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Knowledge and understanding of vascular disease, particularly atherosclerosis, continue to expand across disciplines, as do diagnostic and therapeutic.
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- Manual of Vascular Diseases (Paperback, 2nd Revised edition) (9781609134228)
- Manual of Vascular Diseases : Sanjay Rajagopalan :
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Diseases of the Cerebral Arteries Diehm, Prof. Arteries of the Arm Diehm, Prof. Thoracic and Abdominal Aorta Diehm, Prof.
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- Peripheral Arterial Disease.
- ISBN 13: 9788184737097.
Arteries of the Abdominal Organs Diehm, Prof. Arteries of the Leg Diehm, Prof. Diabetic Foot Syndrome Diehm, Prof. Diseases of Veins Diehm, Prof. Diseases of the Lymphatics Diehm, Prof. Congenital Malformations of Vessels Diehm, Prof. Show next xx. Recommended for you.
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Diehm J. Allenberg K. Might Duel Decks: Nissa vs. Ob Nixilis Duel Decks: Zendikar vs. More Views. Manual of Vascular Diseases Paperback, 2nd Revised edition R Quick Overview Knowledge and understanding of vascular disease, particularlyatherosclerosis, continue to expand across disciplines, as dodiagnostic and therapeutic strategies for treatment of vasculardisorders. This manual offers a consistent "how to" approach thatplaces specific emphasis on management. Each chapter provides thereader with a highly practical approach so that he or she comesaway with a reasonable amount of familiarity as to be able tomanage the patient independently.
Since the first edition, acertification in vascular medicine has become available. Some of the key features include: Practical information such asdrug doses, protocols for managing disorders, andalgorithmsGuidance on diagnostic assessment and treatmentstrategies for the majority of vascular disorders encountered inclinical practice Assimilation of information from areas outsidecardiology, i. Doppler ultrasonography is often used, because pressure gradients and pulse volume waveforms can help distinguish isolated aortoiliac PAD from femoropopliteal PAD and below-the-knee PAD.
If the index is normal 0. Peripheral arterial insufficiency can also be assessed by transcutaneous oximetry TcO 2. Angiography provides details of the location and extent of arterial stenoses or occlusion; it is a prerequisite for surgical correction or percutaneous transluminal angioplasty PTA.
It is not a substitute for noninvasive testing because it provides no information about the functional significance of abnormal findings. Magnetic resonance angiography and CT angiography are noninvasive tests that may eventually supplant contrast angiography. Sometimes pentoxifylline or cilostazol for claudication.
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All patients require aggressive risk factor modification for relief of peripheral arterial disease symptoms and prevention of cardiovascular disease, including smoking cessation essential ; control of diabetes, dyslipidemia, and hypertension; structured exercise therapy; and dietary changes see Atherosclerosis : Diet.
Beta-blockers are safe unless PAD is very severe 1.see
Manual of Vascular Diseases (Paperback, 2nd Revised edition) (9781609134228)
Supervised exercise programs are probably superior to unsupervised programs. Exercise can increase symptom-free walking distance and improve quality of life. Mechanisms probably include increased collateral circulation, improved endothelial function with microvascular vasodilation, decreased blood viscosity, improved RBC filterability, decreased ischemia-induced inflammation, and improved oxygen extraction.
Patients are advised to keep the legs below heart level. For pain relief at night, the head of the bed can be elevated about 10 to 15 cm 4 to 6 inches to improve blood flow to the feet. Patients are also advised to avoid cold and drugs that cause vasoconstriction eg, pseudoephedrine , contained in many sinus and cold remedies.
Preventive foot care is crucial, especially for patients with diabetes. It includes daily foot inspection for injuries and lesions; treatment of calluses and corns by a podiatrist; daily washing of the feet in lukewarm water with mild soap, followed by gentle, thorough drying; and avoidance of thermal, chemical, and mechanical injury, especially that due to poorly fitting footwear.
Manual of Vascular Diseases : Sanjay Rajagopalan :
Foot ulcer management is discussed elsewhere. Antiplatelet drugs may modestly lessen symptoms and improve walking distance in patients with peripheral arterial disease; more importantly, these drugs modify atherogenesis and help prevent acute coronary syndromes and transient ischemic attacks. Aspirin is typically used alone first, followed by addition or substitution of other drugs if PAD progresses.
For relief of claudication, pentoxifylline mg po tid with meals or cilostazol mg po bid may be used to relieve intermittent claudication by improving blood flow and enhancing tissue oxygenation in affected areas; however, these drugs are no substitute for risk factor modification and exercise. Use of pentoxifylline is controversial because evidence of its effectiveness is mixed. The most common adverse effects of cilostazol are headache and diarrhea. Cilostazol is contraindicated in patients with severe heart failure.
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ACE inhibitors have several beneficial effects. They are antiatherogenic and, by inhibiting the degradation of bradykinin and promoting the release of nitric oxide, are potent vasodilators.
Other drugs that may relieve claudication are being studied; they include l - arginine the precursor of endothelium-dependent vasodilator , nitric oxide, vasodilator prostaglandins, and angiogenic growth factors eg, vascular endothelial growth factor [VEGF], basic fibroblast growth factor [bFGF]. In patients with severe limb ischemia, long-term parenteral use of vasodilator prostaglandins may decrease pain and facilitate ulcer healing. PTA with or without stent insertion is the primary nonsurgical method for dilating vascular occlusions.
PTA with stent insertion may keep the artery open better than balloon compression alone, with a lower rate of reocclusion. Stents work best in large arteries with high flow iliac and renal ; they are less useful for smaller arteries and for long occlusions. PTA is also useful for localized iliac stenosis proximal to a bypass of the femoropopliteal artery.
PTA is less useful for diffuse disease, long occlusions, and eccentric calcified plaques. Such lesions are particularly common in patients with diabetes, often affecting small arteries. Complications of PTA include thrombosis at the site of dilation, distal embolization, intimal dissection with occlusion by a flap, and complications related to heparin use.
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Surgery is indicated for patients who can safely tolerate a major vascular procedure and whose severe symptoms do not respond to noninvasive treatments. The goal is to relieve symptoms, heal ulcers, and avoid amputation. Because many patients have underlying coronary artery disease, which places them at risk of acute coronary syndromes during surgical procedures for PAD, patients usually undergo cardiac evaluation prior to surgery.
Thromboendarterectomy surgical removal of an occlusive lesion is used for short, localized lesions in the aortoiliac, common femoral, or deep femoral arteries.