BACKGROUND: A non-randomized, uncontrolled study was undertaken with a retrospective medical record review to evaluate the effect of pain relief of chemical lumbar sympathectomy in patients with peripheral vascular occlusive disease. This was conducted to assess whether the long term outcome of ischemic limbs could be changed and to identify predictable medical factors of patients who would be helped by this procedure. METHODS: A total of 47 patients with Buerger's disease (n = 20) and arteriosclerosis obliterans (n = 17) referred by vascular surgery for the management of ischemic pain were enrolled. All other conservative and surgical management efforts had already failed and were not indicated. The following were evaluated before and after the neurolytic lumbar sympathetic blocks: the stages of disease by Fontaine classification, main sites and numbers of occlusion, pain scores before and after the procedure, physical findings, amputation sites, and medications as well as amounts given and other risk factors. RESULTS: Buerger's disease tends to progress rapidly and aggressively. It is more painful than arteriosclerosis obliterans and is peripherally involved, with higher incidences of complications. Chemical sympathectomy has significant pain relief effects in both groups. Differences in long term outcome measured by amputation could not be found in both groups. No significant risk factors could be identified. No side effects were reported in both groups. CONCLUSIONS: Chemical lumbar sympathectomy has a good analgesic effect for pain in walking. This, however showed no long-term limb-saving effect.
Amputation ; Arterial Occlusive Diseases* ; Arteriosclerosis Obliterans* ; Arteriosclerosis* ; Classification ; Extremities ; Humans ; Incidence ; Medical Records ; Retrospective Studies ; Risk Factors ; Sympathectomy ; Sympathectomy, Chemical ; Thromboangiitis Obliterans* ; Walking

Most of the peripheral arterial occlusive disease are known to develop in old age group and the most cases are atherosclerosis. Even Buerger's disease, Behcet's disease and Takayasu's disease, which occur relatively in younger age group than artherosclerotic arterial occlusive disease are very rare under the age of 20. Recently, we had experienced 2 cases of peripheral arterial occlusive disease in 18-year-old and 16-year-old young men. One case is diagnosed as Behcet's vasculitis involving iliac and popliteal artery and the other is seemed to be Buerger's disease involving distal femoral, posterior tibial and peroneal artery. Here, we report 2 cases with good results, which were treated with aggressive bypass surgery with review of the literature.
Adolescent ; Arterial Occlusive Diseases ; Arteries ; Atherosclerosis ; Humans ; Male ; Popliteal Artery ; Thromboangiitis Obliterans ; Vasculitis ; Young Adult

Buerger's disease is also known as thromboangiitis obliterans, and it is a nonatherosclerotic, segmental, inflammatory, vasoocclusive disease that affects the small- and medium-sized arteries and veins of the upper and lower extremities. It is classified in the miscellaneous category of vasculitis. Although Buerger's disease has a worldwide distribution, it is now considered to be more prevalent in the Middle East, Near East and Far East than in North America and Western Europe. Even though there are some differences between the diagnostic criteria, the commonalities are an earlier onset of distal ischemic symptoms; a smoking history; infra-popliteal or brachial arterial occlusive lesions; either upper extremity involvement or phlebitis migrans; the absence of atherosclerotic risk factors or other distinct arterial occlusive diseases. Although smoking, genetic predisposition, hypercoagulability, endothelial dysfunction and autoimmune mechanisms have been proposed as the etiologic factors of Buerger's disease, there is no single etiologic mechanism present in all the patients with the disease. However, it seems that the condition is strongly associated with heavy smoking and the progression of the disease is also closely linked to continue smoking. The marked cellular proliferation and inflammatory infiltrate in the thrombus is considered as a pathologic hallmark of the disease. The clinical presentations of Buerger's disease range from intermittent claudication to ischemic ulcer. Small finger or toe tip ulcers, superficial thrombophlebitis, Raynaud's phenomenon, sensory findings and an abnormal Allen's test are relatively unique signs and symptoms. It seems that the degree of dependent rubor or migrating thrombophlebitis is an easily recognizable sign that represents aggravation or alleviation of the disease activity. The typical "corkscrew collaterals" are well visualized at the late stage of Buerger's disease. Although various therapies are now available, the only cornerstone therapy is complete cessation of cigarette smoking or the use of tobacco in any form. Because the natural course of life and limb is favorable in many patients with Buerger's disease, any harmful interventional treatments have to be avoided.
Arterial Occlusive Diseases ; Arteries ; Cell Proliferation ; Europe ; Extremities ; Far East ; Fingers ; Genetic Predisposition to Disease ; Humans ; Intermittent Claudication ; Lower Extremity ; Middle East ; North America ; Phlebitis ; Risk Factors ; Smoke ; Smoking ; Thromboangiitis Obliterans* ; Thrombophilia ; Thrombophlebitis ; Thrombosis ; Tobacco ; Toes ; Ulcer ; Upper Extremity ; Vasculitis ; Veins

BACKGROUND AND OBJECTIVES: Half of patients with critical limb ischemia (CLI) are ineligible for revascularization at diagnosis. The aim of this study was to assess the safety and feasibility of intramuscular human umbilical cord blood-derived mesenchymal stem cell (hUCB-MSC) therapy in patients with CLI due to atherosclerosis obliterans (ASO) or thromboangiitis obliterans (TAO). METHODS AND RESULTS: A total of eight patients (all male, median age 52 years, range 31~77) with CLI were enrolled in this phase I trial. All patients were considered ineligible for further revascularization to improve CLI. We injected 1x10(7) hUCB-MSCs per single dose intramuscularly into the affected limb. The primary end points of safety were occurrence of adverse events (procedure-related complication, allergic reaction to hUCB-MSCs, graft-versus-host disease, cardiovascular and cerebrovascular events) and improvement of symptoms/clinical parameters (healing of foot ulcer, ankle-brachial index, and pain-free walking distance). Angiogenesis was measured with conventional angiography and scored by an independent reviewer. There were four adverse events in three patients. One patient, developed whole body urticaria after injection on treatment day, which disappeared after one day of antihistamine treatment. The other adverse events included diarrhea, oral ulceration, and elevation of serum creatinine level; all conditions improved without treatment. Abnormal results of laboratory parameters were not detected in any patients. Three of four ulcerations (75%) healed completely. Angiographic scores increased in three of eight patients. CONCLUSIONS: This phase I study demonstrates that intramuscular hUCB-MSC injection is a safe and well tolerated treatment for patients with end-stage CLI due to ASO and TAO.
Angiography ; Ankle Brachial Index ; Arterial Occlusive Diseases ; Atherosclerosis ; Creatinine ; Diarrhea ; Extremities ; Fetal Blood ; Foot Ulcer ; Graft vs Host Disease ; Humans ; Hypersensitivity ; Ischemia ; Male ; Mesenchymal Stromal Cells ; Oral Ulcer ; Oxalates ; Stem Cells ; Thromboangiitis Obliterans ; Troleandomycin ; Ulcer ; Umbilical Cord ; Urticaria ; Walking

PURPOSE: Bypasses to the infra-inguinal arteries using autologous vein are now routinely used for limb salvage and as this technique has evolved, the distal limits of revascularization have been extended to near the ankle or in the foot. As the prevelances of chronic renal failure, diabetes and Buerger's disease increased, the more infrapopliteal arterial occlusions were detected. But the safety and effect of pedal bypass was not reported so much in our society. So we studied our cases of ankle bypass to find out its effect on preventing from primary amputation in infrapopliteal arterial occlusive diseases. METHOD: From July 2000 to December 2000, 12 cases of ankle bypasses were performed and followed most of them up to May 2001. The underlying diseases included 6 cases of atherosclerosis obliterance and 6 cases of Buerger's disease. Surgical indications were 9 minor toe gangrene, 2 major gangrene and 1 intractable resting pain. The surgical procedures were 3 popliteo-distal bypasses, 3 popliteo-distal bypasses after femoral thrombectomy, 2 above knee popliteo-below knee popliteo-distal sequential bypasses, 2 combined bypasses of femoro-above knee popliteal bypass and below knee popliteo-distal bypass, and 2 femoro-above knee popliteo-below knee popliteo-distal sequential bypasses. The distal bypass sites were 8 posterior tibial artery (PTA) near medial malleolous, 2 dorsalis pedis (DP) and 2 PTA-DP sequentially. RESULT: There were 2 cases of early occlusion from graft thrombosis and 1 case of late occlusion from inflow embolism. These 3 cases were revised and rebypassed. There was one case of amputation due to deep metatarsal infection. One patient with atherosclerosis died of acute myocardial infarction a month after bypass operation. One patient who underwent bilateral bypass was lost to follow up. The others showed patent graft unil may 2001. 3 patients underwent toe amputation but they didn't have any problem in bipedal ambulation. CONCLUSION: Ankle bypass is safe and promising procedure in infrainguinal arterial occlusive disease.
Amputation ; Ankle ; Arterial Occlusive Diseases ; Arteries ; Atherosclerosis ; Embolism ; Foot ; Gangrene ; Humans ; Kidney Failure, Chronic ; Knee ; Limb Salvage ; Lost to Follow-Up ; Metatarsal Bones ; Myocardial Infarction ; Thrombectomy ; Thromboangiitis Obliterans ; Thrombosis ; Tibial Arteries ; Toes ; Transplants ; Veins ; Walking

Refinements in surgical technique have resulted in significant improvement in the patency rates of infrapopliteal artery revascularizations, but the cumulative patency rate were still low. Possibly the principle cause for the late graft failure was the constricting scar formation around the distal anastomosis following surgical injury. Thus we adopted a nondissection method, using pneumatic tourniquet occlusion technique, to simplify the procedure of distal anastomosis and to lessen the surgical injury. Six patients underwent infrapopliteal artery revascularizations with this method. Three of them were diagnosed with arteriosclerosis obliterans and the others with thromboangiitis obliterans. Tourniquet pressures of 350 mmHg were applied from 32 to 60 minutes. All patients were given systemic anticoagulants. The distal anastomoses were performed to peroneal artery in three cases, posterior tibial artery in two, and anterior tibial artery in one. Hemostasis was adequate in all cases and no alternative occlusive devices were required. There were no complications attributable to the use of the pneumatic tourniquet. Therefore we suggest that tourniquet occlusion technique may simplify the infrapopliteal artery revascularization and minimize surgical injury at the distal anastomosis contributed to the long-term patency of the distal bypass.
Anticoagulants ; Arteries* ; Arteriosclerosis Obliterans ; Cicatrix ; Hemostasis ; Humans ; Intraoperative Complications ; Thromboangiitis Obliterans ; Tibial Arteries ; Tourniquets* ; Transplants

Atherosclerosis has more than 60% of the causes of arterial occlusive diseases. The abdominal aorta and lower extremity arteries are the most common sites of occlusion. We have treated surgically 2 cases who had intermittent claudication and were diagnosed as simultaneous aortobifemoral and bilateral femoropopliteal obstruction by angiography, but had ineffective results from medical treatment or angioplasty. Simultaneously aortobifemoral bypass using Hemashield Y graft and bilateral femoropopliteal bypass using autologous greater saphenous vein were done. After operations, the symptom disappeared and there were no specific postoperative complications except abdominal wound dehiscence. In postoperative angiography, we had obtained good patency of bypass graft. We are following up patients through the out patient department without recurrence up to 16 months.
Angiography ; Angioplasty ; Aorta, Abdominal ; Arterial Occlusive Diseases ; Arteries* ; Atherosclerosis ; Humans ; Intermittent Claudication ; Lower Extremity* ; Postoperative Complications ; Recurrence ; Saphenous Vein ; Transplants* ; Wounds and Injuries

Surgery has been a well accepted treatment modality for the advanced lower extremity arterial occlusive disease. From March 1993 through February 1997, 121 limbs with atherosclerosis obliterans (ASO) in 99 patients were treated with infrainguinal bypasses at Department of Surgery, Kyungpook National University Hospital. Indications for the infrainguinal bypasses were intermittent claudication in 66 limbs(54.5%) and limb threatening ischemia in 55 limbs(45.5%). Conduits used for the arterial bypasses were 92 autogenous veins(79 reversed saphenous veins, 7 in situ veins, 2 nonreversed translocated veins, and 4 spliced vein grafts), 21 PTFE grafts, and 8 composite grafts. The operations were performed as the primary procedure in 112 limbs(92.6%) and as redo bypasses in 9 limbs(7.4%). The levels of distal anastomosis were above-knee popliteal artery in 34, below-knee popliteal artery in 57, posterior tibial artery in 19, anterior tibial artery in 4, peronal artery in 5, and inframalleolar artery in 2 limbs. Associated inflow arterial procedures were performed in 45 limbs(37.2%), which included 17 aortofemoral, 24 femorofemoral, 3 axillofemoral bypasses and 1 iliac PTA. Assisted primary patency rates at 4 years after graft implantation were 82.8% in reversed vein grafts(including 4 spliced vein grafts) and 62.8% in prosthetic and composite grafts according to the life table method. Clinical outcomes categorized by the revised SVS/ISCVS standard showed better results in claudication group than in limb threatening ischemia group. Limb salvage rate in the patients with limb threatening ischemia (n=55) was 87.2% at 4 years after graft implantation and operative mortality was absent.
Arterial Occlusive Diseases ; Arteries ; Atherosclerosis ; Extremities ; Gyeongsangbuk-do ; Humans ; Intermittent Claudication ; Ischemia ; Life Tables ; Limb Salvage ; Lower Extremity ; Mortality ; Polytetrafluoroethylene ; Popliteal Artery ; Saphenous Vein ; Tibial Arteries ; Transplants ; Veins

The noninvasive vascular laboratory has become central to the evaluation of patients with peripheral arterial occlusive disease (PAOD) of the lower extremities. Most such patients have atherosclerosis as the cause of PAOD. Because noninvasive vascular laboratory techniques are widely available, relatively inexpensive, well-tolerated, and provide quantitative physiologic information, they are most commonly used as the first line objective modalities to confirm the diagnosis, establish the severity of ischemia, and estimate the anatomic level of involvement in patients that are suspected as having PAOD based on history and physical signs. This article focuses on the commonly used instruments, examination techniques, interpretive guidelines, and clinical application of each modality.
Arterial Occlusive Diseases ; Atherosclerosis ; Humans ; Ischemia ; Lower Extremity

No abstract available.
Arterial Occlusive Diseases*