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1.
Medicine (Baltimore) ; 99(4): e18890, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977898

RESUMO

RATIONALE: Takayasu arteritis (TA) is a systemic large-vessel vasculitis which can be accompanied by the symptoms associated with vascular stenosis. PATIENT CONCERNS: We describe 2 female juveniles with TA who presented with progressive intermittent claudication. DIAGNOSIS: Contrast-enhanced computed tomography (CT) revealed the stenosis of femoral arteries and increased levels of C-reactive protein (CRP), and serum amyloid A (SAA) were noted in both patients. According to European league against rheumatism consensus criteria for the diagnosis of TA was confirmed in both patients. INTERVENTIONS: Both patients had shown resistance to glucocorticoids and treated with tocilizumab (TCZ) (subcutaneous injections, 162 mg/week). OUTCOMES: These treatments improved claudication symptoms. Follow-up imaging by enhanced CT revealed restoration of advanced stenosis of the femoral arteries in both patients. They achieved normalization of levels of the acute-phase reactants CRP and SAA. Serum levels of interleukin-6 were increased transiently after TCZ injection, but declined to within normal ranges at 12 weeks. LESSONS: Juvenile patients with TA presenting with advanced stenosis of the femoral arteries are not rare. The clinical courses of our patients suggested the beneficial effects of TCZ against the progressive vascular stenosis observed in refractory TA.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Arterite de Takayasu/tratamento farmacológico , Adolescente , Constrição Patológica/etiologia , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Interleucina-6/sangue , Claudicação Intermitente/etiologia , Perna (Membro) , Arterite de Takayasu/complicações , Arterite de Takayasu/etiologia , Arterite de Takayasu/fisiopatologia , Resultado do Tratamento
2.
Ann Vasc Surg ; 62: 195-205, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31449941

RESUMO

BACKGROUND: In some cases of complex aortoiliac endovascular repair, the hypogastric landing zone is suboptimal or even insufficient. This study aimed at the technical feasibility and at the outcome of iliac branch device (IBD) deployment with extension of the IBD into the superior gluteal artery (SGA). MATERIALS AND METHODS: This study involves a retrospective analysis of a prospectively maintained single-center cohort of patients with implantation of IBD for aortoiliac and postdissection aneurysms. The IBD cohort with landing zones in the hypogastric main trunk (IIA IBD) was compared with the IBD cohort with landing zones in the SGA (SGA IBD). The main outcome parameters were primary technical success, patency of the hypogastric branch, and freedom from IBD-specific secondary interventions within 30 days. Other outcomes of interest were long-term patency and freedom from buttock claudication, as well as the incidence of endoleaks. Group comparisons were made by univariate significance tests, and freedom from reintervention was analyzed with the Kaplan-Meier-method. RESULTS: From January 2015 to October 2017, a total of 46 IBDs were implanted in 40 patients (39 male; mean age, 71.9 ± 9.1 years). Nineteen of 46 (41.3%) IBDs were extended with at least one bridging stent graft into the SGA because of aneurysmal or short internal iliac artery (IIA). Technical success was achieved in 97.8% (96.3% for IIA IBD vs. 100% for SGA IBD, P = 0.163), and the primary ipsilateral limb patency rate was 100% within 30 days after the procedure. During a mean follow-up period of 19.8 ± 10.0 months (24.7 ± 10.8 for IIA IBD vs. 25.1 ± 9.8 for SGA IBD, P = 0.461), 11.1% IBDs in the IIA IBD group and 15.8% IBDs in the SGA IBD group needed secondary interventions (P = 0.33). Follow-up revealed no patients suffering from persistent buttock claudication or erectile dysfunction. One patient in the SGA IBD group died at late follow-up from a non-aneurysm-related cause. CONCLUSIONS: Extension of IBD into the SGA is a technically feasible and safe maneuver in the treatment of aortoiliac aneurysms with outcomes comparable to those when IBDs extend to the main trunk of the hypogastric artery.


Assuntos
Aneurisma Dissecante/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Nádegas/irrigação sanguínea , Procedimentos Endovasculares/instrumentação , Aneurisma Ilíaco/cirurgia , Artéria Ilíaca/cirurgia , Stents , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Endoleak/etiologia , Procedimentos Endovasculares/efeitos adversos , Estudos de Viabilidade , Feminino , Alemanha , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/fisiopatologia , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Claudicação Intermitente/etiologia , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
4.
BMC Musculoskelet Disord ; 20(1): 431, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31521138

RESUMO

BACKGROUND: Lumbar spinal stenosis (LSS) is a common spinal condition and the most frequent indication for spinal surgery in elderly people. General practitioners (GPs) are on the 1st line for its diagnosis and treatment. We aimed to assess how GPs diagnose and treat people with LSS in France. METHODS: We conducted a cross-sectional survey in a primary care setting. French GPs were selected by a random draw from the French Medical Board. The questionnaire was designed by 3 physicians specialized in physical and rehabilitation medicine and a resident in general practice. A provisional questionnaire was tested in a pilot survey of 11 French GPs. Participants' feedbacks served to build the final questionnaire. This latter was submitted by e-mail or mail to 330 GPs. GPs were surveyed about the 3 main domains relevant to the management of people with LSS in primary care: 1/ diagnosis, 2/ pharmacological treatments and 3/ non-pharmacological treatments, using self-administered open- and closed-ended questions and visual analog scales. RESULTS: Overall, 90/330 (27.3%) GPs completed the survey. 51/89 (57.3%) GPs were confident with managing people with LSS. Low back pain 51/87 (58.6%), neurogenic claudication 38/87 (43.7%) and paresthesia in the lower limbs 31/87 (35.6%) were the 3 most frequently cited clinical signs leading to the diagnosis of LSS. Improvement with lumbar flexion was mentioned by 9/87 (10.3%) GPs. 85/86 (98.8%) would consider prescribing lumbar imaging, 60/84 (71.4%) corticoid spinal injections and 42/79 (53.2%) would never prescribe lumbar flexion-based endurance training. All GPs would refer people with LSS to another specialist. CONCLUSIONS: French GPs lack confidence with diagnosing LSS and prescribing pharmacological and non-pharmacological treatments for people with LSS.


Assuntos
Clínicos Gerais/estatística & dados numéricos , Vértebras Lombares , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Estenose Espinal/diagnóstico , Adulto , Estudos Transversais , Feminino , França , Humanos , Claudicação Intermitente/etiologia , Dor Lombar/etiologia , Masculino , Pessoa de Meia-Idade , Parestesia/etiologia , Projetos Piloto , Estenose Espinal/complicações , Estenose Espinal/terapia , Inquéritos e Questionários/estatística & dados numéricos
5.
Ned Tijdschr Geneeskd ; 1632019 09 24.
Artigo em Holandês | MEDLINE | ID: mdl-31556497

RESUMO

Lumbar spondylolisthesis is usually asymptomatic. However, symptomatic spondylolisthesis results in back and/or leg pain such as radicular syndrome or neurogenic claudication. Variation in symptoms is caused by different types of spondylolisthesis. Lytic spondylolisthesis, most common at L5S1, is caused by spondylolysis of the pars interarticularis. This results in foraminal nerve compression and radicular symptoms. Degenerative spondylolisthesis, most common at L4L5 in patients >50 years old, is caused by slippage of the vertebral body and lamina, resulting in lumbar spinal stenosis and neurogenic claudication. Iatrogenic spondylolisthesis develops in 1.6-32.0% of patients after decompression surgery, causing recurrent neurogenic symptoms. It is important to understand the main symptoms patients experience: back or leg pain. In both cases, the preferred treatment is conservative. Surgery is only an option if patients have persistent/progressive leg pain. Shared decision-making is necessary to select the most accurate surgery for each individual patient while also taking into account age, comorbidities and symptoms. Further research is necessary to determine the advantages of each surgery in order to improve advice to patients.


Assuntos
Dor nas Costas/etiologia , Claudicação Intermitente/etiologia , Vértebras Lombares/patologia , Radiculopatia/etiologia , Estenose Espinal/etiologia , Espondilolistese/complicações , Idoso , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/métodos , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Espondilolistese/patologia , Espondilolistese/cirurgia
6.
Kyobu Geka ; 72(8): 635-637, 2019 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-31353359

RESUMO

A 49-year-old man was admitted to our hospital because of intermittent claudication and refractory hypertension 10 years after surgery to Stanford type A acute aortic dissection. He underwent total arch replacement with an elephant trunk of 22 mm in diameter. Transesophageal echocardiography revealed that distal end of the elephant trunk was stenosed. Systolic blood pressure gradient over this portion reached to more than 100 mmHg. Folding of elephant trunk and thrombus formation were considered to be the cause. Thoracic endovascular aortic repair relieved stenosis and intermittent claudication, and enabled better blood pressure control.


Assuntos
Aneurisma Dissecante , Hipertensão , Claudicação Intermitente , Aorta Torácica , Constrição Patológica/complicações , Humanos , Hipertensão/etiologia , Claudicação Intermitente/etiologia , Masculino , Pessoa de Meia-Idade , Stents , Resultado do Tratamento
8.
J Pak Med Assoc ; 69(6): 874-878, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31201395

RESUMO

OBJECTIVE: This review aimed to determine the impact of exercise protocol among peripheral artery disease patients. Literature search was done from 2005 to 2018. METHODS: Databases such as Google Scholar, Medline and PubMed was reconnoitred for the purpose of research articles by using key words like exercise training, peripheral artery disease, ankle brachial index, haemodynamic and atherosclerosis. Studies fulfilling the inclusion criteria were retrieved and encompassed in the present study. RESULTS: The heterogeneity of the studies included in the analysis and the impact of exercise programmes on outcome measures were assessed by using hedge gstatistical model.Of the54 studies found, 9(16.6%) were analysed that suggest supervised and structured exercises programmes significantly improved (p<0.05) outcome variables. CONCLUSIONS: Future randomized controlled trials related to the duration of exercises regimes are required in order to tailor the training programmes according to the need of individuals.


Assuntos
Terapia por Exercício/métodos , Claudicação Intermitente/reabilitação , Doença Arterial Periférica/reabilitação , Humanos , Claudicação Intermitente/etiologia , Doença Arterial Periférica/complicações , Resultado do Tratamento , Teste de Caminhada
9.
Ann Vasc Surg ; 60: 479.e11-479.e15, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31200062

RESUMO

We report the case of a 68-year-old man complaining of sudden intermittent claudication of the left limb. The patient was rapidly diagnosed with duplex ultrasound (DUS), computed tomography angiography, and magnetic resonance angiography as having a popliteal cyst (PC) compressing the popliteal artery, responsible for intermittent claudication. The patient underwent DUS-guided PC aspiration allowing symptoms resolution. However, he presented 3 recurrent ischemic syndromes from brutal claudication to more severe ischemia in a 3-month period, with increasing severity of the symptoms, treated with 3 DUS-guided PC aspirations. An extensive work-up excluded an atherosclerotic etiology. Consequently, due to increasing severity and quick recurrence of the symptoms and given the underlying knee osteoarthritis, the patient underwent radical treatment and got a total knee prosthetic replacement. One year later, follow-up was uneventful.


Assuntos
Arteriopatias Oclusivas/etiologia , Claudicação Intermitente/etiologia , Isquemia/etiologia , Osteoartrite do Joelho/complicações , Artéria Poplítea , Cisto Popliteal/complicações , Doença Aguda , Idoso , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/fisiopatologia , Artroplastia do Joelho , Humanos , Claudicação Intermitente/diagnóstico por imagem , Claudicação Intermitente/fisiopatologia , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Masculino , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/fisiopatologia , Cisto Popliteal/diagnóstico por imagem , Cisto Popliteal/terapia , Recidiva , Fluxo Sanguíneo Regional , Resultado do Tratamento
10.
Ann Vasc Surg ; 60: 476.e7-476.e11, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31075451

RESUMO

The Angio-Seal vascular closure device is used to reduce time to hemostasis after femoral artery puncture. Although rare, complications associated with Angio-Seal are significant, including infection, pseudoaneurysm formation, symptomatic femoral artery stenosis, and separation and embolization, leading to limb-threatening ischemia. This report describes Angio-Seal polymer anchor embolization to the tibioperoneal trunk successfully retrieved using the 8-French Indigo Aspiration System.


Assuntos
Malformações Arteriovenosas/terapia , Cateterismo Periférico , Remoção de Dispositivo/métodos , Artéria Femoral , Migração de Corpo Estranho/terapia , Mãos/irrigação sanguínea , Técnicas Hemostáticas/efeitos adversos , Claudicação Intermitente/terapia , Isquemia/terapia , Trombectomia/métodos , Dispositivos de Oclusão Vascular/efeitos adversos , Cateterismo Periférico/efeitos adversos , Feminino , Artéria Femoral/diagnóstico por imagem , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Técnicas Hemostáticas/instrumentação , Humanos , Claudicação Intermitente/diagnóstico por imagem , Claudicação Intermitente/etiologia , Isquemia/diagnóstico por imagem , Isquemia/etiologia , Punções , Sucção , Resultado do Tratamento , Adulto Jovem
12.
Khirurgiia (Mosk) ; (3): 98-104, 2019.
Artigo em Russo | MEDLINE | ID: mdl-30938364

RESUMO

Peripheral artery disease is still one of the most important surgical problems. General surgeons treat the majority of patients with chronic lower limb ischemia due to the lack of specialized surgical care. Current methods for risk factors adjustment, exercise therapy and the most common drugs for intermittent claudication management are reviewed in the article. The effect of these medicines on subjective (pain-free walking distance, maximal walking distance, etc.) and objective (ankle-brachial index) parameters and the incidence of complications are analyzed.


Assuntos
Tratamento Conservador/métodos , Isquemia/terapia , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/terapia , Assistência Ambulatorial/métodos , Índice Tornozelo-Braço , Doença Crônica , Terapia por Exercício , Humanos , Claudicação Intermitente/tratamento farmacológico , Claudicação Intermitente/etiologia , Claudicação Intermitente/terapia , Isquemia/etiologia , Doença Arterial Periférica/complicações , Medição de Risco , Fatores de Risco , Federação Russa , Caminhada
13.
J Cardiovasc Med (Hagerstown) ; 20(8): 557-563, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30950984

RESUMO

AIM: To report our experience about hypogastric artery coverage during endovascular aneurysm repair (EVAR) for aortoiliac aneurysms in patients younger than 80 years (group A) compared with octogenarian patients (group B). METHODS: Data of consecutive EVAR with hypogastric artery coverage from 01/1998 to 12/2016 were retrospectively analyzed. Primary outcomes were the occurrence of ischemic colitis, type II endoleak and buttock claudication both at 30 days and in the long term. P values less than 0.05 were considered statistically significant. RESULTS: The hypogastric artery was covered in 107 patients. Twenty-three (21.5%) were octogenarian (group B). At 30 days, one type II endoleak occurred in group B, whereas 16 patients of group A experienced buttock claudication. There were no cases of ischemic colitis. During follow-up (median 63.5 months), no cases of ischemic colitis occurred. Six new type II endoleaks were recorded (five in group B and one in group A, P = 0.0001). Buttock claudication persisted in four patients of group A. No new cases of buttock claudication were observed. CONCLUSION: Unilateral hypogastric artery coverage during EVAR for aortoiliac aneurysms can be performed with an acceptable rate of postoperative complication. Postoperative buttock claudication was more frequent in younger patients, whereas a type II endoleak occurred mostly in octogenarian patients during follow-up.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Ilíaco/cirurgia , Pelve/irrigação sanguínea , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/fisiopatologia , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Circulação Colateral , Endoleak/etiologia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/fisiopatologia , Claudicação Intermitente/etiologia , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
14.
J Med Case Rep ; 13(1): 114, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31018871

RESUMO

BACKGROUND: Peripheral vascular disease is the rarest vascular complication in systemic lupus erythematosus. Some theories propose that immune complexes may promote inflammation in the vessel, and disrupt it in a manner that may cause ischemia. CASE PRESENTATION: A 14-year-old Asian girl presented with intermittent claudication as the chief complaint followed by discoloration of her left big toe for 2 weeks prior to admission. Her medical history showed that 1 month prior to admission she had photosensitivity, rash, and arthralgia, with positive antinuclear antibody test, positive anti-double-stranded DNA test, positive anti-ribosomal protein P, and complement C4 (7.4 mg/dL); she was diagnosed as having systemic lupus erythematosus and started therapy. A local examination of her left toe showed black discoloration, low pulsation, localized tenderness, and decreased sensation. Laboratory results showed C-reactive protein of 1.16 mg/dL and D-dimer of 2.28 uG/mL. A computed tomography angiogram showed near total occlusion of her popliteal artery; critical limb ischemia was confirmed. Peripheral arteriography was performed with invasive strategy. After the procedure, the flow was improved to distal, but there was inflammation in the vessel, so we decided to stop the procedure because of the risk of dissection. Our patient was given atorvastatin and warfarin, and we maximized her systemic lupus erythematosus therapy with prednisone. There were two follow-ups. The first follow-up was 1 week after the procedure. Our patient attended her first follow-up at our out-patient department with no symptoms and improvement in her toe's discoloration; warfarin was stopped, and clopidogrel and cilostazol were added for thrombus prevention therapy, she was then scheduled for debridement. The second follow-up was done 2 months after the first follow-up and discoloration was improved. The third follow-up, 5 months after the second follow-up, showed improvement. CONCLUSION: Critical limb ischemia is a rare complication of systemic lupus erythematosus that requires immediate treatment. Due to our limited resources, we improvised a strategy to achieve the best possible outcome in our patient by using a combination of invasive treatment and medication.


Assuntos
Hallux Valgus/patologia , Claudicação Intermitente/fisiopatologia , Isquemia/fisiopatologia , Extremidade Inferior/irrigação sanguínea , Lúpus Eritematoso Sistêmico/fisiopatologia , Adolescente , Anticoagulantes/uso terapêutico , Procedimentos Endovasculares , Feminino , Humanos , Imunossupressores/uso terapêutico , Claudicação Intermitente/etiologia , Claudicação Intermitente/terapia , Isquemia/terapia , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/terapia , Resultado do Tratamento , Varfarina/uso terapêutico
15.
Physiotherapy ; 105(2): 262-274, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30935673

RESUMO

Neurogenic claudication due to spinal stenosis is a common cause of disability in older adults. Conservative treatments are a favourable treatment option. This paper describes the development and delivery of the BOOST (Better Outcomes for Older adults with Spinal Trouble) intervention, a physiotherapist-delivered physical and psychological intervention for the management of neurogenic claudication in older adults. The BOOST intervention is being tested in a multi-centre, randomised controlled trial in UK National Health Service Trusts; delivered by physiotherapists registered with the Health and Care Professionals Council. Participants are aged 65 years or older, registered with a primary care practice, and report symptoms consistent with neurogenic claudication. Intervention content and delivery was initially informed by clinical and patient experts, research evidence, and behaviour change guidelines; and refined following an intervention development day attended by researchers, health professionals, and Patient and Public Involvement representatives. The BOOST intervention comprises 12 group sessions, promoting sustained adherence with a long term home and physical activity programme. Each session includes education and group discussion, individually tailored exercises, and walking. Initial exercise levels are set at a one-to-one assessment. Continued home exercise adherence and increased physical activity following completion of the sessions is facilitated through support telephone calls. Trial registration ISRCTN12698674.


Assuntos
Educação em Saúde/métodos , Claudicação Intermitente/reabilitação , Modalidades de Fisioterapia , Estenose Espinal/reabilitação , Idoso , Terapia Cognitivo-Comportamental , Avaliação da Deficiência , Feminino , Humanos , Claudicação Intermitente/etiologia , Claudicação Intermitente/psicologia , Masculino , Estenose Espinal/complicações , Estenose Espinal/psicologia , Reino Unido
16.
Am Fam Physician ; 99(6): 362-369, 2019 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-30874413

RESUMO

Lower extremity peripheral artery disease (PAD) affects 12% to 20% of Americans 60 years and older. The most significant risk factors for PAD are hyperlipidemia, hypertension, diabetes mellitus, chronic kidney disease, and smoking; the presence of three or more factors confers a 10-fold increase in PAD risk. Intermittent claudication is the hallmark of atherosclerotic lower extremity PAD, but only about 10% of patients with PAD experience intermittent claudication. A variety of leg symptoms that differ from classic claudication affects 50% of patients, and 40% have no leg symptoms at all. Current guidelines recommend resting ankle-brachial index (ABI) testing for patients with history or examination findings suggesting PAD. Patients with symptoms of PAD but a normal resting ABI can be further evaluated with exercise ABI testing. Routine ABI screening for those not at increased risk of PAD is not recommended. Treatment of PAD includes lifestyle modifications-including smoking cessation and supervised exercise therapy-plus secondary prevention medications, including antiplatelet therapy, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins. Surgical revascularization should be considered for patients with lifestyle-limiting claudication who have an inadequate response to the aforementioned therapies. Patients with acute or limb-threatening limb ischemia should be referred immediately to a vascular surgeon.


Assuntos
Claudicação Intermitente/diagnóstico , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/terapia , Idoso , Índice Tornozelo-Braço , Terapia por Exercício , Humanos , Claudicação Intermitente/etiologia , Extremidade Inferior/fisiopatologia , Pessoa de Meia-Idade , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/fisiopatologia , Guias de Prática Clínica como Assunto , Fatores de Risco
17.
Ann Vasc Surg ; 58: 377.e9-377.e11, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30802588

RESUMO

We report the case of a 54-year-old female who presented with chronic mesenteric ischemia symptoms which could also be provoked on walking 50-100 m. Computed tomography angiography demonstrated ostial occlusion of all 3 mesenteric vessels, with extensive collateralization reconstituting the inferior mesenteric artery from the iliac arteries. As such, her abdominal pain was secondary to preferential flow to the lower limbs stealing from mesenteric vasculature. Endovascular management was trialed, but failed after short-term improvement, so the patient underwent successful transposition of inferior mesenteric to left common iliac artery. Mesenteric ischemia presenting with pain on walking secondary to preferential flow to the lower limbs has not been previously reported, and vascular and general surgeons should be aware of this unusual differential for abdominal pain.


Assuntos
Aorta/cirurgia , Artéria Ilíaca/cirurgia , Artéria Mesentérica Inferior/cirurgia , Isquemia Mesentérica/cirurgia , Oclusão Vascular Mesentérica/cirurgia , Enxerto Vascular/métodos , Dor Abdominal/etiologia , Aorta/diagnóstico por imagem , Aorta/fisiopatologia , Aortografia/métodos , Doença Crônica , Circulação Colateral , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Claudicação Intermitente/etiologia , Artéria Mesentérica Inferior/diagnóstico por imagem , Artéria Mesentérica Inferior/fisiopatologia , Isquemia Mesentérica/complicações , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/fisiopatologia , Oclusão Vascular Mesentérica/complicações , Oclusão Vascular Mesentérica/diagnóstico por imagem , Oclusão Vascular Mesentérica/fisiopatologia , Pessoa de Meia-Idade , Circulação Esplâncnica , Resultado do Tratamento
18.
Ther Adv Cardiovasc Dis ; 13: 1753944718819063, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30803404

RESUMO

BACKGROUND:: The prevalence of exercise-induced ischemia in the asymptomatic limb of patients with unilateral claudication based on history and treadmill evaluation, and with unilateral ipsilateral peripheral artery disease (i.e ankle-to-brachial systolic pressure index <0.90) is unknown. METHODS:: We detected exercise-induced ischemia in the asymptomatic limb of patients with apparently unilateral claudication. Among 6059 exercise-oximetry tests performed in 3407 nondiabetic and 961 diabetic patients. We estimated the intensity of ischemia in the both limb (buttocks and calves) using the lowest minimum value of the decrease from rest of oxygen pressure (DROP; limb changes minus chest changes from rest), with significant ischemia defined as DROP lower than -15 mmHg. RESULTS:: We found 152 tests performed in 142 nondiabetic patients and 40 tests performed in 38 diabetic patients. The asymptomatic limb showed significant ischemia in 46.7% and 37.5% of the tests. Strictly unilateral exercise-induced claudication with apparently unilateral peripheral artery disease was rare (<4% of all tests). However, among these highly selected tests, significant ischemia was found in the asymptomatic limb in more than one-third of cases. CONCLUSION:: The asymptomatic limb of patients with peripheral artery disease should not be considered a normal limb.


Assuntos
Teste de Esforço/efeitos adversos , Tolerância ao Exercício/fisiologia , Claudicação Intermitente/epidemiologia , Doença Arterial Periférica/epidemiologia , Fluxo Sanguíneo Regional/fisiologia , Índice Tornozelo-Braço , Feminino , Seguimentos , França/epidemiologia , Humanos , Claudicação Intermitente/diagnóstico , Claudicação Intermitente/etiologia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/fisiopatologia , Prevalência , Estudos Retrospectivos , Fatores de Tempo
19.
Medicine (Baltimore) ; 98(5): e14214, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30702575

RESUMO

This study aimed to compare the pelvic cavity vasculature before and after the interventional occlusion of a hypogastric artery (IOHA) and to reveal the protective mechanism of the collateral vessels against pelvic ischaemia.Sixty-nine patients with abdominal aortic or aortoiliac aneurysms who underwent endovascular aneurysm repair accompanied with IOHA were retrospectively analysed. Patients were divided into those who complained of buttock claudication (BC) group and asymptomatic patients (non-BC group).Two analyses were performed. In Study 1, the factors associated with postoperative BC were evaluated in patients who underwent IOHA using only 0.035 Tornade embolization coils. In Study 2, the pelvic arterial volume (PAV) was assessed in patients with both pre- and postoperative multidetector computed tomography images. PAV was calculated by subtracting the aortoiliac artery volume from the total PAV. The PAV ratio was defined as the postoperative PAV divided by preoperative PAV and represented collateral development in the pelvis.In Study 1, BC occurred in 16 patients (BC group) and did not occur in 25 patients (non-BC group). Significantly more coils were used in the BC group than in the non-BC group (8.6 ±â€Š1.0 vs 5.6 ±â€Š0.83, P = .013). Study 2 had 24 patients in the BC group and 31 patients in the non-BC group. The PAV ratio was significantly higher in the BC group than in the non-BC group (0.93 ±â€Š0.05 vs 0.62 ±â€Š0.04, P<.0001).The use of more coils in IOHA is associated with BC. In addition, volumetric analysis revealed that less collateral vessel development occurred in the non-BC group than in the BC group, which might reflect a potential reservation capacity of non-BC patients for acute pelvic ischaemia.


Assuntos
Aneurisma da Aorta Abdominal/terapia , Embolização Terapêutica/métodos , Aneurisma Ilíaco/terapia , Pelve/irrigação sanguínea , Idoso , Idoso de 80 Anos ou mais , Embolização Terapêutica/efeitos adversos , Feminino , Humanos , Artéria Ilíaca , Claudicação Intermitente/etiologia , Isquemia , Masculino , Estudos Retrospectivos
20.
World Neurosurg ; 125: e361-e371, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30703594

RESUMO

OBJECTIVE: For effective minimally invasive lumbar decompression, we changed the routine of segmental decompression. Using a high-speed drill or an ultrasound knife, we created a working channel, starting at the base of the spinous process of the upper vertebra slightly above the disc level, to target and decompress the contralateral recess, and termed it the translaminar crossover decompression (TCD). We evaluated the feasibility and compared the outcomes of a navigation-guided endoscopic translaminar crossover approach for segmental decompression (eTCD) in elderly patients with microscopic decompression using the same approach (mTCD). METHODS: A total of 740 elderly patients were enrolled in a prospective cohort study. Of the 740 patients, 297, who had undergone mTCD, and 253, who had undergone eTCD, completed a 1-year follow-up visit. In addition to the surgical data, numerical rating scales (NRSs) for back and leg pain, the Core Outcome Measures Index and Oswestry Disability Index were recorded preoperatively and 3, 6, and 12 months after surgery. The MacNab criteria were supplemented by qualitative assessment of the patients' postoperative pain-free walking distance. RESULTS: A comparison of the preoperative and postoperative clinical scores showed significant improvement after TCD in both cohorts (P < 0.01): Oswestry Disability Index, from 50.3% ± 12.6% to 15.5% ± 7.43%; NRS (back), from 6.9 ± 1.9 to 2.5 ± 1.3; NRS (leg), from 8.0 ± 0.85 to 1.6 ± 0.33; Core Outcome Measures Index (back), from 7.8 ± 2.0 to 2.7 ± 1.5. No statistically significant differences were found in the outcomes between the 2 cohorts. CONCLUSIONS: TCD inherently eliminated central stenosis and facilitated decompression of both recesses via mutual undercutting, with preservation of facet joint integrity.


Assuntos
Descompressão Cirúrgica/métodos , Neuroendoscopia/métodos , Estenose Espinal/cirurgia , Idoso , Dor nas Costas/etiologia , Dor nas Costas/cirurgia , Descompressão Cirúrgica/instrumentação , Avaliação da Deficiência , Desenho de Equipamento , Feminino , Humanos , Claudicação Intermitente/etiologia , Claudicação Intermitente/cirurgia , Vértebras Lombares/cirurgia , Imagem por Ressonância Magnética , Masculino , Microcirurgia/instrumentação , Microcirurgia/métodos , Neuroendoscopia/instrumentação , Neuronavegação/instrumentação , Neuronavegação/métodos , Estudos Prospectivos , Tomografia Computadorizada por Raios X
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