Arteriograms in Ischemic Limbs Worsened After Lumbar Sympathectomy

Bergan, John J.

doi:10.1001/archsurg.1962.01310040115013

Cited by 19 publications

(4 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, in patients without intervention or calculations pre-intervention this plays no role. This minimal relation between macro- and microvascularisation is also reflected in the clinical experience where it is known that improving the inflow to the foot is not always a guarantee for a good clinical outcome [ 7 – 11 ]. The outcome of CLI is very unpredictable, as is shown in the paper by Lepantalo et al [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Functional Imaging of the Foot with Perfusion Angiography in Critical Limb Ischemia

Reekers

Koelemay²,

Marquering³

et al. 2015

Cardiovasc Intervent Radiol

View full text Add to dashboard Cite

PurposeTo report on the first clinical experience with perfusion angiography (PA) of the foot in patients with chronic critical limb ischemia.Materials and MethodsPA is a post-processing software algorithm and no extra digital subtraction angiography (DSA) has to be performed for this analysis. The data used to test the feasibility of PA were obtained from a consecutive group of 89 patients with CLI who were treated with standard below the knee angioplasty and 12 separate patients who were not suitable for endovascular revascularization.ResultsMotion artifacts in the dataset of the DSA made post-procedural analysis impossible in 10 % intervention. In the majority of patients (59/68) PA showed an increase in volume flow in the foot after successful angioplasty of the crural vessels. However, in 9/68 patients no increase was seen after successful angioplasty. With the use of a local administered competitive α-adrenergic receptor antagonist, it is also possible to test and quantify the capillary resistance index which is a parameter for the remaining functionality of the microcirculation in CLI patients.ConclusionPA might be used as a new endpoint for lower limb revascularization and can also be used to test the functionality the microcirculation to identify sub-types of patients with CLI. Clinical evaluation and standardization of PA is mandatory before introduction in daily practice.

show abstract

Section: Discussionmentioning

confidence: 99%

Functional Imaging of the Foot with Perfusion Angiography in Critical Limb Ischemia

Reekers

Koelemay²,

Marquering³

et al. 2015

Cardiovasc Intervent Radiol

View full text Add to dashboard Cite

show abstract

“…How-Fic. 11 ever, the deceleration slope was still prolonged and jagged, which is the typical pattern of distal peripheral arteriosclerotic disease.…”

Section: Coinmentarymentioning

confidence: 97%

Evaluation of Lumbar Sympathectomy by Quantification of Arterial Pulsatile Waveform

Lee¹,

Lapointe

Madden

1971

Vascular Surgery

View full text Add to dashboard Cite

“…While hindlimb temperature was not measured in this experiment, previous data from our laboratory using a comparable animal preparation demonstrated insignificant changes in paw temperature, even when large increases in A-V shunting occurred [6, 71. Predicted peripheral temperature changes of <l "C would not have been sufficient to alter hindlimb metabolism enough to cause the large changes in AVD02 observed in the current study. The observation that AVAs were not affected by large changes in flow and pressure but were affected considerably by sympathetic ablation emphasizes the role of the autonomic nervous system in the regulation of AVAs, as we have previously shown [6, 81. Results of this study concerning the differential effect of A-V shunting upon oxygen consumption at different flow rates may help explain different clinical results following lumbar sympathectomy [2], a procedure known to increase AVA flow rather than nutrient capillary flow [8, 211. Several investigators have suggested that only patients with moderately good peripheral blood flow respond favorably to lumbar sympathectomy.…”

Section: Discussionmentioning

confidence: 99%

Interaction of hindlimb blood flow, A-V shunting and A-V oxygen difference

Cronenwett¹,

Shellito²,

Luce³

et al. 1984

Journal of Surgical Research

View full text Add to dashboard Cite

The interactions of blood flow, A-V O2 difference (AVDO2), and A-V shunting were measured in normal hindlimbs of nine anesthetized dogs. An aorto-iliac nonpulsatile perfusion pump was used to change femoral artery blood flow from zero (collateral flow only) to twice its baseline level. Femoral AVDO2 was measured by in-line spectrophotometric O2 analysis. A-V shunting was measured with radio-labeled microspheres. Systemic hemodynamic parameters and temperature remained constant during the experiments. Despite changes in femoral mean arterial pressure (160 to 54 mm Hg) and AVDO2 (1.8 to 8.2 ml O/2/dl) that occurred with femoral blood flow reduction, peripheral A-V shunting remained constant at 4.1-5.5%. Alpha-adrenergic ablation (sympathectomy) was used to increase A-V shunting (up to 20%) during part of this experiment. When hindlimb blood flow was normal or increased, autoregulation of O2 extraction maintained constant hindlimb O2 consumption, despite sympathectomy-induced changes in A-V shunting. Subnormal femoral artery blood flow reduced hindlimb O2 consumption, and in this setting the increased A-V shunting further decreased femoral AVDO2 and O2 consumption. Since AVDO2 is dependent upon both blood flow and the variable efficiency of cellular O2 extraction, it cannot be used as an accurate indicator of A-V shunting. Direct microsphere techniques should be applied to A-V shunt measurements in clinical settings where A-V shunting is suspected.

show abstract

Arteriograms in Ischemic Limbs Worsened After Lumbar Sympathectomy

Cited by 19 publications

References 12 publications

Functional Imaging of the Foot with Perfusion Angiography in Critical Limb Ischemia

Functional Imaging of the Foot with Perfusion Angiography in Critical Limb Ischemia

Evaluation of Lumbar Sympathectomy by Quantification of Arterial Pulsatile Waveform

Interaction of hindlimb blood flow, A-V shunting and A-V oxygen difference

Contact Info

Product

Resources

About