Peripheral arterial occlusive disease

Direct Fibrinolytics Alfimeprase is a recombinant tmncated form of fibrolase, a fibrinolytic zinc metalloproteinase isolated from the venom of the Southern copperhead snake. It degrades fibrin directly and achieves thrombolysis independent of plasmin formation. This may result in faster recanalization and a decreased risk of hemorrhagic conversion. The initial data on the safety and efficacy of alfimeprase in peripheral arterial occlusion disease appeared very promising, but recent communication from the sponsor revealed that the phase III trials of the drug in peripheral arterial disease and catheter obstruction (NAPA-2 and SONOMA-2) failed to meet their primary and key secondary endpoints of revascularization. A trial for I AT in acute stroke (CARNEROS-1) is planned to begin soon. 

Lagiou, P. et al., Flavonoid classes and risk of peripheral arterial occlusive disease a case-control study in Greece, Eur. J. Clin. Nutr., 60, 214, 2006. 

Unlabeled Uses Treatment of atherosclerosis, gangrene, pain due to severe peripheral arterial occlusive disease, pulmonary hypertension... 

Staben P, Albring M. Treatment of patients with peripheral arterial occlusive disease Fontaine stage III and IV with intravenous iloprost an open study in 900 patients. Prostaglandins Leukot Essent Fatty Acids 1996 54(5) 327-33. 

The effects of PGEi and iloprost on microcirculation have been investigated in a randomized crossover study in 36 patients with peripheral arterial occlusive disease stage III and IV according to Fontaine (6). They received PGEi and iloprost by single 3-hour intravenous infusions on two different days at doses recommended by the... 

In a retrospective analysis of 63 patients treated with arginine vasopressin for catecholamine resistant vasodila-tory shock, 30% developed ischemic skin lesions (23). Pre-existing peripheral arterial occlusive disease and septic shock were independent susceptibility factors. 

Creutzig A, Lehmacher W, Elze M. Meta-analysis of randomised controlled prostaglandin El studies in peripheral arterial occlusive disease stages III and IV. Vasa. 2004 33 137-144. 

Ouriel K, Kaul AF, Leonard MC. Clinical and economic outcomes in thrombolytic treatment of peripheral arterial occlusive disease and deep venous thrombosis. J Vase Surg. 2004 40 971-977. 

Flex A, Gaetani E, Pola R, Santoliquido A, Aloi F, Papaleo P, Dal Lago A, Pola E, Serricchio M, Tondi P, Pola P. The-174 G/C polymorphism of the interleukin-6 gene promoter is associated with peripheral artery occlusive disease. Eur J Vase Endovasc Surg 2002 24 264-268. 

I I Kirk G, McLaren M, Muir AH, et al. Decrease in P-selectin levels in patients with hypercholesterolaemia and peripheral arterial occlusive disease after lipid-lowering treatment. Vase Med 1999 4 23-26. 

Regensteiner JG, Meyer TJ, Krupski WC, et al. Hospital vs home-based exercise rehabilitation for patients with peripheral arterial occlusive disease. Angiology 1997 48 291 -300. 

Ouriel K, Castaneda p McNamara T, et al, Reteplase monotherapy and reteplase/abciximab combination therapy in peripheral arterial occlusive disease results from the RELAX trial. J Vase Inter/ Radiol 2004 15(3) 229-238. 

M. Van den Berg, G. H. Boers, D. G. Franken, H. J. Blom, G. J. Van Kamp, C. Jakobs, J. A. Rauwerda, C. Kluft, and C. D. Stehouwert, Hyperhomocysteinemia and Endothelial Cell Dysfunction in Young Patients with Peripheral Arterial Occlusive Disease, European Journal of Clinical Investigations 25 (1995) 176-181. 

Abciximab is used for prevention of cardiac ischemic events in patients undergoing percutaneous coronary intervention and to prevent myocardial infarction in patients with unstable angina who do not respond to conventional treatment. It has also been used for thrombolysis in patients with peripheral arterial occlusive disease and arterial thrombosis (2). 

Ten patients with peripheral arterial occlusive disease were scheduled to undergo elective percutaneous transluminal angioplasty after a single dose of ciprofloxacin 400 mg (66). Antibiotic concentrations were significantly reduced in ischemic lesions compared with healthy adipose tissue. However, improvement of arterial blood flow in the affected limb was associated with increased cure rates of soft tissue infections. 

Joukhadar C, Klein N, Frossard M, Minar E, Stass H, Lackner E, Herrmann M, Riedmuller E, Muller M. Angioplasty increases target site concentrations of ciprofloxacin in patients with peripheral arterial occlusive disease. Clin Pharmacol Ther 2001 70(6) 532-9. 

Piridoxilate, an equimolar mixture of glyoxylic acid and pyridoxine, is marketed in a few countries (for example France) for peripheral arterial occlusive disease and functional venous disorders. 

Prostaglandin E, Cyclodextrin. The cyclic polysaccharide complex of PGE (Vasoprost) is available as an orphan drug for the treatment of severe peripheral arterial occlusive disease when grafts or angioplasty are not indicated. Cyclodextrin eomplexation is used to enhance water solubility and reduce rapid metabolic inactivation. 

Kiesewetter H, Jung E, Jung EM, et al. Effect of garlic coated tablets in peripheral arterial occlusive disease. Clin Investig 1993 71 383-386. 

Fu S, Zhao H, Shi J, Abzhanov A, Crawford K, Ohno-Machado L, Zhou J, Du Y, Kuo WP, Zhang J, Jiang M, Jin JG (2008) Peripheral arterial occlusive disease global gene expression analyses suggest a major role for immune and inflammatory responses. BMC Genomics 9 369... 

Jackson M, Clagett G. Antithrombotic therapy in peripheral arterial occlusive disease. Chest 2001 119(Suppl) 283S-299S. 

Qagett GP, Sobel M, Jackson MR, Lip GYH, Tangelder M, Verhaeghe R. Antithrombotic therapy in peripheral arterial occlusive disease The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004 126(3 suppl) 609S-26. 

Uric acid nephrolithiasis calcium renal stones Malignant mesothelioma Status epilepticus Herpes simplex encephalitis Neurosyphilis Status epilepticus Cognitive dysfunction Malignant non-Hodgkin s lymphomas Treatment of PCP associated with AIDS Acanthamoeba keratitis Peripheral arterial occlusive disease Congenital or acquired protein C deficiency Respiratory distress syndrome associated with prematurity... 

PAOD (Peripheral Artery Occlusive Disease) VEGF gene (Vascular Endothelial Growth Factor) Plasmid DNA Muscle/ endothelial cells in vivo (i.m.) Improved blood flow... 

Committee for Proprietary Medicinal Products (1995) Note for guidance on the clinical investigation of medicinal products in the treatment of chronic peripheral arterial occlusive disease. EMEA, London. http //www.emea.europa.eu/pdfs/human/ewp/071498eu.pdf. 

B. High-dose infusion is relatively contraindicated in the presence of peripheral arterial occlusive disease with thrombosis or in patients with ergot poisoning (see p 189). 

In patients with stage II peripheral arterial occlusive disease, 800 mg garlic daily for 12 weeks was found to reduce spontaneous thrombocyte aggregation and plasma viscosity (Kiesewetter et al. 1993b). 

Leak, K., Adams, V., Lurz, P., Erbs, S., Linke, A., Gielen, S., Schmidt, A., Scheinert, D., Biamino, G., Emmrich, E., Schuler, G., Hambiecht, R. Therapeutical potential of blood-derived progenitor cells in patients with peripheral arterial occlusive disease and critical limb ischaemia. European Heart Journal 26, 1903-1909 (2005)... 

Intermittent claudication is a clinical diagnosis. Usually lower extremity ischemia is caused by flow-limiting atherosclerotic plaques. Intermittent claudication is the presenting symptomatology in half of the patients with chronic lower extremity ischemia. The other one-third to half of patients with documented peripheral arterial occlusive disease are asymptomatic or silent (8). Other symptoms and physical findings indicating more severe ischemia are pain at rest, pale and cold extremity(s), ischemic ulcers, peripheral cyanosis, and gangrene (12). 

Lord JW Jr, Rossi G, Daliana M, Drago JR, Schwartz M.Unsuspected aneurysm as a cause of peripheral arterial occlusive disease. Am Surg 1973 177 767-771. Hans SS, Zesking HJ. Routine use of limited abdominal aortography with digital subtraction cardiac and cerebral angiography. Stroke 1995 26 1221-1224. 

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