cardiovascular-agents and Ulcer

Penetrating aortic ulcers (PAUs) are an entity within acute aortic syndrome. They often remain undiagnosed and are found incidentally or when they become symptomatic. Management is currently guided by clinical judgment. This review aims to identify indications for treatment and inform management.. We searched PubMed for studies on the management of PAUs. The outcome measures were mortality, progression and resolution of symptoms.. This review incorporates 27 studies involving 1356 patients with PAU. Data was available regarding symptoms for 1213 patients (494 symptomatic, 719 asymptomatic). Overall late mortality for PAUs was found to be higher than 30-day mortality. Early mortality was higher for symptomatic patients as compared to those with asymptomatic PAUs. Early mortality was lowest for PAUs treated with endovascular interventions (5%), followed by PAUs managed medically and highest following open surgical management. Indications for treatment included symptoms, progression/instability, aortic diameter >5 cm, concomitant aortic pathology or pleural effusion. 13% of patients managed conservatively at initial presentation demonstrated progression and were considered for intervention subsequently. 9% of patients required reintervention after initial endovascular surgery.. Endovascular treatment, if anatomically suitable, should be considered as first line treatment for symptomatic PAUs. Patients with asymptomatic PAUs, if associated with high-risk features such as PAU diameter >20 mm, PAU depth >10 mm, aortic diameter >42 mm, concomitant pathology, morphological change or an infective etiology, should also be considered for intervention. Small asymptomatic PAUs with no high-risk features may be managed conservatively but must undergo regular surveillance.

Topics: Aortic Diseases; Cardiovascular Agents; Clinical Decision-Making; Disease Progression; Endovascular Procedures; Humans; Risk Assessment; Risk Factors; Treatment Outcome; Ulcer; Vascular Surgical Procedures

Here we give an overview over treatment recommendations propagated by the European League Against Rheumatism (EULAR), EULAR Scleroderma Trials and Research Group, the German Network for Systemic Sclerosis, the European Respiratory Society, and the International Society of Heart and Lung Transplantation. As response to immunosuppressant (IS) therapy is usually weaker in systematic sclerosis (SSc) compared to other connective tissue disorders IS should be considered with caution. To prevent scleroderma renal crisis steroid doses should not exceed 15 mg/d. The definitive role of a number of new immunosuppressant drugs and the effects of autologous stem cell transplantation in systemic clerosis (SSc) have to be elucidated. Prostanoids, especially iloprost, are widely used as intravenous formulas for the treatment of severe Raynaud's phenomenon (RP) and digital ulcers (DU). Calcium antagonists are of limited therapeutic value. Bosentan, an oral endothelin receptor antagonists (ETRA), was shown to prevent new DU, but failed to heal existing DU, while the oral phopshodiesterase inhibitor (PDI) Sildenafil reduces the occurrence of RP and might be effective in ulcer healing. Combination therapies of PDI with ETRA are currently evaluated. Therapy of pulmonary arterial hypertension (PAH) is usually started as oral monotherapy, frequently using an ETRA. When this first-line therapy is not tolerated ETRA is substituted by PDI. If treatment goals are not reached with monotherapy combinationtherapy is started, for example by adding a PDI to an existing ETRA. In general, treatment of PAH in patients with connective tissue disease follows the same algorithms as in idiopathic PAH.

Topics: Antihypertensive Agents; Cardiovascular Agents; Drug Therapy, Combination; Europe; Familial Primary Pulmonary Hypertension; Humans; Hypertension, Pulmonary; Immunosuppressive Agents; Practice Guidelines as Topic; Raynaud Disease; Scleroderma, Systemic; Societies, Medical; Stem Cell Transplantation; Treatment Outcome; Ulcer

Acute aortic syndromes (AAS) comprise a group of potentially lethal conditions that require prompt recognition, diagnosis as well as acute medical stabilization and surgical intervention. The purpose of this article is to review the relevant variants of AAS presentation, as well as diagnostic and management issues, including adequate long-term medical therapy and follow-up imaging. In this context, the American College of Cardiology and the American Heart Association recently published guidelines on the management of thoracic aortic disease, drawing greater attention to these processes.

Topics: Acute Disease; Angioplasty; Aortic Aneurysm, Thoracic; Aortic Dissection; Aortic Rupture; Aortography; Blood Vessel Prosthesis Implantation; Cardiovascular Agents; Combined Modality Therapy; Echocardiography, Transesophageal; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Magnetic Resonance Angiography; Marfan Syndrome; Multidetector Computed Tomography; Postoperative Complications; Registries; Risk Factors; Stents; Survival Rate; Syndrome; Ulcer

In 2 randomized, double-blind studies, 109 diabetic patients with trophic lesions and 101 non-diabetics suffering from peripheral vascular disease (PVD) stage IV (Fontaine) received daily 6-hour i.v. infusions of iloprost (less than or equal to 2ng/kg/min) or of placebo over 28 days. Iloprost treatment was superior to placebo, showing ulcer healing in more than 60% of patients compared to less than 25% in the control group. The beneficial effects were sustained during a 1 year follow-up period. Platelet activation, adhesion, aggregation and release reaction on atherosclerotic lesions, impaired microvascular perfusion, loss of microvascular barrier function, increased white blood cell - vessel wall interaction and hemorheological disturbances are all believed to play a role in PVD. Stable PGI2-mimetics inhibit platelet activation by all endogenous mediators as well as platelet release of mitogenic factors (PDGF).

Topics: Animals; Blood Platelets; Cardiovascular Agents; Clinical Trials as Topic; Diabetic Angiopathies; Disease Models, Animal; Double-Blind Method; Epoprostenol; Humans; Iloprost; Infusions, Intravenous; Microcirculation; Random Allocation; Rats; Thrombosis; Ulcer; Vascular Diseases

Topics: Cardiovascular Agents; Familial Primary Pulmonary Hypertension; Humans; Hypertension, Pulmonary; Immunosuppressive Agents; Predictive Value of Tests; Raynaud Disease; Scleroderma, Systemic; Treatment Outcome; Ulcer

Although recent studies suggest that medical treatment is appropriate for patients with aortic intramural hematoma (IMH), the outcomes of supportive medical treatment alone have not been satisfactory, and clear guidelines for medical treatment are not yet available. We assessed whether a management protocol of combined early aggressive medical treatment and selective prophylactic aortic stent-grafting would benefit patients with IMH.. Nineteen patients with IMH were prospectively studied; after initial clinical and radiological evaluation, 13 underwent early aggressive medical therapy (group 1), and 6 underwent early aggressive medical therapy and prophylactic endovascular stent-grafting (group 2).. In group 1, one patient with type A IMH died prior to surgical consultation because of cardiac tamponade; another patient with type A IMH underwent replacement of the ascending aorta at the 6-month follow-up. The condition of the other 11 patients stabilized during hospitalization and after discharge. The disease spontaneously regressed in 10 patients, and the intramural hematoma completely resolved in 5 patients. In group 2, follow-up imaging revealed complete coverage of the penetrating aortic ulcers and regression of the intramural hematoma; endovascular leaks have not yet occurred.. Our protocol may be used as an alternative approach for patients with IMH. After initial clinical and radiological evaluation, the condition of patients without complications can be stabilized with medical treatment; frequent follow-up imaging is required in such cases. Early aggressive medical treatment combined with prophylactic aortic stent-grafting is a safe and effective treatment modality for IMH patients with penetrating aortic ulcers in the descending aorta.

Topics: Aged; Aortic Diseases; Aortography; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Cardiovascular Agents; China; Combined Modality Therapy; Drug Therapy, Combination; Endovascular Procedures; Female; Hematoma; Humans; Male; Middle Aged; Prospective Studies; Stents; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Ulcer

Topics: Adrenal Glands; Cardiovascular Agents; Flavonoids; Humans; Ulcer; Vitamins

Topics: Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Humans; Ulcer; Varicose Ulcer; Varicose Veins; Veins

Topics: Cardiovascular Agents; Muscle Relaxants, Central; Peptic Ulcer; Ulcer

Topics: Cardiovascular Agents; Dihydroergotoxine; Ergot Alkaloids; Foot; Foot Ulcer; Humans; Leprosy; Ulcer

Topics: Blood Pressure; Blood Pressure Determination; Cardiovascular Agents; Ergot Alkaloids; Extremities; Humans; Leg; Leg Ulcer; Ulcer

Topics: Cardiovascular Agents; Cyclandelate; Leg; Leg Ulcer; Muscle Relaxants, Central; Ulcer