raffaele Serra
Critical lower limb ischaemia is a diffuse pathology that could cause claudication, severe ischaemic pain and tissue loss. The common treatment includes modification of risk factors, pharmacological therapy and endovascular or surgical revascularisation of the lower limb to restore a pulsatile flow distally. Spinal cord stimulator is seen as a valid alternative in patients unsuitable for revascularisation after endovascular or surgical revascularisation failure and as adjuvant therapy in the presence of a functioning bypass in patients with extensive tissue loss and gangrene presenting a slow and difficult wound healing...
April 2016: International Wound Journal
Giovanni De Caridi, Mafalda Massara, Filippo Benedetto, Paolo Tripodi, Francesco Spinelli, Antonio David, Raffaele Grande, Lucia Butrico, Raffaele Serra, Stefano de Franciscis
Hand ischaemia due to arterial steal syndrome is an infrequent, but potentially serious complication of arteriovenous fistula (AVF) for haemodialysis. We present a case of hand ischaemia caused by steal syndrome in a 69-year-old haemodialysis patient, 10 months after a brachiobasilic fistula creation. The patient underwent multiple operations without resolution of hand pain and tissue loss. The implantation of an adjuvant cervical spinal cord stimulator allowed the patient to obtain complete hand pain relief and wound healing...
February 2016: International Wound Journal
Krzysztof Bojakowski, Rafał Góra, Grzegorz Jodkowski, Piotr Andziak
UNLABELLED: Limb ischaemia caused by formation of dialysis fistula is rare but serious complication. The severity of symptoms may vary but rest pains and necrotic lesions are observed in most advance cases. In these patients different invasive procedures for treatment are performed - from simplest dialysis fistula ligation to complicated vascular reconstructions. The aim of the study was to evaluate treatment results of upper limb ischaemia triggered by dialysis fistula. MATERIAL AND METHODS: We have analysed methods and results of treatment of 14 patients with symptomatic upper limb ischaemia caused by dialysis fistula treated in our department between 1st January, 2006 and 30th June, 2013...
November 2013: Polski Przeglad Chirurgiczny
Gen Takagi, Masaaki Miyamoto, Shuhei Tara, Sonoko Kirinoki-Ichikawa, Yoshiaki Kubota, Tomohito Hada, Ikuyo Takagi, Kyoichi Mizuno
OBJECTIVE: SSc causes intractable ischaemic ulcers. To avoid major amputation, we examined the safety and efficacy of therapeutic vascular angiogenesis for digital ulcers due to SSc. METHODS: A single-centre, open-label pilot study was conducted in patients with an ischaemic digital ulcer [n = 40, mean age 65 years (s.d. 8), Rutherford class III-5 or III-6) due to lcSSc (n = 11) or arteriosclerosis obliterans (ASO; n = 29). Bone marrow mononuclear cells (0.4-5.1 × 10(10) cells in total) were administered into the ischaemic limbs...
May 2014: Rheumatology
V Treska, B Certík, M Cechura, J Molácek, R Sulc, K Houdek
INTRODUCTION: Leriche's syndrome is defined as atherosclerotic occlusion of the infrarenal aorta and/or the iliac axis. It is associated with claudications or critical limb ischaemia and erectile dysfunction in men. MATERIAL AND METHODS: Twenty patients with Leriche's syndrome were operated on at the Department of Surgery, University Hospital in Pilsen between 2008 and 2012. There were 6 women and 14 men of average age 60.3 years (41-76 years). Three patients were in group C and 17 in group D according to the Trans-Atlantic Inter-Society Classification IIb (TASC IIb)...
April 2013: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
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