Peripheral vascular disease

2021 ◽  
pp. 775-808
Keyword(s):  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Lower Limb ◽  
Varicose Veins ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Peripheral Vascular ◽  
Developmental Abnormalities ◽  
Abdominal Aortic ◽  
Associated Risk Factors

This chapter assesses peripheral vascular disease. It begins with acute limbic ischaemia; chronic upper limb ischaemia; chronic lower limb ischaemia; intermittent claudication; and critical limb ischaemia. The chapter then turns to aneurysms; ruptured abdominal aortic aneurysm; vascular developmental abnormalities; carotid disease; vasospastic disorders; varicose veins; deep venous thrombosis; and thrombolysis. It also considers the diabetic foot and amputations, as well as complications in vascular surgery. Complications may occur in the perioperative, early, or late post-operative periods. In general, vascular patients are older and have increased cardiac, cerebral, pulmonary, and renal comorbidities. This is due to the associated risk factors of hypertension, diabetes mellitus, hypercholesterolaemia, and smoking.

Aortic and peripheral vascular disease

2010 ◽  
pp. 315-326
Author(s):  
Juan Carlos Kaski
Keyword(s):  
Peripheral Arterial Disease ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Arterial Disease ◽  
Aortic Aneurysms ◽  
Lower Limbs ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Peripheral Vascular ◽  
Peripheral Arterial

Peripheral arterial disease 316 Aortic aneurysms 320 Aortic dissection 322 Large-vessel vasculitis 324 Peripheral arterial disease (PAD)—sometimes termed peripheral vascular disease—refers to atherosclerosis, usually of the lower limbs, with obstruction to blood supply. This usually gives rise to intermittent claudication and may progress to critical limb ischaemia characterized by rest pain, ulceration, and gangrene. Symptoms may become acutely worse due to atherothrombosis or acute embolization. PAD is increasingly recognized as a marker of arterial disease in other vascular beds as atherosclerosis is usually widespread....

scholarly journals Stem Cell Therapy for Vascular Disorders

2018 ◽  
Vol 1 (1) ◽  
pp. 17-21
Author(s):  
Emad A Hussein
Keyword(s):  
Stem Cell ◽  
Cell Therapy ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Stem Cell Therapy ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Peripheral Vascular ◽  
Vascular Regeneration ◽  
Collateral Growth

Peripheral vascular disease results from narrowing of the peripheral arteries that supply oxygenated blood and nutrients to the legs and feet. This pathology causes symptoms such as intermittent claudication (pain with walking), painful ischaemic ulcerations, or even limbthreatening gangrene. It is generally believed that the vascular endothelium, a monolayer of endothelial cells (ECs) that lines the luminal surface of all blood and lymphatic vessels, plays a dominant role in vascular homeostasis and vascular regeneration. As a result, stem cell-based regeneration of the endothelium may be a promising approach for the treatment of PAD. Critical limb ischaemia (CLI) is an advanced form of peripheral artery disease which is responsible for about 100,000 amputations each year in the US. Trials to date have reported clinical improvement and reduced need for amputation in patients with CLI who receive autologous bone marrow or mobilised peripheral blood stem cells for stimulation of angiogenesis. There is no effective treatment for lower limb ischaemia caused by peripheral vascular disease and it is necessary to amputate the limb at the end stage. Therefore, the concept of effective therapeutic angiogenesis has become widely accepted during the past few years and it has emerged as a strategy to treat tissue ischaemia by promoting collateral growth using drug, gene or cell therapy. This article provides an overview of current therapeutic challenges for the treatment of critical limb ischaemia, the basic mechanisms of stem cell therapy, the most relevant clinical trials as well as future directions for translational research in this area.

scholarly journals O42: THE ROLE OF TOURNIQUETS IN TRANSTIBIAL AMPUTATION FOR PERIPHERAL VASCULAR DISEASE: A SYSTEMATIC REVIEW & META-ANALYSIS

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
D Cagney ◽  
J Byrne ◽  
GJ Fulton ◽  
BJ Manning ◽  
HP Redmond
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Revision Surgery ◽  
Lower Limb ◽  
Cochrane Library ◽  
Peripheral Vascular ◽  
Operative Blood Loss ◽  
Transfusion Requirements

Abstract Introduction The use of lower limb tourniquets is traditionally discouraged in severe atherosclerotic disease. However, blood loss and increased transfusion requirements are associated with post-operative morbidity in patients undergoing major lower limb amputation. The aim of this systematic review is to summarise and pool the available data to determine the impact of tourniquet application when performing trans-tibial amputation for peripheral vascular disease. Method This systematic review was conducted according to PRISMA guidelines. A systematic search of Medline, Embase and Cochrane Library was undertaken for articles which compared the use of a tourniquet versus no tourniquet in patients undergoing trans-tibial amputation for peripheral vascular disease. The main outcomes included intra-operative blood loss, post-operative transfusion requirement, need for revision surgery and 30-day mortality. Result Four studies met the inclusion criteria for quantitative analysis with a total of 267 patients. A tourniquet was used in 130 patients. Both groups were matched for age, gender, co-morbidities and pre-operative haemoglobin. In patients undergoing trans-tibial amputation, tourniquets were associated with significantly lower intra-operative blood loss (Mean difference= -147.6mls; P=0.03) and lower transfusion requirements (pooled odds ratio (OR), 0.12, p=0.03). The need for stump revision (OR, 0.7; p=0.48), proceeding to transfemoral amputation within 30 days (OR, 0.67; p=0.25) and 30-day mortality (OR, 0.65; p=0.41) all favoured tourniquet use but the differences were not found to be significant. Conclusion Tourniquets can reduce intra-operative blood loss and transfusion requirements in patients undergoing trans-tibial amputation without increasing ischaemic complications and need for revision surgery. Take-home message Tourniquets are safe to use in trans-tibial amputation for severe peripheral vascular disease and can reduce intra-operative blood loss without increasing ischaemic complications.

scholarly journals Prevalence of Peripheral Vascular Disease in Diabetic Foot Infections and its Effect on Management Outcome

2019 ◽  
Vol 38 (1) ◽  
pp. 12-17
Author(s):  
Farah Nobi ◽  
Syed Al Nahian ◽  
Afrin Sultana ◽  
Rokhsana Sarmin ◽  
Ayesha Rahman ◽  
...  
Keyword(s):  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Lower Limb ◽  
Diabetic Foot ◽  
Tertiary Care ◽  
Peripheral Vascular ◽  
Tertiary Care Centre ◽  
Term Care ◽  
Diabetic Foot Infection ◽  
Diabetic Foot Infections

Background: Foot infection is a common problem affecting diabetics. Ischemia is a major factor contributing to progress and morbidity of the disease. The prevalence of peripheral vascular disease is higher in diabetics with faster progression. Aim: This study aimed to observe the prevalence of peripheral vascular disease in patients with diabetic foot infections presenting to this tertiary care centre. Methods: This prospective observational study evaluated 250 patients with diabetic foot infection admitted to Ibrahim Medical College and BIRDEM General Hospital, Dhaka, from 1st January 2015 to 31st December 2015.Total 72 patients were selected for Duplex study of lower limb vessels, Ankle Brachial Pressure Index (ABPI) and Pulse oxymetrywhich established the diagnosis of peripheral vascular disease and all patients were treated according to the standard protocol. Results: Of the 72 patients peripheral vascular disease was found in 25 patients (34.7%) and majority of them (88%) had distal below the knee vessel stenosis. There was significant correlation with older age (75%) and history of tobacco use (64%). The clinical presentations and outcomes such as hospital stay, healing time, pain were worse in individuals with peripheral vascular compromise on Duplex study of lower limb vessels, ABPI and pulse oxymetry. Conclusion: In this study we observed that significant number of diabetics presenting with foot infections have underlying peripheral vascular disease .The patients might not all be symptomatic or show obvious signs of PVD but need to be investigated for the same. Early detection of peripheral vascular disease in patients presenting with diabetic foot infection, using Duplex study,ABPI and Pulse oxymetrywith routine clinical and laboratory assessment can be of great value in long term care of these individuals. J Bangladesh Coll Phys Surg 2020; 38(1): 12-17

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