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European Journal of Pediatrics Oct 2010Limbs ischaemia represents a rare event during the neonatal period. The present paper reports an unusual case of precocious arm ischemia that occurred immediately after...
INTRODUCTION
Limbs ischaemia represents a rare event during the neonatal period. The present paper reports an unusual case of precocious arm ischemia that occurred immediately after birth and successfully treated with a peripheral nerve blockade.
CONCLUSIONS
Peripheral nerve blockade resulted in an effective and safe therapeutic approach able to allow the salvaging of the limbs.
Topics: Amides; Anesthetics, Local; Arm; Birth Injuries; Humans; Infant, Newborn; Ischemia; Nerve Block; Ropivacaine; Ultrasonography
PubMed: 20339869
DOI: 10.1007/s00431-010-1182-y -
Journal of Vascular Surgery Mar 2020Chronic limb-threatening ischemia (CLTI) represents the most severe form of peripheral artery disease and has a large impact on quality of life, morbidity, and...
BACKGROUND
Chronic limb-threatening ischemia (CLTI) represents the most severe form of peripheral artery disease and has a large impact on quality of life, morbidity, and mortality. Interventions are aimed at improving tissue perfusion and averting amputation and secondary cardiovascular complications with an optimal risk-benefit ratio. Several prediction models regarding postprocedural outcomes in CLTI patients have been developed on the basis of randomized controlled trials to improve clinical decision-making. We aimed to determine model performance in predicting clinical outcomes in selected CLTI cohorts.
METHODS
This study validated the Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL), Finland National Vascular registry (FINNVASC), and Prevention of Infrainguinal Vein Graft Failure (PREVENT III) models in data sets from a peripheral artery disease registry study (Athero-Express) and two randomized controlled trials of CLTI in The Netherlands, Rejuvenating Endothelial Progenitor Cells via Transcutaneous Intra-arterial Supplementation (JUVENTAS) and Percutaneous Transluminal Angioplasty and Drug-eluting Stents for Infrapopliteal Lesions in Critical Limb Ischemia (PADI). Receiver operating characteristic (ROC) curve analysis was used to calculate their predictive capacity. The primary outcome was amputation-free survival (AFS); secondary outcomes were all-cause mortality and amputation at 12 months after intervention.
RESULTS
The BASIL and PREVENT III models showed predictive values regarding postintervention mortality in the JUVENTAS cohort with an area under the ROC curve (AUC) of 81% and 70%, respectively. Prediction of AFS was poor to fair (AUC, 0.60-0.71) for all models in each population, with the highest predictive value of 71% for the BASIL model in the JUVENTAS population. The FINNVASC model showed the highest predictive value regarding amputation risk in the PADI population with AUC of 78% at 12 months.
CONCLUSIONS
In general, all models performed poor to fair in predicting mortality and amputation. Because the BASIL model performed best in predicting AFS, we propose use of the BASIL model to aid in the clinical decision-making process in CLTI. However, improvements in performance have to be made for any of these models to be of real additional value in clinical practice.
Topics: Aged; Amputation, Surgical; Decision Making; Female; Humans; Ischemia; Male; Peripheral Arterial Disease; Predictive Value of Tests; Randomized Controlled Trials as Topic; Registries; Research Design; Retrospective Studies; Survival Analysis; Vascular Surgical Procedures
PubMed: 31564582
DOI: 10.1016/j.jvs.2019.06.195 -
World Journal of Urology May 2002Epidemiological reports have demonstrated the determinant role that age plays in the pathophysiological mechanism of an erection. The atherosclerosis of the penis and... (Review)
Review
Epidemiological reports have demonstrated the determinant role that age plays in the pathophysiological mechanism of an erection. The atherosclerosis of the penis and its ischaemia that occurs with ageing impacts directly on the intracavernous structures and the erectile physiologic function. The effects of testosterone on libido and sexual behaviour are well established but its function in the erectile mechanism remains unclear. In the animals, testosterone deficiency seems to provoke a decrease in smooth muscle content and nitric oxide (NO) production. In human, testosterone seems to affect the central system rather than the peripheral mechanism of an erection. The role of ischaemia and the decrease in testosterone in the mechanism of erectile dysfunction are reviewed.
Topics: Aging; Humans; Ischemia; Male; Penile Erection; Penis; Testosterone
PubMed: 12088187
DOI: 10.1007/s00345-002-0256-5 -
European Journal of Vascular Surgery Mar 1992A randomised placebo-controlled trial was conducted to investigate the effect of iloprost, a stable prostacyclin mimetic, on peripheral resistance during femoro-distal... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
A randomised placebo-controlled trial was conducted to investigate the effect of iloprost, a stable prostacyclin mimetic, on peripheral resistance during femoro-distal bypass. Patients undergoing femoro-distal long saphenous vein bypass for critical ischaemia received 3000 ng of iloprost or placebo infused into the graft via an unligated side branch over 2 min. Graft blood flow and peripheral resistance were measured for 20 min, using an operative Doppler flowmeter (OpDop 130, SciMed, U.K.) and a pressure transducer to record graft pressure. Postoperatively, graft blood flow was assessed by daily duplex ultrasound for 7 days. Iloprost produced an immediate drop in peripheral resistance in all cases (n = 18) by a mean (range) of 40% (4-80%) compared with controls (n = 15) in whom there was a 5.3% (-8 to +36%) increase in resistance (p less than 0.01, Wilcoxon test). Decreased peripheral resistance in iloprost-treated patients persisted to 20 min. The largest decreases in peripheral resistance occurred in patients with the highest initial resistances (r = 0.56, p less than 0.02). Graft flow during the same period increased by 52% (-7 to 294%) compared with controls in whom there was a 6% (-17 to 26%) increase in flow, (p less than 0.01). Flow remained elevated by 53% over baseline values at 1 week post-infusion in the iloprost-treated group but this did not achieve statistical significance compared to controls in whom flow also increased by 13%. Iloprost produces an immediate decrease in peripheral resistance associated with a prolonged increase in graft blood flow. This may reduce graft failure in the early postoperative period.
Topics: Aged; Anastomosis, Surgical; Drug Administration Schedule; Female; Femoral Artery; Humans; Iloprost; Intraoperative Period; Ischemia; Leg; Male; Middle Aged; Vascular Resistance
PubMed: 1374040
DOI: 10.1016/s0950-821x(05)80240-3 -
Nursing Oct 2008Find out how to halt this progression of peripheral arterial disease before it jeopardizes life and limb.
Find out how to halt this progression of peripheral arterial disease before it jeopardizes life and limb.
Topics: Education, Nursing, Continuing; Extremities; Humans; Ischemia
PubMed: 18813004
DOI: 10.1097/01.NURSE.0000337237.72205.8a -
La Radiologia Medica Feb 2013Malperfusion syndrome is a complication of aortic dissection caused by branch-vessel involvement and resulting in end-organ ischaemic dysfunction. Clinical diagnosis is... (Review)
Review
Malperfusion syndrome is a complication of aortic dissection caused by branch-vessel involvement and resulting in end-organ ischaemic dysfunction. Clinical diagnosis is mandatory, and imaging plays a critical role in confirmation and treatment planning. Radiologists must focus on detecting complications (findings of aortic dilation, rupture, organ ischaemia, etc.) and defining vascular compromise and associated malperfusion mechanisms. All these factors guide the multidisciplinary discussion concerning patient management and the suitability of endovascular treatment. Application of dedicated imaging protocols is mandatory in order to answer clinical and anatomical questions. Endovascular therapy has taken a predominant role in the therapeutic management of malperfusion syndrome with aortic fenestration, peripheral stenting and stent-grafting, all of which are procedures within the domain of expertise of current interventional radiologists. The purpose of this editorial is to present a when, what and how-to guide for all radiologists who encounter complicated aortic dissection.
Topics: Aortic Dissection; Angiography; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Cardiac-Gated Imaging Techniques; Contrast Media; Humans; Ischemia; Syndrome; Tomography, X-Ray Computed
PubMed: 22466875
DOI: 10.1007/s11547-012-0815-9 -
European Journal of Vascular and... Jul 2009This article aims to provide the reader with an insight into the diagnosis and management of limb ischaemia presenting in neonates and infants by examining the published... (Review)
Review
AIM
This article aims to provide the reader with an insight into the diagnosis and management of limb ischaemia presenting in neonates and infants by examining the published literature.
MATERIALS AND METHODS
A Pubmed search and an Ovid Medline/Embase search were both performed. The keywords were: 'neonatal' or 'paediatric' or 'pediatric' and 'limb' and 'ischemia' or 'ischaemia' and relevant articles were retrieved and analysed. Articles pertaining to children over the age of 3 years and non-English literature articles were excluded.
Topics: Catheterization, Peripheral; Female; Fetal Diseases; Fibrinolytic Agents; Hand; Humans; Incidence; Infant, Newborn; Ischemia; Leg; Pregnancy; Thrombectomy; Thrombolytic Therapy; Treatment Outcome; Ultrasonography, Doppler; Ultrasonography, Prenatal; United Kingdom
PubMed: 19362027
DOI: 10.1016/j.ejvs.2009.03.010 -
Scandinavian Journal of Surgery : SJS :... 2012
Topics: Diabetic Foot; Finland; History, 20th Century; History, 21st Century; Humans; Ischemia; Leg; Peripheral Vascular Diseases; Specialties, Surgical; Vascular Surgical Procedures
PubMed: 22623438
DOI: 10.1177/145749691210100201 -
European Journal of Vascular and... Jun 2000
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BMJ Supportive & Palliative Care Jan 2024
Topics: Humans; Pain Management; Chronic Limb-Threatening Ischemia; Peripheral Arterial Disease; Extremities; Treatment Outcome; Ischemia
PubMed: 36347568
DOI: 10.1136/spcare-2022-004046