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Biomedical subjects

E P Torrie

Publications and source records attributed to E P Torrie.

24 records · Page 2Linked to original sources
PubMed1991

Intra-arterial thrombolytic therapy in the management of acute and chronic limb ischaemia.

A group of 54 patients with acute or chronic limb ischaemia were initially treated with low dose intra-arterial thrombolytic therapy using streptokinase (10,000 units h-1) or plasminogen activator (0.5 mg h-1). Complete thrombolysis was obtained in 90 per cent of patients with symptoms of less than 1 week duration, and in 50 per cent with symptoms of greater than 1 week (P less than 0.05). Successful lysis in 36 patients was followed by successful bypass surgery in seven, percutaneous angioplasty in 13, no further treatment in 13, repeat thrombolysis in two and amputation in one. Failed therapy was associated with major amputation in 40 per cent. One patient died of haemorrhage and another of stroke as a direct result of thrombolytic treatment. The most common complication was haematoma at the site of cannulation of the vessel. Intra-arterial thrombolytic therapy can be very useful for the management of acute and chronic limb ischaemia, but complications do occur and patients should be carefully selected.

Acute Disease↗
PubMed1991

Prevalence of abdominal aortic aneurysm in patients with occlusive peripheral vascular disease.

Over a 1-year period, 242 patients with peripheral vascular disease underwent abdominal ultrasonography to detect the presence of an abdominal aortic aneurysm. In 34 (14 per cent) an abdominal aortic aneurysm was found; half of these aneurysms were greater than 4 cm in diameter. In addition, 16 patients had ectatic aortas. Abdominal aortic aneurysms were more common in men than in women (17 versus 8 per cent). Patients with claudication were as likely to have an abdominal aortic aneurysm as those with rest pain or gangrene. The presence of aortoiliac occlusive disease increased the chance of an aneurysm being present (P less than 0.02). Patients with occlusive peripheral vascular disease are a high-risk group with regard to the development of an abdominal aortic aneurysm. Patients with proximal occlusive disease represent a subgroup at even higher risk.

Adult↗
PubMed1991

Limitations to the widespread usage of low-dose intra-arterial thrombolysis.

Despite encouraging results, intra-arterial thrombolysis (IAT) has not been readily accepted by British surgeons. In an attempt to clarify the reasons for this we sent a postal questionnaire to surgeons with a vascular interest, asking them to define their present attitude towards IAT. Subsequently, we re-analysed our own clinical data in the light of the answers received. In all 134 surgeons (58%) replied to the questionnaire; 48 (38%) never used IAT and 56 (45%) used it only occasionally. When stated, the main reasons for this limited use were the doubts about efficacy (45%) and lack of radiological support (47%). From November 1988 to August 1990 we used IAT for 82 occlusions (streptokinase 74, rt-PA8). Lysis was achieved in 82% of cases when treatment was started within 1 week of symptoms starting, and 62% with symptoms of longer duration. Following successful IAT no further treatment was required in 44% of cases, reconstruction was needed in 26% and angioplasty in 23%, one major amputation was performed. Unsuccessful lysis resulted in reconstruction in 40% of cases. Overall, the limb salvage rate was 89%. Major complications occurred in six cases. One patient sustained a fatal CVA and five bled from the catheter insertion site. Two of these patients required an emergency operation and one other, who had an angioplasty immediately following lysis, died. Minor complications included local haematoma formation (16), catheter problems (6), and allergic reactions (2). After insertion of the perfusing catheter, angiograms (median 4, maximum 10) were performed at intervals, with repositioning of the catheter if necessary, until lysis was complete.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon↗
PubMed1991

An evaluation of intravenous digital subtraction angiography in assessing lower limb ischaemia.

Intravenous digital subtraction angiography (IV DSA) is a relatively simple, minimally invasive technique which can be performed on an out-patient basis. On the other hand it lacks the clarity and definition of conventional angiography (CA). This paper evaluates the usefulness of IV DSA in planning intervention in lower limb ischaemia. Between January 1988 and June 1989, 492 IV DSAs were performed on patients with peripheral vascular disease. The results of the DSA were compatible with the clinical impression in 480 cases and management was planned accordingly. In 12 (2.4%) the DSA was inconclusive (failure to confirm clinical findings in three, insufficient information in six, technical failure in three), and CA was performed. This resulted in six patients having an arterial reconstruction who would not otherwise have done so. One hundred and six of the 480 cases routinely had a CA, in addition to the IV DSA prior to planned angioplasty or intra-arterial thrombolysis. These provided a direct comparison between the two techniques. In 99 (93%) the findings of the two procedures were identical. Significant lesions (not seen on DSA) were identified by CA in four patients, (false: -ve 3.8%) two of which were successfully dealt with by angioplasty. In two patients lesions were not confirmed (false: +ve 1.9%) and in one, disease progression was noted. Thus of the 106 patients, two (1.9%) were found to have lesions on CA, but not on IV DSA, which were successfully treated. IV DSA is satisfactory in most patients with lower limb ischaemia. Its imperfections are more than outweighed by its simplicity and patient acceptability.

Aged↗
PubMed1990

Popliteal aneurysms identified by intra-arterial streptokinase: a changing pattern of presentation.

Five patients presenting with chronic or subacute leg ischaemia due to thrombosed popliteal artery aneurysm are described. Only one of these aneurysms was diagnosed before intra-arterial streptokinase infusion, which successfully lysed the thrombus in all cases. One aneurysm had been symptomatic for 5 years and another for 2 years. Popliteal aneurysm may well be underdiagnosed as a cause of chronic leg ischaemia.

Aged↗