Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Peripheral Vascular Diseases”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMed2005

A role for endothelin-1 in peripheral vascular disease.

Peripheral vascular disease can compromise the blood supply to the lower limb with amputation being necessary in severe cases. Reduced blood flow may be due to arterial occlusive disease or constriction of skeletal microvessels with the resultant ischaemia causing pain, tissue damage, ulceration and gangrene. These events are associated with endothelial damage or dysfunction: endothelin-1 is implicated as a mediator via its constrictor, proinflammatory and proliferative actions. Raised plasma and tissue levels of this peptide have been described in various ischaemic conditions, including peripheral vascular disease. Here, the possible role of endothelin-1 in peripheral vascular disease is discussed and potential therapeutic tools are considered.

Animals↗
PubMed1998

Pain and powerlessness: the experience of living with peripheral vascular disease.

Peripheral vascular disease (PVD) is a widespread condition, the most common manifestation being a gradual occlusion of the arteries of the legs due to atheroma, which results in symptoms of ischaemia such as intermittent claudication or rest pain, ulceration and gangrene. Treatment of the condition is palliative and reconstructive, and aims to salvage the limb, restore mobility and function, and relieve pain. It usually involves attempts to revascularize the affected limb, either by surgical procedures such as bypass grafting, or by percutaneous transluminal angioplasty or thrombolysis. In some cases, it may be necessary to amputate the limb or part of it. Despite the chronicity of PVD, little is known about the ways in which individuals with vascular disease cope with their condition and about the effect it has on their life. In this context the aims of this study were to explore the lived experience of peripheral vascular disease, in order to identify key themes and categories, using a phenomenological grounded theory approach. A sample of nine individuals was drawn from patients who had had vascular bypass surgery within the past 18 months. Data were collected using audiotaped one-to-one interviews and the researcher's field notes, and were validated with a group of experienced vascular nurses. Transcripts were analysed using open and axial coding techniques, and major and minor categories were identified and related to other data collected. It appeared that vascular patients experienced powerlessness in relation to the direct effects of their condition and in relation to its treatment modalities. The findings suggested that the 'acute' style of management of PVD often led to unrealistic expectations on the patient's part, which gave rise to the experience of powerlessness. The implications of these findings for the management of patients with PVD are discussed.

Activities of Daily Living↗
PubMed2004

Metabolic inertia in contracting skeletal muscle: a novel approach for pharmacological intervention in peripheral vascular disease.

Peripheral vascular disease (PVD) is generally accepted to result in the failure of skeletal muscle blood flow to increase adequately at the onset of muscular work. There are currently no routine pharmacological interventions towards the treatment of PVD, however, recent Phase III trials in the USA have demonstrated the clinical potential of the phosphodiesterase III inhibitor Cilostazol for pain-free and maximal walking distances in patients with intermittent claudication. PVD is characterized by a marked reliance on oxygen-independent routes of ATP regeneration (phosphocreatine hydrolysis and glycolysis) in skeletal muscle during contraction and the rapid onset of muscular pain and fatigue. The accumulation of metabolic by-products of oxygen-independent ATP production (hydrogen and lactate ions and inorganic phosphate) has long been associated with an inhibition in contractile function in both healthy volunteers and PVD patients. Therefore, any strategy that could reduce the reliance upon ATP re-synthesis from oxygen-independent routes, and increase the contribution of oxygen-dependent (mitochondrial) ATP re-synthesis, particularly at the onset of exercise, might be expected to improve functional capacity and be of considerable therapeutic value. Historically, the increased contribution of oxygen-independent ATP re-synthesis to total ATP generation at the onset of exercise has been attributed to a lag in muscle blood flow limiting oxygen delivery during this period. However, recent evidence suggests that limited inertia is present at the level of oxygen delivery, whilst considerable inertia exists at the level of mitochondrial enzyme activation and substrate supply. In support of this latter hypothesis, we have reported on a number of occasions that activation of the pyruvate dehydrogenase complex, using pharmacological interventions, can markedly reduce the dependence on ATP re-synthesis from oxygen-independent routes at the onset of muscle contraction. This review will focus on these findings and will highlight the pyruvate dehydrogenase complex as a novel therapeutic target towards the treatment of peripheral vascular disease, or any other disease state where premature muscular fatigue is prevalent due to metabolite accumulation.

Acetyl Coenzyme A↗
PubMedDate not supplied

Percutaneous continuous aortic flow augmentation for cardiac recovery in a chronic heart failure patient with peripheral vascular disease.

Peripheral vascular disease is an obstacle to the use of continuous aortic flow augmentation (CAFA). The authors used CAFA in a patient with a 50% stenosis of the left iliac artery. Five hours after initiating therapy, flow rates dropped from 1.47 L/min to 0.2 L/min, possibly due to obstruction around the inflow cannula near the site of the iliac artery stenosis. Flow was stabilized by adequate fluid infusion and successfully restored by slightly withdrawing the tip of the inflow catheter. This finding suggests that peripheral vascular disease is a relative-not an absolute-contraindication for CAFA, but requires close monitoring of flow during CAFA therapy.

Aged↗
PubMed1994

Rationale for the use of antiplatelet drugs in patients with peripheral vascular disease.

Peripheral vascular disease (PVD) is complicated by progression of atherosclerotic disease of lower limbs and by cardiovascular events occurring in cardiac and cerebral area. Antiplatelet treatment seems to be able to retard the atherosclerotic progression of peripheral vessel. This was demonstrated by angiographic studies and by a clinical trial showing that aspirin reduced the need of surgical intervention in PVD patients. Three large clinical trials have been planned to assess the effect of antiplatelet treatment on cardiovascular complications. By intention-to-treat analysis, no study showed a beneficial effect for this treatment. Conversely, by on-treatment analysis, antiplatelet treatment showed a significant reduction of global cardiovascular events. Until now, no study has had the power to assess the effect of antiplatelet treatment on major cardiovascular events. The evaluation of patients at high risk of major events by antiplatelet treatment should be an important issue of future clinical trials.

Arteriosclerosis↗
PubMed2004

Therapeutic angiogenesis for treatment of peripheral vascular disease.

Peripheral vascular disease (PVD) is characterized by compromised circulation to the limbs. Currently, PVD is treated conservatively and the first-line options include therapy with pain medication and "anti-thrombotic" drugs to prevent blood from clotting. Nonsurgical interventions such as angioplasty and thrombolytic therapy provide alternative treatment modalities. However, in the case of severe symptoms and with progressive deterioration, surgical interventions such as bypass surgery, atherectomy and even amputation may be necessary. Despite major advances in these areas, PVD is challenging, and difficult to manage with the current surgical and conservative medical approaches. In some cases, even short-term results in treated patients with advanced stage disease remain unsatisfactory. Indeed, there is a great clinical need for new treatment options that may stimulate collateral blood vessel growth, increase vascularity and improve skeletal muscle function.

Animals↗
PubMed2001

Percutaneous interventions for lower extremity peripheral vascular disease.

Peripheral vascular disease of the lower extremities is an important cause of morbidity that affects up to 10 million people in the United States. The primary care physician can easily identify patients who are at risk for the disease with a questionnaire and a relatively simple test-the ankle brachial index. More than 70 percent of patients diagnosed with the disease remain stable or improve with conservative management. Those who do not improve may undergo contrast angiography or magnetic resonance angiography, which may be used in planning for surgery or percutaneous intervention. Surgical bypass is the gold standard for extensive vascular occlusive disease, but endovascular interventions, including percutaneous transluminal angioplasty and stent placement, are being used more frequently, particularly in patients with significant comorbid conditions.

Angiography↗
PubMed2006

Does nutrition have a role in peripheral vascular disease?

Peripheral vascular disease (PVD) is a manifestation of systemic atherosclerosis in the lower limbs, and PVD patients have a 3- to 5-fold increased risk of cardiovascular mortality compared with age-matched controls. Nevertheless, recent reports show how PVD patients are undertreated with regard to CVD risk-factor reduction and the use of lipid-lowering or antiplatelet drugs. There is appreciable evidence that demonstrates the beneficial effects of certain nutrients and dietary habits in the prevention of CVD, but there has been little attention paid to the role of nutrients in PVD. The purpose of the present review is to provide an overview of our understanding of how foods could possibly benefit PVD. In the last few decades, several nutrients have arisen as potentially health-promoting in PVD. While nutritional interventions in PVD show positive clinical effects for fish oil, carnitine or vitamin E, others such as olive oil or vitamin C seem to interact only at a biochemical level by decreasing risk factors. Moreover, only epidemiological associations exist for the potential role of fibre, folates or vitamin B6 in this disease. In all cases, the limited data available provide no clear-cut evidence in favour of the clinical benefit of nutritional interventions aimed at reducing risk factors and ameliorating symptoms in PVD patients. No practical recommendations can be given at this stage, and further studies are clearly needed.

Antioxidants↗
PubMedDate not supplied

Alterations of thrombogenesis, endothelial damage and oxidative stress with reperfusion during femoral artery bypass surgery for peripheral vascular disease.

Peripheral vascular disease (PVD) is a significant cause of cardiovascular morbidity. We hypothesised that there would be significant alterations of thrombogenesis, platelet activation and endothelial damage, which could be associated with abnormal oxidative stress during femoral artery bypass surgery for PVD, where the femoral artery is cross-clamped (causing acute ischaemia) and reperfused (following revascularisation). To test this hypothesis, we measured sequential changes in von Willebrand factor (vWF, and index of endothelial damage/dysfunction), tissue factor (TF, an index of thrombogenesis) and soluble P-selectin (sP-sel, an index of platelet activation) as well as lipid hydroperoxides (LPO, an index of oxidative stress) in 28 consecutive patients undergoing elective peripheral artery bypass surgery. Mean baseline vWF and sP-sel levels in PVD patients (before clamping) were significantly higher compared with age- and sex-matched controls (unpaired t test, both p < 0.05), but there were no significant differences in TF and LPO levels. There was a correlation between TF and vWF (Spearman's, r = 0.374, p = 0.05), as well as between sP-sel and vWF at the start of surgery (r = 0.467, p = 0.012). The patients undergoing peripheral artery bypass surgery had a mean femoral artery clamp time of 28 min (standard deviation 14 min; range 11-65 min). There were no significant overall changes in sP-sel, vWF, TF and LPO with femoral artery cross-clamping and reperfusion (repeated measures ANOVA, p = NS). In conclusion, we found that during ischaemia-reperfusion during peripheral arterial bypass surgery, thrombogenesis (as measured by plasma TF) and oxidative damage (as measured by LPO) within the affected leg does not increase in the immediate perioperative period. Further studies are required to assess the mechanism(s) of ischaemia-reperfusion injury in PVD, and the contributory role(s) of the endothelium and platelets.

Aged↗
PubMed2005

Evidence-based management of peripheral vascular disease.

Peripheral vascular disease (PVD) is very prevalent in the United States and is part of a global vascular problem. PVD patients have a heightened inflammatory state and are at high risk of death from acute cardiovascular problems rather than from progression of PVD. Modifiable risk factors for PVD include smoking, hypertension, diabetes, hyperlipidemia, elevated high sensitivity C-reactive protein, obesity, and the metabolic syndrome. Symptomatic treatment of claudication includes smoking cessation, exercise, cilostazol, statins, and revascularization with percutaneous or surgical therapy. Antithrombotic therapy with aspirin or clopidogrel is important to reduce cardiovascular events but does not affect symptoms of claudication. Patients with rest limb ischemia or ulceration should be revascularized to minimize the chance of limb loss. Percutaneous revascularization is not without significant complications, however, and future research needs to focus on inflammation, thrombosis, and restenosis in the PVD patient. Finally, new devices that tackle difficult lesions, drug-eluting stents, and pharmacologic agents that reduce global atherosclerosis are on the horizon and are likely to become critical components in the management of the PVD patient.

Angioscopy↗
PubMed1998

Sociology of care in patients with severe peripheral vascular disease.

Peripheral vascular disease (PVD) remains a leading cause of limb amputation, resulting in a significant morbidity and disability. This study was undertaken to evaluate whether earlier referral of the patients with severe limb-threatening PVD to a vascular surgeon could result in a higher limb-salvage rate. Seventy-one consecutive patients, 48 men and 23 women, with mean ages of 67.1 and 70.4 years, respectively, were studied; there were 64 blacks (42 men, 22 women). Risk factors included smoking (39 men, 20 women) and diabetes mellitus (31 men, 11 women). The delay in seeking medical attention in patients with rest pain was 9 to 24 weeks (mean, 14.2), and with nonhealing ulcers the delay was 4 to 20 weeks (mean, 6.7). An additional delay of 11.7 weeks was noted if the patient was seen by a primary-care physician, and only 4 weeks if the patient was seen in the Emergency Department. Ten primary amputations were performed; 61 patients underwent limb-salvaging revascularization procedures, with a success rate of 87 per cent; 8 patients had below-the-knee amputation as a result of failed bypass. Delay in referral of patients with severe PVD can cause an increase in limb loss.

Black or African American↗
PubMed1978

Tuberculosis of the liver presenting as peripheral vascular disease.

Peripheral vascular disease in African males may be associated with a tuberculous infection elsewhere in the body. The case history is described of a patient who presented with gangrenous lesions of both feet and was found to have tuberculosis of the liver. The lesions on the feet healed within 2 months of starting anti-tuberculosis chemotherapy.

Adult↗
PubMed1986

Nursing intervention in patients with peripheral vascular disease.

Peripheral vascular disease is a chronic progressive disease. Nursing intervention will be aimed at primary prevention through risk factor modification. Quality patient care will be facilitated through the development of an individualized plan of care. An essential element to consider in promoting successful nursing intervention is collaboration of the nurse and patient when developing the plan of care. Overall goals of care for a patient with PVD include promotion of circulation, relief of pain, and prevention of tissue damage or infection.

Behavior Therapy↗
PubMed2003

Exercise considerations in coronary artery disease, peripheral vascular disease, and diabetes mellitus.

Physical inactivity is a risk factor for cardiovascular disease. Regular aerobic and resistance training increases exercise capacity and plays a role both in the primary and secondary prevention of cardiovascular disease. Patients with coronary artery disease, peripheral vascular disease, or diabetes mellitus must be considered individually when prescribing exercise because their clinical status can vary greatly. In addition, a majority of these patients have multiple comorbid disorders such as renal, neurologic, and retinal disease that may affect their ability to exercise safely. Therefore, a preparticipation medical evaluation is required. An exercise prescription should be tailored to each person's unique set of circumstances and reflect an effort to maximize the anticipated benefits while minimizing the risks.

Clinical Laboratory Techniques↗
PubMed1998

Epidemiology, risk factors, and management of peripheral vascular disease.

Peripheral vascular occlusive disease is initiated with a genetic risk factor component compounded by patient-controlled contributions including obesity, diabetes, hypertension, and smoking. Medical management of these factors may delay or obviate surgical intervention. Angiography may be used to perform angioplasty (+/- stents) or to guide various interventional procedures. The major contribution to pre- and post-operative assessment is the noninvasive laboratory.

Angioplasty↗
PubMed1975

Peripheral vascular perfusion scanning. Correlation with the arteriogram and clinical assessment in the patient with peripheral vascular disease.

Peripheral vascular perfusion scan during rest and reactive hyperemia does not necessarily offer the same information as the arteriogram or the clinical assessment of the peripheral pulses. The information obtained from the peripheral vascular perfusion scan offers potentially clinically useful information regarding the physiologic significance of various arterial lesions to the surgeon in selection of his therapeutic approach. The peripheral vascular perfusion scan uniquely and under varied physiologic conditions permits assessment of the effect of arterial disease on the distribution of perfusion within the extremity. The peripheral vascular perfusion scan is not in competition with, but is complementary to, arteriography and clinical assessment of the patient with peripheral vascular disease.

Adult↗