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Complications of percutaneous intra-aortic balloon pump use in patients with peripheral vascular disease.

Percutaneous intra-aortic balloon pump use may carry an increased risk for patients with peripheral vascular disease. To determine the incidence and types of associated complications, the medical records of 144 patients who underwent a total of 153 percutaneous intra-aortic balloon pump insertions were reviewed. Patients were divided into two groups. Group 1 was composed of 20 patients with a history of peripheral vascular disease. Group 2 was composed of 124 patients without such history; they underwent a total of 133 insertions. Nineteen major complications (12%) occurred, 12 in group 1 (60% of 20 insertions) and seven in group 2 (5% of 133 insertions). Major complications were further classified by their nature: embolic, occlusive, and technical. All three types of complications occurred more frequently in group 1. Embolic complications occurred more frequently in patients with aneurysms and proved the most lethal, with two of six deaths in group 1 resulting from this complication.

Aneurysm↗

Measurement of leukocyte rheology in vascular disease: clinical rationale and methodology. International Society of Clinical Hemorheology.

The measurement of leukocyte rheology in vascular disease is a recent development with a wide range of new opportunities. The International Society of Clinical Hemorheology has asked an expert panel to propose guidelines for the investigation of leukocyte rheology in clinical situations. This article first discusses the mechanical, adhesive and related functional properties of leukocytes (especially neutrophils) which influence their circulation, and establishes the rationale for clinically-related measurements of parameters which describe them. It is concluded that quantitation of leukocyte adhesion molecules, and of their endothelial receptors may assist understanding of leukocyte behaviour in vascular disease, along with measurements of flow resistance of leukocytes, free radical production, degranulation and gene expression. For instance, vascular cell adhesion molecule (VCAM-1) is abnormally present on endothelial cells in atherosclerosis, diabetes mellitus and inflammatory conditions. Soluble forms of intercellular adhesion molecule (ICAM-1) or VCAM can be found elevated in the blood of patients with rheumatoid arthritis or infections disease. In the second part of the article, possible technical approaches are presented and possible avenues for leukocyte rheological investigations are discussed.

Arteriosclerosis↗

[Application of endolaser in vitrectomy for retinal vascular disease].

PURPOSE: To discuss the usage and effectiveness of endolaser in vitrectomy for retinal vascular disease. METHODS: Twenty-four cases (28 eyes) of vitrectomy for retinal vascular disease were treated with endolaser. The methods of endolaser: 21 eyes were treated with panretinal scatter therapy; 2 eyes with endolaser ring-intercepting around retinal and sealing retinal breaks; 5 eye with focal therapy. RESULTS: After follow-up for 1-24 months (mean 9 months), retinal hemorrhage recurred in 3 eyes; the other 25 eyes, retinas were totally reattached, retinal breaks were sealed, and vision had considerable recovery, no hemorrhage. The ratio of recovery is up to 89.2%. CONCLUSIONS: Endolaser is an important adjuvant in vitreous operation nowadays and an effective procedure in vitrectomy for the cases of retinal hemorrhage.

Adolescent↗

Follow-up of the WHO Multinational Study of Vascular Disease in Diabetes: general description and morbidity.

AIMS: The incidence of retinal, renal and cardiovascular complications and their relation to baseline risk factors was documented in this follow-up study of 10 of the 14 original centres of the WHO Multinational Study of Vascular Disease in Diabetes (WHO MSVDD). METHODS: The incidence of specified items of vascular disease and some associated risk factors was ascertained after 7 to 9 years (11-12 years in Oklahoma, USA) follow-up, re-using baseline examination methodology in 3165 patients (66.9 %) and, through secondary information in 717 (15.2%) of the 4729 original patients, of whom 540 (11.4%) had died and 307 (6.5 %) were untraceable. RESULTS: During follow-up, approximately one third of the patients developed hypertension and one third started insulin. Coronary heart disease incidence varied 10 to 20-fold among centres as did limb amputation rates. Inter-centre differences in incident retinopathy and severe visual impairment were smaller but incident clinical proteinuria and renal failure varied markedly. Vascular disease incidence of all categories was high in Native Americans though coronary heart disease incidence was relatively low in Pima Indians and absolutely low in Hong Kong and Tokyo patients. Specific vascular events and their relation with baseline risk factors are analysed in accompanying papers, summarised in the Epilogue. CONCLUSION/INTERPRETATION: These 10 centres reported very different incidence rates of vascular complications. Observer variation, selection biases and competing causes of mortality contributed to these differences but their validity is supported by the more objective outcome indicators. The following papers also suggest that baseline factors such as raised arterial pressure, cholesterol and fasting glucose (in the centres where it was measured) were important and potentially reversible predictors of risk.

Adult↗

Effects of unilateral, low-frequency, neuromuscular stimulation on superficial circulation in lower extremities of patients with peripheral vascular disease.

The effects of unilateral, low-frequency, neuromuscular stimulation on the circulation in skin of the lower extremities were studied in eight subjects with peripheral vascular disease and eight control subjects with normal peripheral vasculature. Sixty minutes of stimulation (at 2 Hz), of sufficient intensity to produce visible contraction of musculature, was applied through cutaneous electrodes placed over the common peroneal nerve and dorsum of the foot. Systolic and diastolic blood pressure, heart rate, bilateral great-toe photoplethysmographic waveform, and bilateral pedal skin temperature were recorded at 30-min intervals during stimulation and 30 min after stimulation. Mean differences in recordings before and after stimulation were then calculated for each parameter, showing in subjects with peripheral vascular disease significant increases of 5.3 +/- 2.1 mm and 0.5 +/- 0.1 degree C for ipsilateral photoplethysmographic waveform amplitude and pedal skin temperature, respectively. Mean differences for the remaining parameters were not significant. Recorded parameters in the control group did not change after stimulation. These results demonstrate that low-frequency, neuromuscular stimulation produces regional cutaneous vasodilation in subjects with peripheral vascular disease. No evidence of generalized vasodilation after neuromuscular stimulation was found.

Adult↗

[Treatment of peripheral occlusive vascular disease with pentoxifylin (author's transl)].

102 patients suffering from peripheral occlusive vascular disease were treated with Pentoxifylline (Trental) parenterally (i.v. infusions) and orally (dragees). Surprisingly good therapeutic response was obtained not only in patients stage II but also stage III (after Fontaine), in total 84% of the patients showing improvement. These favourable results can only be explained by increase of nutritious circulation indicating an improvement of blood-flow-properties in the microvasculature. The observed particular efficacy of Pentoxifylline necessitates a more differentiated valuation of the systemic (intravenous) administration of vasoactive drugs all the more so as the majority of patients with occlusive vascular disease are accessible to conservative treatment only.

Administration, Oral↗

The prevalence of peripheral vascular disease in familial hypercholesterolaemia.

OBJECTIVES: In patients with familial hypercholesterolaemia (FH), the prevalence of haemodynamically significant peripheral vascular disease (PVD) was measured in relation to lipoproteins, general risk factors and the presence of coronary artery disease (CAD). DESIGN: A case control study. SETTING: The outpatient lipid clinic of a university hospital (tertiary referral centre). SUBJECTS: Patients with heterozygous FH [n = 68; age 45.8 +/- 11.6 years; untreated LDL-cholesterol 9.2 +/- 2.0 mmol L-1] were compared with control subjects matched for gender, age, weight, smoking and presence of hypertension [n = 27; age 44.0 years; LDL-cholesterol 3.8 +/- 1.3 mmol L-1]. MAIN OUTCOME MEASURES: PVD was assessed during cholesterol-lowering treatment using ankle/arm blood pressure ratios and analyses of Doppler-derived blood flow velocities in the femoral artery at rest and during reactive hyperaemia. The diagnosis of CAD was assessed clinically. RESULTS: Haemodynamically significant PVD was found in 21 (31%) FH patients and in one (3.7%) control subject, predominantly localized in the femoro-popliteal vessels. CAD was present in 30 (44.1%) FH patients and in one (3.7%) control subject. PVD could be demonstrated in 50% of FH patients with CAD [relative risk 3.2 (95% CI 1.4-7.2)] and in 19% as the first manifestation of vascular disease. Males and females were equally affected. Mean arterial blood pressure of FH patients with PVD was higher compared to FH patients without PVD. CONCLUSIONS: Haemodynamically significant PVD appears to be more prevalent in FH patients than is generally assumed, especially in those with CAD. A relation with lipoprotein levels could not be demonstrated.

Adult↗

Immunology of ischemic vascular disease: plaque to attack.

Interest and studies focused on the role of immune and inflammatory mechanisms in vascular disease have advanced in synchrony with the advances in the understanding of innate immune system regulation and the interplay between innate and adaptive immunity. Clinical studies have implicated immune and inflammatory mechanisms in stroke and acute coronary syndromes. Analyses of genetically modified mice and in vitro and in vivo preclinical ischemia models have yielded insights into pathobiological mechanisms. Deciphering the role of innate immune mechanisms that confer tolerance to ischemia might guide translation of more effective therapies. Antigen-targeted and other forms of focused immunomodulation that can suppress vessel activation and protect ischemic tissue might ultimately find a niche in the prevention and treatment of vascular disease.

Animals↗

The future role of neurosurgery in the case of vascular diseases of the central nervous system.

On the basis of 2542 cerebro-spinal vascular diseases (933 aneurysms, 689 cerebro-spinal angiomas, 410 spontaneous intracerebral hematomas, 361 vascular bypass operations and 149 endarterectomies of neck vessels) the present situation and problems, as well as the future prospects of cerebral vascular neurosurgery are reviewed. It is expected that the main development will take place in the field of pathophysiology and pathochemistry of vascular diseases through the acquisition of data obtained not in experimental studies but in patients. This will refine the diagnosis and indications. It is not expected that the operative technique will undergo very substantial change. New methods in the application of laser and photosensitization techniques will be probably included in the technical armamentarium. Endovascular methods of treatment will be further developed and will lead to the limitation of the indications for direct operation. It is assumed that mortality and morbidity can be further reduced by improving the diagnosis and establishing the optimal lines of therapy.

Blood-Brain Barrier↗

Osteochondroma: an unusual cause of vascular disease in young adults.

Vascular complications such as pseudoaneurysm, arterial thrombosis, luminal stenosis due to extrinsic compression, deep venous thrombosis, and arteriovenous fistula are known complications of osteochondroma. The authors describe three cases of vascular injury caused by osteochondroma: popliteal artery impingement, popliteal artery pseudoaneurysm formation, and superficial femoral artery pseudoaneurysm with peripheral occlusion of the tibial and peroneal arteries due to embolization. Fifty-six cases of vascular complications due to osteochondroma from the English literature are also reviewed. This entity should be considered in young patients with evidence of peripheral vascular insufficiency or in patients with known osteochondroma who develop symptoms of local pain and swelling in the involved extremity.

Adolescent↗

Amputation in vascular disease.

The management of vascular amputees in the Roehampton Limb Surgery Unit since its opening in 1975 is outlined and the results in 167 cases presented. Of the 35 patients over the age of 80, 57% were walking independently at the time of their discharge from the unit.

Aged↗