Arterial insufficiency

A calorimetric study was carried out with the purpose to measure heat production rate in skeletal muscle of patients with different degrees of peripheral arterial insufficiency, defined by blood flow measurements [84], A linear positive relationship was found between heat production, reflecting overall muscle metabolism, and degree of diminished blood flow. Calorimetric 

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Peripheral vascular disease Treatment with -antagonists reduces cardiac output and can precipitate or aggravate the symptoms of arterial insufficiency in patients with peripheral or mesenteric vascular disease. 

Most adverse effects are mild and transient and rarely require withdrawal of therapy. Cardiovascuiar Bradycardia torsade de pointes and other serious new ventricular arrhythmias chest pain hypertension hypotension peripheral ischemia pallor flushing worsening of angina and arterial insufficiency shortness of breath ... 

Peripheral vascular disease -blockers can precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral vascular disease. Exercise caution. Hypotension and postural hypotension Hypotension and postural hypotension occurred in 9.7% and syncope in 3.4% of CHF patients receiving carvedilol, compared with 3.6% and 2.5% of placebo patients, respectively. The risk for these events was highest during the first 30 days of dosing. 

Adverse effects include bradycardia, nausea, vomiting, epigastric discomfort, dizziness, fatigue, tiredness, skin rash, leg pain, cold extremities because of peripheral arterial insufficiency. 

Tiredness Dizziness Depression Diarrhea Pruritus/rash Shortness of breath Bradycardia Cold extremities Arterial insufficiency (Raynaud type)... 

Antithrombotic therapy for acute peripheral occlusive disease is largely empirical. Thrombolytic therapy typically is reserved for patients in whom the occlusion is not amenable to surgery and for those in whom a possible delay between the initiation of therapy and thrombolysis would not jeopardize the viability of the limb. Evidence that antithrombotic therapy changes the natural course of the peripheral disease is sparse, but these patients are at an increased risk of cardiovascular mortality and should receive long-term aspirin therapy. Initial trials suggest that ticlopidine may improve the symptoms of chronic arteriosclerotic arterial insufficiency and also reduce fatal and nonfatal cardiovascular events, but further studies are needed. 

Wertz Jl, BymeJ, Clagett GR etal. Diagnosis and treatment of chronic arterial insufficiency of the lower extremities a critical review. Circulation 1996 94 3026-3049. 

Smith, G.S., Birnbaum, B.A., Jacobs, J.E. Hepatic infarction secondary to arterial insufficiency in native livers CT findings in 10 patients. Radiology 1998 208 223 - 229... 

Diseases of the heart and circulatory system, cardiovascular diseases, have long been the leading cause of mortality in Europe and North America, and total cholesterol and low-density lipoprotein (LDL) cholesterol are the two most important risk factors for coronary heart disease. Decreased arterial compliance of the arteries is thought to contribute to systolic hypertension and coronary artery insufficiency. A number of nutraceuticals have been used for long-term prevention or symptom reduction in cardiovascular diseases, notably soy products, tea flavonoids, octacosanol, n-3-polyunsaturated fatty acids (PUFAs), and, to a lesser extent, melatonin, Pycnogenol, resveratrol, coenzyme QIO, lycopene, and DHEA. 

Caution should also be exercised in patients with thyrotoxicosis and with valvular stenosis, coronary artery insufficiency (36), or other conditions in which a tachycardia is hazardous. 

Jeffrey, I., Weitz, M.D., Byme, J., Patrick Clagett, G., Farkouh, M.E., Porter, J.M., Sackett, D.L., Strandness, D.E., Taylor, L.M., 1996. Diagnosis and treatment of chronic arterial insufficiency of the lower extremities a critical review. Circulation 94, 3026—3049. 

The diagnosis of lower limb ulceration must start by determining the patient s full clinical history, together with a physical examination of the condition. It is essential to identify possible risk factors that could cause ulceration or impact on the treatment of the ulcer. These risk factors could include arterial insufficiency, trauma, diabetes, sickle cell disease, infection, malignancy, and inflammatory disorders. ... 

Vascular pathology may involve lesions of the inflow or outflow mechanisms of penile erection. Erectile dysfunction may be a manifestation of generalized atherosclerosis and may even be its initial presentation. Common risk factors associated with generalized penile arterial insufficiency include hypertension, hyperlipidemia, cigarette smoking, diabetes mellitus, and pelvic irradiation (Rosen et al. 1991). Less commonly, local stenosis of the conunon penile artery may occur in men who have sustained blunt pelvic or perineal trauma (Levine et al. 1990). 

Chronic renal failure is also frequently associated with diminished erectile function, impaired libido, and infertility. The mechanism is probably multifactorial low serum testosterone concentrations, diabetes mellitus, vascular insufficiency, multiple medications, autonomic and somatic neuropathy, and psychological stress. Men with angina, myocardial infarction, or heart failure may have erectile dysfunction from anxiety, depression, or concomitant penile arterial insufficiency. 

In the field of erectile dysfunction, penile vascular imaging modalities have diminished in importance over the past 10 years with the introduction of new effective oral medications and recognition that surgical treatment of both penile venous leak and arterial insufficiency has poor long-term clinical outcomes. 

Some authors have studied the possibility to deliver prostaglandin El using transdermal liposomal formulations through the foreskin in men with erectile dysfunction secondary to spinal cord injury or with mild arterial insufficiency (Foldvari et al. 1998). 

The flow detected at the level of the cavernosal arteries can be asymmetric, and when the difference of PSV is greater than 10 cm/s a unilateral arterial insufficiency must be suspected with secondary flow impairment (Fig. 6.15). 

Although alteration of the venous occlusive mechanism has been claimed to be present in a high percent of Peyronie s patients with erectile dysfunction (Weidner et al. 1997), the role of arterial inflow must be investigated. In fact, color Doppler ultrasonography shows associated arterial insufficiency in 30%-50% of these patients (Kadioglu et... 

Postraumatic penile arterial obstruction characteristically involves the proximal portion of the dorsal penile and cavernosal arteries and the distal internal pudendal artery at the level of the urogenital diaphragm. The integrity of arterial vascular supply to the penis can be assessed by Doppler interrogation of the cavernosal arteries. A peak systolic velocity of 25 cm/s or less after prostaglandin El intracavernosal injection reflects arterial insufficiency (Fig. 12.11). 

Fig. 12.11a-c. Postraumatic erectile dysfunction. A 32-year-old patient who received pelvic bone fractures during a traffic accident, a Doppler interrogation of the cavernosal arteries shows low velocity flows of 12 cm/s, consistent with postraumatic arterial insufficiency, b Left internal pudendal arteriogram shows interruption of the vascular supply to the penis with no opacification of the cavernosal artery, c MDCT angiography demonstrates the same vascular features non-invasively... 

Moreland 1998). Systemic connective tissue disorders, such as systemic sclerosis, are associated to erectile dysfunction in as much as 80% of patients due to combined arterial insufficiency and collage-nization of corporeal smooth muscle (Lotfi et al. 1995). 

In patients with circumscribed fibrotic changes leakage pathways are often identified as color Doppler ultrasound adjacent to the region in which the cavernosal tissue is replaced by a fibrotic scar (Fig. 18.8). Scar-related arterial insufficiency can be associated when cavernosal arteries are encased by the scar. In... 

Dahllof A-G, Bjomtorp P, Holm J, Schersten T. Metabolic activity of skeletal muscle in patients with peripheral arterial insufficiency. Eur J Clin Invest 1974 4 9-15. 

Dahllof A-G, Holm J, Schersten T, Sivertsson R. Peripheral arterial insufficiency Effect of physical training on walking tolerance, calf blood flow, and blood flow resistance. Scand J Rehab Med 1976 8 19-26. 

Lundgren F, Dahllof A-G, Schersten T, Bylund-Fellenius AC. Muscle enzyme adaptation in patients with peripheral arterial insufficiency Spontaneous adaptation, effect of different treatments and consequences on walking performance. Clin Sci 1989 77 485 93. 

Peripheral skin temperature measurement - Skin temperature is useful for detecting arterial insufficiency. The most common means is to apply small thermistors at various levels on the extremities. Blood skin temperature will be lower where blood flow is reduced. The method requires careful control of ambient temperature. The... 

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