The natural history of chronic leg ischemia
Tóm tắt
The onset of leg ischemia may be sudden or gradual, occurring over a wide age spectrum and as a result of multiple causes. The clinical outcome is extremely variable, and only about 1 patient in 8 will progress to the stage of ischemic gangrene. Many patients have the capacity to show marked clinical improvement, or to maintain a comfortable life with claudication that is not severely disabling. Of over 2,000 patients referred to a vascular unit, only about 30% required operative intervention. Rigorous conservative measures should be given a trial for at least 3 months in all patients except those whose limbs are severely threatened, since that period of time is necessary to judge the capacity for spontaneous improvement, before the patient is subjected to the invasive technique of aortography. A flow chart of management decisions is suggested for patients with intermittent claudication.
Tài liệu tham khảo
Tracy, G.D.: Management of peripheral gangrene in the aged. Postgrad. Med.37:464, 1965
Tracy, G.D., Lord, R.S.A., Hill, D.A., Graham, A.R., McGrath, M.A.: The management of foot ischemia beyond arterial reconstruction. Surg. Gynecol. Obstet.155:377, 1981
Barnett, A.J., St. Clair, A.: Intermittent claudication: Clinical aspects. Med. J. Aust.2:786, 1956
Hoyle, S.J., Teitelbaum, S., Grove, I., Warren, R.: Atheromatous embolization. N. Engl. J. Med.261:128, 1959
Mehigan, J.T., Stoney, R.J.: Lower extremity atheromatous embolization. Am. J. Surg.132:163, 1976
De Palma, R.G., Habay, C. A., Insull, W., Jr., Robinson, A.V., Hartman, P.H.: Progression and regression of experimental atherosclerosis. Surg. Gynecol. Obstet.131:633, 1970
Walden, R., Adar, R., Mozes, M.: Gangrene of toes with normal peripheral pulses. Ann. Surg.185:269, 1977
McGrath, M.A., Tracy, G.D., Lord, R.S.A., Penny, R.: Peripheral ischemia caused by blood hyperviscosity. Aust. N.Z. J. Surg.41:2, 1973
Verta, M.J., Jr., Gross, W.S., van Bellen, B., Yao, J.S.T., Bergan, J.J.: Forefoot perfusion pressure and minor amputation for gangrene. Surgery80:729, 1976
Clifford, P.C., Davies, P.W., Hayne, J.A., Baird, R.N.: Intermittent claudication: Is a supervised exercise class worthwhile? Br. Med. J.1:1503, 1980
Marshall, A.J., Roberts, C.J.C., Barritt, D.W.: Raynaud's phenomenon as side effect of betablockers in hypertension. Br. Med. J.1:1498, 1976
Hughson, W.G., Mann, J.I., Tibbs, D.J., Woods, H.F., Walton, I.: Intermittent claudication: Factors determining outcome. Br. Med. J.1:1377, 1978
Dintenfass, L.: Elevation of blood viscosity, aggregation of red cells, hematocrit values and fibrinogen levels in cigarette smokers. Med. J. Aust.1:617, 1975
Dormandy, J.A., Hoare, E., Colley, J., Arrowsmith, D.E., Dormandy, T.L.: Clinical, hemodynamic, rheological and biochemical findings in 126 patients with intermittent claudication. Br. Med. J.67:576, 1973
Myers, K.A., King, R.B., Scott, D.F., Johnson, N., Morris, P.J.: The effect of smoking on the late patency of arterial reconstruction in the legs. Br. J. Surg.65:267, 1978
Harker, L.A., Slichter, S.J., Savage, L.R.: Platelet consumption by arterial prostheses. Ann. Surg.186:594, 1977
Gruntzig, A., Kumpe, D.A.: Technique of percutaneous transluminal angioplasty with the Gruntzig balloon catheter. Am. J. Roentgenol.132:547, 1979