Impact of Muscular Arteries State on the Results of Surgical Treatment of Lower Limb Obliterating Atherosclerosis

The failure of surgical treatment of obliterating atherosclerosis of the lower extremities may be associated with underestimation of changes in local hemodynamics, particularly in arterial hypertension.The objective of the research was to study the state of small muscular arteries in patients with arterial hypertension and its impact on the course of obliterating atherosclerosis and the results of surgical treatment.Materials and methods. There were examined 281 patients with obliterating atherosclerosis and 32 patients with arterial hypertension. Patients with obliterating atherosclerosis received presumptive treatment: an intravenous infusion of 4.2 g of L-arginine, forceful intra-arterial injection of 20-80 ml of infusate (heparin, pentoxifylline, procaine), femoral and gluteal nerve block. Results. Among hypertensive patients without obliterating atherosclerosis 13 persons had paraesthesia, feeling of coldness in the feet, platypodia, hypomyotonia, slow (63.7±1.3 sec) reactive hyperemia, arterial stenosis (40-45%), and low-amplitude or nonpulsative local blood flow. Among 97 patients with stable course of obliterating atherosclerosis 49 (50.5%) persons were diagnosed with uncomplicated arterial hypertension. Most of patients (80.3%) had single level occlusions of the iliac-femoral or femoral-popliteal segment. Presumptive treatment was effective in 87.1% of cases, reactive hyperemia was rapid (26.2±0.4 sec), local blood flow was pulsative. Arterial reconstruction with limb preservation for more than 1 year was performed in 12 (12.4%) cases. Among 184 patients with progressive course of obliterating atherosclerosis 162 (88.0%) persons were diagnosed with complicated arterial hypertension. Most of patients (83.7%) had multilevel lesions with diffuse stenosis or occlusions of the tibial arteries. Presumptive treatment was effective in 9.5% cases, reactive hyperemia was slow (106.3±2.7 sec), local blood flow was nonpulsative. Within 2 months 83 patients underwent above-knee amputation. Arterial reconstruction with limb preservation for more than 1 year was performed in 17 cases. Patients with arterial hypertension and obliterating atherosclerosis developed sclerosis of muscular arteries, intimal hyperplasia.Conclusions. Arterial hypertension causes lesions of small muscular arteries of the lower limbs. Hypertensive arteriopathy initiates the ascending development of obliterating atherosclerosis, causes hypertensive foot syndrome and unsatisfactory results of arterial reconstructions.

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Renal artery aneurysms

Atherothrombosis Journal ◽

10.21518/2307-1109-2021-11-1-164-174 ◽

2021 ◽

pp. 164-174

Author(s):

A. E. Zotikov ◽

Z. A. Adyrkhaev ◽

A. M. Solovyova

Keyword(s):

Blood Flow ◽

Surgical Treatment ◽

Arterial Hypertension ◽

Renal Artery ◽

Renal Blood Flow ◽

Antihypertensive Drugs ◽

Renal Parenchyma ◽

Artery Dissection ◽

Childbearing Age ◽

Ehlers Danlos Syndrome

Renal artery aneurysms are a rare condition and are usually found when other abdominal organ diseases are being searched. Among the causes of renal artery aneurysms, atherosclerosis and fibromuscular dysplasia predominate. However, they can also be observed in congenital Ehlers-Danlos syndrome, neurofibromatosis, arteritis, and due to traumatic effects. Most patients have an asymptomatic course of the disease. Literature data suggest slow growth of aneurysms, and their progression is associated with arterial hypertension, absence of wall calcification and pregnancy in young women. The aim of surgical treatment is to prevent aneurysm rupture, eliminate the risk of renal parenchyma embolism and correct arterial hypertension. Most authors believe that surgical treatment is indicated for asymptomatic course of the disease when the aneurysm is over 20 mm in diameter, aneurysm growth is over 5 mm within a year, arterial hypertension resistant to drug therapy, renal artery dissection and aneurysm presence in women of childbearing age. There are a number of surgical and endovascular techniques to restore renal blood flow. Both open and endovascular interventions are used for renal artery trunk surgery. For aneurysms of the renal artery branches, aortorenal shunting by autovenous or internal iliac artery as well as extracorporeal surgeries are more often used. The use of endografts is most appropriate for localization of aneurysms in the renal artery trunk, while embolization with microspirals and glue is most effective for saccular aneurysms. The embolization technique can cause embolization of the renal parenchyma itself as a potential complication, which aggravates arterial hypertension. The authors present the literature and their own data on various techniques to restore the renal blood flow. Up to 80-90% of the operated kidneys can be saved in the long term. Reconstructive surgery reduces the level of arterial pressure and reduces the number of antihypertensive drugs used and the need for renal replacement therapy.

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Changes in Blood Flow and Vascular Volume in Skeletal Muscle during Reactive Hyperemia with Free Flow or with Artificial Arterial Stenosis

Scandinavian Journal of Clinical and Laboratory Investigation ◽

10.3109/00365516909077012 ◽

1969 ◽

Vol 23 (2) ◽

pp. 109-114 ◽

Cited By ~ 5

Author(s):

G. Stören ◽

S. Akre

Keyword(s):

Skeletal Muscle ◽

Blood Flow ◽

Reactive Hyperemia ◽

Free Flow ◽

Arterial Stenosis ◽

Vascular Volume

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Local Regulation of Blood Flow and the Occurrence of Edema after Arterial Reconstruction of the Lower Limbs

Annals of Surgery ◽

10.1097/00000658-198204000-00015 ◽

1982 ◽

Vol 195 (4) ◽

pp. 474-478 ◽

Cited By ~ 38

Author(s):

J. H. EICKHOFF ◽

H. C. ENGELL

Keyword(s):

Blood Flow ◽

Lower Limbs ◽

Arterial Reconstruction ◽

Local Regulation

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A case of successful surgical treatment of patient with rare vascular anomaly – hypoplasia of infrarenal abdominal aorta

I P Pavlov Russian Medical Biological Herald ◽

10.23888/pavlovj2020284506-513 ◽

2020 ◽

Vol 28 (4) ◽

pp. 506-513

Author(s):

Alexander F. Kharazov ◽

V. A. Kul'bak ◽

Naida Minatullaevna Basirova

Keyword(s):

Surgical Treatment ◽

Arterial Pressure ◽

Arterial Hypertension ◽

Abdominal Aorta ◽

Clinical Manifestations ◽

Vascular Anomaly ◽

The Body ◽

Lower Limbs ◽

Critical Ischemia ◽

Infrarenal Abdominal Aorta

Aim. To demonstrate a case of treatment of a patient with a rare vascular anomaly hypoplasia of infrarenal abdominal aorta. On a clinical example of female patient U., 41 years of age, with critical ischemia of the lower limbs and diagnosis hypoplasia of the abdominal aorta made on the basis of the clinical and instrumental data, the manifestations, diagnostics and potentials of the successful surgical treatment of the given pathology were demonstrated. Conclusion. Clinical manifestations of hypoplasia of the aorta depend on localization of the lesion and involvement of renal arteries. The commonest clinical sign is arterial hypertension and symptoms associated with the elevated arterial pressure. Hypoplasia of the aorta may also be manifested by hypertrophy of the upper limbs in combination with poor development of muscles of the lower limbs. More aged individuals present with arterial insufficiency leading to clinically significant ischemia of the lower limbs. Thus, in the case described, the patient already had ischemic trophic ulcers of the lower limbs. Without treatment, secondary arterial hypertension and cardiac failure may lead a patient to early death. Today, irrespective of the etiology, the only effective method of treatment of this disease is surgery. In case of our patient, resection of the hypoplastic segment of the aorta and its prosthetics were performed. This permitted to restore circulation in the lower parts of the body and further led to complete healing of trophic ulcers of the shin and to normalization of the systemic arterial pressure.

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Peculiarities of the reaction of the lower limbs venous blood flow to the orthostatic test in men with arterial hypertension

Medical Council ◽

10.21518/2079-701x-2019-5-86-89 ◽

2019 ◽

pp. 86-89

Author(s):

T. F. Vagapov ◽

V. M. Baev ◽

S. V. Letyagina

Keyword(s):

Blood Flow ◽

Arterial Hypertension ◽

Flow Rate ◽

Femoral Vein ◽

Venous Blood ◽

Test Group ◽

Blood Flow Rate ◽

Lower Limbs ◽

Control Group ◽

Venous Blood Flow

A comparative analysis of the dynamics of lower limb vein angioscopy parameters in case of orthostasis between male patients (age 30–50 years) with arterial hypertension (test group – 60 people) and normal arterial pressure (control group – 27 people) was made. Orthostatic sample in all examined patients was characterized by a reliable increase in the diameter and area of vein section at a decrease in blood flow rate. However, in patients with hypertension the increase in the area of vein section was significantly less than in the control group. In orthostasis, the drop in blood flow rate in the total femoral vein was lower in men with hypertension than in men in the control group. In the great saphenous vein, a larger decrease in blood flow velocity was recorded than in the control group. In hypertension, no increase in the number of refluxes was recorded in orthostasis. Thus, hypertension in men is characterized by altered reaction of venous blood flow to orthostasis in both deep and saphenous veins.

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Influence of operative treatment of variсocele on the development of arterial hypertension

Urologicheskie vedomosti ◽

10.17816/uroved9425-30 ◽

2020 ◽

Vol 9 (4) ◽

pp. 25-30

Author(s):

Valentin N. Krupin ◽

Mihail N. Uezdnyj ◽

Polina I. Petrova

Keyword(s):

Blood Flow ◽

Surgical Treatment ◽

Arterial Hypertension ◽

Spermatic Cord ◽

Varicose Veins ◽

Venous Hypertension ◽

Compensatory Process ◽

Flow Through ◽

Renal Venous Hypertension ◽

The Relationship

Purpose of the research. To assess the incidence of arterial hypertension in men with varicocele and to identify the relationship between increased blood pressure and surgical treatment of varicocele. Material and methods. A survey of 412 men receiving treatment for arterial hypertension, 482 men previously operated on for varicocele and 68 patients with varicocele who had no surgical treatment was conducted. Results. Varicose veins of the spermatic cord in patients with arterial hypertension were detected in 44.6% of cases, which exceeds the incidence of varicocele occurrence in men of a comparable age category by 1.52 times. Surgical treatment of the left spermatic cord varicocele is combined with the development of arterial hypertension in 51.2% of patients, which is three times higher than the incidence of hypertension in men who didnt undergo surgical treatment for varicocele and twice the frequency of hypertension in the general population of men of comparable age. The more frequent occurrence of renal arterial hypertension in patients who underwent surgical treatment for varicocele may indicate an adverse effect of occlusion of the internal spermatic vein on the state of renal venous hemodynamics. Conclusion. Varicocele should be considered as a compensatory process for renal venous hypertension due to obstruction of blood flow through the renal vein, and elimination of compensatory blood flow can lead to renal venous hypertension, hypoxia and the development of arterial hypertension.

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Ventilatory threshold is related to walking tolerance in patients with intermittent claudication

VASA ◽

10.1024/0301-1526/a000203 ◽

2012 ◽

Vol 41 (4) ◽

pp. 275-281 ◽

Cited By ~ 3

Author(s):

da Rocha Chehuen ◽

G. Cucato ◽

P. dos Anjos Souza Barbosa ◽

A. R. Costa ◽

M. Ritti-Dias ◽

...

Keyword(s):

Blood Flow ◽

Oxygen Uptake ◽

Intermittent Claudication ◽

Lower Limb ◽

Ventilatory Threshold ◽

Reactive Hyperemia ◽

Ankle Brachial Index ◽

Metabolic Parameters ◽

Walking Distance ◽

The Relationship

Background: This study assessed the relationship between lower limb hemodynamics and metabolic parameters with walking tolerance in patients with intermittent claudication (IC). Patients and methods: Resting ankle-brachial index (ABI), baseline blood flow (BF), BF response to reactive hyperemia (BFRH), oxygen uptake (VO2), initial claudication distance (ICD) and total walking distance (TWD) were measured in 28 IC patients. Pearson and Spearman correlations were calculated. Results: ABI, baseline BF and BF response to RH did not correlate with ICD or TWD. VO2 at first ventilatory threshold and VO2peak were significantly and positively correlated with ICD (r = 0.41 and 0.54, respectively) and TWD (r = 0.65 and 0.71, respectively). Conclusions: VO2peak and VO2 at first ventilatory threshold, but not ABI, baseline BF and BFHR were associated with walking tolerance in IC patients. These results suggest that VO2 at first ventilatory threshold may be useful to evaluate walking tolerance and improvements in IC patients.

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THE POSSIBILITIES OF ENDOVENOUS LASER OBLITERATION IN THE IMPLEMENTATION OF THE HEMODYNAMIC PROGRAM OF SURGICAL TREATMENT OF LOWER LIMBS VARICOSE DISEASE

The Journal of scientific articles Health and Education millennium ◽

10.26787/nydha-2226-7425-2018-20-1-134-138 ◽

2018 ◽

Vol 20 (1) ◽

pp. 134-138

Author(s):

M.P. Potapov ◽

Keyword(s):

Surgical Treatment ◽

Lower Limbs ◽

Varicose Disease

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Using reactive hyperemia to investigate the effect of cupping sizes of cupping therapy on skin blood flow responses

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-200120 ◽

2021 ◽

pp. 1-7

Author(s):

Xiangfeng He ◽

Xueyan Zhang ◽

Fuyuan Liao ◽

Li He ◽

Xin Xu ◽

...

Keyword(s):

Blood Flow ◽

Laser Doppler Flowmetry ◽

Skin Blood Flow ◽

Repeated Measures ◽

Recovery Time ◽

Reactive Hyperemia ◽

Cupping Therapy ◽

Doppler Flowmetry ◽

Healthy Participants ◽

Hyperemic Response

BACKGROUND: Various cupping sizes of cupping therapy have been used in managing musculoskeletal conditions; however, the effect of cupping sizes on skin blood flow (SBF) responses is largely unknown. OBJECTIVE: The objective of this study was to compare the effect of three cupping sizes of cupping therapy on SBF responses. METHODS: Laser Doppler flowmetry (LDF) was used to measure SBF on the triceps in 12 healthy participants in this repeated measures study. Three cup sizes (35, 40 and 45 mm in diameter) were blinded to the participants and were tested at -300 mmHg for 5 minutes. Reactive hyperemic response to cupping therapy was expressed as a ratio of baseline SBF. RESULTS: All three sizes of cupping cups resulted in a significant increase in peak SBF (p< 0.001). Peak SBF of the 45 mm cup (9.41 ± 1.32 times) was significantly higher than the 35 mm cup (5.62 ± 1.42 times, p< 0.05). Total SBF of the 45 mm cup ((24.33 ± 8.72) × 103 times) was significantly higher than the 35 mm cup ((8.05 ± 1.63) × 103 times, p< 0.05). Recovery time of the 45 mm cup (287.46 ± 39.54 seconds) was significantly longer than the 35 mm cup (180.12 ± 1.42 seconds, p< 0.05). CONCLUSIONS: Our results show that all three cup sizes can significantly increase SBF. The 45 mm cup is more effective in increasing SBF compared to the 35 mm cup.

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