[Arteriopathy of the lower limbs: toward a global medical care].
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Angiography↗
Biomedical subjects
P Priollet
Publications and source records attributed to P Priollet.
[Raynaud's phenomena: diagnostic and treatment study].
Raynaud's phenomenon is a common paroxystic vasomotor disorder. Diagnosis is easily made based on white fingers caused by cold. Aetiological evaluation must distinguish between functional disorders (primary Raynaud's phenomenon or Raynaud's disease) and secondary Raynaud's phenomenon. Initially, physical examination as well as nailfold capillary microscopy are sufficient for the diagnosis of bilateral Raynaud's phenomenon. Prescription of other investigations is guided by the results of this first evaluation. Progressive systemic sclerosis is the first hypothesis if the bilateral vasomotor disorder does not satisfy the criteria for primary Raynaud's phenomenon. Unilateral Raynaud's phenomenon is much less common and always secondary to local or regional vascular disease. Treatment of Raynaud's phenomenon must be adapted to the level of discomfort and to the cause of the vasomotor disorder. Prescription of drugs must be restricted to the most serious cases.
Capillaries↗
[Quality of life and peripheral obliterative arteriopathy. Perspective for the future].
Atherosclerosis is the primary cause of peripheral arterial disease. Because atherosclerosis is a generalised disease, it is possible that patients with peripheral arterial disease may have other arterial disorders. Such patients have a reasonable chance of continuing to walk, although their general prognosis is less favourable because of high cardiovascular morbidity and mortality. Nevertheless, the following approaches can be used to improve the management of patients with peripheral arterial disease: diagnosis of peripheral arterial disease in its early stages by systematic measurement of the ankle/brachial index; improvement in screening for lesions in other arteries by analysing the clinical symptomatology and performing simple complementary examinations; improvement in the management of atherosclerosis risk factors, particularly cigarette smoking, as well as in the treatment of diabetes, arterial hypertension and hypercholesterolaemia; enhancement of antithrombotic agents by the development of new, more effective antiplatelet drugs. Finally, quality of life should be considered an essential factor governing treatment choice. A self-administered questionnaire concerning intermittent claudication has been used to assess the quality of life of patients with peripheral arterial disease undergoing treatment with ifenprodil tartrate. This study showed that the evaluation of intermittent claudication should not be limited to walking distance alone, but that a more general criterion, better adapted to atherosclerotic disease, should be considered: measurement of quality of life.
Arterial Occlusive Diseases↗
[Obliterative arteriopathy of the aorta and lower limbs of atheromatous origin. Diagnosis, course, complications, treatment].
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Aortic Diseases↗
[Physiopathology of Raynaud phenomenon: current data].
Despite over a century of investigation, the pathophysiology of Raynaud's phenomenon remains an enigma. The two main theories of the cause of digital artery vasospasm are increased activity of the sympathetic nervous system and a local fault in the digital vasculature. An increased sensitivity and/or concentration of alpha-2 adrenoreceptors is suggested. The activation of serotoninergic receptors may play a role in the maintenance of vasospasm. The recently discovered increase in the vasoconstrictive peptide endothelin-1 and the quantitative deficit in the potent vasodilating calcitonin gene-related peptide may lead to a better understanding of vasospasm mechanisms and open the field for new therapeutical approaches to Raynaud's phenomenon.
Calcitonin Gene-Related Peptide↗
Clinical features in 36 patients homozygous for the ARG 506-->GLN factor V mutation.
We analyzed the clinical features of 36 patients homozygous for the Arg 506 to Gln factor V mutation and found a circumstantial event at risk for thrombosis in 29 of the 31 patients with thrombosis. The most frequent predisposing factors were the post-partum period and the use of oral contraceptives in women, and surgery in both sexes. Venous thrombosis recurred in 48% of the patients. One patient had a myocardial infarction at age 33 years, and also had an antiphospholipid syndrome. Homozygous Gln 506 mutation leads to far less severe thrombotic complications than homozygous protein C and protein S deficiencies and does not seem to predispose patients to arterial thrombosis.
Adult↗
[Malingering in vascular disease].
Pathomimicry occurs in all fields of medicine. Although difficult to recognize, all physicians should be aware of the underlying mechanisms in order to avoid excessive ordering of complementary examinations and therapeutic propositions which may be dangerous. Pathomimesis is to be distinguished from Munchhausen's syndrome which involves simulation of severe disease and extravagant lies with false history reporting leading to successive hospitalizations in different hospitals. Pathomimesis is also distinguished by the goal of the simulation which is to obtain a precise material benefit. In vascular pathology, pathomimesis can take on several aspects:hemorrhagic syndrome by self-prescribed anticoagulants, self-induced limb edema (tourniquet), or self-inflicted skin wounds. Diagnosis is suggested by the absence of a cause, identification of the stricture groove in case of edema, imprivement with occlusive dressings for skin ulcers and by the general presentation. Pathomimesis is usually encountered in young intelligent women with some medical knowledge. This behavior has a psychopathological significance, the provoked symptoms demonstrating difficult emotional events in the past. The patient attempts to overcome an earlier tragic situation. Pathomimicry is thus expressed during acute episodes of fear and/or anxiety. For the practitioner, it is important to avoid accusing the patient or attempting to get the patient to avow as there is an important risk of exaggerated or self-destructive response. The patient should be led to realize that the physician knows what is happening. This unstated interchange allows the patient to establish a confident relationship with the physician, a relationship which should lead to an accepted psychotherapy.
Attitude of Health Personnel↗
[Arteriopathy of the lower limb in the diabetic patient. Recommendations of ALFEDIAM (French Language Association for the study of Diabetes and Metabolic Diseases)].
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Arterial Occlusive Diseases↗
[Necrotic angiodermatitis: treatment by early cutaneous grafts].
INTRODUCTION: Necrotic angiodermitis is an uncommonly hypertensive ischemic ulceration. It usually occurs on the legs in elderly, hypertensive and sometimes diabetic patients. Its extensive and highly painful nature is characteristic. Currently, there is no simple effective treatment which is known to stop the development. We report the results of a patch graft method applied early before the angiodermitis develops into an advanced stage. PATIENTS AND METHODS: The technique was used in 13 consecutive patients with 16 episodes of necrotic angiodermitis. The graft was made 8 days (mean) after hospitalization. RESULTS: The analgesic effect of the graft was apparent within the first days after the graft. The violet halo of extension disappeared a mean of 8 days after the graft. A second or even third graft was required in 8 of 16 episodes. Total cicatrization was obtained after a mean delay of 33 days. CONCLUSION: Patch graft is a simple, low-cost, non invasive treatment which can be performed at the bedside and even in an outpatient clinic. This stops the extension of the necrotic angiodermitis and controls pain. Delay to cicatrization is shorter. The favourable effect of the graft could possibly be mediated by vasodilator peptides liberated by the graft tissue which would counteract the hypothetical vasospasm.
Aged↗
[Essential varicose veins and chronic venous insufficiency].
Chronic venous insufficiency of the lower limbs has varied expressions: purely functional disorders, varicose veins, varicosities, oedema and trophic cutaneous disorders. For a given individual, these aspects are not necessarily increasing stages of severity of the same disease. On the other hand, many associations are possible; they are determined by the mechanism and the degree of chronic venous insufficiency, as well as by the clinical situation in which they develop. Work-up is based on careful clinical examination. Doppler examination and echography are useful for varices if radical treatment is considered. Ultrasound examination is required in case of cutaneous ulcer in order not to mistake a varicose ulcer for a trophic disorder due to incontinence of deep venous trunks, most often of thrombotic origin. Varicose veins can become complicated. Varicose haemorrhage requires immediate treatment by compression. Superficial phlebitis needs doppler examination and echography because it can be associated to deep venous thrombosis. With regard to varices and chronic venous insufficiency, treatment varies according to the concerns of the patients. Elastic compression stockings are useful whatever the clinical expression of the disease. "Phlebotropic" drugs can be used whenever venous insufficiency is associated with functional symptoms. The use of radical treatment, whether sclerosing injections or surgery, depends on anatomic lesions, the degree of venous incontinence and the severity of symptoms, but also on the desires of the patients, fully informed as to the advantages and the limitations of each technique. Personalized treatment is thus possible.
Chronic Disease↗
[Diabetic arteritis: therapeutic implications based on the profile of the lesion].
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Adult↗
[Epidemiology of chronic venous insufficiency].
From an epidemiological point of view, at least three different entities of chronic venous insufficiency (CVI) can be defined: heavy legs syndrome is experienced by about half the working people of industrialized countries. It is most frequently linked to varicosis, nevertheless, in one case out of three, no venous incompetence is associated. Female sex, prolonged standing position and overweight are other significant risk factors; varicosis comes with modern civilization. Its prevalence is very low in African and Asian or Australasian aborigen populations although immigrant subjects from these regions have the same risk as the population of their host country. Sedentarity, overweight, tight clothing may provide part of the explanation. But the main factor is probably linked to the low fiber diet in industrialized countries through induced constipation and increased abdominal pressure, or because of the associated low vitamin F intake. Varicosis is rarely seen before adulthood, and its prevalence increases with aging. Sex ratio is unbalanced (F/M estimates: 1.5 to 3.5), that is mainly explained by childbearing and hormonal gactors. A familial factor has also been evidenced, with a relative risk of 2, when one parent has varicosis, and about 3 when both are involved; epidemiological data regarding cutaneous trophic changes in CVI are restricted to leg ulcers: 1% of the general population, and 4 to 5% of people aged 80 and more are afflicted. Leg ulcers are frequently found in the post-thrombotic syndrome, but female sex and varicosis are other significant risk factors. Up to now, epidemiological data are too scarce for a definite demonstration of the natural history of the different subsets of CVI. On the other hand, they clearly show that major medical, social and economical problems are involved.
Adult↗
[Chronic venous insufficiency: clinical aspects].
Manifestations of chronic venous insufficiency of the lower limbs are related to congenital or acquired stasis in the deep veins, to post-phlebitis occlusion of the deep veins or to stasis in the superficial veins. Functional impairment may be associated with varicose veins or not. Clinical signs include a heavy feeling in the legs, fatigue, and sometimes cramps or impatience in the evening. Sometimes there is a seasonal character to the complaints. The varicosities are localized in the territory of the medial saphenous vein, the lateral saphenous vein, or both and sometimes affect the pelvic region. Complications may occur including hemorrhage of the varicose veins, superficial phlebitis or orthostatic hypotension. An echo coupled Doppler helps determine the therapeutic indications and provides a mapping of the venous system for functional evaluations. Varicose veins result from minute dilatations of superficial vessels. There are exclusively of aesthetic importance. Chronic venous insufficiency can lead to permanent or intermittant oedema of the lower limbs without inflammation. When permanent, a large cold leg fits into a suggestive clinical picture non venous causes of oedema can be determined with an ultrasound exploration. Postphlebitic reactions are the most frequent causes of large cold lower limbs due to venous insufficiency. Poor cutaneous trophism of venous origin includes dermo-epidermitis, pigmented purpura dermitis, capillary ectasia, leukoderma, sclerodermiform hypodermitis and leg ulcers. Superficial venous ulcers are often quite large, painless and chronic. Their prevalence increases with age. Venous ulcers are more often secondary to phlebitis than to varicose veins. The socio-economic impact is great.
Chronic Disease↗