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Sample records for evident peripheral arterial

  1. Peripheral arterial line (image)

    Science.gov (United States)

    A peripheral arterial line is a small, short plastic catheter placed through the skin into an artery of the arm or leg. The purpose of a peripheral arterial line is to allow continuous monitoring of blood pressure ...

  2. Occlusive Peripheral Arterial Disease

    Science.gov (United States)

    ... but also to the worsening of the disease. Obstructive peripheral arterial disease most commonly develops in the arteries of the legs, including the two branches of the aorta (iliac arteries), main arteries of the thighs (femoral arteries), of ... arterial disease may also develop in the part ...

  3. Drug-eluting balloon catheters for lower limb peripheral arterial disease: the evidence to date

    Directory of Open Access Journals (Sweden)

    Barkat M

    2016-05-01

    Full Text Available Mohamed Barkat,1 Francesco Torella,1 George A Antoniou2 1Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, 2Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK Abstract: A significant proportion of patients with severe lower limb peripheral arterial disease require revascularization. Over the past decade, an endovascular-first approach even for complex disease has gained widespread use among vascular specialists. An important limitation of percutaneous transluminal balloon angioplasty or stenting remains the occurrence of restenosis. Drug-coated balloons have emerged as an exciting technology developed to overcome the limitations of standard balloon angioplasty and stenting. Drug-eluting devices inhibit neointimal growth of vascular smooth muscle cells with the potential of preventing restenosis. This review provides a synopsis of the up-to-date evidence on the role of drug-coated balloons in the treatment of lower limb peripheral arterial disease. Bibliographic searches were conducted using MEDLINE, EMBASE, and the Cochrane Library electronic database. Eleven randomized clinical trials, two systematic reviews, and a published registry providing the best available evidence were identified. Current evidence suggests that angioplasty with drug-coated balloon is reliable, safe, and efficient in increasing patency rates and reducing target lesion revascularization and restenosis. However, it remains unknown whether these improved results can translate into beneficial clinical outcomes, as current randomized clinical trials have failed to demonstrate a significant benefit in limb salvage and mortality. Further randomized trials focusing on clinical and functional outcomes of drug-eluting balloons and on cost versus clinical benefit are required. Keywords: drug-eluting balloon, drug-coated balloon, angioplasty, peripheral arterial

  4. Antithrombotic Therapy in Peripheral Artery Disease: Generating and Translating Evidence Into Practice.

    Science.gov (United States)

    Jones, W Schuyler; Patel, Manesh R

    2018-01-23

    Atherosclerotic cardiovascular (CV) disease remains a major health concern affecting more than 200 million adults worldwide, and lower extremity peripheral artery disease (PAD) is associated with significant morbidity and mortality. Treatment strategies to reduce the burden of major adverse CV events and limb events have mainly involved the use of antiplatelet and statin medications. Unlike other types of atherosclerotic CV disease, the evidence base is not well developed for therapies in patients with PAD. Recently, studies from subgroups of patients with PAD and a large clinical trial of PAD patients have been published, signaling a burgeoning interest in studying this higher risk population. This review outlines the inherent CV risks of patients with PAD, risk reduction strategies, emerging clinical trial data, and opportunities for the CV community to generate evidence in real-world settings and translate evidence into practice as new therapies become available. Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  5. Peripheral Arterial Disease

    Science.gov (United States)

    Peripheral arterial disease (PAD) happens when there is a narrowing of the blood vessels outside of your heart. The cause of ... smoking. Other risk factors include older age and diseases like diabetes, high blood cholesterol, high blood pressure, ...

  6. Peripheral artery bypass - leg

    Science.gov (United States)

    ... 25638515 www.ncbi.nlm.nih.gov/pubmed/25638515 . White CJ. Endovascular treatment of peripheral artery disease. In: Creager MA, Beckman JA, Loscalzo J, eds. Vascular Medicine: A Companion to Braunwald's Heart Disease . 2nd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 20. Review Date 1/31/2017 ...

  7. Translation of an evidence-based therapeutic exercise program for patients with peripheral artery disease.

    Science.gov (United States)

    Salisbury, Dereck L; Whipple, Mary O; Burt, Marsha; Brown, Rebecca J L; Hirsch, Alan; Foley, Christopher; Treat-Jacobson, Diane

    2018-03-01

    The purpose of this study was to implement and evaluate quality outcomes including referral, enrollment, and completion rates of a new peripheral artery disease (PAD)-specific supervised exercise therapy (SET) program within a preexisting clinical exercise wellness program and to evaluate the clinical effectiveness and patient-centered outcomes derived from 12 weeks of PAD-specific SET. Recruited participants completed an individualized, minimally supervised, PAD-specific SET program based on the AHA-ACC guidelines. Exercise workloads (metabolic equivalents of task [METs]) were tracked and evaluated throughout the program. Short Physical Performance Battery, 6-minute walk test (6MWT) Walking Impairment Questionnaire, Short-Form 36 (SF-36), and Peripheral Artery Disease Quality of Life Questionnaire (PADQOL) were assessed before and after the program. Paired t-tests were used to examine differences between baseline and follow-up outcome variables. On average, participants (n = 46) attended 23 (standard deviation [SD] 12.9) out of the possible 36 training sessions, for a 64% attendance rate. Among participants who used treadmill walking as the primary mode of exercise (n = 40), the overall mean MET level just prior to program completion was 3.79 (SD 1.49), which represented an increase of 0.92 (34%) METs compared to baseline (P < .001). Total distance on the 6MWT increased 115 (11%) feet (P = .011), which is considered a clinically meaningful improvement. Significant improvements were noted in the PADQOL: symptoms and limitations in physical functioning (P = .007). This study demonstrates that a minimally staffed PAD-specific SET program can improve functional performance in patients with claudication due to PAD and serves as a foundation to help build a clinically effective, Centers for Medicare and Medicaid reimbursed PAD-specific rehabilitation program. Copyright © 2017 Society for Vascular Nursing, Inc. Published by Elsevier Inc. All rights reserved.

  8. Epigenetics and Peripheral Artery Disease.

    Science.gov (United States)

    Golledge, Jonathan; Biros, Erik; Bingley, John; Iyer, Vikram; Krishna, Smriti M

    2016-04-01

    The term epigenetics is usually used to describe inheritable changes in gene function which do not involve changes in the DNA sequence. These typically include non-coding RNAs, DNA methylation and histone modifications. Smoking and older age are recognised risk factors for peripheral artery diseases, such as occlusive lower limb artery disease and abdominal aortic aneurysm, and have been implicated in promoting epigenetic changes. This brief review describes studies that have associated epigenetic factors with peripheral artery diseases and investigations which have examined the effect of epigenetic modifications on the outcome of peripheral artery diseases in mouse models. Investigations have largely focused on microRNAs and have identified a number of circulating microRNAs associated with human peripheral artery diseases. Upregulating or antagonising a number of microRNAs has also been reported to limit aortic aneurysm development and hind limb ischemia in mouse models. The importance of DNA methylation and histone modifications in peripheral artery disease has been relatively little studied. Whether circulating microRNAs can be used to assist identification of patients with peripheral artery diseases and be modified in order to improve the outcome of peripheral artery disease will require further investigation.

  9. Peripheral Artery Disease and Diabetes

    Science.gov (United States)

    ... Venous Thromboembolism Aortic Aneurysm More Peripheral Artery Disease & Diabetes Updated:Jan 26,2016 People with diabetes are ... life. This content was last reviewed January 2016. Diabetes • Home • About Diabetes • Why Diabetes Matters Introduction Cardiovascular ...

  10. Peripheral artery disease - legs

    Science.gov (United States)

    ... the legs, feet, and toes Painful, non-bleeding sores on the feet or toes (most often black) that are slow ... block small arteries Coronary artery disease Impotence Open sores ... (gangrene) The affected leg or foot may need to be amputated

  11. Therapeutic resistance exercises for individuals with peripheral arterial obstructive disease: evidence for prescription

    OpenAIRE

    Câmara, Lucas Caseri; Santarém, José Maria; Wolosker, Nelson; Dias, Raphael Mendes Ritti

    2007-01-01

    A prática regular de exercícios é parte do tratamento clínico inicial para pacientes com doença arterial obstrutiva periférica. Nesse sentido, a utilização de exercícios contra resistência (exercícios resistidos) tem sido amplamente recomendada para diferentes populações, especialmente para pessoas idosas com e sem doenças associadas. Os poucos trabalhos encontrados utilizando essa forma de exercícios em pacientes com doença arterial obstrutiva periférica documentam a sua eficiência terapêuti...

  12. [Peripheral arterial disease and diabetes].

    Science.gov (United States)

    Malý, R; Chovanec, V

    2010-04-01

    Peripheral arterial disease (PAD) is a disease characterised by narrowing and blockade of peripheral arteries, usually based on underlying obliterating atherosclerosis. According to the results of large epidemiological studies, the risk of PAD in patients with diabetes mellitus (DM) is fourfold higher compared to non-diabetic population. Patients with DM and PAD have a high risk of cardiovascular morbidity and mortality. Diabetes worsens the prognosis of patients with PAD; the onset of PAD in diabetics occurs at an earlier age, the course is faster than in non-diabetic patients and the disease is often diagnosed at its advanced stages. All these factors reduce the likelihood of revascularisation in DM patients with PAD. A range of factors (higher age, arterial hypertension, smoking, obesity, hyperfibrinogenaemia, insulin resistance etc.) contribute to the development of PAD in DM. Diabetes control is an independent risk factor of PAD as every 1% increase of hemoglobin A1C is associated with 28% increase of PAD. There are different clinical signs of PAD in diabetic and non-diabetic patients. In addition to the history of claudications, PAD diagnostic criteria include the presence of murmur over the large arteries, signs of chronic ischemia on the skin and distal ulcerations and gangrene. Among the imaging techniques, non-invasive investigations including Doppler pressure measurement, ankle brachial pressure index, color duplex ultrasonography, plethysmography, transcutaneous tension measurement, MR and CT angiography are preferred. Ankle brachial pressure index measurement is the easiest and the main investigation technique. The key principles of PAD treatment in diabetic patients include modification of risk factors, pharmacotherapy and revascularisation interventions aimed at improving clinical signs and prevention of cardiovascular morbidity and mortality. Antiplatelet treatment may prevent PAD progression and reduce cardiovascular events in DM patients. Early

  13. Minimum training requirement in ultrasound imaging of peripheral arterial disease

    DEFF Research Database (Denmark)

    Eiberg, J P; Hansen, M A; Grønvall Rasmussen, J B

    2008-01-01

    To demonstrate the minimum training requirement when performing ultrasound of peripheral arterial disease.......To demonstrate the minimum training requirement when performing ultrasound of peripheral arterial disease....

  14. Dissolution of peripheral arterial thrombi by ultrasound.

    Science.gov (United States)

    Ariani, M; Fishbein, M C; Chae, J S; Sadeghi, H; Michael, A D; Dubin, S B; Siegel, R J

    1991-10-01

    We have previously shown that continuous-wave ultrasound can rapidly dissolve human thrombi in vitro, with 99% of all residual particles measuring less than 10 microns in diameter. To assess the effects of pulsed-wave ultrasound energy on whole blood clots, 1) in vitro studies were preformed to assess precisely the rates of clot disruption and to quantify particulate size, and 2) in vivo studies were performed to assess the efficacy and safety of catheter-delivered ultrasound for intra-arterial thrombus dissolution. In vitro, we studied 50 samples of human whole blood clots and using an 89-cm-long wire probe, applied pulse-wave energies from 8 to 23 W. The corresponding peak-to-peak tip displacement range was 63.5 - 102 microns. We studied arterial thrombosis in vivo in 21 canine superficial femoral arteries. To produce an acute thrombosis, 200 units of thrombin followed by 2 ml of 72-hour-old autologous clot were injected into a 5-7-cm segment of femoral artery and left to coagulate for 2 hours. Ultrasound energy was intermittently applied at a frequency of 20 kHz with a prototype ultrasound wire ensheathed in a catheter and directed to clots by fluoroscopy. In nine cases, angioscopic guidance was used to put the probe into direct contact with the intra-arterial thromboses. In vitro clot dissolution times were inversely related to the ultrasound power output (r = 0.95). All in vivo canine thromboses were disrupted in 4 minutes or less. All successful recanalizations were confirmed by angiography and in nine cases by angioscopy as well. Angioscopy demonstrated that probe activation caused rapid clot disruption. Histological studies of the vessels showed no evidence of thermal or cavitation injury, occlusive distal embolization, or perforation. Our findings in this experimental canine model suggest that ultrasound clot dissolution has the potential to be an effective and safe alternative to current treatment modalities for peripheral arterial thrombosis.

  15. Arterial and Peripheral Sympathectomy for Vasospastic Disease

    Medline Plus

    Full Text Available Arterial and Peripheral Sympathectomy for Vasospastic Disease Click Here to view the BroadcastMed, Inc. Privacy Policy and Legal Notice © 2017 BroadcastMed, Inc. All rights reserved.

  16. Evaluation of Peripheral Arterial Disease in Prediabetes

    Directory of Open Access Journals (Sweden)

    Elham Faghihimani

    2014-01-01

    Conclusions: Peripheral arterial disease is common in asymptomatic diabetes and prediabetes patients. Management of hypertensive prediabetes patients and early detection of PAD in this group as well as in asymptomatic patients is important.

  17. Preventive aspects in peripheral artery disease.

    Science.gov (United States)

    Aggarwal, Saurabh; Loomba, Rohit Seth; Arora, Rohit

    2012-04-01

    The prevalence of peripheral artery disease is steadily increasing and is associated with significant morbidity, including a significant percentage of amputations. Peripheral artery disease often goes undiagnosed, making its prevention increasingly important. Patients with peripheral arterial disease are at increased risk of adverse cardiovascular outcomes which makes prevention even more important. Several risk factors have been identified in the pathophysiology of peripheral artery disease which should be modified to decrease risk. Smoking, hyperlipidemia, hypertension, and diabetes are among proven risk factors for the development of peripheral artery disease, thus smoking cessation, lipid control, blood pressure control, and glucose control have been tried and shown to be effective in preventing the morbidity associated with this disease. Pharmacologic agents such as aspirin and clopidogrel alone or in combination have been shown to be effective, though risk of bleeding might be increased with the combination. Anticoagulation use is recommended only for acute embolic cases. Other treatment modalities that have been tried or are under investigation are estrogen replacement, naftidrofuryl, pentoxifylline, hyperbaric oxygen, therapeutic angiogenesis, and advanced glycation inhibitors. The treatment for concomitant vascular diseases does not change in the presence of peripheral artery disease, but aggressive management of risk factors should be undertaken in such cases.

  18. Peripheral arterial disease and revascularization of the diabetic foot.

    Science.gov (United States)

    Forsythe, R O; Brownrigg, J; Hinchliffe, R J

    2015-05-01

    Diabetes is a complex disease with many serious potential sequelae, including large vessel arterial disease and microvascular dysfunction. Peripheral arterial disease is a common large vessel complication of diabetes, implicated in the development of tissue loss in up to half of patients with diabetic foot ulceration. In addition to peripheral arterial disease, functional changes in the microcirculation also contribute to the development of a diabetic foot ulcer, along with other factors such as infection, oedema and abnormal biomechanical loading. Peripheral arterial disease typically affects the distal vessels, resulting in multi-level occlusions and diffuse disease, which often necessitates challenging distal revascularisation surgery or angioplasty in order to improve blood flow. However, technically successful revascularisation does not always result in wound healing. The confounding effects of microvascular dysfunction must be recognised--treatment of a patient with a diabetic foot ulcer and peripheral arterial disease should address this complex interplay of pathophysiological changes. In the case of non-revascularisable peripheral arterial disease or poor response to conventional treatment, alternative approaches such as cell-based treatment, hyperbaric oxygen therapy and the use of vasodilators may appear attractive, however more robust evidence is required to justify these novel approaches. © 2014 John Wiley & Sons Ltd.

  19. ORIGINAL ARTICLES Peripheral arterial disease

    African Journals Online (AJOL)

    arterial disease is confirmed by its adverse prognostic significance for coronary and cerebrovascular events.2. •. 5. ·. 8 ABPI has been found to be an independent predictor even when the effects of advanced age, hypertension, diabetes mellitus, and pre-existing cardiovascular disease have been taken into account using ...

  20. Peripheral arterial stenosis and coronary artery disease coincidence

    Directory of Open Access Journals (Sweden)

    Reza Ghasemi

    2014-12-01

    Full Text Available Atherosclerosis is a chronic slow-developing condition affecting medium-size and large blood vessels. It is the principal underlying pathology of coronary heart disease and stroke. In some countries, coronary artery disease (CAD is the cause of nearly half (48% of the deaths and, loss of productivity life. Peripheral arterial disease (PAD is defined as atherosclerosis in peripheral arteries instead of coronary arteries. CAD and PAD have same risk factors and underlying pathophysiological processes. Therefore, patient with CAD should be considered for PAD. Ankle brachial index (ABI, duplex sonography, and some other non-invasive techniques are recommended for PAD diagnosis in patients with the history of CAD. Pharmacotherapy, endovascular interventions, and surgical management could be chosen according to the patient’s situation. Cardiologists and general practitioners should consider PAD in a patient with CAD or DM as a strong correlated disease.      

  1. Histopathological Evidence of Adventitial or Medial Injury Is a Strong Predictor of Restenosis During Directional Atherectomy for Peripheral Artery Disease.

    Science.gov (United States)

    Tarricone, Arthur; Ali, Ziad; Rajamanickam, Anitha; Gujja, Karthik; Kapur, Vishal; Purushothaman, K-Raman; Purushothaman, Meerarani; Vasquez, Miguel; Zalewski, Adrian; Parides, Micheal; Overbey, Jessica; Wiley, Jose; Krishnan, Prakash

    2015-10-01

    To investigate the impact on restenosis rates of deep injury to the adventitial layer during directional atherectomy. Between 2007 and 2010, 116 consecutive patients (mean age 69.6 years; 56 men) with symptomatic femoropopliteal stenoses were treated with directional atherectomy at a single center. All patients had claudication and TASC A/B lesions in the superficial femoral or popliteal arteries. Histopathology analysis of atherectomy specimens was performed to identify adventitial injury. Clinical follow-up included physical examination and duplex ultrasound scans at 3, 6, and 12 months in all patients. The primary endpoint was the duplex-documented 1-year rate of restenosis, which was determined by a peak systolic velocity ratio injury were identified in 62 (53%) of patients. There were no differences in baseline demographic and clinical features (p>0.05), lesion length (58.7±12.8 vs 56.2±13.6 mm, p=0.40), or vessel runoff (1.9±0.6 vs 2.0±0.6, p=0.37) between patients with and without adventitial injury, respectively. The overall 1-year incidence of restenosis was 57%, but the rate was significantly higher (pinjury (97%, 60/62) as compared with those without (11%, 6/54). Lack of adventitial injury after atherectomy for femoropopliteal stenosis is strongly related to patency at 1 year. © The Author(s) 2015.

  2. Advances in peripheral arterial disease endovascular revascularization.

    Science.gov (United States)

    Panico, Ambrose; Jafferani, Asif; Shah, Falak; Dieter, Robert S

    2015-02-01

    Significant advances have been made in the endovascular treatment of lower extremity arterial occlusive disease. Since the 2011 update, technologies has developed and allowed for the revascularization of complex vascular lesions. Although this technical success is encouraging, these technologies must provide measurable long-term clinical success at a reasonable cost. Large, randomized, controlled trials need to be designed to focus on clinical outcomes and success rates for treatment. These future studies will serve as the guide by which clinicians can provide the most successful clinical and cost effect care in treating patients with lower-extremity peripheral artery disease. Published by Elsevier Inc.

  3. Radial artery access for peripheral endovascular procedures.

    Science.gov (United States)

    Kumar, Avnee J; Jones, Lauren E; Kollmeyer, Kenneth R; Feldtman, Robert W; Ferrara, Craig A; Moe, Michelle N; Chen, Julia F; Richmond, Jasmine L; Ahn, Sam S

    2017-09-01

    The radial artery is often used for coronary angiography, with a demonstrated decrease in local complications and an increase in postoperative mobility of the patient. Data on radial artery access for peripheral endovascular procedures, however, are limited. We describe our experience with radial artery access for diagnostic and endovascular interventions. Between February 2012 and March 2015, there were 95 endovascular procedures performed using radial artery access in 80 unique patients. Demographic and clinical data were recorded. Perioperative, postoperative, and 30-day follow-up data were evaluated retrospectively for major and minor complications. Major adverse events included any immediate hospitalization admission, stroke, hand amputation, bleeding requiring transfusion, hematoma requiring surgery, and death. Minor complications included superficial bleeding and hematoma. The patients (52.6% male, 47.4% female) had a mean age of 72.1 ± 9.4 years. Radial artery access was used for diagnostic purposes in 15.8% of all procedures and for therapeutic intervention, including angioplasty and stenting, in 84.2%. The radial artery was the only access point in 80% of patients and was accessed in conjunction with other sites in 20%. Percutaneous access was achieved in 100% of patients with a 100% technical success rate. Hemostasis after catheterization was achieved by manual compression (22.1%) and TR band (Terumo Medical, Tokyo, Japan; 77.9%). Major adverse events occurred in three cases (3.2%) and were unrelated to radial artery access. Radial artery access site-related complications occurred in three cases (3.2%), all of which were minor hematomas that required no treatment. The risk of radial artery complication was not associated with procedure type, vessels treated, or use of heparin. The incidence of stroke, hand ischemia, and upper extremity limb or finger loss was 0%. Radial artery access for peripheral endovascular procedures appears to be safe and

  4. Peripheral Endothelial Function After Arterial Switch Operation for D-looped Transposition of the Great Arteries.

    Science.gov (United States)

    Sun, Heather Y; Stauffer, Katie Jo; Nourse, Susan E; Vu, Chau; Selamet Tierney, Elif Seda

    2017-06-01

    Coronary artery re-implantation during arterial switch operation in patients with D-looped transposition of the great arteries (D-TGA) can alter coronary arterial flow and increase shear stress, leading to local endothelial dysfunction, although prior studies have conflicting results. Endothelial pulse amplitude testing can predict coronary endothelial dysfunction by peripheral arterial testing. This study tested if, compared to healthy controls, patients with D-TGA after arterial switch operation had peripheral endothelial dysfunction. Patient inclusion criteria were (1) D-TGA after neonatal arterial switch operation; (2) age 9-29 years; (3) absence of known cardiovascular risk factors such as hypertension, diabetes, hypercholesterolemia, vascular disease, recurrent vasovagal syncope, and coronary artery disease; and (4) ability to comply with overnight fasting. Exclusion criteria included (1) body mass index ≥85th percentile, (2) use of medications affecting vascular tone, or (3) acute illness. We assessed endothelial function by endothelial pulse amplitude testing and compared the results to our previously published data in healthy controls (n = 57). We tested 20 D-TGA patients (16.4 ± 4.8 years old) who have undergone arterial switch operation at a median age of 5 days (0-61 days). Endothelial pulse amplitude testing indices were similar between patients with D-TGA and controls (1.78 ± 0.61 vs. 1.73 ± 0.54, p = 0.73).In our study population of children and young adults, there was no evidence of peripheral endothelial dysfunction in patients with D-TGA who have undergone arterial switch operation. Our results support the theory that coronary arterial wall thickening and abnormal vasodilation reported in these patients is a localized phenomenon and not reflective of overall atherosclerotic burden.

  5. Peripheral arterial disease in the elderly

    Directory of Open Access Journals (Sweden)

    Wilbert S Aronow

    2008-01-01

    Full Text Available Wilbert S AronowCardiology Division, Department of Medicine, New York Medical College, Valhalla, New YorkAbstract: Smoking should be stopped and hypertension, diabetes mellitus, dyslipidemia, and hypothyroidism treated in elderly patients with peripheral arterial disease (PAD of the lower extremities. Statins reduce the incidence of intermittent claudication and improve exercise duration until the onset of intermittent claudication in patients with PAD and hypercholesterolemia. Antiplatelet drugs such as aspirin or clopidogrel, especially clopidogrel, angiotensin-converting enzyme inhibitors, and statins should be given to all elderly patients with PAD without contraindications to these drugs. Beta blockers should be given if coronary artery disease is present. Exercise rehabilitation programs and cilostazol increase exercise time until intermittent claudication develops. Chelation therapy should be avoided. Indications for lower extremity percutaneous transluminal angioplasty or bypass surgery are (1 incapacitating claudication in patients interfering with work or lifestyle; (2 limb salvage in patients with limb-threatening ischemia as manifested by rest pain, non-healing ulcers, and/or infection or gangrene; and (3 vasculogenic impotence.Keywords: peripheral arterial disease, intermittent claudication, antiplatelet drugs, statins, angiotensin-converting enzyme inhibitors, cilostazol, exercise rehabilitation, revascularization

  6. [Physical activity and peripheral arterial obstructive disease].

    Science.gov (United States)

    Calanca, Luca; Pellegrin, Maxime; Mazzolai, Lucia

    2010-02-10

    Intermittent claudication (IC) is the most common clinical manifestation of atherosclerotic peripheral arterial disease. Exercise training plays a major role in treating patients with IC. Regular exercise increases functional walking capacity, reduces cardiovascular mortality and improves quality of life. This seems to be achieved by: favorable effect on cardiovascular risk factors, anti-inflammatory effect, increased collateral blood flux, improved rheology profile, endothelial function, fibrinolysis, and muscular metabolism. However, exact mechanisms underlying beneficial effect of exercise remain largely unknown. Exercise modalities will be discussed in this article.

  7. Peripheral Arteries May Be Reliable Indicators of Coronary Vascular Disease.

    Science.gov (United States)

    Hoehmann, Christopher L; Futterman, Bennett; Beatty, Brian Lee

    2017-07-01

    Atherosclerosis is a stronger predictor for ischemic cardiovascular events than traditional risk factors such as race, age, sex, history, and metabolic profile. Previous research had primarily used ultrasound; however, we performed a study using histopathology to more accurately grade atherosclerosis development using the American Heart Association's grading scale. We cross-sectioned 13 different arteries from 48 cadavers and placed them into three separate groups based on anatomic location: central arteries, peripheral arteries, and carotid arteries. The central artery group included arteries that are non-palpable and commonly lead to ischemic diseases when occluded. The peripheral artery group included arteries that are accessible to palpation. The carotid artery group included branches of the carotid artery. We investigated whether a centrally located atherosclerotic vessel was associated with atherosclerosis of a specific peripheral artery. We hypothesized a correlation between carotid, peripheral and central arteries that may point to specific arteries that are more effective to analyze clinically when assessing cardiovascular risk. We observed a correlation between pathology in the left coronary artery and bifurcation of the carotid artery (r = 0.37 P ≤ 0.016), two arteries known to be implicated in ischemic stroke and ischemic heart disease. Importantly, our study demonstrates that the radial artery, a peripheral vessel, exhibited a positive correlation between both the pathologic left coronary (r = 0.33 P ≤ 0.041) and bifurcation of the carotid arteries (r = 0.34 P ≤ 0.025). Therefore, we propose investigating the radial artery as a clinically accessible location to monitor with ultrasound when assessing a patient's risk for ischemic cardiovascular disease. Anat Rec, 300:1230-1239, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  8. Peripheral artery disease (PAD) screening in the asymptomatic population

    DEFF Research Database (Denmark)

    Sillesen, Henrik; Falk, Erling

    2011-01-01

    Measurement of ankle-brachial index (ABI) was developed to assess peripheral artery disease (PAD) in patients with symptoms of peripheral ischemia being present at rest or only functionally dependent (intermittent claudication). Reduced ABI is caused by arterial obstruction between the aortic arch...

  9. Gene expression in peripheral arterial chemoreceptors.

    Science.gov (United States)

    Gauda, Estelle B

    2002-11-01

    The peripheral arterial chemoreceptors of the carotid body participate in the ventilatory responses to hypoxia and hypercapnia, the arousal responses to asphyxial apnea, and the acclimatization to high altitude. In response to an excitatory stimuli, glomus cells in the carotid body depolarize, their intracellular calcium levels rise, and neurotransmitters are released from them. Neurotransmitters then bind to autoreceptors on glomus cells and postsynaptic receptors on chemoafferents of the carotid sinus nerve. Binding to inhibitory or excitatory receptors on chemoafferents control the electrical activity of the carotid sinus nerve, which provides the input to respiratory-related brainstem nuclei. We and others have used gene expression in the carotid body as a tool to determine what neurotransmitters mediate the response of peripheral arterial chemoreceptors to excitatory stimuli, specifically hypoxia. Data from physiological studies support the involvement of numerous putative neurotransmitters in hypoxic chemosensitivity. This article reviews how in situ hybridization histochemistry and other cellular localization techniques confirm, refute, or expand what is known about the role of dopamine, norepinephrine, substance P, acetylcholine, adenosine, and ATP in chemotransmission. In spite of some species differences, review of the available data support that 1). dopamine and norepinephrine are synthesized and released from glomus cells in all species and play an inhibitory role in hypoxic chemosensitivity; 2). substance P and acetylcholine are not synthesized in glomus cells of most species but may be made and released from nerve fibers innervating the carotid body in essentially all species; 3). adenosine and ATP are ubiquitous molecules that most likely play an excitatory role in hypoxic chemosensitivity. Copyright 2002 Wiley-Liss, Inc.

  10. Nitric Oxide Manipulation: A Therapeutic Target for Peripheral Arterial Disease?

    Directory of Open Access Journals (Sweden)

    Gareth Williams

    2012-01-01

    Full Text Available Peripheral Arterial Disease (PAD is a cause of significant morbidity and mortality in the Western world. Risk factor modification and endovascular and surgical revascularisation are the main treatment options at present. However, a significant number of patients still require major amputation. There is evidence that nitric oxide (NO and its endogenous inhibitor asymmetric dimethylarginine (ADMA play significant roles in the pathophysiology of PAD. This paper reviews experimental work implicating the ADMA-DDAH-NO pathway in PAD, focussing on both the vascular dysfunction and effects within the ischaemic muscle, and examines the potential of manipulating this pathway as a novel adjunct therapy in PAD.

  11. Beta-2 microglobulin as a predictor of peripheral arterial disease in ...

    African Journals Online (AJOL)

    2012-08-15

    Aug 15, 2012 ... Original Research: Beta-2 microglobulin as a predictor of peripheral arterial disease in diabetes. 141. 2012 Volume 17 No 3. JEMDSA. Introduction. Epidemiological evidence confirms an association be- tween diabetes and increased prevalence of periphe- ral arterial disease (PAD). Individuals with ...

  12. Clinical impact of exercise in patients with peripheral arterial disease.

    Science.gov (United States)

    Novakovic, Marko; Jug, Borut; Lenasi, Helena

    2017-08-01

    Increasing prevalence, high morbidity and mortality, and decreased health-related quality of life are hallmarks of peripheral arterial disease. About one-third of peripheral arterial disease patients have intermittent claudication with deleterious effects on everyday activities, such as walking. Exercise training improves peripheral arterial disease symptoms and is recommended as first line therapy for peripheral arterial disease. This review examines the effects of exercise training beyond improvements in walking distance, namely on vascular function, parameters of inflammation, activated hemostasis and oxidative stress, and quality of life. Exercise training not only increases walking distance and physiologic parameters in patients with peripheral arterial disease, but also improves the cardiovascular risk profile by helping patients achieve better control of hypertension, hyperglycemia, obesity and dyslipidemia, thus further reducing cardiovascular risk and the prevalence of coexistent atherosclerotic diseases. American guidelines suggest supervised exercise training, performed for a minimum of 30-45 min, at least three times per week, for at least 12 weeks. Walking is the most studied exercise modality and its efficacy in improving cardiovascular parameters in patients with peripheral arterial disease has been extensively proven. As studies have shown that supervised exercise training improves walking performance, cardiovascular parameters and quality of life in patients with peripheral arterial disease, it should be encouraged and more often prescribed.

  13. Skin microcirculation in peripheral arterial obliterative disease.

    Science.gov (United States)

    Rossi, M; Carpi, A

    2004-10-01

    The important role of microcirculation in the pathophysiology and symptoms of peripheral arterial obliterative disease (PAOD) has been progressively emphasized during the past twenty years, thanks to the use of different non-invasive methods, such as capillaroscopy, laser Doppler (LD) fluxmetry and transcutaneous measurement of oxygen tension (tcPO2). Basally, in the diseased leg of stage II PAOD patients, leg skin perfusion recorded by means of LD fluxmetry is quantitatively normal. However, spectral analysis of skin LD tracing shows an abnormal flowmotion, with increased amplitude of the flowmotion waves related to endothelial, neurogenic and myogenic activities, suggesting a relatively early skin microcirculatory adaptation in this PAOD stage. Following ischemia, an impaired total skin LD hyperemia and a reduced skin capillary nutritional blood flow at capillaroscopy, concomitantly with a reduced increase of flowmotion waves related to endothelial, myogenic and sympathetic activities, have been observed in the diseased leg of stage II PAOD patients. In critical limb ischemia (CLI), a more advanced cutaneous microcirculatory deterioration has been clarified, with a more severely impaired post-ischemic hyperemia, a reduced tcPO2 and a severely perturbed skin flowmotion in the diseased leg. This integrated skin microcirculatory diagnostic approach can be used for a better management of PAOD patients.

  14. Plurivascular Lesions in Patients with Peripheral Arterial Disease

    Directory of Open Access Journals (Sweden)

    Kelemen Piroska

    2016-09-01

    Full Text Available Introduction: Occlusive arterial disease, regardless of etiology, is a progressive chronic disease with multiple vessel involvement. The importance of obstructive arterial disease is that it leads to an increased mortality and morbidity of other cardiovascular disorders. Therefore, the presence of a lesion on a certain artery should lead to the identification of other lesions on the carotid and coronary arteries. The aim of the study was to assess the frequency and severity of lesions in peripheral arterial disease of different etiologies, and also to study its association with multivessel lesions at the level of the coronary tree and the carotid arteries.

  15. A case of William's syndrome associated peripheral pulmonary arterial stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Kyung Hwa; Hwang, Mi Soo; Kim, Sun Yong; Chang, Jae Chun; Park, Bok Hwan [College of Medicine, Yeungam University, Daegu (Korea, Republic of)

    1988-06-15

    William's syndrome, in order to more completely delineate the total spectrum of the disorder, indicates that 'infantile hypercalcemia', 'peculiar facies' and 'supravalvular aortic stenosis.' In has other many vascular anomalies, such as peripheral pulmonary arterial stenosis, coronary arterial stenosis, celiac arterial stenosis, and renal aterial stenosis. Only 32% of the patients have evidence of supravalvular aortic stenosis. And it is very rare disease entity that has been reported rarely in Korea. Recently authors experienced a case that was questioned William's syndrome with peripheral pulmonary arterial stenosis, clinically and preliminary radiologically and this case was confirmed by operation. Here we report a case of William's syndrome with peripheral pulmonary arterial stenosis and reviewed literatures.

  16. Statin use in patients with peripheral arterial disease.

    Science.gov (United States)

    Harris, Sheena K; Roos, Matt G; Landry, Gregory J

    2016-12-01

    Statins are recommended for use in patients with peripheral arterial disease (PAD) to reduce cardiovascular events and mortality. However, much of the data regarding benefits of statins stem from the cardiovascular literature. Here, we review the literature regarding statin use specifically in patients with PAD regarding its effects on cardiovascular events and mortality, limb-related outcomes, statin use after endovascular interventions, statin dosing, and concerns about statins. We performed a literature review using PubMed for literature after the year 2000. Search terms included "statins," "peripheral arterial disease," "peripheral vascular disease," "lipid-lowering medication," and "cardiovascular disease." There is good evidence of statins lowering cardiovascular events and cardiovascular-related mortality in patients with PAD. Though revascularization rates were reduced with statins, amputation rates and amputation-free survival did not improve. Small randomized controlled trials show that patients taking statins can slightly improve pain-free walking distance or pain-free walking time, although the extent of the effect on quality of life is unclear. Statin use for patients undergoing endovascular interventions is recommended because of the reduction of postoperative cardiovascular events. Not enough data exist to support local effects of systemic statin therapy, such as prevention of restenosis. For statin dosing, there is little increased benefit to intense therapy compared with the adverse effects, whereas moderate-dose therapy has significant benefits with very few adverse effects. Adverse effects of moderate-dose statin therapy are rare and mild and are greatly outweighed by the cardiovascular benefits. There is strong evidence to support use of statins in patients with PAD to reduce cardiovascular events and mortality. Use in patients undergoing open and endovascular interventions is also recommended. Statin use may reduce the need for

  17. The Role of Hyperlipidaemia in Peripheral Arterial Occlusive Disease

    OpenAIRE

    Drexel H

    2003-01-01

    A recent report from the Physicians' Health Study proved elevated plasma cholesterol, elevated triglycerides, and low HDL-cholesterol predictive of the incidence of peripheral arterial occlusive disease. The strongest predictor was the cholesterol/HDL-cholesterol ratio. In contrast, new risk factors, eg lipoprotein (a), homocysteine and apolipoproteins A and B did not have additional predictive power for peripheral arterial occlusive disease, whereas C-reactive protein and fibrinogen were in...

  18. Exercise Training and Peripheral Arterial Disease

    Science.gov (United States)

    Haas, Tara L.; Lloyd, Pamela G.; Yang, Hsiao-Tung; Terjung, Ronald L.

    2013-01-01

    Peripheral arterial disease (PAD) is a common vascular disease that reduces blood flow capacity to the legs of patients. PAD leads to exercise intolerance that can progress in severity to greatly limit mobility, and in advanced cases leads to frank ischemia with pain at rest. It is estimated that 12–15 million people in the United States are diagnosed with PAD, with a much larger population that is undiagnosed. The presence of PAD predicts a 50–1500% increase in morbidity and mortality, depending on severity. Treatment of patients with PAD is limited to modification of cardiovascular disease risk factors, pharmacological intervention, surgery, and exercise therapy. Extended exercise programs that involve walking ~5 times/wk, at a significant intensity that requires frequent rest periods, are most significant. Pre-clinical studies and virtually all clinical trials demonstrate the benefits of exercise therapy, including: improved walking tolerance, modified inflammatory/hemostatic markers, enhanced vasoresponsiveness, adaptations within the limb (angiogenesis, arteriogenesis, mitochondrial synthesis) that enhance oxygen delivery and metabolic responses, potentially delayed progression of the disease, enhanced quality of life indices, and extended longevity. A synthesis is provided as to how these adaptations can develop in the context of our current state of knowledge and events known to be orchestrated by exercise. The benefits are so compelling that exercise prescription should be an essential option presented to patients with PAD in the absence of contraindications. Obviously, selecting for a life style pattern, that includes enhanced physical activity prior to the advance of PAD limitations, is the most desirable and beneficial. PMID:23720270

  19. Effects of Mechanical Pumping on the Arterial Pulse Wave Velocity: Peripheral Artery and Micro-Vessels

    Science.gov (United States)

    2001-10-25

    EFFECTS OF MECHANICAL PUMPING ON THE ARTERIAL PULSE WAVE VELOCITY : PERIPHERAL ARTERY AND MICRO -VESSELS Shu-Mei Wu*†, Yio-Wha Shau**, Bor-Shyh...was contributed from the results of BA-RA, the PWV for the micro -vessels (BA-finger) on the contrary was increased. Keywords- Mechanical Pumping ...arterial conduit (brachial artery-radial artery; BA-RA) and the micro -vessels (RA-ring finger) to mechanical pumping was evaluated. II

  20. Ultrastructural changes in peripheral arteries and nerves in diabetic ...

    African Journals Online (AJOL)

    All cases were subjected to complete history taking, complete clinical examination, and routine laboratory investigations. ''Light and electron microscopic studies” of biopsies from the peripheral small arteries and nerves e.g. digital or posterior tibial arteries and nerves during amputation of diabetic gangrene of the toes, ...

  1. Peripheral arterial occlusive disease: role of MR angiography.

    Science.gov (United States)

    Gozzi, M; Amorico, M G; Colopi, S; Favali, M; Gallo, E; Torricelli, P; Polverini, I; Gargiulo, M

    2006-03-01

    Magnetic resonance angiography (MRA) has recently become instrumental in the diagnosis of arterial disease in various body districts and is gaining an increasingly important role in the study of peripheral vascularisation. The aim of our study was to evaluate the reliability of MRA using digital subtraction angiography (DSA) as the reference standard. Between November 2003 and August 2004, 30 patients with known peripheral arterial disease were studied by MRA and DSA. MRA was performed with a Philips Intera 1.5 T, with acquisitions from the coeliac trunk to the feet. For acquisitions of the feet and ankles we used unenhanced time-of-flight (TOF) sequences with a head coil. The angiographic sequence was acquired in three volumes of 40-45 cm after administration of paramagnetic contrast material. In the patients with peripheral arterial disease, the technique provided a precise evaluation of the stenosis (mild, moderate, severe) or obstruction of the peripheral district as well as the detection of other diseases, such as stenosis of the renal arteries or aneurysms. Total-body three-dimensional (3D) MRA allows a fast, safe, and accurate assessment of the arterial system in patients with arteriosclerosis and can be considered an alternative to DSA in the management of patients with steno-obstructive disease of the peripheral arteries.

  2. Lower limb movement variability in patients with peripheral arterial disease.

    Science.gov (United States)

    Crowther, Robert G; Spinks, Warwick L; Leicht, Anthony S; Quigley, Frank; Golledge, Jonathan

    2008-10-01

    Peripheral arterial disease is a chronic obstructive disease of the arteries of the lower limb caused by atherosclerosis. The resultant decrease in blood flow can result in symptoms of pain in the lower limb on exercise known as intermittent claudication. Exercise induced pain is experienced in the calves, thigh or buttocks restricting activities of daily living and thus reducing quality of life. This study investigated lower limb movement variability in individuals with peripheral arterial disease-intermittent claudication (n=28) compared to individuals without peripheral arterial disease-intermittent claudication (control, n=25). A further aim was to examine the efficacy of various techniques used to describe single joint movement variability. All participants underwent two-dimensional angular kinematics analysis of the lower limb during normal walking. Single joint movement variability was measured using linear (spanning set and coefficient of variation) techniques. Between group differences were examined by one-way ANOVA. The peripheral arterial disease-intermittent claudication participants displayed significantly higher levels of lower limb movement variability in all joints when assessed using the coefficient of variation technique. There were no significant between group differences using the spanning set technique. Individuals with peripheral arterial disease-intermittent claudication have higher levels of lower limb movement variability and reduced walking speed compared to healthy age and mass matched controls. This variability may be an adaptation to the gradual onset of ischaemic pain in this population.

  3. IGF-I and IGFBP2 in peripheral artery disease

    DEFF Research Database (Denmark)

    Urbonaviciene, Grazina; Frystyk, Jan; Urbonavicius, Sigitas

    2014-01-01

    BACKGROUND AND OBJECTIVES: The search for novel risk factors of cardiovascular disease (CVD) has provided valuable clinical data concerning underlying mechanism of disease. Increasing evidence indicates a possible involvement of insulin-like growth factor-I (IGF-I) and its binding protein 2 (IGFBP......-2) in the pathogenesis of CVD disorders. The aim of this study was to examine the relationship between levels of IGF-I and IGFBP-2 with all-cause and CVD mortality in a prospective study of patients with lower-extremity peripheral artery disease (PAD). METHODS AND MATERIAL: Serum IGF-I and IGFBP-2...... levels were obtained in 440 patients (257 males) with symptomatic PAD. Patients were followed for a median of 6.1 (IQ 5.1-7.2) years. The relationship between times to lethal outcome and baseline serum IGF-I and IFGBP-2 levels were examined by Cox proportional hazard analysis. The role of IFGBP-2...

  4. Angioplasty and stent placement - peripheral arteries

    Science.gov (United States)

    ... blood flow. A stent is a small, metal mesh tube that keeps the artery open. Angioplasty and ... 1570. PMID: 23473760 www.ncbi.nlm.nih.gov/pubmed/23473760 . Society for Vascular Surgery Lower Extremity Guidelines ...

  5. Cannabinoid receptor expression in peripheral arterial chemoreceptors during postnatal development.

    Science.gov (United States)

    McLemore, Gabrielle L; Cooper, Reed Z B; Richardson, Kimberlei A; Mason, Ariel V; Marshall, Cathleen; Northington, Frances J; Gauda, Estelle B

    2004-10-01

    Prenatal exposure to tobacco smoke increases risk of sudden infant death syndrome (SIDS). Marijuana is frequently smoked in conjunction with tobacco, and perinatal exposure to marijuana is associated with increased incidence of SIDS. Abnormalities in peripheral arterial chemoreceptor responses during sleep may be operative in infants at risk for SIDS, and nicotine exposure adversely affects peripheral arterial chemoreceptor responses. To determine whether marijuana could potentially affect the activity of peripheral arterial chemoreceptors during early postnatal development, we used in situ hybridization histochemistry to characterize the pattern and level of mRNA expression for cannabinoid type 1 receptor (CB1R) in the carotid body, superior cervical ganglia (SCG), and nodose-petrosal-jugular ganglia (NG-PG-JG) complex in newborn rats. We used immunohistochemistry and light, confocal, and electron microscopy to characterize the pattern of CB1R and tyrosine hydroxylase protein expression. CB1R mRNA expression was intense in the NG-PG-JG complex, low to moderate in the SCG, and sparse in the carotid body. With maturation, CB1R gene expression significantly increased (P peripheral arterial chemoreceptors. The novel finding of nuclear localization of CB1Rs in peripheral ganglion cells suggests that these receptors may have an, as yet, undetermined role in nuclear signaling in sensory and autonomic neurons.

  6. Moyamoya Disease with Peripheral Pulmonary Artery Stenoses and Coronary Artery Fistulae

    Directory of Open Access Journals (Sweden)

    Lindsay Reardon

    2009-01-01

    Full Text Available Moyamoya is a progressive disorder of the cerebral vasculature. Our report describes a rare case of Moyamoya disease with distal peripheral pulmonary artery stenoses and coronary fistulae in a 12-year-old Caucasian female patient.

  7. Duplex ultrasound scanning of peripheral arterial disease of the lower limb

    DEFF Research Database (Denmark)

    Eiberg, Jonas Peter; Rasmussen, John Bøje Grønvall; Hansen, Marc Allan

    2010-01-01

    To assess the reliability and applicability of duplex ultrasound scanning (DUS) of lower limb arteries, compared with digital subtraction angiography (DSA), in patients with peripheral arterial disease (PAD)....

  8. Low-grade inflammation can partly explain the association between the metabolic syndrome and either coronary artery disease or severity of peripheral arterial disease: the CODAM study

    NARCIS (Netherlands)

    Jacobs, M.; Greevenbroek, M.M.; Kallen, C.J.; Ferreira, I.; Blaak, E.E.; Feskens, E.J.M.; Jansen, E.H.; Schalkwijk, C.G.; Stehouwer, C.D.

    2009-01-01

    Background Low-grade inflammation has been hypothesized to underlie the coronary artery disease (CAD) risk associated with the metabolic syndrome, but the evidence is not conclusive. For peripheral arterial disease (PAD; as measured by the ankle-arm index), this association has not been studied

  9. Coronary artery bypass grafting following simultaneous treatment of abdominal aortic aneurysm and peripheral arterial disease.

    Science.gov (United States)

    Temizkan, Veysel; Ugur, Murat; Alp, Ibrahim; Ucak, Alper; Yedekci, Erturk; Yilmaz, Ahmet Turan

    2014-01-01

    Atherosclerosis might affect all arterial segments of the vascular system, thus peripheral arterial disease (PAD) accompanying coronary artery disease (CAD) is not uncommon. In addition to this coexistence, abdominal aortic aneurysm (AAA) is frequently associated with CAD. Although treatment strategies of CAD and PAD or CAD and AAA has been reported previously, treatment of these three pathologies has not been reported. The management of a therapeutic strategy is important for avoiding perioperative mortality and morbidity in CAD associated with AAA and PAD. We are reporting our simultaneous treatment strategy of three pathologies with endovascular AAA repair, stent implantation into the superficial femoral artery (SFA) and coronary artery bypass grafting (CABG).

  10. Peripheral arterial disease - high prevalence in rural black South ...

    African Journals Online (AJOL)

    Background. The prevalence of peripheral arterial disease (PAD) worldwide has been estimated at between 4.5% and 29%. PAD has been associated with male gender, advanced age, diabetes, hypertension, hypercholesterolaemia and smoking. Clinical experience with amputations at Mthatha General Hospital, a district ...

  11. Ultrastructural changes in peripheral arteries and nerves in diabetic ...

    African Journals Online (AJOL)

    Mohamed E. Salem

    2017-01-30

    Jan 30, 2017 ... Ultrastructural changes in peripheral arteries and nerves in diabetic ischemic lower limbs, by electron microscope. Mohamed E. Salem a,*. , Abdel-Azzem A. Ismael b, Amr Salem c, Tarek Salem d a Department of Vascular Surgery, Faculty of Medicine, Alexandria University, Egypt b Department of Cell ...

  12. Nitrite and Nitric Oxide Metabolism in Peripheral Artery Disease

    OpenAIRE

    Allen, Jason D; Giordano, Tony; Kevil, Christopher G.

    2012-01-01

    Peripheral Artery Disease (PAD) represents a burgeoning form of cardiovascular disease associated with significant clinical morbidity and increased 5 year cardiovascular disease mortality. It is characterized by impaired blood flow to the lower extremities, claudication pain and severe exercise intolerance. Pathophysiological factors contributing to PAD include atherosclerosis, endothelial cell dysfunction, and defective nitric oxide metabolite physiology and biochemistry that collectively le...

  13. The burden and characteristics of peripheral arterial disease in ...

    African Journals Online (AJOL)

    SUMMARY. Background: To determine the prevalence of Peripheral Arterial Disease (PAD) and associated risk factors in pa- tients undergoing amputation at the Korle Bu Teaching Hospital (KBTH), Accra, Ghana. Objectives: A cross- sectional study of all patients undergoing lower extremity amputation at the Department of.

  14. Feasibility and Safety of Routine Transpedal Arterial Access for Treatment of Peripheral Artery Disease.

    Science.gov (United States)

    Kwan, Tak W; Shah, Sooraj; Amoroso, Nicholas; Diwan, Ravi; Makker, Parth; Ratcliffe, Justin A; Lala, Moinakhtar; Huang, Yili; Nanjundappa, Aravinda; Daggubati, Ramesh; Pancholy, Samir; Patel, Tejas

    2015-07-01

    To demonstrate the feasibility and safety of transpedal arterial access for lower-extremity angiography and intervention. Traditionally, the femoral artery is chosen for the initial access site in symptomatic peripheral artery disease (PAD), but this approach carries a substantial portion of the entire procedural complication risk. 80 patients were prospectively evaluated for the treatment of PAD between May and July 2014. All patients underwent peripheral angiography, and intervention if necessary. A pedal artery was the initial access site for all patients. Under ultrasound guidance, one of the pedal arteries was visualized and accessed, and a 4 Fr Glidesheath was inserted. Retrograde orbital atherectomy and balloon angioplasty were performed with a 4 Fr sheath or upsizing to a 6 Fr Glidesheath Slender (Terumo) for stenting as needed. Clinical and ultrasound assessment of the pedal arteries were performed before the procedure and at 1-month follow-up. Diagnostic transpedal peripheral angiography was performed in all 80 patients. 43 out of 51 patients (84%) who required intervention were successful using a pedal artery as the sole access site. No immediate or delayed access-site complications were detected. Clinical follow-up was achieved in 77 patients (96%) and access artery patency was demonstrated by ultrasound at 1 month in 100% of patients. The routine use of a transpedal approach for the treatment of PAD may be feasible and safe. Pedal artery access may also avoid many of the complications associated with the traditional femoral approach, but further study is needed.

  15. Prevalence of significant carotid artery stenosis in Iranian patients with peripheral arterial disease

    Directory of Open Access Journals (Sweden)

    Ghabili K

    2011-10-01

    Full Text Available Abolhassan Shakeri Bavil1, Kamyar Ghabili2, Seyed Ebrahim Daneshmand3, Masoud Nemati3, Moslem Shakeri Bavil4, Hossein Namdar5, Sheyda Shaafi61Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 2Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 3Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran; 4Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, Iran; 5Department of Cardiology, Tabriz University of Medical Sciences, Tabriz, Iran; 6Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, IranBackground: Generalized screening for carotid artery stenosis with carotid duplex ultrasonography in patients with peripheral arterial disease is controversial.Objectives: The aim of the present study was to determine the prevalence of significant internal carotid artery (ICA stenosis in a group of Iranian patients with peripheral arterial disease.Methods: We prospectively screened 120 patients with a known diagnosis of peripheral vascular disease for carotid artery stenosis. Based on the angiographic assessment of abdominal aorta and arteries of the lower extremities, patients with stenosis greater than 70% in the lower extremity arteries were included. A group of healthy individuals aged ≥50 years was recruited as a control. Risk factors for atherosclerosis including smoking, diabetes mellitus, hyperlipidemia, ischemic heart disease, and cerebrovascular disease were recorded. Common carotid arteries (CCAs and the origins of the internal and external arteries were scanned with B-mode ultrasonogaphy. Significant ICA stenosis, >70% ICA stenosis but less than near occlusion of the ICA, was diagnosed when the ICA/CCA peak systolic velocity ratio was ≥3.5.Results: Ninety-five patients, with a mean age of 58.52 ± 11.04 years, were studied. Twenty-five patients had a history of smoking, six

  16. Peripheral arterial chemoreceptors and sudden infant death syndrome.

    Science.gov (United States)

    Gauda, Estelle B; Cristofalo, Elizabeth; Nunez, Jeanne

    2007-07-01

    Sudden infant death syndrome (SIDS) is the major cause of death in infants between 1 month and 1 year of age. Two particular concerns are that (1) premature or low birth weight (peripheral arterial chemoreceptors (PACs) may be one biological mechanism that could help to explain the epidemiological association between the increased incidence of SIDS in formerly premature infants. Because premature infants are often exposed to the extremes of oxygen stress during early postnatal development, they are more likely to have a maladaptive response of PACs later in their lives. As the first line of defense that mediates an increase in ventilation to a hypoxic challenge during wakefulness and sleep, PACs also mediate arousal responses during sleep in response to an asphyxial event that is often associated with upper airway obstruction. In most mammalian species, PACs are not fully developed at birth and thus are vulnerable to plasticity-induced changes mediated by environmental exposures such as the extremes of oxygen tension. Hypoxic or hyperoxic exposure during early postnatal development can lead to hyposensitive or hypersensitive PAC responses later in life. Although baseline chemoreceptor activity may not be the cause of an initial hypoxic or asphyxial event, the level of peripheral chemoreceptor drive does modulate the (1) time to arousal, (2) resumption of airflow during airway obstruction, (3) escape behaviors during rebreathing, and (4) cardiorespiratory responses that result from activation of the laryngeal chemoreflex. The laryngeal chemoreflex can be stimulated by reflux of gastric contents above the upper esophageal sphincter, or an increase in nasopharyngeal secretions from upper respiratory tract infections--events that contribute to some cases of SIDS. In this review, evidence is presented that both hypo- and hypersensitivity of PACs may be disadvantageous to the premature infant who is placed in an at risk environment for the occurrence of hypoxemia

  17. Duplex ultrasound in the assessment of peripheral arterial disease

    Science.gov (United States)

    Aly, Sayed A. A. F.

    Arteriography plays a central role in the assessment of peripheral arterial disease. Arteriography is associated with the risk of damage to the artery, peripheral embolisation, hazards of intra-arterial injection and exposure to ionising radiation. Arteriography provides an anatomical assessment of arterial stenosis but does not measure the functional results of the stenosis. Modern high resolution ultrasound imaging technology enables non-invasive assessment of vascular diseases and allows functional assessment of blood flow. This investigation is of proven value in studying carotid disease. The aim of the study was to determine the accuracy of duplex ultrasonography (DUS) in assessment of lower limb arterial disease in comparison with arteriography (IA DSA). A technical comparison has been made between the description of arterial lesion as indicated by DUS and IA DSA. In addition, the sensitivity of DUS in assessing multisegmental arterial disease has been determined. The clinical decision has been investigated in a further study in which five surgeons were asked to determine patient management based on IA DSA and DUS data in the same patient group. Concordance between management strategies was assessed. DUS was used as the primary method of investigation in further series of patients. Criteria were established to determine which patients would require angiography. The computer-assisted image analysis was used to study the ultrasound images of arterial stenosis and a method of analysing such images objectively was established. Two studies have been included in this section. These assess the technical accuracy of ultrasound image analysis compared with histological examination of plaque. The reproducibility of the image analysis has also been tested. I have developed a classification for peripheral arterial disease to be used to facilitate the communication between vascular laboratory staff who perform the duplex ultrasonography and surgeons who use this

  18. Review of aspirin and clopidogrel resistance in peripheral arterial disease.

    Science.gov (United States)

    Guirgis, Mina; Thompson, Peter; Jansen, Shirley

    2017-11-01

    Aspirin resistance (AR) and clopidogrel resistance (CR) are terms used to describe a reduction in the medication's efficacy in inhibiting platelet aggregation despite regular dosing. This review gives context to the clinical role and implications of antiplatelet resistance in peripheral arterial disease (PAD). A review of English-language literature on AR and CR in PAD involving human subjects using PubMed and MEDLINE databases was performed in April 2017. A total of 2075 patients in 22 relevant studies were identified. To give this issue context, a review of the larger, more established literature on antiplatelet resistance in coronary disease was undertaken, identifying significant research associating resistance to major adverse cardiovascular events (MACEs). Studies in the coronary arterial disease literature have strongly associated antiplatelet resistance with increased MACE. Prevalence of AR or CR in coronary disease appears to be >55% for each in some studies. Meta-analyses of >50 studies revealed that AR and CR are significantly associated with MACE (relative risk of 2.09 and 2.8, respectively). This adds further weight to the literature reporting antiplatelet resistance as an independent predictor of and a threefold risk factor for major adverse cardiovascular events. The prevalence of resistance in PAD in this review was comparable to that in the coronary disease literature, with AR and CR prevalence up to 60% and 65%, respectively. There is evidence that the adverse effects of antiplatelet resistance are significant in PAD. In fact, research directly studying stent thrombosis populations with either coronary arterial disease or PAD revealed more significantly impaired platelet responsiveness to clopidogrel and aspirin in PAD compared with similar individuals with coronary disease. AR in PAD was found in studies to be a significant risk factor for iliofemoral stent reocclusion (P = .0093) and stroke in patients with symptomatic carotid disease (P

  19. Epidemiology, classification, and modifiable risk factors of peripheral arterial disease

    Directory of Open Access Journals (Sweden)

    Nicolas W Shammas

    2007-05-01

    Full Text Available Nicolas W ShammasMidwest Cardiovascular Research Foundation, Cardiovascular Medicine, PC, Davenport, IA, USAAbstract: Peripheral arterial disease (PAD is part of a global vascular problem of diffuse atherosclerosis. PAD patients die mostly of cardiac and cerebrovascular-related events and much less frequently due to obstructive disease of the lower extremities. Aggressive risk factors modification is needed to reduce cardiac mortality in PAD patients. These include smoking cessation, reduction of blood pressure to current guidelines, aggressive low density lipoprotein lowering, losing weight, controlling diabetes and the use of oral antiplatelet drugs such as aspirin or clopidogrel. In addition to quitting smoking and exercise, cilostazol and statins have been shown to reduce claudication in patients with PAD. Patients with critical rest limb ischemia or severe progressive claudication need to be treated with revascularization to minimize the chance of limb loss, reduce symptoms, and improve quality of life.Keywords: peripheral arterial disease, epidemiology, risk factors, classification

  20. Non-invasive imaging for subclinical coronary atherosclerosis in patients with peripheral artery disease

    DEFF Research Database (Denmark)

    Ripa, Rasmus Sejersten; Kjaer, Andreas; Hesse, Birger

    2014-01-01

    of subclinical coronary artery disease varies widely in patients with peripheral artery disease, it could include more than half of patients. No consensus exists to date on either the rationale for screening patients with peripheral artery disease for coronary atherosclerosis or the optimal algorithm and method......Patients with peripheral artery disease are at high risk of coronary artery disease. An increasing number of studies show that a large proportion of patients with peripheral artery disease have significant coronary atherosclerosis, even in the absence of symptoms. Although the reported prevalence...

  1. Challenges associated with peripheral arterial disease in women

    OpenAIRE

    Barochiner, Jessica; Aparicio, Lucas S; Waisman, Gabriel D

    2014-01-01

    Jessica Barochiner, Lucas S Aparicio, Gabriel D Waisman Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina Abstract: Peripheral arterial disease (PAD) is an increasingly recognized disorder that is associated with functional impairment, quality-of-life deterioration, increased risk of cardiovascular ischemic events, and increased risk of total and cardiovascular mortality. Although earlier studies suggested that PAD was more common ...

  2. Metabolic syndrome in patients with peripheral arterial disease.

    Science.gov (United States)

    Estirado, E; Lahoz, C; Laguna, F; García-Iglesias, F; González-Alegre, M T; Mostaza, J M

    2014-11-01

    The prevalence of metabolic syndrome (MS) in patients with peripheral arterial disease (PAD) and coronary or cerebrovascular disease is increasing, but it is not known whether this association also exists in patients with isolated PAD. The aim of the current study was to assess the prevalence of MS in patients with PAD who had no coronary or cerebrovascular disease, the prescription rate of evidence-based cardiovascular therapies and the attainment of therapeutic goals in patients with PAD and with and without MS. Multicenter, cross-sectional study of 3.934 patients aged ≥ 45 years with isolated PAD who were treated in primary care and specialized outpatient clinics during 2009. A diagnosis of PAD was reached for ankle brachial indices <0.9, a previous history of amputation or revascularization. In the overall population, the mean age was 67.6 years, 73.8% were males and 63% had MS (95% CI 61.5-64.3%). Patients with MS had a higher prevalence of cardiovascular risk factors and comorbidities, more severe PAD and higher prescription rate of evidence-based cardiovascular therapies. After adjusting for risk factors and comorbidity, there was a more frequent use of renin-angiotensin system blockers, beta-blockers, diuretics and statins among the patients with MS. A lower percentage of patients with MS achieved the therapeutic goals for blood pressure (22% vs. 41.5%, p<0.001). Similarly, a lower percentage of patients with diabetes achieved the glycated hemoglobin goals (44% vs. 53.1%, p<0.001), with no differences in LDL-cholesterol levels (29.8% vs. 39.1%, p=0.265). Patients with PAD have a high prevalence of MS. Patients with MS do not attain therapeutic goals as frequently as those without, despite taking more cardiovascular drugs. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  3. Statin therapy in lower limb peripheral arterial disease: Systematic review and meta-analysis.

    Science.gov (United States)

    Antoniou, George A; Fisher, Robert K; Georgiadis, George S; Antoniou, Stavros A; Torella, Francesco

    2014-11-01

    To investigate and analyse the existing evidence supporting statin therapy in patients with lower limb atherosclerotic arterial disease. A systematic search of electronic information sources was undertaken to identify studies comparing cardiovascular outcomes in patients with lower limb peripheral arterial disease treated with a statin and those not receiving a statin. Estimates were combined applying fixed- or random-effects models. Twelve observational cohort studies and two randomised trials reporting 19,368 patients were selected. Statin therapy was associated with reduced all-cause mortality (odds ratio 0.60, 95% confidence interval 0.46-0.78) and incidence of stroke (odds ratio 0.77, 95% confidence interval 0.67-0.89). A trend towards improved cardiovascular mortality (odds ratio 0.62, 95% confidence interval 0.35-1.11), myocardial infarction (odds ratio 0.62, 95% confidence interval 0.38-1.01), and the composite of death/myocardial infarction/stroke (odds ratio 0.91, 95% confidence interval 0.81-1.03), was identified. Meta-analyses of studies performing adjustments showed decreased all-cause mortality in statin users (hazard ratio 0.77, 95% confidence interval 0.68-0.86). Evidence supporting statins' protective role in patients with lower limb peripheral arterial disease is insufficient. Statin therapy seems to be effective in reducing all-cause mortality and the incidence cerebrovascular events in patients diagnosed with peripheral arterial disease. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Pathophysiology of Intermittent Claudication in Peripheral Artery Disease.

    Science.gov (United States)

    Hamburg, Naomi M; Creager, Mark A

    2017-02-24

    Peripheral artery disease (PAD) affects more than 200 million adults worldwide. Patients with lower extremity PAD have a heightened risk for cardiovascular events because of the systemic nature of atherosclerosis, and benefit from treatment with risk factor-modifying therapies. Limb symptoms in PAD include intermittent claudication and diminished walking ability. Arterial obstruction from atherosclerotic lesions initiates limb ischemia; however, decreased perfusion incompletely determines the clinical expression of PAD and its response to therapy. Potential mechanistic drivers of claudication in addition to arterial obstruction include inflammation, vascular dysfunction, reduced microvascular flow, impaired angiogenesis, and altered skeletal muscle function. An improved understanding of the pathophysiology of limb symptoms has the potential to accelerate development of novel therapeutic strategies to increase functional capacity in patients with PAD.

  5. EVALUATION OF GENDER DIFFERENCE IN ENDOTHELIUM-INDEPENDENT DILATION USING PERIPHERAL ARTERIAL TONOMETRY

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    McCue, Meghan C.; Marlatt, Kara L.; Kelly, Aaron S.; Steinberger, Julia; Dengel, Donald R.

    2011-01-01

    A change in peripheral arterial tonometry (PAT) in response to reactive hyperemia is often used to provide a non-invasive measure of endothelium-dependent dilation (EDD). Reactive hyperemia does not allow one to quantify endothelium-independent dilation (EID), which is part of overall vascular function. Although most research examining vascular function and cardiovascular disease has focused on EDD, there is evidence that cardiovascular risk factors may impair EID.

  6. The contribution of arterial calcification to peripheral arterial disease in pseudoxanthoma elasticum.

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    Georges Leftheriotis

    Full Text Available The contribution of arterial calcification (AC in peripheral arterial disease (PAD and arterial wall compressibility is a matter of debate. Pseudoxanthoma elasticum (PXE, an inherited metabolic disease due to ABCC6 gene mutations, combines elastic fiber fragmentation and calcification in various soft tissues including the arterial wall. Since AC is associated with PAD, a frequent complication of PXE, we sought to determine the role of AC in PAD and arterial wall compressibility in this group of patients.Arterial compressibility and patency were determined by ankle-brachial pressure index (ABI in a cohort of 71 PXE patients (mean age 48 ± SD 14 yrs, 45 women and compared to 30 controls without PAD. Lower limb arterial calcification (LLAC was determined by non-contrast enhanced helicoidal CT-scan. A calcification score (Ca-score was computed for the femoral, popliteal and sub-popliteal artery segments of both legs. Forty patients with PXE had an ABI1.40. LLAC increased with age, significantly more in PXE subjects than controls. A negative association was found between LLAC and ABI (r = -0.363, p = 0.002. The LLAC was independently associated with PXE and age, and ABI was not linked to cardiovascular risk factors.The presence of AC was associated with PAD and PXE without affecting arterial compressibility. PAD in PXE patients is probably due to proximal obstructive lesions developing independently from cardiovascular risk factors.

  7. The contribution of arterial calcification to peripheral arterial disease in pseudoxanthoma elasticum.

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    Leftheriotis, Georges; Kauffenstein, Gilles; Hamel, Jean François; Abraham, Pierre; Le Saux, Olivier; Willoteaux, Serge; Henrion, Daniel; Martin, Ludovic

    2014-01-01

    The contribution of arterial calcification (AC) in peripheral arterial disease (PAD) and arterial wall compressibility is a matter of debate. Pseudoxanthoma elasticum (PXE), an inherited metabolic disease due to ABCC6 gene mutations, combines elastic fiber fragmentation and calcification in various soft tissues including the arterial wall. Since AC is associated with PAD, a frequent complication of PXE, we sought to determine the role of AC in PAD and arterial wall compressibility in this group of patients. Arterial compressibility and patency were determined by ankle-brachial pressure index (ABI) in a cohort of 71 PXE patients (mean age 48 ± SD 14 yrs, 45 women) and compared to 30 controls without PAD. Lower limb arterial calcification (LLAC) was determined by non-contrast enhanced helicoidal CT-scan. A calcification score (Ca-score) was computed for the femoral, popliteal and sub-popliteal artery segments of both legs. Forty patients with PXE had an ABI1.40. LLAC increased with age, significantly more in PXE subjects than controls. A negative association was found between LLAC and ABI (r = -0.363, p = 0.002). The LLAC was independently associated with PXE and age, and ABI was not linked to cardiovascular risk factors. The presence of AC was associated with PAD and PXE without affecting arterial compressibility. PAD in PXE patients is probably due to proximal obstructive lesions developing independently from cardiovascular risk factors.

  8. Non-Invasive Therapy of Peripheral Arterial Disease.

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    Marcial, José M; Pérez, Reynerio; Vargas, Pedro; Franqui-Rivera, Hilton

    2015-01-01

    Peripheral arterial disease (PAD) is a significant cause of morbidity and mortality worldwide. Lifestyle changes, like the cessation of the use of tobacco as well as a modification of dietary and exercise habits, can be the most cost-effective interventions in patients with PAD. Smocking cessation is the most important intervention, since it increases survival in these patients. Antiplatelet therapy is an essential component in the treatment of peripheral arterial disease (PAD) of the lower extremities. In addition to delaying arterial obstructive progression, these agents are most usefull in reducing adverse cardiovascular events such as non-fatal myocardial infarction (MI), stroke and vascular death. Mainstay of treatment continues to be aspirin monotherapy (75-325mg daily). Current treatment for lower extremity PAD is directed towards the relief of symptoms and improvement in QoL. The two agents which have consistently been found to be most efficient in achieving these goals are cilostazol and naftidrofuryl oxalate. Naftidrofuryl oxalate may emerge as the most efficient and cost-effective treatment for symptom relief.

  9. Peripheral artery disease: potential role of ACE-inhibitor therapy

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    Giuseppe Coppola

    2008-12-01

    Full Text Available Giuseppe Coppola, Giuseppe Romano, Egle Corrado, Rosa Maria Grisanti, Salvatore NovoDepartment of Internal Medicine, Cardiovascular and Nephro-Urological Diseases, Chair of Cardiovascular Disease, University of Palermo, Palermo, ItalyAbstract: Subjects with peripheral arterial disease (PAD of the lower limbs are at high risk for cardiovascular and cerebrovascular events and the prevalence of coronary artery disease in such patients is elevated. Recent studies have shown that regular use of cardiovascular medications, such as therapeutic and preventive agents for PAD patients, seems to be promising in reducing long-term mortality and morbidity. The angiotensin-converting-enzyme (ACE system plays an important role in the pathogenesis and progression of atherosclerosis, and ACE-inhibitors (ACE-I seem to have vasculoprotective and antiproliferative effects as well as a direct antiatherogenic effect. ACE-I also promote the degradation of bradykinin and the release of nitric oxide, a potent vasodilator; further, thay have shown important implications for vascular oxidative stress. Other studies have suggested that ACE-I may also improve endothelial dysfunction. ACE-I are useful for reducing the risk of cardiovascular events in clinical and subclinical PAD. Particularly, one agent of the class (ie, ramipril has shown in many studies to able to significantly reduce cardiovascular morbidity and mortality in patients with PAD.Keywords: atherosclerosis, peripheral arterial disease, endothelial dysfunction, ACE-inhibitors

  10. Plasma viscosity increase with progression of peripheral arterial atherosclerotic disease.

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    Poredos, P; Zizek, B

    1996-03-01

    Increased blood and plasma viscosity has been described in patients with coronary and peripheral arterial disease. However, the relation of viscosity to the extent of arterial wall deterioration--the most important determinant of clinical manifestation and prognosis of the disease--is not well known. Therefore, the authors studied plasma viscosity as one of the major determinants of blood viscosity in patients with different stages of arterial disease of lower limbs (according to Fontaine) and its relation to the presence of some risk factors of atherosclerosis. The study encompassed four groups of subjects: 19 healthy volunteers (group A), 18 patients with intermittent claudication up to 200 m (stage II; group B), 15 patients with critical ischemia of lower limbs (stage III and IV; group C), and 16 patients with recanalization procedures on peripheral arteries. Venous blood samples were collected from an antecubital vein without stasis for the determination of plasma viscosity (with a rotational capillary microviscometer, PAAR), fibrinogen, total cholesterol, alpha-2-macroglobulin, and glucose concentrations. In patients with recanalization procedure local plasma viscosity was also determined from blood samples taken from a vein on the dorsum of the foot. Plasma viscosity was most significantly elevated in the patients with critical ischemia (1.78 mPa.sec) and was significantly higher than in the claudicants (1.68 mPa.sec), and the claudicants also had significantly higher viscosity than the controls (1.58 mPa.sec). In patients in whom a recanalization procedure was performed, no differences in systemic and local plasma viscosity were detected, neither before nor after recanalization of the diseased artery. In all groups plasma viscosity was correlated with fibrinogen concentration (r=0.70, P < 0.01) and total cholesterol concentration (r=0.24, P < 0.05), but in group C (critical ischemia) plasma viscosity was most closely linked to the concentration of alpha-2

  11. A Structured Review of Antithrombotic Therapy in Peripheral Artery Disease With a Focus on Revascularization: A TASC (InterSociety Consensus for the Management of Peripheral Artery Disease) Initiative.

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    Hess, Connie N; Norgren, Lars; Ansel, Gary M; Capell, Warren H; Fletcher, John P; Fowkes, F Gerry R; Gottsäter, Anders; Hitos, Kerry; Jaff, Michael R; Nordanstig, Joakim; Hiatt, William R

    2017-06-20

    Peripheral artery disease affects >200 million people worldwide and is associated with significant limb and cardiovascular morbidity and mortality. Limb revascularization is recommended to improve function and quality of life for symptomatic patients with peripheral artery disease with intermittent claudication who have not responded to medical treatment. For patients with critical limb ischemia, the goals of revascularization are to relieve pain, help wound healing, and prevent limb loss. The baseline risk of cardiovascular and limb-related events demonstrated among patients with stable peripheral artery disease is elevated after revascularization and related to atherothrombosis and restenosis. Both of these processes involve platelet activation and the coagulation cascade, forming the basis for the use of antiplatelet and anticoagulant therapies to optimize procedural success and reduce postprocedural cardiovascular risk. Unfortunately, few high-quality, randomized data to support use of these therapies after peripheral artery disease revascularization exist, and much of the rationale for the use of antiplatelet agents after endovascular peripheral revascularization is extrapolated from percutaneous coronary intervention literature. Consequently, guideline recommendations for antithrombotic therapy after lower limb revascularization are inconsistent and not always evidence-based. In this context, the purpose of this structured review is to assess the available randomized data for antithrombotic therapy after peripheral arterial revascularization, with a focus on clinical trial design issues that may affect interpretation of study results, and highlight areas that require further investigation. © 2017 American Heart Association, Inc.

  12. Exercícios resistidos terapêuticos para indivíduos com doença arterial obstrutiva periférica: evidências para a prescrição Therapeutic resistance exercises for individuals with peripheral arterial obstructive disease: evidence for prescription

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    Lucas Caseri Câmara

    2007-09-01

    Full Text Available A prática regular de exercícios é parte do tratamento clínico inicial para pacientes com doença arterial obstrutiva periférica. Nesse sentido, a utilização de exercícios contra resistência (exercícios resistidos tem sido amplamente recomendada para diferentes populações, especialmente para pessoas idosas com e sem doenças associadas. Os poucos trabalhos encontrados utilizando essa forma de exercícios em pacientes com doença arterial obstrutiva periférica documentam a sua eficiência terapêutica. No entanto, os efeitos documentados dos exercícios resistidos em outras populações têm evidenciado melhoria da aptidão física e da qualidade de vida, com segurança cardiovascular e músculo-esquelética. Essas informações fornecem indicativos sobre os possíveis benefícios dos exercícios resistidos na terapia de indivíduos com doença arterial obstrutiva periférica. Nesse sentido, esta revisão objetivou apresentar informações científicas que permitam auxiliar a prescrição dos exercícios resistidos para essa população.A regular physical activity program is part of the initial clinical approach to patients with peripheral arterial obstructive disease. Therefore, use of exercises against resistance loads (resistance training has been widely recommended for different populations, especially for elderly individuals with and without associated diseases. The few studies that have used this form of exercise in patients with peripheral arterial obstructive disease demonstrated its therapeutic efficiency. However, reported effects of resistance training in other populations have evidenced improvement in physical fitness and quality of life, with cardiovascular and musculoskeletal safety. These data indicate the possible benefits of resistance training in peripheral arterial obstructive disease therapy. Thus, this review aimed at presenting scientific information that can help prescription of resistance training for this

  13. Peripheral Arterial Disease in Patients with Type 2 Diabetes Mellitus

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    Sang Youl Rhee

    2015-08-01

    Full Text Available Peripheral arterial disease (PAD in patients with type 2 diabetes mellitus (T2DM exhibits broad clinical characteristics and various consequences and is known as one of the major macrovascular complications of T2DM. Atherosclerosis is recognized as the most direct and important cause of PAD, but acute or chronic limb ischemia may be the result of various risk factors. In light of the increasing number of patients who undergo peripheral vascular procedures, the number of subjects who are exposed to the risks for PAD and related complications is increasing. In this review, we will discuss the clinical and epidemiological characteristics of PAD, as well as the clinical significance of PAD in T2DM subjects.

  14. Impact of age and sex on carotid and peripheral arterial wall thickness in humans.

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    van den Munckhof, I; Scholten, R; Cable, N T; Hopman, M T E; Green, D J; Thijssen, D H J

    2012-12-01

    Although previous studies have reported age-related wall thickening in carotid arteries, it is not clear whether this is a systemic phenomenon which is also apparent in peripheral conduit arteries or whether conduit wall thickness (WT) changes occur to a similar degree in men and women. To determine whether sex modifies the impact of ageing on WT or wall-to-lumen ratio (W:L) in atherosclerosis-prone (i.e. carotid artery, femoral, superficial femoral, popliteal artery) and atherosclerosis-resistant (i.e. brachial artery) conduit arteries. We included 30 young (23 ± 2 year; 15M : 15F) and 31 older (70 ± 5 year; 18M : 13F) healthy subjects. High-resolution ultrasound was used to measure diameter, WT and wall-to-lumen ratio (W/L) in all arteries. Older subjects had increased WT and W/L in the carotid, femoral, superficial femoral, popliteal and brachial arteries (all P < 0.05). Compared with women, men demonstrated larger diameter and WT (both P < 0.01) across all arteries. Sex did not impact upon age-related changes in WT or W/L (P = 0.39 and 0.43 respectively). Our data suggest that age-related wall thickening, evident in the carotid artery, is also apparent in the arteries of the upper and lower limbs. The impact of age on wall thickening did not differ between men and women. These data support the presence of systemic increases in WT and W/L with age in apparently healthy humans, independent of sex. © 2012 The Authors Acta Physiologica © 2012 Scandinavian Physiological Society.

  15. Spectral Doppler ultrasound of peripheral arteries: a pictorial review.

    Science.gov (United States)

    Nuffer, Zachary; Rupasov, Andrey; Bekal, Neel; Murtha, Jacqueline; Bhatt, Shweta

    This article reviews the pathophysiology and sonographic findings of peripheral arterial lesions, with emphasis on the spectral Doppler waveforms encountered in each. It discusses the characteristic features of the Doppler spectra in obstructive conditions, including thromboembolism, atherosclerotic disease, bypass graft occlusion, dissection, trauma, and compartment syndrome, as well as non-obstructive conditions, including hyperemia, pseudoaneurysm, and arteriovenous fistula. Familiarity with the commonly-encountered spectral waveforms in the setting of these lesions is necessary for timely and accurate diagnosis and treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Peripheral arterial thrombolysis by modified pulse-spray method

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    Lee, Jung Mi; Park, Byeong Ho; Kim, Jae Ik; Choi, Sun Seob; Lee, Ki Nam; Nam, Kyeong Jin; Lee, Yung Il [Dong-A University Hospital, Pusan (Korea, Republic of)

    1994-05-15

    The purpose of this study were to evaluate the efficacy of thrombolysis and to find optimal dose of urokinase and injection time by modified pulse-spray method with multiside-hole catheter in patients of arteriosclerosis obliterans of lower limbs. Over a 2-month period, 5 cases of peripheral arterial occlusion of lower limbs were treated with 0.7-1.3 million unit of urokinase by modified pulse spray method. With antegrade puncture at the site of superficial femoral artery, the tip of modified pig-tail catheter was initially placed approximately 2 cm proximal to the distal end of the clot. The procedure started with the use of initial bolus dose of UK(100,000 U) of lacing, and then small pulses of highly concentrated urokinase, which are forcefully sprayed throughout the thrombus at a rate of 20,000 U/min. After the initial rapid period of deposition, the concentration of UK was reduced to 4,000 U/min for residual thrombus. Completed clot lysis were achieved in 3 of 5 occlusions. Mean duration for completion of lysis was 140 min (40-180 min) and initial recanalization of artery required 45 min(20-90 min). Total required dose of UK was 1,120,000 U and mean dose for initial recanalization was 660,000 U. No significant complications occurred except distal vasospasm in one case. Modified pulse spray method using ultrahigh and high dose urokinase is safe, required less time and has cost effectiveness in the management of peripheral arterial thrombolysis. Further study is warranted.

  17. Correlations between geriatric nutritional risk index and peripheral artery disease in elderly coronary artery disease patients.

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    Kawamiya, Toshiki; Suzuki, Susumu; Ishii, Hideki; Hirayama, Kenshi; Harada, Kazuhiro; Shibata, Yohei; Tatami, Yosuke; Harata, Shingo; Kawashima, Kazuhiro; Kunimura, Ayako; Takayama, Yohei; Shimbo, Yusaku; Osugi, Naohiro; Yamamoto, Dai; Ota, Tomoyuki; Kono, Chikao; Murohara, Toyoaki

    2017-07-01

    Malnutrition is associated with the development of atherosclerosis and an increased risk of cardiovascular mortality in elderly patients. The present study aimed to investigate the association between the Geriatric Nutritional Risk Index (GNRI), a simple nutritional assessment tool, and the prevalence of peripheral artery disease (PAD) in elderly coronary artery disease patients. We evaluated 228 elderly coronary artery disease patients (mean age 74.0 ± 5.7 years). Ankle-brachial index (ABI) measurements were routinely carried out to investigate the prevalence of lower extremity PAD. Patients showing ABI risk of having PAD than those with high GNRI and low C-reactive protein levels. GNRI values showed a strong relationship with PAD in elderly coronary artery disease patients. These data reinforce the utility of GNRI as a screening tool in clinical practice. Geriatr Gerontol Int 2017; 17: 1057-1062. © 2016 Japan Geriatrics Society.

  18. Evaluation of Asymptomatic Peripheral Arterial Disease by Ankle-brachial Index in Patients with Concomitant Coronary Arterial Disease

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    Hosein Vakili

    2012-12-01

    Full Text Available Background: Peripheral arterial disease is associated with adverse cardiovascular outcomes. As such, it is found that screening for peripheral arterial disease (PAD improves risk assessment. Thus, intensive risk factor modification and medical treatment in these patients are necessary. Objectives: The purpose of this study was to determine the prevalence of asymptomatic peripheral arterial disease in patients with concomitant coronary arterial disease. Methods: Asymptomatic peripheral arterial disease was investigated in 400 patients (60% males, 40% females, aged 59.7± 11.3 with a documented coronary arterial disease. Results: Among patients with documented CAD, 12% had asymptomatic PAD with the ABI ratio of less than 0.9. Conclusions: It is advisable to screen for PAD not only as a disease but also as a risk assessment method for atherosclerosis.

  19. Isolated Unilateral Absent Branch Pulmonary Artery with Peripheral Pulmonary Stenosis and Coronary Artery Disease

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    Sunil Abhishek B

    2017-09-01

    Full Text Available Isolated Unilateral Absent Pulmonary Artery (UAPA is a rare congenital anomaly. It is usually associated with congenital heart defects. A 45 year old male patient presented with complaints of fever with cough and expectoration for 15 days and retrosternal chest discomfort for the previous 2 days. ECG showed diffuse ST segment depression with T wave inversion in the inferior and lateral leads. Coronary Angiogram done through the right femoral approach revealed diffusely diseased Left Anterior Descending (LAD artery that was totally cut off at the mid segment. The Left Circumflex (LCx artery was providing blood supply to the right middle and lower lung areas. There was another collateral arising from the Left Subclavian Artery supplying the right middle and lower lung areas. The left pulmonary artery was normal, but branches supplying the middle and lower lobes of the right lung were absent and the upper lobe branch had pulmonary stenosis. UAPA is a rare clinical entity; collaterals from coronaries are extremely rare in this condition and till now there has not been any case report of unilateral absent branch pulmonary artery with peripheral stenosis of other branches, on the affected side and associated coronary artery disease.

  20. Clinical Application of Vascular Regenerative Therapy for Peripheral Artery Disease

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    Hiroshi Suzuki

    2013-01-01

    Full Text Available Prognosis of peripheral artery disease (PAD, especially critical limb ischemia, is very poor despite the development of endovascular therapy and bypass surgery. Many patients result in leg amputation and, therefore, vascular regenerative therapy is expected in this field. Gene therapy using vascular endothelial growth factor is the first step of vascular regenerative therapy, but did not confirm effectiveness in a large-scale randomized comparative study. Based on animal experiments, bone marrow mononuclear cells (MNCs, peripheral blood MNCs were used as the cell source for regenerative therapy. Those cells were confirmed to be effective to decrease rest pain and ulcer size, but its effect was not fully satisfied. Mesenchymal stem cells (MSCs are expected as an effective cell source for vascular regeneration and clinical studies are ongoing, because the cells are able to differentiate into various cell types and produce a significant amount of vascular growth factors. Of vascular regeneration therapy, peripheral MNCs and bone marrow MNCs were recognized as advanced medical technology but do not attain to the standard therapy. However, clinical use of MSCs have already started, and induced pluripotent stem cells are surely promising tool for vascular regeneration therapy although further basic studies are required for clinical application.

  1. Prevalence of peripheral arterial disease in hemodialysis patients.

    Science.gov (United States)

    Jabbari, Mosadegh; Kazemi Jahromi, Mitra; Bahar, Nasime; Yousefi-Far, Elham Sadat; Arabi, Mohsen; Asefi, Nastaran; Mahmoudian, Alireza

    2012-11-01

    The ankle-brachial index (ABI), measurement of carotid artery intima-media thickness (CIMT), and assessment of the thickness of interventricular septum (IVS), are noninvasive methods used to predict subclinical atherosclerosis in hemodialysis patients. This study aimed to determine the prevalence of peripheral arterial disease and to assess the correlations between ABI, CIMT, the thickness of IVS, and blood parameters in hemodialysis patients. The ABI, CIMT, and the thickness of IVS were measured in 50 patients on hemodialysis. Data were collected regarding the levels of calcium, urine nitrogen, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, cholesterol, creatinine, albumin in serum, as well as erythrocyte sedimentation rate. Results. Ten percent of the patients showed a reduced ABI (< 0.9). The mean values for ABI, CIMT, and IVS were 1.09 ± 0.13, 0.68 ± 0.11 mm, and 9.83 ± 1.65 mm, respectively. The levels of calcium, cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride in the serum of the patients with normal ABI were significantly higher than in patients with reduced ABI. There was a negative correlation between ABI and levels of serum LDLC (r = -0.29, P = .04) and triglyceride (r = -0.32, P = .02). Conclusions. The prevalence of peripheral arterial disease in the patients with CRF was 10% and it was correlated with several classical risk factors for atherosclerosis, including elevated LDL and cholesterol levels. CIMT and the thickness of IVS showed no apparent association with ABI.

  2. Vascular quality of care pilot study: how admission to a vascular surgery service affects evidence-based pharmacologic risk factor modification in patients with lower extremity peripheral arterial disease

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    Steenhof N

    2014-06-01

    Full Text Available Naomi Steenhof,1,2 Francesca Le Piane,1 Kori Leblanc,1–3 Naomi R Eisenberg,4 Yvonne Kwan,1 Christine Malmberg,1,6 Alexandra Papadopoulos,5,7 Graham Roche-Nagle4,7,8 1Department of Pharmacy, University Health Network, 2Leslie Dan Faculty of Pharmacy, University of Toronto, 3Centre for Innovation in Complex Care, University Health Network, 4Division of Vascular Surgery, University Health Network, 5Faculty of Nursing, University of Toronto, Toronto, ON, 6Victoria General Hospital, Vancouver Island Health Authority, Victoria, BC, 7Peter Munk Cardiac Centre, University Health Network, 8Faculty of Medicine, University of Toronto, Toronto, ON, Canada Background: Peripheral arterial disease (PAD guidelines recommend aggressive risk factor modification to improve cardiovascular outcomes. Recommended pharmacologic therapies include antiplatelets, angiotensin converting enzyme (ACE inhibitors, and HMG-CoA-reductase inhibitors (statins. Purpose: We studied the degree to which patient admission to a vascular surgery service increased the use of these therapies. Patients and methods: The authors conducted a retrospective chart review of 150 patients with PAD admitted to the vascular surgery service at a large Canadian tertiary care hospital. The use of recommended pharmacologic therapies at the time of admission and discharge were compared. A multidisciplinary clinical team established criteria by which patients were deemed ineligible to receive any of the recommended therapies. Angiotensin receptor blockers (ARBs were considered an alternative to ACE inhibitors. Results: Prior to hospital admission, 64% of patients were on antiplatelet therapy, 67% were on an ACE inhibitor or ARB, and 71% were on a statin. At the time of discharge, 91% of patients were on an antiplatelet (or not, with an acceptable reason, 77% were on an ACE inhibitor or an ARB (or not, with an acceptable reason, and 85% were on a statin (or not, with an acceptable reason. While new

  3. Relationship of Inflammatory Biomarkers with Severity of Peripheral Arterial Disease

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    Kimihiro Igari

    2016-01-01

    Full Text Available Objective. The pentraxin family, including high-sensitivity C-reactive protein (hs-CRP, serum amyloid P (SAP, and pentraxin 3 (PTX3, has been identified as playing a key role in inflammatory reactions such as in atherosclerosis and cardiovascular disease. In this study, we examined the relationship between peripheral arterial disease (PAD and serum levels of pentraxins. Methods. This study was undertaken via a retrospective review of PAD patients with surgical intervention for lesions of the common femoral artery. We evaluated the preoperative patient conditions, hemodynamic status, such as ankle brachial index (ABI, and clinical ischemic conditions according to Rutherford classification. Preoperatively, we collected blood samples for determining the serum levels of hs-CRP, SAP, and PTX3. Results. Twelve PAD patients with common femoral arterial lesions were treated and examined. The hemodynamic severity of PAD was not negatively correlated with hs-CRP, SAP, or PTX3. The clinical severity evaluated by Rutherford classification was significantly positively correlated with the serum level of PTX3 (p=0.019. Conclusion. We demonstrated that PTX3 might be a better marker of PAD than hs-CRP and SAP. Furthermore, PTX3 might be a prognostic marker to evaluate the severity of PAD.

  4. Association of peripheral arterial and cardiovascular diseases in familial hypercholesterolemia.

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    Pereira, Carolina; Miname, Marcio; Makdisse, Marcia; Kalil Filho, Roberto; Santos, Raul D

    2014-08-01

    Familial hypercholesterolemia (FH) is an autosomal dominant genetic disease characterized by an elevation in the serum levels of total cholesterol and of low-density lipoproteins (LDL- c). Known to be closely related to the atherosclerotic process, FH can determine the development of early obstructive lesions in different arterial beds. In this context, FH has also been proposed to be a risk factor for peripheral arterial disease (PAD). This observational cross-sectional study assessed the association of PAD with other manifestations of cardiovascular disease (CVD), such as coronary artery and cerebrovascular disease, in patients with heterozygous FH. The diagnosis of PAD was established by ankle-brachial index (ABI) values ≤ 0.90. This study assessed 202 patients (35% of men) with heterozygous FH (90.6% with LDL receptor mutations), mean age of 51 ± 14 years and total cholesterol levels of 342 ± 86 mg /dL. The prevalences of PAD and previous CVD were 17% and 28.2 %, respectively. On multivariate analysis, an independent association between CVD and the diagnosis of PAD was observed (OR = 2.50; 95% CI: 1.004 - 6.230; p = 0.049). Systematic screening for PAD by use of ABI is feasible to assess patients with FH, and it might indicate an increased risk for CVD. However, further studies are required to determine the role of ABI as a tool to assess the cardiovascular risk of those patients.

  5. Association of Peripheral Arterial and Cardiovascular Diseases in Familial Hypercholesterolemia

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    Carolina Pereira

    2014-08-01

    Full Text Available Background: Familial hypercholesterolemia (FH is an autosomal dominant genetic disease characterized by an elevation in the serum levels of total cholesterol and of low-density lipoproteins (LDL- c. Known to be closely related to the atherosclerotic process, FH can determine the development of early obstructive lesions in different arterial beds. In this context, FH has also been proposed to be a risk factor for peripheral arterial disease (PAD. Objective: This observational cross-sectional study assessed the association of PAD with other manifestations of cardiovascular disease (CVD, such as coronary artery and cerebrovascular disease, in patients with heterozygous FH. Methods: The diagnosis of PAD was established by ankle-brachial index (ABI values ≤ 0.90. This study assessed 202 patients (35% of men with heterozygous FH (90.6% with LDL receptor mutations, mean age of 51 ± 14 years and total cholesterol levels of 342 ± 86 mg /dL. Results: The prevalences of PAD and previous CVD were 17% and 28.2 %, respectively. On multivariate analysis, an independent association between CVD and the diagnosis of PAD was observed (OR = 2.50; 95% CI: 1.004 - 6.230; p = 0.049. Conclusion: Systematic screening for PAD by use of ABI is feasible to assess patients with FH, and it might indicate an increased risk for CVD. However, further studies are required to determine the role of ABI as a tool to assess the cardiovascular risk of those patients.

  6. Association of Peripheral Arterial and Cardiovascular Diseases in Familial Hypercholesterolemia

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    Pereira, Carolina [Instituto do Coração HCFMUSP, São Paulo, SP (Brazil); Hospital Israelita Albert Einstein, São Paulo, SP (Brazil); Miname, Marcio [Instituto do Coração HCFMUSP, São Paulo, SP (Brazil); Makdisse, Marcia [Hospital Israelita Albert Einstein, São Paulo, SP (Brazil); Kalil, Roberto Filho [Instituto do Coração HCFMUSP, São Paulo, SP (Brazil); Santos, Raul D., E-mail: rdsf@cardiol.br [Instituto do Coração HCFMUSP, São Paulo, SP (Brazil); Hospital Israelita Albert Einstein, São Paulo, SP (Brazil)

    2014-08-15

    Familial hypercholesterolemia (FH) is an autosomal dominant genetic disease characterized by an elevation in the serum levels of total cholesterol and of low-density lipoproteins (LDL- c). Known to be closely related to the atherosclerotic process, FH can determine the development of early obstructive lesions in different arterial beds. In this context, FH has also been proposed to be a risk factor for peripheral arterial disease (PAD). This observational cross-sectional study assessed the association of PAD with other manifestations of cardiovascular disease (CVD), such as coronary artery and cerebrovascular disease, in patients with heterozygous FH. The diagnosis of PAD was established by ankle-brachial index (ABI) values ≤ 0.90. This study assessed 202 patients (35% of men) with heterozygous FH (90.6% with LDL receptor mutations), mean age of 51 ± 14 years and total cholesterol levels of 342 ± 86 mg /dL. The prevalences of PAD and previous CVD were 17% and 28.2 %, respectively. On multivariate analysis, an independent association between CVD and the diagnosis of PAD was observed (OR = 2.50; 95% CI: 1.004 - 6.230; p = 0.049). Systematic screening for PAD by use of ABI is feasible to assess patients with FH, and it might indicate an increased risk for CVD. However, further studies are required to determine the role of ABI as a tool to assess the cardiovascular risk of those patients.

  7. IWGDF guidance on the diagnosis, prognosis and management of peripheral artery disease in patients with foot ulcers in diabetes

    NARCIS (Netherlands)

    Hinchliffe, R. J.; Brownrigg, J. R. W.; Apelqvist, J.; Boyko, E. J.; Fitridge, R.; Mills, J. L.; Reekers, J.; Shearman, C. P.; Zierler, R. E.; Schaper, N. C.

    2016-01-01

    Recommendations Examine a patient with diabetes annually for the presence of peripheral artery disease (PAD); this should include, at a minimum, taking a history and palpating foot pulses. (GRADE strength of recommendation: strong; quality of evidence: low) Evaluate a patient with diabetes and a

  8. Gender disparities in disease-specific health status in postoperative patients with peripheral arterial disease

    DEFF Research Database (Denmark)

    Mastenbroek, M H; Hoeks, S E; Pedersen, Susanne S.

    2012-01-01

    To investigate gender disparities in disease-specific health status (HS), 3- and 5-year post-intervention in peripheral arterial disease (PAD) patients.......To investigate gender disparities in disease-specific health status (HS), 3- and 5-year post-intervention in peripheral arterial disease (PAD) patients....

  9. Pathophysiology of peripheral arterial disease in diabetes mellitus.

    Science.gov (United States)

    Yang, Shao-Ling; Zhu, Lv-Yun; Han, Rui; Sun, Lei-Lei; Li, Jun-Xia; Dou, Jing-Tao

    2017-02-01

    Peripheral arterial disease (PAD) increases the risk of lower extremity amputation. It is also an independent predictor of cardiovascular and cerebrovascular ischemic events, affecting both the quality and expectancy of life. Many studies have demonstrated that the prevalence of PAD in patients with diabetes mellitus (DM) is higher than in non-diabetic patients. In diabetic patients, PAD occurs early with rapid progression, and is frequently asymptomatic. Multiple metabolic aberrations in DM, such as advanced glycation end-products, low-density lipoprotein cholesterol, and abnormal oxidative stress, have been shown to worsen PAD. However, the role of DM in PAD is not completely understood. The purpose of the present article is to review and discuss the pathophysiology of PAD in DM. © 2016 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

  10. Current Perspective on Hemodialysis Patients with Peripheral Artery Disease.

    Science.gov (United States)

    Okamoto, Shin; Iida, Osamu; Mano, Toshiaki

    2017-06-25

    The prevalence of peripheral artery disease is substantially higher in patients on chronic hemodialysis than in the general population. The presence of calcified lesions characteristic of hemodialysis patients has an adverse influence on the initial success and long-term outcomes of both surgical bypass and endovascular therapy. Although the selection of revascularization strategy depends on whether an autologous vein is available and if the patient has a life expectancy of at least two years, it is difficult to predict the life expectancy in a real-world clinical situation. Endovascular therapy may be appropriate for many hemodialysis patients with poor general condition because of the high risk of perioperative complications and the poor long-term prognosis. Deciding which treatment option is more appropriate should be done on a case-by-case basis, especially in hemodialysis patients with critical limb ischemia.

  11. Fusion Guidance in Endovascular Peripheral Artery Interventions: A Feasibility Study

    Energy Technology Data Exchange (ETDEWEB)

    Sailer, Anna M., E-mail: anni.sailer@mumc.nl; Haan, Michiel W. de, E-mail: m.de.haan@mumc.nl; Graaf, Rick de, E-mail: r.de.graaf@mumc.nl; Zwam, Willem H. van, E-mail: w.van.zwam@mumc.nl [Maastricht University Medical Center, Department of Radiology (Netherlands); Schurink, Geert Willem H., E-mail: gwh.schurink@mumc.nl [Maastricht University Medical Center, Department of Surgery (Netherlands); Nelemans, Patricia J., E-mail: patty.nelemans@maastrichtuniversity.nl [Maastricht University Medical Centre, Department of Epidemiology (Netherlands); Wildberger, Joachim E., E-mail: j.wildberger@mumc.nl; Das, Marco, E-mail: m.das@mumc.nl [Maastricht University Medical Center, Department of Radiology (Netherlands)

    2015-04-15

    PurposeThis study was designed to evaluate the feasibility of endovascular guidance by means of live fluoroscopy fusion with magnetic resonance angiography (MRA) and computed tomography angiography (CTA).MethodsFusion guidance was evaluated in 20 endovascular peripheral artery interventions in 17 patients. Fifteen patients had received preinterventional diagnostic MRA and two patients had undergone CTA. Time for fluoroscopy with MRA/CTA coregistration was recorded. Feasibility of fusion guidance was evaluated according to the following criteria: for every procedure the executing interventional radiologists recorded whether 3D road-mapping provided added value (yes vs. no) and whether PTA and/or stenting could be performed relying on the fusion road-map without need for diagnostic contrast-enhanced angiogram series (CEAS) (yes vs. no). Precision of the fusion road-map was evaluated by recording maximum differences between the position of the vasculature on the virtual CTA/MRA images and conventional angiography.ResultsAverage time needed for image coregistration was 5 ± 2 min. Three-dimensional road-map added value was experienced in 15 procedures in 12 patients. In half of the patients (8/17), intervention was performed relying on the fusion road-map only, without diagnostic CEAS. In two patients, MRA roadmap showed a false-positive lesion. Excluding three patients with inordinate movements, mean difference in position of vasculature on angiography and MRA/CTA road-map was 1.86 ± 0.95 mm, implying that approximately 95 % of differences were between 0 and 3.72 mm (2 ± 1.96 standard deviation).ConclusionsFluoroscopy with MRA/CTA fusion guidance for peripheral artery interventions is feasible. By reducing the number of CEAS, this technology may contribute to enhance procedural safety.

  12. Peripheral arterial disease in patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Pecci, R; De La Fuente Aguado, J; Sanjurjo Rivo, A B; Sanchez Conde, P; Corbacho Abelaira, M

    2012-10-01

    Cardiovascular disease (CV) is the second leading cause of morbidity and mortality in chronic obstructive pulmonary disease (COPD). Peripheral arterial disease (PAD) is associated with cardiovascular disease, and its risk factors are common to other atherosclerotic diseases. The objective is to determine the prevalence of PAD in a population of patients with COPD using the ankle / brachial index (ABI) and to investigate the relationship between PAD and lung disease severity. In a prospective cross-sectional study, 246 patients with COPD were recruited. Patients were enrolled consecutively according to their admission to Povisa hospital from September 1, 2008, until March 1, 2010, and were assessed by clinical history, spirometry and ABI. The COPD severity was graded by GOLD criteria in spirometry. Overall, 84 patients (36.8%) had abnormal ABI results and 59 (70.2%) were asymptomatic for PAD. COPD patients with PAD had a higher prevalence of moderate to severe COPD (61.9% vs. 41.7%, P=0.004), lower mean forced expiratory volume in 1 second (FEV1) values (46.7% ± 15 vs. 52.3±14%, P=0.001) and a higher prevalence of hypertension (69% vs. 54.3%, P=0.03) and previous cardiovascular disease (34.5% vs. 21.3%, P=0.03). There was a high prevalence of asymptomatic PAD in the COPD patients we examined. Abnormal ABI results were associated with a higher prevalence of cardiovascular risk factors and more severe lung disease. The diagnosis of peripheral arterial disease in COPD is important because this is an entity that limits the patient's physical activity and impairs their quality of life in addition to turn it into a high cardiovascular risk patient that requiring additional therapeutic measures.

  13. Challenges associated with peripheral arterial disease in women

    Directory of Open Access Journals (Sweden)

    Barochiner J

    2014-03-01

    Full Text Available Jessica Barochiner, Lucas S Aparicio, Gabriel D Waisman Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina Abstract: Peripheral arterial disease (PAD is an increasingly recognized disorder that is associated with functional impairment, quality-of-life deterioration, increased risk of cardiovascular ischemic events, and increased risk of total and cardiovascular mortality. Although earlier studies suggested that PAD was more common in men, recent reports based on more sensitive tests have shown that the prevalence of PAD in women is at least the same as in men, if not higher. PAD tends to present itself asymptomatically or with atypical symptoms more frequently in women than in men, and is associated with comorbidities or situations particularly or exclusively found in the female sex, such as osteoporosis, hypothyroidism, the use of oral contraceptives, and a history of complications during pregnancy. Fat-distribution patterns and differential vascular characteristics in women may influence the interpretation of diagnostic methods, whereas sex-related vulnerability to drugs typically used in subjects with PAD, differences in risk-factor distribution among sexes, and distinct responses to revascularization procedures in men and women must be taken into account for proper disease management. All these issues pose important challenges associated with PAD in women. Of note, this group has classically been underrepresented in research studies. As a consequence, several sex-related challenges regarding diagnosis and management issues should be acknowledged, and research gaps should be addressed in order to successfully deal with this major health issue. Keywords: peripheral arterial disease, women, diagnosis, management

  14. Iskemia pada Jari Tangan Penderita Diabetes Melitus: Suatu Keadaan Peripheral Arterial Disease

    Directory of Open Access Journals (Sweden)

    Eva Decroli

    2015-05-01

    Full Text Available Abstrak Pendahuluan: Peripheral Arterial Disease (PAD adalah penyumbatan pada arteri perifer akibat proses atherosklerosis atau proses inflamasi yang menyebabkan lumen arteri menyempit (stenosis, atau pembentukantrombus. Tempat tersering terjadinya PAD adalah daerah tungkai bawah dan jarang ditemukan pada jari tangan.Metode: Laporan kasus. Hasil: Telah dilaporkan suatu kasus iskemia jari tangan yang jarang ditemui di klinik, merupakan suatu PAD. Pembahasan: Selain adanya faktor risiko konvensional seperti diabetes melitus dan keganasan untuk terjadinya trombosis, juga didapatkan suatu kelainan herediter berupa defisiensi antikoagulan yaitu defisiensi protein S, sekalipun protein C dalam batas normal yang secara bersama-sama diduga mempermudah terjadinya trombosis pada arteri perifer. Kata kunci: Diabetes, Iskemia, Peripheral arterial disease, Protein S, Trombosis Abstract Introduction: Peripheral Arterial Disease (PAD is occlusion in peripheral artery caused by atherosclerosis or inflammation process that make stenosis in artery, or thrombus formation. High incidence of PAD occur in lower extremity, and rarely in hand and finger. Method: Case report. Result: Has been reported hand ischaemia that rarely found in hand and finger. Discussion: Despite conventional risk factor for thrombosis like diabetes mellitus and malignancy, hereditary disorder of anticoagulant factor deficiency played the same role, like protein S deficiency,eventhough protein C in normal limit. These risk factors made thrombosis at peripheral arteri easier to occur.Keywords:  Diabetes, Ischaemia, Peripheral arterial disease, Protein S, Thrombosis

  15. Clinical Characteristics of Patients on Hemodialysis With Peripheral Arterial Disease.

    Science.gov (United States)

    Matsuzawa, Ryota; Aoyama, Naoyoshi; Yoshida, Atsushi

    2015-11-01

    Patients on hemodialysis (HD; n = 210) were examined for peripheral arterial disease (PAD) using ankle-brachial index (ABI) and toe-brachial index (TBI). The prevalence of PAD was 38.1%. Among patients with PAD, 87.5% were newly diagnosed with PAD, 42.5% were diagnosed with TBI <0.6 despite ABI ≥ 0.9, and 68.7% had no lower limb symptoms. In patients with PAD, the prevalence rate of cerebrovascular disease was 36.3%, coronary artery disease was 42.5%, spinal stenosis was 33.2%, and vertebral fracture 15.0% and was significantly higher than those of the non-PAD patients. Low high-density lipoprotein cholesterol was the most important biomarker among patients with PAD. PAD has been underdiagnosed and untreated in patients on HD because most patients do not have symptoms that could be due to diabetic neuropathy or have insufficient daily activity to experience exertional leg symptoms. Screening for PAD using the ABI and TBI increased diagnostic efficiency in patients on HD and may lead to effective early treatments, including pharmacotherapy, revascularization therapy, and exercise rehabilitation to avoid the worst possible scenario such as lower limb amputation, cardiovascular event, and death. © The Author(s) 2015.

  16. Visualization of peripheral pulmonary artery red thrombi utilizing optical coherence tomography

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Cheng; Wang, Wei; Zhong, Nan Shan; Zeng, Guang Qiao; Zhang, Nuo Fu [The First Affiliated Hospital of Guangzhou Medical College, Guangzhou (China)

    2013-10-15

    Optical coherence tomography (OCT) is a new imaging technique capable of obtaining high-resolution intravascular images and has been used in interventional cardiology. However, an application of OCT in pulmonary arteries had seldom been documented. In this case, OCT imaging is performed in peripheral pulmonary arteries and shows mural red thrombi. Subsequently, the red thrombi are aspirated and confirmed by a histological examination. These findings suggest that OCT may be a useful tool to depict peripheral pulmonary artery thrombi.

  17. An endovascular model of ischemic myopathy from peripheral arterial disease.

    Science.gov (United States)

    Long, Chandler A; Timmins, Lucas H; Koutakis, Panagiotis; Goodchild, Traci T; Lefer, David J; Pipinos, Iraklis I; Casale, George P; Brewster, Luke P

    2017-09-01

    Peripheral arterial disease (PAD) is a significant age-related medical condition with limited pharmacologic options. Severe PAD, termed critical limb ischemia, can lead to amputation. Skeletal muscle is the end organ most affected by PAD, leading to ischemic myopathy and debility of the patient. Currently, there are not any therapeutics to treat ischemic myopathy, and proposed biologic agents have not been optimized owing to a lack of preclinical models of PAD. Because a large animal model of ischemic myopathy may be useful in defining the optimal dosing and delivery regimens, the objective was to create and to characterize a swine model of ischemic myopathy that mimics patients with severe PAD. Yorkshire swine (N = 8) underwent acute right hindlimb ischemia by endovascular occlusion of the external iliac artery. The effect of ischemia on limb function, perfusion, and degree of ischemic myopathy was quantified by weekly gait analysis, arteriography, hindlimb blood pressures, femoral artery duplex ultrasound scans, and histologic examination. Animals were terminated at 5 (n = 5) and 6 (n = 3) weeks postoperatively. Ossabaw swine (N = 8) fed a high-fat diet were used as a model of metabolic syndrome for comparison of arteriogenic recovery and validation of ischemic myopathy. There was persistent ischemia in the right hindlimb, and occlusion pressures were significantly depressed compared with the untreated left hindlimb out to 6 weeks (systolic blood pressure, 31 ± 21 vs 83 ± 15 mm Hg, respectively; P = .0007). The blood pressure reduction resulted in a significant increase of ischemic myopathy in the gastrocnemius muscle in the treated limb. Gait analysis revealed a functional deficit of the right hindlimb immediately after occlusion that improved rapidly during the first 2 weeks. Peak systolic velocity values in the right common femoral artery were severely diminished throughout the entire study (P ischemic limb underwent significant arteriogenic

  18. Intradialytic Muscle Cramp and its Association with Peripheral Arterial Disease in End Stage Renal Disease Patients on Hemodialysis

    Directory of Open Access Journals (Sweden)

    Madhav Ghimire

    2014-12-01

    Conclusions: Intradialytic Muscle cramps and peripheral arterial disease were common occurrence in end stage renal disease patients on hemodialysis patients, however there was no association between the presence of intradialytic Muscle cramps and peripheral arterial disease. Keywords: end stage renal disease; intradialytic muscle cramps; peripheral arterial disease.

  19. Measurement of peripheral blood flow in patients with peripheral artery disease: Methods and considerations.

    Science.gov (United States)

    Salisbury, Dereck L; Brown, Rebecca Jl; Bronas, Ulf G; Kirk, Laura N; Treat-Jacobson, Diane

    2018-02-01

    Peripheral artery disease (PAD) is a manifestation of generalized atherosclerosis which results in hemodynamic compromise of oxygen and substrate delivery to the lower extremity skeletal muscles. Hemodynamic assessments are vital in PAD diagnosis and in the evaluation of strategies aimed at treating claudication (i.e. exercise training, revascularization, and pharmacological agents). Venous occlusion plethysmography (VOP) is a century-old, non-invasive technique used to quantify limb blood flow and has been used to evaluate hemodynamic compromise in patients with PAD. However, the literature suggests a wide array of methodological variability in the measurement and analysis of limb blood flow using VOP. In this manuscript, we overview the clinical application of VOP measurement, and secondly we review the methodological variation that occurs during the measurement and analysis of VOP in healthy individuals and in patients with claudication.

  20. Dynamic contrast-enhanced ultrasound and transient arterial occlusion for quantification of arterial perfusion reserve in peripheral arterial disease

    Energy Technology Data Exchange (ETDEWEB)

    Amarteifio, E., E-mail: erick.amarteifio@med.uni-heidelberg.de [University Hospital of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Department of Radiology, German Cancer Research Center, Heidelberg (Germany); Wormsbecher, S. [University Hospital of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Department of Radiology, German Cancer Research Center, Heidelberg (Germany); Krix, M. [University Hospital of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Department of Radiology, German Cancer Research Center, Heidelberg (Germany); Bracco Imaging Germany, Konstanz (Germany); Demirel, S. [University Hospital of Heidelberg, Department of Vascular Surgery, Heidelberg (Germany); Braun, S. [Department of Biostatistics, German Cancer Research Center, Heidelberg (Germany); Delorme, S. [Department of Radiology, German Cancer Research Center, Heidelberg (Germany); Boeckler, D. [University Hospital of Heidelberg, Department of Vascular Surgery, Heidelberg (Germany); Kauczor, H.-U. [University Hospital of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Weber, M.-A. [University Hospital of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Department of Radiology, German Cancer Research Center, Heidelberg (Germany)

    2012-11-15

    Objective: To quantify muscular micro-perfusion and arterial perfusion reserve in peripheral arterial disease (PAD) with dynamic contrast-enhanced ultrasound (CEUS) and transient arterial occlusion. Materials and methods: This study had local institutional review board approval and written informed consent was obtained from all subjects. We examined the dominant lower leg of 40 PAD Fontaine stage IIb patients (mean age, 65 years) and 40 healthy volunteers (mean age, 54 years) with CEUS (7 MHz; MI, 0.28) during continuous intravenous infusion of 4.8 mL microbubbles. Transient arterial occlusion at mid-thigh level simulated physical exercise. With time-CEUS-intensity curves obtained from regions of interest within calf muscles, we derived the maximum CEUS signal after occlusion (max) and its time (t{sub max}), slope to maximum (m), vascular response after occlusion (AUC{sub post}), and analysed accuracy, receiver operating characteristic (ROC) curves, and correlations with ankle-brachial index (ABI) and walking distance. Results: All parameters differed in PAD and volunteers (p < 0.014). In PAD, t{sub max} was delayed (31.2 {+-} 13.6 vs. 16.7 {+-} 8.5 s, p < 0.0001) and negatively correlated with ankle-brachial-index (r = -0.65). m was decreased in PAD (4.3 {+-} 4.6 mL/s vs. 13.1 {+-} 8.4 mL/s, p < 0.0001) and had highest diagnostic accuracy (sensitivity/specificity, 75%/93%) for detection of diminished muscular micro-perfusion in PAD (cut-off value, m < 5{approx}mL/s). Discriminant analysis and ROC curves revealed m, and AUC{sub post} as optimal parameter combination for diagnosing PAD and therefore impaired arterial perfusion reserve. Conclusions: Dynamic CEUS with transient arterial occlusion quantifies muscular micro-perfusion and arterial perfusion reserve. The technique is accurate to diagnose PAD.

  1. Shockwave therapy in patients with peripheral artery disease.

    Science.gov (United States)

    Ciccone, Marco Matteo; Notarnicola, Angela; Scicchitano, Pietro; Sassara, Marco; Carbonara, Santa; Maiorano, Mariagrazia; Moretti, Biagio

    2012-08-01

    Previous studies support the fact that extracorporeal shockwave (SW) induces angiogenesis and improves symptoms in patients affected by limb ischemia. The aim of this study was to evaluate the effects of SW therapy in patients with peripheral artery disease (PAD). Twenty-two patients were enrolled in this study and were randomly assigned into two groups: SW treatment (12 patients, 67 ± 9 years) and control (10 patients, 68 ± 12 years). The inclusion criteria were the following: age over 40 years, PAD diagnosis, optimal medical therapy, and ankle-brachial index less than 0.9. SW therapy was administered using the Minilith® SL1 litotriptor with an ultrasound guide able to detect the target area using a B-mode technique and a 7.5 MHz convex probe emitting 2,000 impulses with an energy flux density of 0.03 mJ/mm(2). The variation in the degree of stenosis before and after treatment was statistically significant between the groups (-9% ± -10% vs. 0% ± 0%; P = 0.001). In addition, a significantly higher number of treated patients than controls showed a reduction in the Fontaine stage (12 [63%] vs. 0 [0%]; P < 0.001). This result was confirmed by analyzing the difference in patients' pain-free walking distance before and after SW therapy (76 ± 46 m vs. 0 ± 0 m for treated patients vs. controls; P < 0.001) and the difference in pain severity (measured on a pain scale; -1.4 ± 0.5 in the treated patients vs. -0.2 ± 0.4 in the controls; P < 0.001). On the basis of these results the authors hypothesized a direct effect of SW on the ultrastructural composition of the vessel walls, inducing a reduction in artery stenosis. These data support the application of SW therapy as a new medical tool to improve the natural clinical course of PAD.

  2. Leptospirosis and Peripheral Artery Occlusive Disease: A Nationwide Cohort Analysis.

    Science.gov (United States)

    Chiu, Chun-Hsiang; Lin, Cheng-Li; Lee, Feng-You; Wang, Ying-Chuan; Kao, Chia-Hung

    2016-03-01

    Data on the association between peripheral artery occlusive disease (PAOD) and leptospirosis are limited. We conducted a retrospective cohort study for determining whether leptospirosis is one of the possible risk factors for PAOD. Patients diagnosed with leptospirosis by using 2000 to 2010 data from the Taiwan National Health Insurance Research Database. Patients with leptospirosis without a history of PAOD were selected. For each leptospirosis patient, 4 controls without a history of leptospirosis and PAOD were randomly selected and frequency-matched for sex, age, the year of the index date, and comorbidity diseases. The follow-up period was from the time of the initial diagnosis of leptospirosis to the diagnosis date of PAOD, or December 31, 2011. The Cox proportional hazard regression models were used for analyzing the risk of PAOD. During the follow-up period, the cumulative incidence of PAOD was higher among the patients from the leptospirosis cohort than among the nonleptospirosis cohort (log-rank test, P leptospirosis cohort and 81 from the nonleptospirosis cohort were observed with the incidence rates of 2.1 and 1.3 per 1000 person-years, respectively, yielding a crude hazards ratio (HR) of 1.62 (95% confidence interval [CI] = 1.44-1.81) and adjusted HR (aHR) of 1.75 (95% CI = 1.58-1.95).The risk of PAOD was 1.75-fold higher in the patients with leptospirosis than in the general population.

  3. The patient's experience of amputation due to peripheral arterial disease.

    Science.gov (United States)

    Torbjörnsson, Eva; Ottosson, Carin; Blomgren, Lena; Boström, Lennart; Fagerdahl, Ann-Mari

    2017-06-01

    It is not uncommon that patients with peripheral arterial disease (PAD) need to undergo a lower limb amputation, with or without previous revascularization attempts. Despite that, the patient's experience of the amputation has been scarcely studied. The aim of this qualitative study was to describe the patient's experience of amputation due to PAD. Thirteen interviews were conducted with vascular patients who had undergone a lower limb amputation at tibia, knee, or femoral level. Data were analyzed with content analysis. Our findings of the patient's experiences during the amputation process resulted in three themes with additional time sequences: the decision phase "From irreversible problem to amputation decision", the surgical phase "A feeling of being in a vacuum," and the rehabilitation phase "Adaptation to the new life". One main finding was that the patients felt abandoned during the surgical period. Despite that, most of the participants were satisfied with the decision, some of them even regretted that they had not undergone an amputation earlier in the process. It is important for the patient's well-being to develop a partnership with the surgeon to increase a feeling of being participating in the care. Vascular patients need better information on lower limb amputation, and its consequences so as to be better prepared for the whole process. To increase the patient's quality of life and reduce unnecessary suffering, amputation may be presented earlier in the process as a valuable treatment option. Copyright © 2016 Society for Vascular Nursing, Inc. Published by Elsevier Inc. All rights reserved.

  4. Functional MRI in peripheral arterial disease: arterial peak flow versus ankle-brachial index.

    Directory of Open Access Journals (Sweden)

    Bas Versluis

    Full Text Available OBJECTIVES: The purpose of this study was to compare the success rate of successful arterial peak flow (APF and ankle-brachial index (ABI measurements in patients with suspected or known peripheral arterial disease (PAD. MATERIALS AND METHODS: 183 patients with varying degrees of PAD were included. All subjects underwent ABI measurements and MR imaging of the popliteal artery to determine APF. Proportions of patients with successful APF and ABI measurements were compared and the discriminative capability was evaluated. RESULTS: APF was successfully measured in 91% of the patients, whereas the ABI could be determined in 71% of the patients (p<0.01. Success rates of APF and ABI were significantly higher in patients with intermittent claudication (95% and 80%, respectively than in patients with critical ischemia (87% and 62%, respectively. CONCLUSIONS: Compared to the assessment of PAD severity with ABI, the success rate of MRI-based APF measurements in patients with a clinical indication for MRA is 20% higher, with similar discriminatory capacity for disease severity. Therefore, APF is an especially convenient and valuable measure to assess severity in PAD patients scheduled to undergo MR angiography to obtain additional functional information concerning the vascular status.

  5. Prevalence of peripheral arterial disease and related risk factors in Turkish elders

    Directory of Open Access Journals (Sweden)

    Yesilkayali Teoman

    2011-09-01

    Full Text Available Abstract Background It is known that prevalence of peripheral arterial disease being a widespread atherosclerotic vascular disease increases by age. On the other hand, no comprehensive study showing the prevalence of peripheral arterial disease in Turkish elders is seen. In this study, it is aimed to assess prevalence of peripheral arterial disease and related risk factors in Turkish elders in primary health center. Methods 507 elderly staying at Narlidere Geriatric Care Center and Residential Home and accepting to participate in the study were included in the study. Epidemiological data for diagnosis of peripheral arterial disease, risk factors, findings of physical examination and ankle brachial index measurements were assessed in the study. Data were analyzed in terms of prevalence of peripheral arterial disease, age and gender relation and other cardiovascular risk factors. Results Of the participants, 317 (62.5% were female. The mean age was 77.61 ± 6.93 years (62-102. The most wide-spread chronic diseases in elderly included hypertension, coronary artery disease, hyperlipidemia and Type 2 DM, respectively. On the other hand, only 7 (1.4% elderly were diagnosed with peripheral arterial disease. The number of elderly ABI of whom was measured as Conclusions Peripheral arterial disease is expected to be seen prevailing in elderly. However, it was determined at very low rate before the study due to the fact that the disease cannot be diagnosed clinically especially in early-period. Peripheral arterial disease determined in the study is lower than expected as per the age group. This can be associated with practices of geriatrics nursing and family practice including continuous care to reduce cardiovascular risk factors of patients staying at the unit.

  6. Alcohol consumption and risk of peripheral arterial disease: the Rotterdam study

    NARCIS (Netherlands)

    R. Vliegenthart (Rozemarijn); J.M. Geleijnse (Marianne); W.T. Meijer (Wouter); F.J.A. van Rooij (Frank); D.E. Grobbee (Diederick); J.C.M. Witteman (Jacqueline); A. Hofman (Albert)

    2002-01-01

    textabstractModerate alcohol consumption is associated with a reduced risk of cardiovascular disease. Data on alcohol consumption and atherosclerosis are scarce. To determine the association between alcohol consumption and risk of peripheral arterial disease, the authors carried

  7. Readmissions After Revascularization Procedures for Peripheral Arterial Disease: A Nationwide Cohort Study.

    Science.gov (United States)

    Secemsky, Eric A; Schermerhorn, Marc; Carroll, Brett J; Kennedy, Kevin F; Shen, Changyu; Valsdottir, Linda R; Landon, Bruce; Yeh, Robert W

    2018-01-16

    Limited data suggest high rates of unplanned rehospitalization after endovascular and surgical revascularization for peripheral arterial disease. However, the overall burden of readmissions has not been comprehensively explored. To evaluate nationwide readmissions after peripheral arterial revascularization for peripheral arterial disease and to assess whether readmission risk varies among hospitals. Retrospective cohort study. 1085 U.S. acute care hospitals participating in the Nationwide Readmissions Database. 61 969 unweighted hospitalizations of patients with peripheral arterial disease who had peripheral arterial revascularization and were discharged alive between 1 January and 30 November 2014. 30-day readmission rates, causes, and costs of unplanned rehospitalizations after peripheral arterial revascularization; 30-day risk-standardized readmission rates (RSRRs), calculated using hierarchical logistic regression, to assess for heterogeneity of readmission risk between hospitals. Among 61 969 hospitalizations of patients with peripheral arterial disease who were discharged alive after peripheral arterial revascularization, the 30-day nonelective readmission rate was 17.6%. The most common cause of readmission was procedural complications (28.0%), followed by sepsis (8.3%) and complications due to diabetes mellitus (7.5%). Among rehospitalized patients, 21.0% underwent a subsequent peripheral arterial revascularization or lower extremity amputation, 4.6% died, and the median cost of a readmission was $11 013. Thirty-day RSRRs varied from 10.0% to 27.3% (interquartile range, 16.6% to 18.8%). Inability to distinguish out-of-hospital deaths after discharge and potential misclassification bias due to use of billing codes to ascertain diagnoses and interventions. More than 1 in 6 patients with peripheral arterial disease who undergo peripheral arterial revascularization have unplanned readmission within 30 days, with high associated mortality risks and costs

  8. Underdiagnosis of Obstructive Sleep Apnoea in Peripheral Arterial Disease.

    Science.gov (United States)

    Pizarro, Carmen; Schaefer, Christian; Kimeu, Irene; Pingel, Simon; Horlbeck, Fritz; Tuleta, Izabela; Nickenig, Georg; Skowasch, Dirk

    2015-02-21

    Background: Obstructive sleep apnoea (OSA) has interdependently been related to the onset and progression of a large portion of atherosclerotic cardiovascular disorders. In due consideration of OSA-mediated endothelial dysfunction, its impact on peripheral artery disease is conceivable, but undefined. Objectives: The aim of this study was to identify the prevalence of OSA in a lower extremity artery disease (LEAD) study population. Methods: A total of 91 patients receiving in- and outpatient treatment for LEAD were included in this prospectively conducted trial. In addition to an angiological examination, all patients underwent nocturnal screening for sleep-disordered breathing by use of SOMNOcheck micro® (SC micro) and - depending on the results obtained - polysomnography. Results: Patients were principally late middle-aged (69.3 ± 10.8 years), male (71.4%) and slightly overweight (BMI 26.8 ± 3.9). Overnight screening determined a sleep apnoea prevalence of 78.0%, of which 90.1% exhibited a predominantly obstructive genesis. The mean apnoea-hypopnoea index (AHI; events/h) and oxygen desaturation index (events/h) averaged 11.8 ± 13.4 and 8.9 ± 14.2, respectively. The individual AHI categories of non-pathological (<5), mild (5 to <15), moderate (15 to <30) and severe sleep apnoea (≥30) accounted for 22.0, 59.3, 13.2 and 5.5%, respectively. A distributive examination of AHI within LEAD severity groups evinced a significant association (p = 0.047). In cases of at least moderate sleep apnoea (AHI ≥15) polysomnography was performed (n = 17, 18.7% of the whole collective). Correlative analysis revealed a significant correlation between values obtained by SC micro recording and polysomnography, establishing the diagnostic accuracy of the screening results. Conclusions: OSA exhibits an important prevalence of 70.3% in LEAD patients with prior undiagnosed sleep-disordered breathing, indicating major OSA unawareness in this cardiovascular cohort. However, the impact

  9. Systematic review of screening investigations for peripheral arterial disease in patients with diabetes mellitus.

    Science.gov (United States)

    Ozdemir, Baris A; Brownrigg, Jack R; Jones, Keith G; Thompson, Matt M; Hinchliffe, Robert J

    2013-09-01

    Diabetes-related foot complications are a major cause of amputation. The presence of peripheral arterial disease (PAD) identifies those at increased risk of ulceration, failure to heal an ulcer, and amputation. This systematic review assesses the ability of noninvasive screening tests to detect PAD in patients with diabetes mellitus. A database search was performed using the OVIDSP Web site, from 1946 to June 30, 2012 (MEDLINE®), and from 1974 to June 30, 2012 (EMBASE), to identify studies assessing the utility of screening tests in detecting PAD or predicting clinical outcomes in patients with diabetes mellitus. Thirteen studies were identified that reported sensitivity and specificity data on screening tests. No single screening test was reliable in identifying or excluding peripheral arterial disease in patients with diabetes. Although the evidence base is limited, transcutaneous oxygen measurements appear to be predictive of ulcer or surgical wound healing. The diagnosis of PAD (and the decision to revascularize) in patients with diabetes is unreliable using screening tests. Therefore, all patients with diabetes-related foot ulceration should be assessed by a multidisciplinary diabetes foot team that has access to a vascular specialist. A low threshold for noninvasive diagnostic imaging seems appropriate in patients with diabetes-related foot ulceration.

  10. The role of Visfatin in atherosclerotic peripheral arterial obstructive disease.

    Science.gov (United States)

    Pitoulias, Matthaios G; Skoura, Lemonia; Pitoulias, Apostolos G; Chatzidimitriou, Dimitris; Margariti, Apostolia; Arsenakis, Minas; Pitoulias, Georgios A

    2017-03-01

    Visfatin is an adipokine molecule acting as an essential coenzyme in multiple cellular redox reactions. The increased serum levels of Visfatin have been correlated with metabolic syndrome and endothelial homeostasis. In this study we investigate the possible relationship of Visfatin serum levels with the severity and location of atherosclerotic peripheral arterial occlusive disease (PAOD). Study protocol included 45 consecutive PAOD and 20 Control patients with age >55years old. Definition of PAOD was based in Rutherord's classification (RC). End-stage PAOD patients (RC-V & -VI) were excluded from study. Data were collected prospectively and included age, gender, atherosclerotic risk factors and the body mass index (BMI). In PAOD patients recorded the PAOD's clinical stage and the presence of carotid stenosis >50%. PAOD patients divided in two subgroups, those with mild (RC-I & -II) and moderate disease (RC-III & -IV). In all serum samples Visfatin was measured, blindly, twice by anosoenzymatic technique. Statistical analysis was performed by non-parametric Mann-Whitney U test, Pearson's chi-square, One Way Anova and Kruskall-Wallis tests, as appropriate. The mean Visfatin value in PAOD and Control groups were 38.5±16.0 and 13.9±3.8ng/ml respectively (p0.05). Univariate analysis showed that severity of PAOD (mild vs severe), presence of carotid stenosis >50% and multilevel disease significantly affected outcomes (p=0.018, p=0.010 and p=0.006 respectively). In multivariate regression analysis severity of PAOD was the solely factor with strong correlation with high visfatin values (p=0.001). High Visfatin levels seem to be strongly correlated with the presence and severity of PAOD. Further and in depth investigation is needed to define the possible role of Visfatin in atherosclerosis and it's value as a potential prognostic biomarker of PAOD. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Sleep apnoea is common in severe peripheral arterial disease.

    Science.gov (United States)

    Schahab, Nadjib; Sudan, Sarah; Schaefer, Christian; Tiyerili, Vedat; Steinmetz, Martin; Nickenig, Georg; Skowasch, Dirk; Pizarro, Carmen

    2017-01-01

    Atherosclerotic conditions have been demonstrated to be associated with sleep- disordered breathing (SDB). Peripheral arterial disease (PAD) represents severe atherosclerosis with a high mortality. In early stages of PAD a substantial prevalence of sleep apnoea has already been shown. Here, we sought to determine the frequency of undiagnosed sleep apnoea in a homogeneous group of advanced PAD patients undergoing percutaneous revascularization. 59 consecutive patients (mean age: 71.1 ± 9.8 years, 67.8% males) with PAD in Fontaine stages IIb-IV that underwent percutaneous transluminal angioplasty at our department were enrolled for pre-procedural polygraphy. Patients appertained to Fontaine clinical stage IIb, III and IV in 54.2%, 23.8% and 22.% of cases, respectively, and were principally intervened for femoropopliteal occlusive disease (71.2% of total study population). Polygraphy revealed sleep apnoea in 48 out of 59 patients (81.4%), of whom 60.4% offered a primarily obstructive-driven genesis. Among those patients with polygraphically confirmed sleep apnoea, mean apnoea hypopnoea index (AHI) and mean oxygen desaturation index (ODI) averaged 28.2 ± 19.5/h and 26.7 ± 18.8/h, respectively. 18 patients even offered an AHI ≥30/h that is indicative of severe sleep apnoea. For obstructive-driven apnoeic events, AHI correlated significantly with PAD severity stages (p = 0.042). In our PAD collective, sleep apnoea was frequent and obstructive sleep apnoea´s severity correlated with PAD severity stages. Long-term results regarding the vasoprotective impact of CPAP treatment on PAD course remains to be determined.

  12. Peripheral arterial disease: application of the chronic care model.

    Science.gov (United States)

    Lovell, Marge; Myers, Kathryn; Forbes, Thomas L; Dresser, George; Weiss, Ed

    2011-12-01

    Management of chronic diseases is one of the greatest challenges facing health care professionals globally. With the aging population increasing worldwide, the number of patients afflicted with chronic diseases will increase. Peripheral Arterial Disease (PAD) is a common, chronic atherosclerotic vascular disease that is associated with a high risk of stroke, myocardial infarction and cardiovascular death. The objective of this study was to determine if a multidisciplinary Vascular Risk Management Clinic (VRMC) would improve risk factor management and health outcomes for patients with PAD with poorly-controlled risk factors. A multidisciplinary VRMC was established utilizing a novel application of the Chronic Care Model to meet the needs of PAD patients. Interventions included optimization of medical therapy, investigations for undiagnosed atherosclerosis in other vascular distributions, smoking cessation therapy, dietary assessment and counseling, and active involvement of patients in evaluating progress towards their risk factor target goals. Assessment of risk factor control was done at each clinic visit and included measures of symptom severity, blood pressure, fasting blood sugar (FBS), lipid profile, body mass index (BMI), and smoking status. Analysis of risk factors was performed for the first 103 patients followed in the clinic. Average follow-up time was 528 days, and statistically significant improvements were seen in blood pressure, LDL, HDL, total cholesterol (TC), and TC/HDL ratio, while BMI, FBS, and triglycerides remained stable. Participation in a specialized vascular risk management clinic resulted in significant improvement in risk factors for disease progression compared to baseline status. Copyright © 2011 Society for Vascular Nursing, Inc. Published by Mosby, Inc. All rights reserved.

  13. Properties of solitary tract neurones responding to peripheral arterial chemoreceptors.

    Science.gov (United States)

    Paton, J F; Deuchars, J; Li, Y W; Kasparov, S

    2001-01-01

    Despite the highly integrated pattern of response evoked by peripheral chemoreceptor stimulation, limited information exists regarding the neurones within the nucleus of the solitary tract that mediate this reflex. Using a working heart-brainstem preparation, we describe evoked synaptic response patterns, some intrinsic membrane properties, location, morphology and axonal projections of physiologically characterised 'chemoreceptive' neurones located in the solitary tract nucleus in the rat. From 172 whole cell recordings, 56 neurones were identified as chemoreceptive since they responded to aortic injections of low doses of sodium cyanide (2-5 microg). Chemoreceptive neurones had a mean resting membrane potential of -52+/-1 mV and input resistance was 297+/-15 M(Omega) (n=56). Synaptic responses evoked included excitatory synaptic potentials alone, excitatory-inhibitory post-synaptic potential complexes, inhibitory synaptic potentials alone and central respiratory modulated synaptic potentials. Synaptic response latency data were obtained by stimulating electrically the solitary tract: the mean excitatory synaptic latency was 5.2+/-0.4 ms (range 2.5-8.0 ms; n=17). Chemoreceptive neurones showed a heterogeneity in their intrinsic membrane properties: neurones displayed either steady state, augmenting or adapting firing responses to depolarising current injection and, in some neurones, either delayed excitation or rebound activity following hyperpolarising pulses. Eleven chemoreceptive neurones were labelled and provided the first morphological data of these cells. Labelled somata were detected dorsomedial or medial to the solitary tract spanning the obex. Neurones typically had three to eight primary dendrites which often entered the solitary tract as well as extending across the ipsilateral region of the nucleus of the solitary tract. Axons were mostly unmyelinated with boutons of the en passant variety and often ramified within the solitary tract nucleus as well

  14. Metabolic syndrome and peripheral artery disease: Two related conditions.

    Science.gov (United States)

    Oriol Torón, Pilar Ángeles; Badía Farré, Teresa; Romaguera Lliso, Amparo; Roda Diestro, Jovita

    2016-01-01

    To ascertain the prevalence of metabolic syndrome (MS) in patients with peripheral artery disease (PAD) at the Martorell primary care (PC) center. To analyze the differences in comorbidities and cardiovascular risk factors between patients with PAD with and without MS. A cross-sectional, descriptive study on patients diagnosed with PAD according to computerized clinical records of the Martorell PC center. Variables collected included age, sex, high blood pressure (HBP), dyslipidemia (DLP), diabetes (DM), smoking, obesity, cardiovascular disease (CVD), erectile dysfunction (ED), renal failure (RF), and oligoalbuminuria. An analysis comparing patients with and without MS was performed. There were 131 patients diagnosed with PAD, 104 (79%) of whom were male. Sixty-three (48.1%) also had MS. Patients with both PAD and MS had, as compared to those with PAD only, a higher prevalence of HBP (87.3 vs. 60.3%, P: 0.001), DLP (77.8 vs. 60.3%, P: 0.03), DM (69.8 vs. 30.9%, P<.001), obesity (25.4 vs. 10.3%, P: 0.03), CVD (42.9 vs. 19.1%); P: 0.004), ED (81.3 vs. 54.3%, P: 0.02), and RF (40.3 vs. 17.9%, P: 0.006). Patients with both PAD and MS had a higher prevalence of HBP, DLP, DM, and obesity. They also had more cardiovascular events and were significantly associated with pathological conditions highly relevant for cardiovascular prognosis such as erectile dysfunction and chronic kidney disease. Copyright © 2016 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

  15. Atherosclerotic burden in coronary and peripheral arteries in patients with first clinical manifestation of coronary artery disease.

    Science.gov (United States)

    Kranjec, Igor

    2011-04-01

    The aim of our study was to assess the atherosclerotic burden in patients with the first symptoms of coronary artery disease (CAD). The study population consisted of 100 consecutive patients (new-onset severe angina or myocardial infarction) and 70 age and sex matched asymptomatic volunteers. Functional and morphologic atherosclerotic markers were sought in carotid, brachial and femoral arteries of all individuals by means of high-resolution ultrasonography, whereas coronary arteriography was performed in the CAD patients only. A total of 347 coronary lesions [230 (66%) obstructive] were discovered in the CAD patients as well as 105 peripheral plaques [26 (25%) obstructive]. The mean percentage diameter stenosis of the culprit coronary lesion was 83.8 ± 15.8%, the mean vessel score 1.7 (range 0-3), the mean stenosis score 19.8 (range 1.5-89.0), and the mean extent score 49.1% (range 10-65%). Endothelium-dependent vasodilation, as assessed by the brachial flow-mediated response (FMR), was reduced by 50% in the CAD patients (P peripheral arteries of the CAD patients (P arteries of the CAD patients by 43%, in brachial arteries by 20% and in femoral arteries by 57% (P peripheral arteries of our patients with the first clinical presentation of CAD.

  16. Peripheral arterial disease, gender, and depression in the Heart and Soul Study

    NARCIS (Netherlands)

    Grenon, S. Marlene; Cohen, Beth E.; Smolderen, Kim; Vittinghoff, Eric; Whooley, Mary A.; Hiramoto, Jade

    2014-01-01

    Background Despite the high prevalence of peripheral arterial disease (PAD) in women, risk factors for PAD in women are not well understood. Methods Gender-specific risk factors for PAD were examined in a prospective cohort study of 1024 patients (184 women and 840 men) with stable coronary artery

  17. Ischemic neuromyopathy due to peripheral arterial embolization of an adenocarcinoma in a cat.

    Science.gov (United States)

    Sykes, J E

    2003-12-01

    A case of peripheral arterial tumor embolization in a cat is described. The cat presented with signs of aortic thromboembolism, including decreased peripheral pulse quality, pallor, and coolness of the distal limbs, as well as proprioceptive deficits. Thoracic radiographs revealed a cavitary lung mass; echocardiography was unremarkable. Cytologic evaluation of aspirates of the mass suggested malignancy. The left hindlimb was amputated, and histopathology confirmed embolization of an adenocarcinoma. Although rare, peripheral arterial tumor embolization should be considered as a differential in cats presenting with signs of thromboembolic disease.

  18. Evaluation of endothelial function by peripheral arterial tonometry and relation with the nitric oxide pathway

    DEFF Research Database (Denmark)

    Hedetoft, Morten; Olsen, Niels Vidiendal

    2014-01-01

    by flow-mediated dilation in the brachial artery, but the two methods are not interchangeable. We have reviewed the recent literature in an effort to evaluate peripheral arterial tonometry as a method to assess the function of the endothelium and additionally suggest directions for future research......Endothelial dysfunction is an important component in the development of cardiovascular diseases. Endothelial function may be evaluated by peripheral arterial tonometry (PAT) which measures the vasodilator function in the microvasculature of the fingertip during reactive hyperaemia. The reactive...

  19. Peripheral arterial obliterative disease. Cost of illness in France.

    Science.gov (United States)

    Montron, A; Guignard, E; Pelc, A; Comte, S

    1998-01-01

    The main purpose of this study, carried out in 1995, was to determine, using available sources, the cost of peripheral arterial obliterative disease (PAOD) in France over a 1-year period. This cost-of-illness study was based on a retrospective analysis of the available literature and databases. It involved a description of epidemiological data and a cost estimate of the different medical resources consumed over 1 year. For this latter purpose, a payer perspective was chosen. Data were extracted from national representative surveys and databases with respect to morbidity and mortality [from the National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale; INSERM) and the National Sickness Insurance Fund for Salaried People (Caisse Nationale d'Assurance Maladie des Travailleurs Salariés; CNAMTS)], consultations, examination tests and drug prescriptions [from the French Medical Audit conducted by Intercontinental Medical Statistics (IMS)], hospitalisations [from the Statistical Unit of the Department of Health-Service des Statistiques, des Etudes et des Systemes d'Information (SESI) and the National Public Research Centre in Health Economics (Centre de Recherche d'Etude et de Documentation en Economie de la Santé; CREDES)] and related health expenditure from CNAMTS. In France, the prevalence of stage II PAOD (Leriche and Fontaine classification) in 1992 was estimated to be 675,000; 53% of these patients had undergone vascular or bypass surgery. The total annual cost of healthcare (including consultations, drugs, laboratory tests, hospitalisation and hydrotherapy) for the management of patients with PAOD ranged from 3.9 billion French francs (F) to F4.6 billion (1995 values), depending on the type of hospital considered. 50% of this cost was related to hospitalisations and 75% was covered by the CNAMTS. Although this study was only a partial evaluation and did not take into account indirect costs or nonmedical direct

  20. PLASMA NITRITE FLUX PREDICTS EXERCISE PERFORMANCE IN PERIPHERAL ARTERIAL DISEASE FOLLOWING 3 MONTHS OF EXERCISE TRAINING

    Science.gov (United States)

    Allen, Jason D; Stabler, Thomas; Kenjale, Aarti; Ham, Katherine L.; Robbins, Jennifer.L.; Duscha, Brian D; Dobrosielski, Devon A; Annex, Brian H

    2010-01-01

    Plasma nitrite is a major oxidation product of nitric oxide. It has also recently been suggested to perform an endocrine-like function as a nitric oxide donor in hypoxic tissues, allowing vasodilation. Exercise performance is limited in peripheral arterial disease due to an inadequate blood supply to working tissues. We hypothesized that exercise training in peripheral arterial disease subjects will demonstrate improved “plasma nitrite flux” and endothelial function, to accompany increased exercise performance. Peripheral arterial disease subjects were tested at baseline and following 3 months supervised or home exercise training. Venous blood (arm) was drawn at rest and 10min following a maximal graded treadmill test. Samples were added to heparin, centrifuged and plasma snap frozen for analysis by reductive chemiluminescence. Brachial artery endothelial function was measured in response to a hyperemic stimulus (flow-mediated dilation). At 3 months the peripheral arterial disease-supervised exercise group showed increases in claudication onset pain time (+138sec, p≤0.05) peak walking time (+260sec, p≤0.01), VO2peak (1.3ml/kg/min, p≤0.05), brachial artery flow-mediated dilation (+2%, p≤0.05) and plasma nitrite flux (+33% p≤0.05). There were no changes in the peripheral arterial disease-home exercise group. The change in plasma nitrite flux predicted the change in claudication onset pain (r2=0.59, p≤0.01). These findings suggest changes in plasma nitrite are related to endothelial function and predict exercise performance in peripheral arterial disease. PMID:20620208

  1. The Use of Heparin during Endovascular Peripheral Arterial Interventions: A Synopsis

    Directory of Open Access Journals (Sweden)

    Arno M. Wiersema

    2016-01-01

    Full Text Available A large variety exists for many aspects of the use of heparin as periprocedural prophylactic antithrombotics (PPAT during peripheral arterial interventions (PAI. This variation is present, not only within countries, but also between them. Due to a lack of (robust data, no systematic review on the use of heparin during PAI could be justified. A synopsis of all available literature on heparin during PAI describes that heparin is used on technical equipment to reduce the thrombogenicity and in the flushing solution with saline. Heparin could have a cumulative anticoagulant effect when used in combination with ionic contrast medium. No level-1 evidence exists on the use of heparin. A measurement of actual anticoagulation status by means of an activated clotting time should be mandatory.

  2. Mitochondrial dysfunction in calf muscles of patients with combined peripheral arterial disease and diabetes type 2

    DEFF Research Database (Denmark)

    Lindegaard Pedersen, Brian; Bækgaard, Niels; Quistorff, Bjørn

    2017-01-01

    BACKGROUND: This study elucidate the effects on muscle mitochondrial function in patients suffering from combined peripheral arterial disease (PAD) and type 2 diabetes (T2D) and the relation to patient symptoms and treatment. METHODS: Near Infra Red Spectroscopy (NIRS) calf muscle exercise tests...... tested applying high resolution oxygraphy on isolated muscle fibers. RESULTS: The NIRS exercise tests showed evidence of mitochondrial dysfunction in the PAD+T2D group by a longer recovery of the deoxygenation resulting from exercise in spite of a higher exercise oxygenation level compared to the PAD...... were conducted on Forty subjects, 15 (PAD), 15 (PAD+T2D) and 10 healthy age matched controls (CTRL) recruited from the vascular outpatient clinic at Gentofte County Hospital, Denmark. Calf muscle biopsies (~ 80 mg) (Gastrocnemius and Anterior tibial muscles) were sampled and mitochondrial function...

  3. Surgery of traumatic peripheral arterial injury with delayed transfer ...

    African Journals Online (AJOL)

    Hospital, UK, for revising the manuscript. Reference: 1. Higher C. W. Arterial repair during the Korean. War. Ann Surg 1958; 147555. 2. De Bakey M Et Someone F A. Battle injuries of the arteries during the second World War and analysis of 2471 cases. Ann Surg 1946; 123: 534. 3. Lumley J S Pt Rich N M. Vascular Injury.

  4. Circulating Progenitor Cells Identify Peripheral Arterial Disease in Patients With Coronary Artery Disease

    Science.gov (United States)

    Hayek, Salim S.; MacNamara, James; Tahhan, Ayman; Awad, Mosaab; Yadalam, Adithya; Ko, Yi-An; Healy, Sean; Hesaroieh, Iraj; Ahmed, Hina; Gray, Brandon; Sher, Salman S.; Ghasemzadeh, Nima; Patel, Riyaz; Kim, Jinhee; Waller, Edmund K.; Quyyumi, Arshed

    2016-01-01

    Rationale Peripheral arterial disease (PAD) is a clinical manifestation of extra-coronary atherosclerosis. Despite sharing the same risk factors, only 20–30% of patients with coronary artery disease (CAD) develop PAD. Declines in the number of bone-marrow derived circulating progenitor cells (PCs) is thought to contribute to the pathogenesis of atherosclerosis. Whether specific changes in PCs differentiate patients with both PAD and CAD from those with CAD alone is unknown. Objective Determine whether differences exist in PCs counts of CAD patients with and without known PAD. Methods and Results 1497 patients (mean age 65, 62% male) with known CAD were identified in the Emory Cardiovascular Biobank. Presence of PAD (n=308) was determined by history, review of medical records or imaging, and was classified as carotid (53%), lower extremity (41%), upper extremity (3%) and aortic disease (33%). Circulating PCs were enumerated by flow cytometry. Patients with CAD and PAD had significantly lower PC counts compared to those with only CAD. In multivariable analysis, a 50% decrease in CD34+ or CD34+/VEGFR2+ counts were associated with a 31% (P=0.032) and 183% (P=0.002) increase in the odds of having PAD, respectively. CD34+ and CD34+/VEGFR2+ counts significantly improved risk prediction metrics for prevalent PAD. Low CD34+/VEGFR2+ counts were associated with a 1.40-fold (95%CI, 1.03, 1.91) and a 1.64-fold (95%CI 1.07, 2.50) increase in the risk of mortality and PAD-related events, respectively. Conclusions PAD is associated with low CD34+ and CD34+/VEGFR2+ PC counts. Whether low PC counts are useful in screening for PAD needs to be investigated. PMID:27267067

  5. Identification of International Classification of Functioning, Disability and Health categories for patients with peripheral arterial disease.

    Science.gov (United States)

    Vyskocil, Erich; Gruther, Wolfgang; Steiner, Irene; Schuhfried, Othmar

    2014-07-01

    Disease-specific categories of the International Classification of Functioning, Disability and Health have not yet been described for patients with chronic peripheral arterial obstructive disease (PAD). The authors examined the relationship between the categories of the Brief Core Sets for ischemic heart diseases with the Peripheral Artery Questionnaire and the ankle-brachial index to determine which International Classification of Functioning, Disability and Health categories are most relevant for patients with PAD. This is a retrospective cohort study including 77 patients with verified PAD. Statistical analyses of the relationship between International Classification of Functioning, Disability and Health categories as independent variables and the endpoints Peripheral Artery Questionnaire or ankle-brachial index were carried out by simple and stepwise linear regression models adjusting for age, sex, and leg (left vs. right). The stepwise linear regression model with the ankle-brachial index as dependent variable revealed a significant effect of the variables blood vessel functions and muscle endurance functions. Calculating a stepwise linear regression model with the Peripheral Artery Questionnaire as dependent variable, a significant effect of age, emotional functions, energy and drive functions, carrying out daily routine, as well as walking could be observed. This study identifies International Classification of Functioning, Disability and Health categories in the Brief Core Sets for ischemic heart diseases that show a significant effect on the ankle-brachial index and the Peripheral Artery Questionnaire score in patients with PAD. These categories provide fundamental information on functioning of patients with PAD and patient-centered outcomes for rehabilitation interventions.

  6. Pathogenesis of the limb manifestations and exercise limitations in peripheral artery disease.

    Science.gov (United States)

    Hiatt, William R; Armstrong, Ehrin J; Larson, Christopher J; Brass, Eric P

    2015-04-24

    Patients with peripheral artery disease have a marked reduction in exercise performance and daily ambulatory activity irrespective of their limb symptoms of classic or atypical claudication. This review will evaluate the multiple pathophysiologic mechanisms underlying the exercise impairment in peripheral artery disease based on an evaluation of the current literature and research performed by the authors. Peripheral artery disease results in atherosclerotic obstructions in the major conduit arteries supplying the lower extremities. This arterial disease process impairs the supply of oxygen and metabolic substrates needed to match the metabolic demand generated by active skeletal muscle during walking exercise. However, the hemodynamic impairment associated with the occlusive disease process does not fully account for the reduced exercise impairment, indicating that additional pathophysiologic mechanisms contribute to the limb manifestations. These mechanisms include a cascade of pathophysiological responses during exercise-induced ischemia and reperfusion at rest that are associated with endothelial dysfunction, oxidant stress, inflammation, and muscle metabolic abnormalities that provide opportunities for targeted therapeutic interventions to address the complex pathophysiology of the exercise impairment in peripheral artery disease. © 2015 American Heart Association, Inc.

  7. Diagnostic performance of computed tomography angiography in peripheral arterial disease: a systematic review and meta-analysis

    NARCIS (Netherlands)

    Met, Rosemarie; Bipat, Shandra; Legemate, Dink A.; Reekers, Jim A.; Koelemay, Mark J. W.

    2009-01-01

    CONTEXT: Computed tomography angiography (CTA) is an increasingly attractive imaging modality for assessing lower extremity peripheral arterial disease (PAD). OBJECTIVE: To determine the accuracy of CTA compared with intra-arterial digital subtraction angiography (DSA) in differentiating extent of

  8. Adverse outcomes in patients with atrial fibrillation and peripheral arterial disease

    DEFF Research Database (Denmark)

    Proietti, Marco; Raparelli, Valeria; Laroche, Cécile

    2017-01-01

    in this analysis. Event rates were determined at 1-year follow-up. RESULTS: Peripheral arterial disease was recorded in 328 (11%) patients. Age (P diabetes mellitus (P = 0.0001), chronic heart failure (P ...AIMS: Peripheral arterial disease (PAD) is highly prevalent in general population. Data on the prevalence of symptomatic PAD in patients with atrial fibrillation (AF) are limited, and the impact of PAD on adverse outcomes in AF patients is controversial. Our aims were: (i) to define the prevalence.......0060), and antiplatelet drug treatment (P = 0.0001) were associated with the presence of PAD, while female gender was inversely associated (P = 0.0002). Peripheral arterial disease patients had higher absolute rates of both cardiovascular (CV) and all-cause death (both P

  9. Management of peripheral arterial disease in the elderly: focus on cilostazol

    Directory of Open Access Journals (Sweden)

    Travis M Falconer

    2008-03-01

    Full Text Available Travis M Falconer1, John W Eikelboom2, Graeme J Hankey3, Paul E Norman11School of Surgery, University of Western Australia, Fremantle Hospital, Western Australia; 2Department of Medicine, McMaster University, Hamilton, Canada; 3Department of Neurology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western AustraliaAbstract: Symptomatic and asymptomatic peripheral arterial disease (PAD is a common problem in the elderly. The management of PAD includes the prevention of cardiovascular events and relief of symptoms – most commonly intermittent claudication (IC. Both require treatment of the causes and consequences of atherothrombosis, but some strategies are more effective for prevention of cardiovascular events and others are more effective for the relief of symptoms. Priorities for the prevention of cardiovascular events include smoking cessation, exercise, antiplatelet therapy, and the treatment of dyslipidemia, hypertension, and diabetes. Walking time and ability are improved by exercise. The benefit of numerous drugs in the treatment of IC has been assessed. The results have generally been disappointing, but there is some evidence that statins and cilostazol (an inhibitor of phosphodiesterase 3 are of benefit. Meta-analyses suggest that cilostazol increases maximum walking distance by 40%–50% and improves other objective measures of walking. The safety profile of cilostazol in patients with PAD appears to be acceptable although the mechanism for its effect on IC is unclear. In addition to risk factor management, treatment with cilostazol should be considered in patients with disabling IC.Keywords: peripheral arterial disease, intermittent claudication, risk factors, cilostazol

  10. Intelligence in Childhood and Atherosclerosis of the Carotid and Peripheral Arteries in Later Life: The Lothian Birth Cohort 1936

    Science.gov (United States)

    Gale, Catharine R.; Eadie, Elizabeth; Thomas, Avril; Bastin, Mark E.; Starr, John M.

    2015-01-01

    Objective There is some evidence that people who score higher on tests of intelligence in childhood have lower carotid intima-media thickness and higher ankle brachial index in middle age. These findings need replicating in other, older populations. We investigated the prospective relationship between intelligence in childhood and atherosclerosis in the carotid and peripheral arteries at age 73 years. Methods Participants were 713 members of the Lothian Birth Cohort 1936 whose intelligence was assessed at age 11 years. At age 73 years, carotid intima-media thickness and degree of stenosis were measured using ultrasound imaging; ankle-brachial index was measured using Doppler ultrasound. Results There were no significant associations between intelligence at age 11 and measures of atherosclerosis at age 73. In age- and sex-adjusted analyses, for a standard deviation higher score in intelligence, intima-media thickness (x 10) was lower by 0.07 (-0.20, 0.06) mm and ankle brachial index (x 10) was lower by 0.09 (-0.24, 0.07); odds ratios for having carotid stenosis >25% or peripheral arterial disease were 0.98 (0.82, 1.16) and 1.05 (0.81, 1.36) respectively. Conclusion In this study of people aged 73 years, higher childhood intelligence was not associated with reduced risk of atherosclerosis in the carotid or peripheral arteries. PMID:25915652

  11. Measures of chronic kidney disease and risk of incident peripheral artery disease: a collaborative meta-analysis of individual participant data.

    Science.gov (United States)

    Matsushita, Kunihiro; Ballew, Shoshana H; Coresh, Josef; Arima, Hisatomi; Ärnlöv, Johan; Cirillo, Massimo; Ebert, Natalie; Hiramoto, Jade S; Kimm, Heejin; Shlipak, Michael G; Visseren, Frank L J; Gansevoort, Ron T; Kovesdy, Csaba P; Shalev, Varda; Woodward, Mark; Kronenberg, Florian

    2017-09-01

    Some evidence suggests that chronic kidney disease is a risk factor for lower-extremity peripheral artery disease. We aimed to quantify the independent and joint associations of two measures of chronic kidney disease (estimated glomerular filtration rate [eGFR] and albuminuria) with the incidence of peripheral artery disease. In this collaborative meta-analysis of international cohorts included in the Chronic Kidney Disease Prognosis Consortium (baseline measurements obtained between 1972 and 2014) with baseline measurements of eGFR and albuminuria, at least 1000 participants (this criterion not applied to cohorts exclusively enrolling patients with chronic kidney disease), and at least 50 peripheral artery disease events, we analysed adult participants without peripheral artery disease at baseline at the individual patient level with Cox proportional hazards models to quantify associations of creatinine-based eGFR, urine albumin-to-creatinine ratio (ACR), and dipstick proteinuria with the incidence of peripheral artery disease (including hospitalisation with a diagnosis of peripheral artery disease, intermittent claudication, leg revascularisation, and leg amputation). We assessed discrimination improvement through c-statistics. We analysed 817 084 individuals without a history of peripheral artery disease at baseline from 21 cohorts. 18 261 cases of peripheral artery disease were recorded during follow-up across cohorts (median follow-up was 7·4 years [IQR 5·7-8·9], range 2·0-15·8 years across cohorts). Both chronic kidney disease measures were independently associated with the incidence of peripheral artery disease. Compared with an eGFR of 95 mL/min per 1·73 m 2 , adjusted hazard ratios (HRs) for incident study-specific peripheral artery disease was 1·22 (95% CI 1·14-1·30) at an eGFR of 45 mL/min per 1·73 m 2 and 2·06 (1·70-2·48) at an eGFR of 15 mL/min per 1·73 m 2 . Compared with an ACR of 5 mg/g, the adjusted HR for incident study

  12. Factors influencing quality of life following lower limb amputation for peripheral arterial occlusive disease: A systematic review of the literature.

    Science.gov (United States)

    Davie-Smith, Fiona; Coulter, Elaine; Kennon, Brian; Wyke, Sally; Paul, Lorna

    2017-12-01

    The majority of lower limb amputations are undertaken in people with peripheral arterial occlusive disease, and approximately 50% have diabetes. Quality of life is an important outcome in lower limb amputations; little is known about what influences it, and therefore how to improve it. The aim of this systematic review was to identify the factors that influence quality of life after lower limb amputation for peripheral arterial occlusive disease. MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science and Cochrane databases were searched to identify articles that quantitatively measured quality of life in those with a lower limb amputation for peripheral arterial occlusive disease. Articles were quality assessed by two assessors, evidence tables summarised each article and a narrative synthesis was performed. Systematic review. Twelve articles were included. Study designs and outcome measures used varied. Quality assessment scores ranged from 36% to 92%. The ability to walk successfully with a prosthesis had the greatest positive impact on quality of life. A trans-femoral amputation was negatively associated with quality of life due to increased difficulty in walking with a prosthesis. Other factors such as older age, being male, longer time since amputation, level of social support and presence of diabetes also negatively affected quality of life. Being able to walk with a prosthesis is of primary importance to improve quality of life for people with lower limb amputation due to peripheral arterial occlusive disease. To further understand and improve the quality of life of this population, there is a need for more prospective longitudinal studies, with a standardised outcome measure. Clinical relevance This is of clinical relevance to those who are involved in the rehabilitation of persons with lower limb amputations. Improved quality of life is associated with successful prosthetic use and focus should be directed toward achieving this.

  13. Acute Brachial Artery Thrombosis in a Neonate Caused by a Peripheral Venous Catheter

    Directory of Open Access Journals (Sweden)

    Simon Berzel

    2014-01-01

    Full Text Available This case describes the diagnostic testing and management of an acute thrombosis of the brachial artery in a female neonate. On day seven of life, clinical signs of acutely decreased peripheral perfusion indicated an occlusion of the brachial artery, which was confirmed by high-resolution Doppler ultrasound. Imaging also showed early stages of collateralization so that surgical treatment options could be avoided. Unfractionated heparin was used initially and then replaced by low-molecular-weight heparin while coagulation parameters were monitored closely. Within several days, brachial artery perfusion was completely restored. Acetylsalicylic acid was given for additional six weeks to minimize the risk of recurring thrombosis. If inadequately fixated in a high-risk location, a peripheral venous catheter can damage adjacent structures and thus ultimately cause arterial complications.

  14. [Huge Solitary Fibrous Tumor of Pleura Combined with Peripheral Pulmonary Artery Aneurysm: A Case Resport].

    Science.gov (United States)

    Cheng, Yuanda; Gao, Yang; Zhang, Weixing; Zhang, Chunfang

    2015-08-01

    Solitary fibrous tumor of pleura (SFTP) is uncommon, accounts for less than 5% of all pleural tumors. Pulmonary artery aneurysm (PAA) is also not common, 80% of which often occurs in the main pulmonary trunk and peripheral PAA is rare. SFTP combined with PAA in one patient has not been reported. This paper reports a case of SFTP combined with peripheral PAA, and SFTP maybe accelerate PAA formation.

  15. Positive predictive values of peripheral arterial and venous thrombosis codes in French hospital database.

    Science.gov (United States)

    Prat, Mandy; Derumeaux, Hélène; Sailler, Laurent; Lapeyre-Mestre, Maryse; Moulis, Guillaume

    2018-02-01

    French hospital database, called Programme de Médicalisation des Systèmes d'Information (PMSI), covers all hospital stays in France (>66 million inhabitants). The aim of this study was to estimate the positive predictive values (PPVs) of primary diagnosis codes of peripheral arterial and venous thrombosis codes in the PMSI, encoded with the International Classification of Diseases, 10th revision. Data were extracted from the PMSI database of Toulouse University Hospital, south of France. We identified all the hospital stays in 2015 with a code of peripheral arterial or venous thrombosis as primary diagnosis. We randomly selected 100 stays for each category of thrombosis and reviewed the corresponding medical charts. The PPV of peripheral arterial thrombosis codes was 83.0%, 95% confidence interval (CI): 73.9-89.1, and the PPV of correct location of thrombosis was 81.0%, 95% CI: 72.2-87.5. The PPV of pulmonary embolism was 99.0%, 95% CI: 93.8-99.9. The PPV of peripheral venous thrombosis was 95.0%, 95% CI: 88.2-98.1, and the PPV of correct location of thrombosis was 85.0%, 95% CI: 76.7-90.7. Primary diagnoses of peripheral arterial and venous thrombosis demonstrated good PPVs in the PMSI. © 2017 Société Française de Pharmacologie et de Thérapeutique.

  16. Measures of chronic kidney disease and risk of incident peripheral artery disease: a collaborative meta-analysis of individual participant data

    NARCIS (Netherlands)

    Matsushita, K.; Ballew, S.H.; Coresh, J.; Arima, H.; Arnlov, J.; Cirillo, M.; Ebert, N.; Hiramoto, J.S.; Kimm, H.; Shlipak, M.G.; Visseren, F.L.; Gansevoort, R.T.; Kovesdy, C.P.; Shalev, V.; Woodward, M.; Kronenberg, F.; Wetzels, J.F.M.; Grams, M.; Sang, Y.

    2017-01-01

    BACKGROUND: Some evidence suggests that chronic kidney disease is a risk factor for lower-extremity peripheral artery disease. We aimed to quantify the independent and joint associations of two measures of chronic kidney disease (estimated glomerular filtration rate [eGFR] and albuminuria) with the

  17. ORIGINAL ARTICLES Assessing peripheral arteries in South African ...

    African Journals Online (AJOL)

    May 2004, Vol.94, No.5 SAMJ higher of the two indices was used as the ABI for a given foot.' An ABI less than 0.9 was used to define peripheral vascular disease." Photo plethysmography (Hokanson, Washington) was used to measure toe systolic blood pressure. Before taking two measurements, on the left and right hallux, ...

  18. Serum leptin levels positively correlate with peripheral arterial stiffness in kidney transplantation patients.

    Science.gov (United States)

    Lee, M-C; Chen, Y-C; Ho, G-J; Shih, M-H; Chou, K-C; Hsu, B-G

    2014-01-01

    Leptin is a protein predominantly produced by adipocytes that plays a pathophysiologic role in the pathogenesis of hypertension and cardiovascular diseases. The aim of this study was to evaluate the relationship between fasting serum leptin levels and peripheral arterial stiffness among kidney transplant (KT) patients. Fasting blood samples were obtained from 74 KT patients. Brachial-ankle pulse wave velocity (baPWV) was measured in the right or left brachial artery to the ankle segments using an automatic pulse wave analyzer (VaSera VS-1000). Plasma leptin levels were measured using a commercial enzyme-linked immunosorbent assay kit. In this study, left or right baPWV values of less than 14.0 m/s were used to define the high arterial stiffness group. Forty KT patients (54.1%) were defined in high arterial stiffness group. Hypertension (P leptin level (P leptin (odds ratio, 1.033; 95% CI, 1.004-1.062; P = .023), KT duration (odds ratio, 1.023; 95% CI, 1.004-1.044; P = .020), and high-density lipoprotein cholesterol level (odds ratio, 0.925; 95% CI, 0.872-0.982; P = .010) were the independent predictors of peripheral arterial stiffness in KT patients. Serum fasting leptin level was positively associated with peripheral arterial stiffness among KT patients. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Mechanical Recanalization of Subacute Vessel Occlusion in Peripheral Arterial Disease with a Directional Atherectomy Catheter

    Energy Technology Data Exchange (ETDEWEB)

    Massmann, Alexander, E-mail: Alexander.Massmann@uks.eu; Katoh, Marcus [Saarland University Hospital, Department of Diagnostic and Interventional Radiology (Germany); Shayesteh-Kheslat, Roushanak [Saarland University Hospital, Department of General Surgery, Visceral, Vascular, and Pediatric Surgery (Germany); Buecker, Arno [Saarland University Hospital, Department of Diagnostic and Interventional Radiology (Germany)

    2012-10-15

    Purpose: To retrospectively examine the technical feasibility and safety of directional atherectomy for treatment of subacute infrainguinal arterial vessel occlusions. Methods: Five patients (one woman, four men, age range 51-81 years) with peripheral arterial disease who experienced sudden worsening of their peripheral arterial disease-related symptoms during the last 2-6 weeks underwent digital subtraction angiography, which revealed vessel occlusion in native popliteal artery (n = 4) and in-stent occlusion of the superficial femoral artery (n = 1). Subsequently, all patients were treated by atherectomy with the SilverHawk (ev3 Endovascular, USA) device. Results: The mean diameter of treated vessels was 5.1 {+-} 1.0 mm. The length of the occlusion ranged 2-14 cm. The primary technical success rate was 100%. One patient experienced a reocclusion during hospitalization due to heparin-induced thrombocytopenia. There were no further periprocedural complications, in particular no peripheral embolizations, until hospital discharge or during the follow-up period of 1 year. Conclusion: The recanalization of infrainguinal arterial vessel occlusions by atherectomy with the SilverHawk device is technically feasible and safe. In our limited retrospective study, it was associated with a high technical success rate and a low procedure-related complication rate.

  20. Peripheral arterial disease in rheumatoid arthritis patients at the ...

    African Journals Online (AJOL)

    Objective: To determine the magnitude of the rosclerotic arterial disease in Rheumatoid Arthritis(RA) patients at Kenyatta National Hospital. Design: hospital based cross-sectional study. Setting: Kenyatta National Hospital Rheumatology outpatient clinic. Subjects: Rheumatoid Arthritis patients. Results: We obtained ABI ...

  1. Ultrastructural changes in peripheral arteries and nerves in diabetic ...

    African Journals Online (AJOL)

    Mohamed E. Salem

    2017-01-30

    Jan 30, 2017 ... biopsies in diabetic neuropathy comparing with biopsies of normal arteries and nerves of traumatic amputation as a control group. ... the metabolism of carbohydrate, protein, fat, water and elec- trolytes, sometimes with grave .... loss of the vessel architecture in some sections. The vasa vasorum changes ...

  2. Surgery of traumatic peripheral arterial injury with delayed transfer ...

    African Journals Online (AJOL)

    xjla. l1.ltients with a false aneurysm presented with a pulsai;le mass. Brisk uncontrolled bleeding also suggested a probable arterial Injury. Operative Technique. A pneumatic tourniquet inflated by compressed air was, whenever possible, applied before removal of pressure bandages. The tourniquet remained inflated.

  3. Peripheral arterial disease: an underestimated aetiology of exercise intolerance in chronic obstructive pulmonary disease patients.

    Science.gov (United States)

    Castagna, Olivier; Boussuges, Alain; Nussbaum, Eric; Marqueste, Louis; Brisswalter, Jeanick

    2008-06-01

    To assess the prevalence of peripheral arterial disease and its implications for exercise limitation in chronic obstructive pulmonary disease (COPD) patients. One hundred and fifty-one moderate-to-severe COPD patients (forced expiratory volume in 1 s: 37+/-6 SD% predicted) and 73 healthy age-matched control individuals (divided into 31 smokers and 42 nonsmokers) participated in this study. All COPD patients were either exsmokers or current smokers and their tobacco-smoking history was similar to that of healthy smokers. To evaluate the existence of arterial disease, lower limb perfusion pressure impairment was assessed using the ankle brachial index, whereas arterial stiffness was assessed by the pulse wave velocity (PWV). The definition of peripheral arterial disease required an ankle brachial index value of 0.90 or less, whereas the PWV increment was considered to be a direct witness of arterial stiffness increase. A 6-min walk test was performed to assess physical exercise capacity. Prevalence of peripheral arterial disease was higher in COPD patients than in healthy participants (81+/-3 SD; 49+/-5 SD and 9+/-2 SD%, respectively, in COPD, healthy smokers and nonsmokers). PWV mean values were significantly higher in COPD patients compared with healthy smokers and nonsmokers (10.3+/-2.1 SD m/s; 9.2+/-1.3 SD m/s and 8.7+/-2.2 SD m/s, respectively). The distance covered during the 6-min-walk test was associated positively with the degree of peripheral arterial disease (r=0.78; P=0.05) and negatively with the PWV values (r=-0.74; P=0.05). Not only tobacco-smoking history but also COPD severity was shown to influence these associations. The effect of peripheral arterial disease on exercise intolerance in COPD seems to be considerable. Therefore, COPD patients participating in a pulmonary rehabilitation programme should profit from a systematic search for arterial disease. Arterial dysfunction has to be taken into account in the multidisciplinary treatment of these

  4. Detection of Peripheral Artery Disease by Duplex Ultrasonography among Hemodialysis Patients

    OpenAIRE

    Ogata, Hiroaki; Kumata-Maeta, Chiaki; Shishido, Kanji; Mizobuchi, Masahide; Yamamoto, Masahiro; Koiwa, Fumihiko; Kinugasa, Eriko; Akizawa, Tadao

    2010-01-01

    Background and objectives: Peripheral arterial disease (PAD) is a known predictor of cardiovascular morbidity and mortality among hemodialysis patients. Although ankle-brachial BP index (ABI) is a simple and reliable test for PAD screening, its sensitivity has been suggested to decrease among dialysis patients.

  5. Beta-2 microglobulin as a predictor of peripheral arterial disease in ...

    African Journals Online (AJOL)

    Background: Peripheral arterial disease (PAD) is common in patients with type 2 diabetes mellitus. Its definitive diagnosis requires ultrasound or angiography. Beta-2 microglobulin (â2 microglobulin) has been proposed as a diagnostic marker for PAD. The objective of the study was to evaluate the diagnostic value of â2 ...

  6. Abdominal fat and risk of coronary heart disease in patients with peripheral arterial disease

    NARCIS (Netherlands)

    Brouwer, Beate G.; Visseren, Frank L. J.; Stolk, Ronald P.; van der Graaf, Yolanda

    Objective: We investigated whether the presence of concomitant coronary heart disease (CHD) in patients with peripheral arterial disease (PAD) can be explained by intra-abdominal fat accumulation and compared different measures of adiposity as predictors of CHD in patients with PAD. Research Methods

  7. The management of combined coronary artery disease and peripheral vascular disease

    NARCIS (Netherlands)

    A. Cassar (Andrew); D. Poldermans (Don); C.S. Rihal (Charanjit); B.J. Gersh (Bernard)

    2010-01-01

    textabstractCoronary artery disease (CAD) and peripheral vascular disease (PVD) remain highly prevalent in the population due to population ageing, smoking, diabetes, unhealthy lifestyles, and the epidemic of obesity, and frequently coexist. The management of combined CAD and PVD is a common

  8. Screen or not to screen for peripheral arterial disease: Guidance from a decision model

    NARCIS (Netherlands)

    A. Vaidya (Anil); M.A. Joore (Manuela); A.J. Ten Cate-Hoek (Arina J); H. ten Cate (Hugo); J.L. Severens (Hans)

    2014-01-01

    markdownabstract__Abstract__ Background: Asymptomatic Peripheral Arterial Disease (PAD) is associated with greater risk of acute cardiovascular events. This study aims to determine the cost-effectiveness of one time only PAD screening using Ankle Brachial Index (ABI) test and subsequent anti

  9. Current status and future perspectives of bioresorbable stents in peripheral arterial disease

    NARCIS (Netherlands)

    van Haelst, Steven T W; Peeters Weem, Stefanie M O; Moll, Frans L; de Borst, Gert J

    2016-01-01

    BACKGROUND: Endovascular treatment of peripheral arterial disease (PAD) still yields unsatisfactory patency rates. Recent new developments include the use of bioresorbable stents. The objective of this study was to provide an overview of currently available data on the use of bioresorbable stents in

  10. Alcohol consumption and risk of peripheral arterial disease : the Rotterdam Study

    NARCIS (Netherlands)

    Vliegenthart, R.; Geleijnse, J.M.; Hofman, A.; Meijer, W.T.; Rooij, van F.J.A.; Grobbee, D.E.; Witteman, J.C.M.

    2002-01-01

    Moderate alcohol consumption is associated with a reduced risk of cardiovascular disease. Data on alcohol consumption and atherosclerosis are scarce. To determine the association between alcohol consumption and risk of peripheral arterial disease, the authors carried out a cross-sectional study

  11. Alcohol consumption and risk of peripheral arterial disease - The Rotterdam Study

    NARCIS (Netherlands)

    Vliegenthart, R; Geleijnse, JM; Hofman, A; Meijer, WT; van Rooij, FJA; Grobbee, DE; Witteman, JCM

    2002-01-01

    Moderate alcohol consumption is associated with a reduced risk of cardiovascular disease. Data on alcohol consumption and atherosclerosis are scarce. To determine the association between alcohol consumption and risk of peripheral arterial disease, the authors carried out a cross-sectional study

  12. Osteoprotegerin is higher in peripheral arterial disease regardless of glycaemic status.

    LENUS (Irish Health Repository)

    O'Sullivan, Eoin P

    2010-12-01

    Peripheral arterial disease (PAD) and type 2 diabetes mellitus (DM) are both associated with excessive vascular calcification and elevated levels of inflammatory markers IL-6 and hsCRP. The recently identified Osteoprotegerin(OPG)\\/RANKL\\/TRAIL pathway has been implicated in vascular calcification, but data on levels in PAD and effect of co-existent DM are lacking.

  13. Peripheral artery disease is a coronary heart disease risk equivalent among both men and women

    DEFF Research Database (Denmark)

    Subherwal, Sumeet; Patel, Manesh R; Kober, Lars

    2015-01-01

    AIMS: Lower extremity peripheral artery disease (PAD) has been proposed as a 'coronary heart disease (CHD) risk equivalent'. We aimed to examine whether PAD confers similar risk for mortality as incident myocardial infarction (MI) and whether risk differs by gender. METHODS: Using nationwide Danish...

  14. Plasma homocysteine, dietary B vitamins, betaine, and choline and risk of peripheral artery disease

    NARCIS (Netherlands)

    Bertoia, Monica L.; Pai, Jennifer K.; Cooke, John P.; Joosten, Michel M.; Mittleman, Murray A.; Rimm, Eric B.; Mukamal, Kenneth J.

    Objective: Few studies have examined the roles of homocysteine and related nutrients in the development of peripheral artery disease (PAD). We examined the associations between plasma homocysteine, dietary B vitamins, betaine, choline, and supplemental folic acid use and incidence of PAD. Methods:

  15. Assessing peripheral arteries in South African black women with type 2 diabetes mellitus

    NARCIS (Netherlands)

    Rheeder, P; van Wyk, JT; Stolk, RP; Grobbee, DE

    Objectives. To determine the value of ankle and toe blood pressure indices and pedal pulse palpation in the assessment of peripheral arterial disease in subjects with type 2 diabetes mellitus (DM). Design. Cross-sectional study. Subjects. A convenience sample of 85 female subjects with type 2 DM

  16. Amputation rates for patients with diabetes and peripheral arterial disease: the effects of race and region

    Science.gov (United States)

    Spangler, Emily; Dzebisashvili, Nino; Goodman, David C.; Goodney, Philip

    2016-01-01

    BACKGROUND It remains unknown whether care of high-risk vascular patients with both diabetes and peripheral arterial disease is improving. We examined national trends in care of patients with both peripheral arterial disease and diabetes. METHODS A cohort of patients diagnosed with peripheral arterial disease and diabetes between 2007–2011 undergoing open or endovascular diagnostic or revascularization procedures was analyzed using Medicare claims data. Main outcome measure was amputation-free survival measured from time of initial revascularization procedure to 24 months, stratified by race and hospital referral region (HRR). RESULTS 2.3 per 1,000 patients underwent a major amputation from 2007–2011, with the higher rate among black patients (5.5 per 1,000 versus 1.9 per 1,000, pamputation rates in black patients (2.1 to 16.1 per 1,000). Overall, amputation-free survival was approximately 74.6% at 2 years, 68.4% among black patients and 75.4% among non-black patients, with the disparity between the 2 groups increasing over time. CONCLUSIONS Prevalence of concurrent peripheral arterial disease and diabetes is increasing, but amputation rates and amputation-free survival vary significantly by both race and hospital referral region. Prevention and care coordination effort should aim to limit racial disparities in the treatment and outcomes of these high-risk patients. PMID:26549811

  17. Advancing beyond the "heart-healthy diet" for peripheral arterial disease.

    Science.gov (United States)

    Nosova, Emily V; Conte, Michael S; Grenon, S Marlene

    2015-01-01

    Peripheral arterial disease (PAD) is a burdensome cardiovascular condition that results from chronic inflammatory insults to the arterial vasculature. Key risk factors include age, gender, type 2 diabetes mellitus, hypertension, hypercholesterolemia, hyperhomocysteinemia, smoking, lack of physical fitness, and poor diet, the latter three being modifiable in the development and progression of PAD. A growing body of evidence indicates that imbalanced nutrient intake may contribute to the development and progression of PAD. The purpose of this review is to summarize current knowledge about nutritional patterns among patients with PAD and to ascertain whether certain health-promoting foods and nutrients could benefit patients with this condition. We conducted a comprehensive literature review to examine primary source evidence for or against the nutrients that are commonly associated with PAD and their potential utility as therapies. We summarized nine categories of nutrients, as well as four diets endorsed by the American Heart Association that may be prescribed to patients with or at risk for PAD. The nutrients reviewed included omega-3 polyunsaturated fatty acids (n-3 PUFAs), folate and B-series vitamins, and antioxidants. The diet plans described include the Dietary Approaches to Stop Hypertension (DASH) diet, Mediterranean diet, low-fat diet, low carbohydrate diet, Dr Dean Ornish's Spectrum Diet and Dr Andrew Weil's Anti-Inflammatory Diet. PAD is a chronic inflammatory condition that is associated with longstanding poor nutrition habits. We advocate for an intensified use of diet in PAD therapy, and we specifically recommend following eating patterns that are rich in nutrients with anti-inflammatory and antioxidant properties. Published by Elsevier Inc.

  18. Can fish oil supplementation improve endothelial function in asymptomatic offspring of patients with peripheral arterial disease?

    Directory of Open Access Journals (Sweden)

    Spark JI

    2013-07-01

    Full Text Available J Ian Spark,1 Christopher L Delaney,1 Richard B Allan,1 Melissa HL Ho,2 Michelle D Miller21Department of Vascular Surgery, Flinders Medical Centre and Flinders University, 2Department of Nutrition and Dietetics, Flinders University, Bedford Park, Adelaide, South Australia, AustraliaBackground: Peripheral arterial disease affects 10%–25% of adults aged .55 years, and while a multitude of risk factors exist, one key influence is genetics. Rather than awaiting the onset of debilitating symptoms, interventions that target high-risk individuals and prevent or delay the onset of symptoms would have widespread impact. The aim of this study is to implement a 12-week fish oil intervention (10 mL/day containing approximately 1.5 g of eicosapentaenoic acid and 1 g of docosahexaenoic acid, with the intention of improving endothelial function, inflammation, and lipid status in a high-risk population, ie, those with impaired endothelial function and a parent with symptomatic peripheral arterial disease.Methods: This is a parallel-group, double-blind, randomized controlled trial involving administration of fish oil containing either about 1.5 g of docosahexaenoic acid and 1 g of docosahexaenoic acid (intervention or about 0.15 g of eicosapentaenoic acid and about 0.1 g of docosahexaenoic acid for 12 consecutive weeks (control. The participants are 100 offspring of adults with diagnosed peripheral arterial disease who themselves have an ankle-brachial pressure index ≥0.9 but impaired endothelial function according to peripheral arterial tonometry. Measures performed at baseline and at 6 and 12 weeks include flow-mediated dilatation, C-reactive protein, absolute neutrophil and lymphocyte counts, tumor necrosis factor-α, interleukin-1ß, and interleukin-6 levels, thromboxane and prostacyclin, lipid status, and homocysteine, nitrite, and nitrate levels. Participants will be phoned fortnightly to monitor adherence and side effects, while participants will

  19. New Innovations in Drug-Eluting Stents for Peripheral Arterial Disease.

    Science.gov (United States)

    Altit, Roi; Gray, William A

    2017-10-12

    The purpose of this paper was to provide a review of the burden of peripheral arterial disease; to examine older therapies and their limitations; and especially to highlight new treatment innovations as well as the data supporting their use. Building on the success of paclitaxel in the prevention of restenosis in the peripheral circulation, the newest generation drug-eluting stent is presented, which combines paclitaxel with a polymer-allowing the drug to be eluted slowly over 12 months. The positive results of the pilot MAJESTIC study led to the ongoing IMPERIAL trial. Limited data of bioresorbable scaffolds in above and below-the-knee applications are also reviewed. Endovascular therapy of peripheral arterial disease has had many advances in the preceding two decades. However, drug-eluting stent technology has had the greatest impact to date and holds great promise for the future.

  20. Activation products of the haemostatic system in coronary, cerebrovascular and peripheral arterial disease.

    Science.gov (United States)

    van der Bom, J G; Bots, M L; Haverkate, F; Meijer, P; Hofman, A; Kluft, C; Grobbee, D E

    2001-02-01

    To determine the presence of a 'hypercoagulable state' as assessed by indices of thrombin and plasmin generation and of the amount of fibrin that is lysed, in patients with stable coronary, cerebral and peripheral arterial disease a population-based cross-sectional study was performed. From a population-based cohort comprising 7983 men and women aged 55 years and over, we randomly selected 127 subjects with a history of myocardial infarction, 124 with a history of stroke and/or transient ischemic attack, 131 patients with peripheral arterial disease and 263 control subjects in the same age group without arterial disease. Subjects using anticoagulant drugs were not selected. F1+2, TAT, and PAP were not associated with a history of cardiovascular events, nor with peripheral arterial disease. In contrast, positive associations were found for D-Dimer. Mean D-Dimer level was 40 microg/l (95% CI 35, 44) in control subjects; 53 microg/l (47, 61) in those with a history of myocardial infarction and 51 microg/l (45, 58) in those with a history of stroke and or transient ischemic attack. D-Dimer increased gradually with increasing severity of peripheral atherosclerosis; a decrease in ankle/arm systolic blood pressure ratio of 0.1 was associated with an increase in D-Dimer of 3.9 microg/l (p<0.01). This was more pronounced in subjects with higher F1+2, TAT and PAP concentration. In conclusion, the markers of onset of coagulation F1+2, TAT and PAP are not associated with the presence of arterial disease, but increased levels of these markers are necessary for the positive association between D-Dimer and arterial disease.

  1. Association of lower extremity arterial calcification with amputation and mortality in patients with symptomatic peripheral artery disease.

    Directory of Open Access Journals (Sweden)

    Chi-Lun Huang

    Full Text Available OBJECTIVE: The clinical implication of the coronary artery calcium score (CS is well demonstrated. However, little is known about the association between lower extremity arterial calcification and clinical outcomes. METHODS AND RESULTS: Eighty-two patients with symptomatic peripheral artery disease (age 61.0±12.4 years were followed for 21±11 months. CSs, ranging from the common iliac artery bifurcation to the ankle area, were analyzed through noncontrast multidetector computed tomography images retrospectively. The primary endpoints of this study were amputation and mortality. Old age, diabetes, hyperlipidemia, and end-stage renal disease were associated with higher CSs. Patients with more advanced Fontaine stages also tended to have significantly higher CSs (p = 0.03. During the follow-up period (21±11 months, 29 (35% patients underwent amputation, and 24 (29% patients died. Among the patients who underwent amputation, there were no significant differences in CSs between the amputated legs and the non-amputated legs. In the Cox proportional hazard model with CS divided into quartiles, patients with CS in the highest quartile had a 2.88-fold (95% confidence interval [CI] 1.18-12.72, p = 0.03 and a 5.16-fold (95% CI 1.13-21.61, p = 0.04 higher risk for amputation and all-cause mortality, respectively, than those with CS in the lowest quartile. These predictive effects remained after conventional risk factor adjustment. CONCLUSION: Lower extremity arterial CSs are associated with disease severity and outcomes, including amputation and all-cause mortality, in patients with symptomatic peripheral artery disease. However, the independent predictive value needs further investigation in large scale, prospective studies.

  2. Regulation of oxygen sensing in peripheral arterial chemoreceptors.

    Science.gov (United States)

    Lahiri, S; Rozanov, C; Roy, A; Storey, B; Buerk, D G

    2001-08-01

    The carotid bodies are a small pair of highly vascularized and well perfused organs located at each carotid artery bifurcation, strategically situated to sense oxygen in arterial blood as it leaves the heart. Carotid body glomus cells are identified as the primary oxygen sensors, which respond to changes in blood P(O(2)) within milliseconds. Acute hypoxia causes a rapid increase in carotid sinus nerve (CSN) activity, providing afferent signals to the respiratory center in the brainstem. Glomus cells secrete numerous neurotransmitters that modulate CSN firing rates. This review will discuss major hypotheses that have emerged regarding acute oxygen sensing by glomus cells. In contrast, chronic responses to hypoxia are much slower, involving cytosolic reactions that take place over several minutes and nuclear reactions which occur over several hours. Converging concepts from different areas of research in oxygen sensing cells and tissues (including the carotid body) have been combined to describe molecular and biochemical changes that take place in the carotid body with chronic hypoxia. These include oxygen dependent proteolytic processes in the cytosol and gene transcription in the nucleus. In addition, cellular and nuclear responses to chronic hypoxia will be discussed.

  3. Evaluation of gender differences in endothelium-independent dilation using peripheral arterial tonometry.

    Science.gov (United States)

    McCue, Meghan C; Marlatt, Kara L; Kelly, Aaron S; Steinberger, Julia; Dengel, Donald R

    2012-03-01

    A change in peripheral arterial tonometry (PAT) in response to reactive hyperaemia is often used to provide a non-invasive measure of endothelium-dependent dilation (EDD). Reactive hyperaemia does not allow one to quantify endothelium-independent dilation (EID), which is part of overall vascular function. Although most research examining vascular function and cardiovascular disease has focused on EDD, there is evidence that cardiovascular risk factors may impair EID. To examine the microvascular vasodilation response to nitroglycerin (NTG) in healthy adults using PAT. Microvascular responses to reactive hyperaemia and NTG were evaluated in 86 (41 female and 45 male) healthy subjects (age 37 ± 5 years). Beat-to-beat plethysmographic measurements of finger arterial pulse waves were recorded for 5 min following reactive hyperaemia. After a 10-min rest period, sublingual NTG (0.4 mg) was administered and PAT signal changes were measured for 10 min. Peak reactive hyperaemic index (RHI) and peak NTG-mediated index (NMI) were determined in all subjects. There were no significant gender differences in peak RHI (females: 2.07 ± 0.56 versus males: 1.91 ± 0.58, P = 0.20). Mean peak NMI for all subjects was 2.78 (± 1.49). Peak NMI was significantly greater in females than in males (3.11 ± 1.59 versus 2.50 ± 1.34, P = 0.05). Time to peak NMI was not significantly different between genders (7 min, 28 s [± 1 min, 47 s], versus 7 min, 14 s [± 1 min, 49 s], P = 0.58). In this population of healthy adults, peak NMI was significantly greater in females than in males. These findings suggest that gender differences exist in the microvascular vasodilation responses to NTG using PAT. © 2011 The Authors. Clinical Physiology and Functional Imaging © 2011 Scandinavian Society of Clinical Physiology and Nuclear Medicine.

  4. Meta-analysis: Accuracy of contrast-enhanced magnetic resonance angiography for assessing steno-occlusions in peripheral arterial disease.

    Science.gov (United States)

    Menke, Jan; Larsen, Jörg

    2010-09-07

    Contrast-enhanced magnetic resonance angiography (MRA) is a noninvasive, radiation-free imaging method for studying peripheral arterial disease (PAD) of the lower extremities. To summarize evidence of prospective studies about how well MRA identifies or excludes arterial steno-occlusions (50% to 100% lumen reduction) in adults with PAD symptoms. PubMed and 3 other databases were searched from 1998 to 2009 without language restrictions. Two independent reviewers selected 32 studies that compared MRA with intra-arterial digital subtraction angiography in PAD. Eligible studies were prospective and provided data to reconstruct 2 x 2 or 3 x 3 contingency tables ( or =50% stenosis or occlusion of arterial segments) in at least 10 patients with PAD symptoms. Two reviewers independently assessed the study quality and extracted the study data, with disagreements resolved by consensus. The 32 included studies generally had high methodological quality. About 26% of the 1022 included patients had critical limb ischemia with pain at rest or tissue loss. Overall, the pooled sensitivity of MRA was 94.7% (95% CI, 92.1% to 96.4%) and the specificity was 95.6% (CI, 94.0% to 96.8%) for diagnosing segmental steno-occlusions. The pooled positive and negative likelihood ratios were 21.56 (CI, 15.70 to 29.69) and 0.056 (CI, 0.037 to 0.083), respectively. Magnetic resonance angiography correctly classified 95.3%, overstaged 3.1%, and understaged 1.6% of arterial segments. Similar to most studies of computed tomographic angiography in PAD, the primary studies reported the diagnostic accuracy of MRA on a per-segment basis, not a per-patient basis. This meta-analysis of 32 prospective studies further increases the evidence that contrast-enhanced MRA has high accuracy for identifying or excluding clinically relevant arterial steno-occlusions in adults with PAD symptoms. None.

  5. Is There a Real Correlation Between Red Cell Distribution Width and Peripheral Arterial Disease?

    Directory of Open Access Journals (Sweden)

    Duman Enes

    2017-08-01

    Full Text Available Background: Few data is available concerning the association between peripheral arterial disease (PAD and red cell distribution width (RDW. In this study, we analyzed the relationship between RDW and atherosclerosis of the vessels other than coronary arteries in patients who had undergone digital substraction angiography (DSA. Methods: This study included 730 patients who had undergone DSA. Patients were divided into two groups according to their angiographic images. The association between RDW and atherosclerosis of peripheral arteries was analyzed. The relationship between atherosclerosis and smoking, hypertension (HT, diabetes mellitus (DM, hs-CRP, hemoglobin, white blood cell (WBC, triglyceride, total cholesterol, HDL and LDL cholesterol levels was assessed. Results: Atherosclerosis was observed more common in male and patients with older age, HT, DM and smoking (p0.05. Conclusion: Our results seem to demonstrate that older age, male gender, HT, DM and smoking are powerful risk factors for PAD. In contrast to the previous reports, RDW levels are found not to be associated with atherosclerosis of peripheral arteries.

  6. Arterial cutdown reduces complications after brachial access for peripheral vascular intervention.

    Science.gov (United States)

    Kret, Marcus R; Dalman, Ronald L; Kalish, Jeffrey; Mell, Matthew

    2016-07-01

    Factors influencing risk for brachial access site complications after peripheral vascular intervention are poorly understood. We queried the Society for Vascular Surgery Vascular Quality Initiative to identify unique demographic and technical risks for such complications. The Vascular Quality Initiative peripheral vascular intervention data files from years 2010 to 2014 were analyzed to compare puncture site complication rates and associations encountered with either brachial or femoral arterial access for peripheral vascular intervention. Procedures requiring multiple access sites were excluded. Complications were defined as wound hematoma or access vessel stenosis/occlusion. Univariate and hierarchical logistic regression was used to identify independent factors associated with site complications after brachial access. Of 44,634 eligible peripheral vascular intervention procedures, 732 (1.6%) were performed through brachial access. Brachial access was associated with an increased complication rate compared with femoral access (9.0% vs 3.3%; P access site stenosis/occlusion (2.1% vs 0.4%; P access complications included age, female gender, and sheath size. Complications occurred less frequently after arterial cutdown (4.1%) compared with either ultrasound-guided (11.8%) or fluoroscopically guided percutaneous access (7.3%; P = .07 across all variables). Neither surgeons' overall peripheral vascular intervention experience nor prior experience with brachial access predicted likelihood of adverse events. By multivariate analysis, male gender (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.28-0.84; P access complications. Larger sheath sizes (>5F) were associated with increased risk of complications (OR, 2.19; 95% CI, 1.07-4.49; P = .03). Brachial access for peripheral vascular intervention carries significantly increased risks for access site occlusion or hematoma formation. Arterial cutdown and smaller sheath diameters are associated with lower

  7. Endovascular treatment of peripheral and visceral arterial injuries in patients with acute trauma.

    Science.gov (United States)

    Erbahçeci Salık, Aysun; Saçan İslim, Filiz; Çil, Barbaros Erhan

    2016-11-01

    The present study is an evaluation of the efficacy of endovascular treatment in emergency setting for patients with acute peripheral and visceral arterial injury secondary to penetrating or blunt trauma. Twelve patients (11 men) aged 35.8±11.3 years (range: 18-56 years) with penetrating or blunt trauma who underwent endovascular treatment in our department between March 2010 and June 2014 for peripheral and visceral arterial injury were retrospectively reviewed. Selective coil embolization was performed on 11 patients and particle embolization of the injured vessel was performed on 1 patient. Criteria for endovascular treatment included active extravasation or pseudoaneurysm on contrast-enhanced computed tomography and decrease in hemoglobin level or temporary hemodynamic instability. Arterial injuries were secondary to penetrating injury due to gunshot wound in 4 patients and stab wound in 5, and blunt abdominal injury as result of traffic accident in 3 patients. Traumatic lesions were in the right hepatic artery (n=3), left hepatic (n=2), right hepatic and right renal (n=1), left inferior epigastric (n=2), left facial (n=1), anterior tibial (n=1), and deep femoral (n=1) arteries. Technical success with no procedural complications was seen in all cases. Two patients died due to coexisting injuries on 29th and 43rd days of hospitalization. Median hospitalization period was 6.0 days (range: 1-43 days) and mean intensive care unit hospitalization was 7.7 days (range: 0-43 days). In our experience, endovascular treatment was a safe and effective option for acute traumatic peripheral and visceral arterial lesions.

  8. Asymptomatic carotid artery stenosis in patients with severe peripheral vascular diseases

    Directory of Open Access Journals (Sweden)

    Rasoul Mirsharifi

    2009-04-01

    Full Text Available

    • BACKGROUND: The prevalence of carotid artery stenosis (CAS in the  eneral population is not high enough to justify screening programs. This study was done to determine the prevalence of asymptomatic carotid artery stenosis (ACAS among patients with severe peripheral vascular disease (PVD.
    • METHODS: Between March 2005 and February 2006, 54 consecutive  atients with severe PVD admitted at a vascular surgery unit and underwent carotid duplex scanning in a prospective study. A  uestionnaire was used to collect data concerning known risk factors. Significant CAS was defined as a stenosis of 70% or greater.
    • RESULTS: The mean age was 62.5 years (51-72. Out of 54 patients, 2 (3.7% had an occluded internal carotid artery. Significant CAS was found in 9 (16.7% and its presence was correlated with diabetes, hypertension, hypercholesterolemia, hypertriglyceridemia, coronary artery disease, severity of symptoms, ankle-brachial index, and carotid bruit. On multivariate analysis, only hypercholesterolemia and carotid bruit seemed to have independent influence.
    • CONCLUSION: The prevalence of significant ACAS is higher among  atients with severe PVD. This patient population may indicate a  uitable subgroup for screening of ACAS, especially when hypercholesterolemia and carotid bruit are present.
    • KEYWORDS: Carotid artery stenosis, duplex ultrasound scanning, peripheral vascular disease, carotid endarterectomy,
    • cerebrovascular accident.

  9. Dysfunctional vasa vasorum in diabetic peripheral artery obstructive disease with critical lower limb ischaemia.

    Science.gov (United States)

    Orrico, C; Pasquinelli, G; Foroni, L; Muscarà, D; Tazzari, P L; Ricci, F; Buzzi, M; Baldi, E; Muccini, N; Gargiulo, M; Stella, A

    2010-09-01

    To establish whether in diabetic patients with peripheral artery obstructive disease (PAOD) vasa vasorum (vv) neoangiogenesis is altered with increased arterial damage. Thirty-three patients with PAOD and critical lower limb ischaemia, 22 with type II diabetes. Immunohistochemistry for endothelial cell markers (CD34 and von Willebrand Factor); real-time reverse transcription polymerase chain reaction (RT-PCR) to quantify arterial wall expression of vascular endothelial growth factor (VEGF); enzyme-linked immunosorbent assay (ELISA) to assess blood VEGF; flow cytometry to detect circulating endothelial cells (CECs). Patients with PAOD and diabetes have a higher frequency (60% vs. 45%) of advanced atherosclerotic lesions and a significant reduction (p = 0.0003) in CD34(+) capillaries in the arterial media. Adventitial neoangiogenesis was increased equally (CD34(+) and vWF(+)) in all patients. Likewise, all patients have increased CEC and VEGF concentration in the blood as well as in-situ VEGF transcript expression. Patients with PAOD have remarkable arterial damage despite increased in-situ and circulating expression of the pro-angiogenic VEGF; a dysfunctional vv angiogenesis was seen in diabetics which also showed a higher frequency of parietal damage; it is suggested that in diabetic arterial wall, injury is worsened by vv inability to finalise an effective VEGF-driven arterial wall neoangiogenesis. Copyright 2010 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  10. Management of dyslipidemia with statins in the patient with peripheral arterial disease.

    Science.gov (United States)

    Blum, Andrew S

    2006-06-01

    The relationship between peripheral arterial disease (PAD), cardiovascular disease (CAD), and underlying atherosclerotic risk factors such as dyslipidemia, smoking, diabetes, and hypertension is well established. Patients with PAD have dramatically increased risks of cardiovascular mortality due to underlying atherosclerosis. As interventionalists, we focus primarily on improving the functional status of our patients by "fixing" their peripheral arterial occlusions, often ignoring the more serious concerns, as well as the root cause of the problem. In addition to interventional strategies, comprehensive clinical management of PAD should include attention to risk factor modification, lifestyle changes, exercise therapy, and pharmacologic interventions. Conventional training in interventional radiology imparts very little familiarity with these management issues. The following article addresses one critical modifiable risk factor, dyslipidemia, and treatment with the powerful class of drugs, the statins, reviewing the rationale for as well as the practical considerations in the use of these agents.

  11. Aspirin Resistance Predicts Adverse Cardiovascular Events in Patients with Symptomatic Peripheral Artery Disease.

    Science.gov (United States)

    Pasala, Tilak; Hoo, Jennifer Soo; Lockhart, Mary Kate; Waheed, Rehan; Sengodan, Prasanna; Alexander, Jeffrey; Gandhi, Sanjay

    2016-12-01

    Antiplatelet therapy reduces the risk of myocardial infarction, stroke, and vascular death in patients who have symptomatic peripheral artery disease. However, a subset of patients who take aspirin continues to have recurrent cardiovascular events. There are few data on cardiovascular outcomes in patients with peripheral artery disease who manifest aspirin resistance. Patients with peripheral artery disease on long-term aspirin therapy (≥4 wk) were tested for aspirin responsiveness by means of the VerifyNow Aspirin Assay. The mean follow-up duration was 22.6 ± 8.3 months. The primary endpoint was a composite of death, myocardial infarction, or ischemic stroke. Secondary endpoints were the incidence of vascular interventions (surgical or percutaneous), or of amputation or gangrene caused by vascular disease. Of the 120 patients enrolled in the study, 31 (25.8%) were aspirin-resistant and 89 (74.2%) were aspirin-responsive. The primary endpoint occurred in 10 (32.3%) patients in the aspirin-resistant group and in 13 (14.6%) patients in the aspirin-responsive group (hazard ratio=2.48; 95% confidence interval, 1.08-5.66; P=0.03). There was no significant difference in the secondary outcome of revascularization or tissue loss. By multivariate analysis, aspirin resistance and history of chronic kidney disease were the only independent predictors of long-term adverse cardiovascular events. Aspirin resistance is highly prevalent in patients with symptomatic peripheral artery disease and is an independent predictor of adverse cardiovascular risk. Whether intervening in these patients with additional antiplatelet therapies would improve outcomes needs to be explored.

  12. Effects of Programmed Kinesiologic Stimulus to Hemodynamics at Peripheral Artery Disease of Lower Limbs

    OpenAIRE

    Baltic, Abel; Radjo, Izet; Mahmutovic, Ifet; Mahmutovic, Indira

    2014-01-01

    Goal: The goal of the article is to examine level of hemodynamic improvement in the peripheral artery diseases of lower limbs among patients on medication therapy and patients included in programmed physical activities simultaneously with the medication therapy. Material and methods: Prospective-retrospective study includes 100 patients of the Clinic for Vascular Disease, Clinical Center of Sarjevo University (CCUS). It has been found out that the majority of patients in both groups were male...

  13. Angiogenic response to passive movement and active exercise in individuals with peripheral arterial disease

    DEFF Research Database (Denmark)

    Høier, Birgitte; Walker, Meegan; Passos, Madla

    2013-01-01

    Peripheral arterial disease (PAD) is caused by atherosclerosis and is associated with microcirculatory impairments in skeletal muscle. The present study evaluated the angiogenic response to exercise and passive movement in skeletal muscle of PAD patients compared to healthy control subjects. Twen...... increased in response to either passive movement or active exercise in both subject groups. The basal muscle dialysate level of the angiostatic factor trombospondin-1 protein (TSP-1) was markedly higher (P...

  14. Peripheral arterial disease decreases muscle torque and functional walking capacity in elderly.

    Science.gov (United States)

    Dziubek, Wioletta; Bulińska, Katarzyna; Stefańska, Małgorzata; Woźniewski, Marek; Kropielnicka, Katarzyna; Jasiński, Tomasz; Jasiński, Ryszard; Pilch, Urszula; Dąbrowska, Grażyna; Skórkowska-Telichowska, Katarzyna; Wojcieszczyk-Latos, Joanna; Kałka, Dariusz; Janus, Agnieszka; Zywar, Katarzyna; Paszkowski, Rafał; Szuba, Andrzej

    2015-08-01

    The aim of this study is to compare values of force-velocity and functional walking capacity in elderly patients with intermittent claudication with respect to the control group. The study involved 135 individuals: 85-peripheral arterial disease (PAD) group diagnosed with stage II chronic lower limb ischemia, according to Fontaine's classification, and 50-control group. The studies included an assessment of walking capacity using a six-minute walk test (6MWT) and measurement of force-velocity parameters (peak torque-PTQ, total work-TW, average power-AVGP) of the lower limbs obtained by means of a functional dynamometry under isokinetic conditions. The peripheral arterial disease group is characterized by significantly lower values of force-velocity parameters compared to the control group (pmuscle strength in the isokinetic test. Mean values of all force-velocity parameters and walk distance were significantly higher in the control group than in the peripheral arterial disease group. In the PAD group, in both men and women, the value of the agonist/antagonist ratio of both lower limbs are lower in men and women comparing to the control group. A rehabilitation program for patients with intermittent claudication must consider exercises improving strength, exercise capacity, and endurance in patients with PAD. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  15. PSYCHOLOGICAL ADAPTATION IN PATIENTS WITH PERIPHERAL ARTERIAL DISEASE, UNDERGOING SURGICAL TREATMENT

    Directory of Open Access Journals (Sweden)

    Arina Aleksandrovna Dmitrieva

    2015-12-01

    Full Text Available In this article the theoretical analysis of Russian and foreign literature on the problem of psychological adaptation of patients with peripheral arterial disease, undergoing vascular and endovascular surgery is carried out. Most studies are dedicated to assessing quality of life of patients before and after reconstructive intervention. Improvement of quality of life, mainly in physical parameters is often found. Though, parameters of quality of life in the long-term period after surgery tend to decrease steadily. Psychological aspects of surgical treatment of patients with peripheral arterial disease are poorly investigated. The article stresses, that such aspects as the patients’ emotional response to illness and treatment, influence of personal cha-racteristics on the medical and social prognosis, personal attitudes of patients with peripheral arterial disease, in particular, the attitude to illness and treatment, psychological factors of treatment adherence are not well investigated. In the article problems of further research for the purpose of improvement of the medical and psychological prognosis are outlined.

  16. Prevalence of peripheral arterial disease in type 2 diabetes mellitus and its correlation with coronary artery disease and its risk factors.

    Science.gov (United States)

    Agarwal, A K; Singh, Manjeet; Arya, Vivek; Garg, Umesh; Singh, Vivek Pal; Jain, Vineet

    2012-07-01

    Peripheral arterial disease (PAD) is one of the macrovascular complications of type 2 diabetes mellitus. Unlike other complications, it has received little attention in the Indian medical literature. There is significant difference in the reported prevalence of PAD and its associated risk factors between Indian and Western studies. In order to assess PAD in diabetics, its associated risk factors and its relationship with coronary artery disease, we conducted a hospital-based, cross-sectional study. Consecutive patients on regular follow up in our diabetes clinic were included. In addition to a detailed history and physical examination, anthropometric parameters like body mass index, waist circumference and waist hip ratio were measured. Relevant laboratory investigations were performed. Modified Rose questionnaire and Minnesota codes were used to diagnose coronary artery disease (CAD). Colour Doppler examination of the arteries of the lower limbs was performed. Arteries were evaluated both longitudinally and transversely. Individual ABI was obtained for each leg by dividing corresponding ankle pressure by the brachial pressure. The lower of the values obtained for the two legs was taken as the true ABI. A cut off of define peripheral arterial disease. Predictors of PAD were assessed using univariate tests of significance. Binary logistic regression was used to identify independent predictors of CAD. We studied 146 patients (79 men and 67 women; mean age 59.4 +/- 7.2 years; mean duration of diabetes 8.8 +/- 3.8 years). The prevalence of PAD was 14.4% with women having a slightly higher prevalence (14.9%), as compared to men (13.9%) (p=0.864). CAD was present in 28%. Age, duration of diabetes, smoking, systolic and diastolic blood pressures and an HbA1c >7% were significant predictors of PAD. We did not find a correlation between measures of obesity and PAD. Using binary logistic regression, older age (p=0.01), higher HbA1c levels (p=0.02), microalbuminuria (p=0

  17. Peripheral arterial vasodilation hypothesis: a proposal for the initiation of renal sodium and water retention in cirrhosis

    DEFF Research Database (Denmark)

    Schrier, R W; Arroyo, V; Bernardi, M

    1988-01-01

    . While the occurrence of primary renal sodium and water retention and plasma volume expansion prior to ascites formation favors the "overflow" hypothesis, the stimulation of the renin-angiotensin-aldosterone system, vasopressin release and sympathetic nervous system associated with cirrhosis...... is not consonant with primary volume expansion. In this present article, the "Peripheral Arterial Vasodilation Hypothesis" is proposed as the initiator of sodium and water retention in cirrhosis. Peripheral arterial vasodilation is one of the earliest observations in the cirrhotic patient and experimental animals...... and drug-induced peripheral arterial vasodilation. However, a predilection for the retained sodium and water to transudate into the abdominal cavity occurs with cirrhosis because of the presence of portal hypertension. The Peripheral Arterial Vasodilation Hypothesis also explains the continuum from...

  18. Application of artificial palpation in vascular surgeries for detection of peripheral arterial stenosis.

    Science.gov (United States)

    Abouei Mehrizi, A; Moini, M; Afshari, E; Kadkhodapour, J; Sadjadian, A; Najarian, S

    2014-05-01

    Palpation is one of the applied methods that surgeons usually use during surgery in order to verify the health condition of a tissue/organ. In fact, most of surgical assessments are based on analysis of the force feedback received from tissue/organ via palpation. Although palpation has a key role in efficient progress of surgery operations, it depends very much on the experience and skill of the surgeons. This limits the application of this technique in some cases to a large extent. In this regard, an artificial tactile sensing approach is an innovative technology that tries to make tactile data more available for surgeons, especially in situations where doing the palpation is not possible or is too difficult. In this paper, having considered the present problems of artery bypass surgery in peripheral arterial occlusive disease (PAOD), applicability of a new tactile sensory system capable of detecting arterial stenosis during surgery was evaluated. Presenting the modelling and numerical solution of the problem, it was demonstrated that the artificial tactile sensing approach is not only capable of detecting the presence of an arterial stenosis in an artery, but also its type. Furthermore, it was shown that the new tactile sensory system (previously designed, fabricated and tested in laboratory) is efficiently capable of detecting the simulated artery in the simulated biological tissue as well as diagnosis of the stenosis occurred inside it.

  19. Galectin-3 in Peripheral Artery Disease. Relationships with Markers of Oxidative Stress and Inflammation

    Directory of Open Access Journals (Sweden)

    Isabel Fort-Gallifa

    2017-05-01

    Full Text Available Galectin-3 is a modulator of oxidative stress, inflammation, and fibrogenesis involved in the pathogenesis of vascular diseases. The present study sought to characterize, in patients with peripheral artery disease (PAD, the localization of galectin-3 in arterial tissue, and to analyze the relationships between the circulating levels of galectin-3 and oxidative stress and inflammation. It also sought to compare the diagnostic accuracy of galectin-3 with that of other biochemical markers of this disease. We analyzed femoral or popliteal arteries from 50 PAD patients, and four control arteries. Plasma from 86 patients was compared with that from 72 control subjects. We observed differences in the expression of galectin-3 in normal arteries, and arteries from patients with PAD, with a displacement of the expression from the adventitia to the media, and the intima. In addition, plasma galectin-3 concentration was increased in PAD patients, and correlated with serologic markers of oxidative stress (F2-isoprostanes, and inflammation [chemokine (C−C motif ligand 2, C-reactive protein, β-2-microglobulin]. We conclude that the determination of galectin-3 has good diagnostic accuracy in the assessment of PAD and compares well with other analytical parameters currently in use.

  20. Galectin-3 in Peripheral Artery Disease. Relationships with Markers of Oxidative Stress and Inflammation.

    Science.gov (United States)

    Fort-Gallifa, Isabel; Hernández-Aguilera, Anna; García-Heredia, Anabel; Cabré, Noemí; Luciano-Mateo, Fedra; Simó, Josep M; Martín-Paredero, Vicente; Camps, Jordi; Joven, Jorge

    2017-05-04

    Galectin-3 is a modulator of oxidative stress, inflammation, and fibrogenesis involved in the pathogenesis of vascular diseases. The present study sought to characterize, in patients with peripheral artery disease (PAD), the localization of galectin-3 in arterial tissue, and to analyze the relationships between the circulating levels of galectin-3 and oxidative stress and inflammation. It also sought to compare the diagnostic accuracy of galectin-3 with that of other biochemical markers of this disease. We analyzed femoral or popliteal arteries from 50 PAD patients, and four control arteries. Plasma from 86 patients was compared with that from 72 control subjects. We observed differences in the expression of galectin-3 in normal arteries, and arteries from patients with PAD, with a displacement of the expression from the adventitia to the media, and the intima. In addition, plasma galectin-3 concentration was increased in PAD patients, and correlated with serologic markers of oxidative stress (F2-isoprostanes), and inflammation [chemokine (C-C motif) ligand 2, C-reactive protein, β-2-microglobulin]. We conclude that the determination of galectin-3 has good diagnostic accuracy in the assessment of PAD and compares well with other analytical parameters currently in use.

  1. Risk factors of accelerated progression of peripheral artery disease in hemodialysis

    Directory of Open Access Journals (Sweden)

    Shang-Reu Hsu

    2013-02-01

    Full Text Available Ankle-brachial index (ABI and brachial-ankle pulse wave velocity (baPWV are markers for peripheral artery occlusive disease (PAOD and arterial stiffness, respectively. The aims of this study were to assess whether PAOD and arterial stiffness progressed and to determine the risk factors for ABI and baPWV progression in patients on hemodialysis. This study enrolled 173 routine patients on hemodialysis. Both ABI and baPWV were measured by an ABI-form device at baseline and at 1 year of follow-up. Progression in ABI was defined as reduction in ABI exceeding 0.3, while baPWV measured at 1 year of follow-up exceeding that at baseline indicated baPWV progression. Comparison with baseline data showed increase in both prevalence of ABI < 0.9 (p = 0.045 and baPWV (p = 0.028 at 1 year of follow-up. Multiple linear regression analyses identified high fasting glucose and old age as independent factors of annual change in ABI and baPWV, respectively. Good control of blood sugar may contribute to delay the progression of peripheral artery disease in patients on hemodialysis.

  2. Imaging of Small Animal Peripheral Artery Disease Models: Recent Advancements and Translational Potential

    Directory of Open Access Journals (Sweden)

    Jenny B. Lin

    2015-05-01

    Full Text Available Peripheral artery disease (PAD is a broad disorder encompassing multiple forms of arterial disease outside of the heart. As such, PAD development is a multifactorial process with a variety of manifestations. For example, aneurysms are pathological expansions of an artery that can lead to rupture, while ischemic atherosclerosis reduces blood flow, increasing the risk of claudication, poor wound healing, limb amputation, and stroke. Current PAD treatment is often ineffective or associated with serious risks, largely because these disorders are commonly undiagnosed or misdiagnosed. Active areas of research are focused on detecting and characterizing deleterious arterial changes at early stages using non-invasive imaging strategies, such as ultrasound, as well as emerging technologies like photoacoustic imaging. Earlier disease detection and characterization could improve interventional strategies, leading to better prognosis in PAD patients. While rodents are being used to investigate PAD pathophysiology, imaging of these animal models has been underutilized. This review focuses on structural and molecular information and disease progression revealed by recent imaging efforts of aortic, cerebral, and peripheral vascular disease models in mice, rats, and rabbits. Effective translation to humans involves better understanding of underlying PAD pathophysiology to develop novel therapeutics and apply non-invasive imaging techniques in the clinic.

  3. Imaging of Small Animal Peripheral Artery Disease Models: Recent Advancements and Translational Potential

    Science.gov (United States)

    Lin, Jenny B.; Phillips, Evan H.; Riggins, Ti’Air E.; Sangha, Gurneet S.; Chakraborty, Sreyashi; Lee, Janice Y.; Lycke, Roy J.; Hernandez, Clarissa L.; Soepriatna, Arvin H.; Thorne, Bradford R. H.; Yrineo, Alexa A.; Goergen, Craig J.

    2015-01-01

    Peripheral artery disease (PAD) is a broad disorder encompassing multiple forms of arterial disease outside of the heart. As such, PAD development is a multifactorial process with a variety of manifestations. For example, aneurysms are pathological expansions of an artery that can lead to rupture, while ischemic atherosclerosis reduces blood flow, increasing the risk of claudication, poor wound healing, limb amputation, and stroke. Current PAD treatment is often ineffective or associated with serious risks, largely because these disorders are commonly undiagnosed or misdiagnosed. Active areas of research are focused on detecting and characterizing deleterious arterial changes at early stages using non-invasive imaging strategies, such as ultrasound, as well as emerging technologies like photoacoustic imaging. Earlier disease detection and characterization could improve interventional strategies, leading to better prognosis in PAD patients. While rodents are being used to investigate PAD pathophysiology, imaging of these animal models has been underutilized. This review focuses on structural and molecular information and disease progression revealed by recent imaging efforts of aortic, cerebral, and peripheral vascular disease models in mice, rats, and rabbits. Effective translation to humans involves better understanding of underlying PAD pathophysiology to develop novel therapeutics and apply non-invasive imaging techniques in the clinic. PMID:25993289

  4. Wall morphology, blood flow and wall shear stress: MR findings in patients with peripheral artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Galizia, Mauricio S.; Barker, Alex; Collins, Jeremy; Carr, James [Northwestern University, Department of Radiology, Feinberg School of Medicine, Chicago, IL (United States); Liao, Yihua [Northwestern University' s Feinberg School of Medicine, Department of Preventive Medicine, Chicago, IL (United States); McDermott, Mary M. [Northwestern University' s Feinberg School of Medicine, Department of Preventive Medicine, Chicago, IL (United States); Northwestern University' s Feinberg School of Medicine, Department of Medicine, Chicago, IL (United States); Markl, Michael [Northwestern University, Department of Radiology, Feinberg School of Medicine, Chicago, IL (United States); Northwestern University, Department Biomedical Engineering, McCormick School of Engineering, Chicago, IL (United States)

    2014-04-15

    To investigate the influence of atherosclerotic plaques on femoral haemodynamics assessed by two-dimensional (2D) phase-contrast (PC) magnetic resonance imaging (MRI) with three-directional velocity encoding. During 1 year, patients with peripheral artery disease and an ankle brachial index <1.00 were enrolled. After institutional review board approval and written informed consent, 44 patients (age, 70 ± 12 years) underwent common femoral artery MRI. Patients with contra-indications for MRI were excluded. Sequences included 2D time-of-flight, proton-density, T1-weighted and T2-weighted MRI. Electrocardiogram (ECG)-gated 2D PC-MRI with 3D velocity encoding was acquired. A radiologist classified images in five categories. Blood flow, velocity and wall shear stress (WSS) along the vessel circumference were quantified from the PC-MRI data. The acquired images were of good quality for interpretation. There were no image quality problems related to poor ECG-gating or slice positioning. Velocities, oscillatory shear stress and total flow were similar between patients with normal arteries and wall thickening/plaque. Patients with plaques demonstrated regionally increased peak systolic WSS and enhanced WSS eccentricity. Combined multi-contrast morphological imaging of the peripheral arterial wall with PC-MRI with three-directional velocity encoding is a feasible technique. Further study is needed to determine whether flow is an appropriate marker for altered endothelial cell function, vascular remodelling and plaque progression. (orig.)

  5. Risk factors of accelerated progression of peripheral artery disease in hemodialysis.

    Science.gov (United States)

    Hsu, Shang-Reu; Su, Ho-Ming; Hsieh, Ming-Chia; Su, Shin-Li; Chen, Szu-Chia; Chen, Hung-Chun

    2013-02-01

    Ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) are markers for peripheral artery occlusive disease (PAOD) and arterial stiffness, respectively. The aims of this study were to assess whether PAOD and arterial stiffness progressed and to determine the risk factors for ABI and baPWV progression in patients on hemodialysis. This study enrolled 173 routine patients on hemodialysis. Both ABI and baPWV were measured by an ABI-form device at baseline and at 1 year of follow-up. Progression in ABI was defined as reduction in ABI exceeding 0.3, while baPWV measured at 1 year of follow-up exceeding that at baseline indicated baPWV progression. Comparison with baseline data showed increase in both prevalence of ABI hemodialysis. Copyright © 2012. Published by Elsevier B.V.

  6. Origin of pain in migraine: evidence for peripheral sensitisation

    DEFF Research Database (Denmark)

    Olesen, Jes; Burstein, Rami; Ashina, Messoud

    2009-01-01

    Migraine is the most common neurological disorder, and much has been learned about its mechanisms in recent years. However, the origin of painful impulses in the trigeminal nerve is still uncertain. Despite the attention paid recently to the role of central sensitisation in migraine pathophysiology......, in our view, neuronal hyperexcitability depends on activation of peripheral nociceptors. Although the onset of a migraine attack might take place in deep-brain structures, some evidence indicates that the headache phase depends on nociceptive input from perivascular sensory nerve terminals. The input...

  7. Does squatting worsen lower limb ischemia in patients with peripheral arterial disease?

    Science.gov (United States)

    Raghavendra, Gargeshwari Krishnamurthy Guru

    2012-08-01

    Peripheral arterial disease (PAD) is an important cause of morbidity and mortality in the world affecting up to 20% in people over 70 years of age. The prevalence is increasing in India due to combined effects of increased life expectancy, increased tobacco smoking and increased prevalence of diabetes mellitus. The aim of the study was to examine the hypothesis whether squatting posture reduces blood flow to lower limbs resulting in worsening of symptoms of lower limb ischemia in patients with PAD. 10 patients with arterial disorders due to thromboangiitis obliterans (TAO), atherosclerosis and diabetic macro vascular disease were selected for patients and were compared with 10 healthy volunteers as controls. Clinical examination and duplex scan of posterior tibial artery (PTA) and dorsalis pedis artery (DPA) performed in standing and squatting position in a clinical environment. They were asked about symptoms of numbness, ischemic pain and the results were noted. Results were tabulated and analysed using Microsoft Excel®. Members in the control group complained of numbness of both the limbs after a period of 30 min on an average. In the patients group, members while squatting complained of numbness in the involved limb within 5 min. They complained of ischemic pain in the involved limb within 10 min and developed numbness in the opposite limb in within 15 min. Posterior tibial artery and dorsalis pedis artery pulsations disappeared for the entire duration of squatting in both groups as confirmed by duplex scanning. It may be recommended that patients with established peripheral vascular disease should avoid squatting position, even if it is for a very short period of time. It is desirable to advice such patients to use appropriate structures as supports which will allow them to work without squatting. This may also necessitate a change in occupation.

  8. Computational simulation of postoperative pulmonary flow distribution in Alagille patients with peripheral pulmonary artery stenosis.

    Science.gov (United States)

    Yang, Weiguang; Hanley, Frank L; Chan, Frandics P; Marsden, Alison L; Vignon-Clementel, Irene E; Feinstein, Jeffrey A

    2017-12-01

    Up to 90% of individuals with Alagille syndrome have congenital heart diseases. Peripheral pulmonary artery stenosis (PPS), resulting in right ventricular hypertension and pulmonary flow disparity, is one of the most common abnormalities, yet the hemodynamic effects are ill-defined, and optimal patient management and treatment strategies are not well established. The purpose of this pilot study is to use recently refined computational simulation in the setting of multiple surgical strategies, to examine the influence of pulmonary artery reconstruction on hemodynamics in this population. Based on computed tomography angiography and cardiac catheterization data, preoperative pulmonary artery models were constructed for 4 patients with Alagille syndrome with PPS (all male, age range: 0.6-2.9 years), and flow simulations with deformable walls were performed. Surgeon directed virtual surgery, mimicking the surgical procedure, was then performed to derive postoperative models. Postoperative simulation-derived hemodynamics and blood flow distribution were then compared with the clinical results. Simulations confirmed substantial resistance, resulting from preoperative severe ostial stenoses, and the use of newly developed adaptive outflow boundary conditions led to excellent agreement with in vivo measurements. Relief of PPS decreased pulmonary artery pressures and improved pulmonary flow distribution both in vivo and in silico with good correlation. Using adaptive outflow boundary conditions, computational simulations can estimate postoperative overall pulmonary flow distribution in patients with Alagille syndrome after pulmonary artery reconstruction. Obstruction relief along with pulmonary artery vasodilation determines postoperative pulmonary flow distribution and newer methods can incorporate these physiologic changes. Evolving blood flow simulations may be useful in surgical or transcatheter planning and in understanding the complex interplay among various

  9. The Peripheral Arterial disease study (PERART/ARTPER: prevalence and risk factors in the general population

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    Vicheto Marisa

    2010-01-01

    Full Text Available Abstract Background The early diagnosis of atherosclerotic disease is essential for developing preventive strategies in populations at high risk and acting when the disease is still asymptomatic. A low ankle-arm index is a good marker of vascular events and may be diminished without presenting symptomatology (silent peripheral arterial disease. The aim of the study is to know the prevalence and associated risk factors of peripheral arterial disease in the general population. Methods We performed a cross-sectional, multicentre, population-based study in 3786 individuals >49 years, randomly selected in 28 primary care centres in Barcelona (Spain. Peripheral arterial disease was evaluated using the ankle-arm index. Values Results The prevalence (95% confidence interval of peripheral arterial disease was 7.6% (6.7-8.4, (males 10.2% (9.2-11.2, females 5.3% (4.6-6.0; p Multivariate analysis showed the following risk factors: male sex [odds ratio (OR 1.62; 95% confidence interval 1.01-2.59]; age OR 2.00 per 10 years (1.64-2.44; inability to perform physical activity [OR 1.77 (1.17-2.68 for mild limitation to OR 7.08 (2.61-19.16 for breathless performing any activity]; smoking [OR 2.19 (1.34-3.58 for former smokers and OR 3.83 (2.23-6.58 for current smokers]; hypertension OR 1.85 (1.29-2.65; diabetes OR 2.01 (1.42-2.83; previous cardiovascular disease OR 2.19 (1.52-3.15; hypercholesterolemia OR 1.55 (1.11-2.18; hypertriglyceridemia OR 1.55 (1.10-2.19. Body mass index ≥25 Kg/m2 OR 0.57 (0.38-0.87 and walking >7 hours/week OR 0.67 (0.49-0.94 were found as protector factors. Conclusions The prevalence of peripheral arterial disease is low, higher in males and increases with age in both sexes. In addition to previously described risk factors we found a protector effect in physical exercise and overweight.

  10. Signature of subclinical femoral artery atherosclerosis in peripheral blood mononuclear cells.

    Science.gov (United States)

    Llorente-Cortés, Vicenta; de Gonzalo-Calvo, David; Orbe, Josune; Páramo, Jose Antonio; Badimon, Lina

    2014-06-01

    Peripheral arterial disease is a relevant public health problem associated with increased risk of morbimortality. Most of the patients with this condition are asymptomatic. Therefore, the development of accessible biochemical markers seems to be necessary to anticipate diagnosis. Our hypothesis is that asymptomatic subjects with objectively confirmed femoral artery atherosclerosis could be distinguished from control subjects by gene expression analysis in peripheral blood mononuclear cells (PBMC). A total of 37 asymptomatic males over 50 years old were recruited at the University Clinic of Navarra (Spain). Nineteen participants were free from atherosclerotic vascular disease and 18 participants presented subclinical femoral artery atherosclerosis defined by means of Doppler ultrasound. PBMC were isolated from blood and the RNA extracted. A panel of atherosclerotic-related genes were evaluated by Taqman low-density array. In univariate logistic regression models, we found a direct relationship between IL4, ITGAM and TLR2 expression levels in PBMC and femoral atherosclerosis, even when the models were adjusted for age and hypertension prevalence. Multivariate logistic regression models showed that elevated IL4 expression levels were intimately associated with subclinical femoral atherosclerosis after adjusting for the same potential confounders. Current data suggest that gene expression in PBMC, in particular IL4 expression, could be a useful tool in the diagnosis of femoral artery atherosclerosis in asymptomatic patients. Furthermore, in patients with no differences in cardiovascular risk factors except for hypertension, the results point to the immune and inflammatory deregulation as a feature of subclinical peripheral atherosclerosis. © 2014 Stichting European Society for Clinical Investigation Journal Foundation.

  11. Reliability of peripheral arterial tonometry in patients with heart failure, diabetic nephropathy and arterial hypertension.

    Science.gov (United States)

    Weisrock, Fabian; Fritschka, Max; Beckmann, Sebastian; Litmeier, Simon; Wagner, Josephine; Tahirovic, Elvis; Radenovic, Sara; Zelenak, Christine; Hashemi, Djawid; Busjahn, Andreas; Krahn, Thomas; Pieske, Burkert; Dinh, Wilfried; Düngen, Hans-Dirk

    2017-08-01

    Endothelial dysfunction plays a major role in cardiovascular diseases and pulse amplitude tonometry (PAT) offers a non-invasive way to assess endothelial dysfunction. However, data about the reliability of PAT in cardiovascular patient populations are scarce. Thus, we evaluated the test-retest reliability of PAT using the natural logarithmic transformed reactive hyperaemia index (LnRHI). Our cohort consisted of 91 patients (mean age: 65±9.7 years, 32% female), who were divided into four groups: those with heart failure with preserved ejection fraction (HFpEF) ( n=25), heart failure with reduced ejection fraction (HFrEF) ( n=22), diabetic nephropathy ( n=21), and arterial hypertension ( n=23). All subjects underwent two separate PAT measurements at a median interval of 7 days (range 4-14 days). LnRHI derived by PAT showed good reliability in subjects with diabetic nephropathy (intra-class correlation (ICC) = 0.863) and satisfactory reliability in patients with both HFpEF (ICC = 0.557) and HFrEF (ICC = 0.576). However, in subjects with arterial hypertension, reliability was poor (ICC = 0.125). We demonstrated that PAT is a reliable technique to assess endothelial dysfunction in adults with diabetic nephropathy, HFpEF or HFrEF. However, in subjects with arterial hypertension, we did not find sufficient reliability, which can possibly be attributed to variations in heart rate and the respective time of the assessments. Clinical Trial Registration Identifier: NCT02299960.

  12. Abdominal obesity is associated with peripheral artery disease in hemodialysis patients.

    Directory of Open Access Journals (Sweden)

    Peir-Haur Hung

    Full Text Available BACKGROUND: Peripheral arterial disease (PAD is a leading cause of morbidity in hemodialysis (HD patients. Recent evidence suggests that abdominal obesity (AO may play a role in PAD. However, the association between AO and PAD has not been thoroughly studied in HD patients. METHODS: The present cross-sectional study aimed to examine the relationship between AO and PAD in a cohort of 204 chronic HD patients. The ankle brachial index (ABI was used as an estimate of the presence of PAD. Plasma adiponectin levels, interleukin-6 (IL-6 levels, high sensitivity C-reactive protein (hs-CRP levels, asymmetric dimethylarginine (ADMA levels, and lipid profiles were measured. Logistic regression was used to estimate the association between the presence of PAD and AO as well as other potential risk factors. RESULTS: The metabolic risk factors and all individual traits, including elevated ln-transformed hs-CRP, were found to be significant (P<0.05 more frequently in HD patients with AO than that in control subjects. Patients with AO had a higher prevalence of PAD than the control individuals, with a mean ABI of 0.96 ± 0.23 and 1.08 ± 0.16 (P<0.0001 and PAD prevalence of 26.9% and 10.8% (P = 0.003, respectively. By multivariate analysis, AO (odds ratio [OR], 4.532; 95% CI, 1.765-11.639; P = 0.002, elevated serum ln-transformed ADMA (OR, 5.535; 95% CI, 1.323-23.155; P = 0.019, and ln-transformed IL-6 (OR, 1.567; 95% CI, 1.033-2.378; P = 0.035 were independent predictors of the presence of PAD. CONCLUSIONS: HD patients with AO exhibited a cluster of metabolic risk factors and lower ABI. AO, elevated serum ln-transformed ADMA, and ln-transformed IL-6 were independent predictors of the presence of PAD.

  13. Dynamic F wave study in patients suffering from peripheral arterial occlusive disease.

    Science.gov (United States)

    Argyriou, A A; Tsolakis, I; Papadoulas, S; Polychronopoulos, P; Gourzis, P; Chroni, E

    2007-02-01

    To prospectively detect significant transient F wave abnormalities obtained after exercise in patients with peripheral arterial disease (PAD) and to assess the potential diagnostic sensitivity of dynamic F wave study in such a context. A series of 40 electrical stimuli were delivered to the peroneal and the posterior tibial nerves of 25 patients with PAD in order to obtain F waves at rest and post-exercise. The following variables were estimated and the obtained pre- and post-exercise data were compared: F persistence, F wave latency, amplitude, duration and F chronodispersion. For each nerve studied, the minimum, average and maximum values were calculated. Conventional electrophysiological data were also collected pre- and post-exercise and the data obtained were also compared. Twenty-five healthy age-, gender- and height-matched individuals served as controls. No evidence of conventional nerve conduction abnormalities was recorded either pre- or post-exercise in the group of patients. As regards the peroneal nerve, the significantly reduced F wave persistence (P = 0.007) and maximum F wave amplitude post- as opposed to pre-exercise (P = 0.05)- were the main findings to emerge. The average (P = 0.017) and the minimum duration (P = 0.005) of tibial F waves were also significantly increased post- compared with pre-exercise. Insignificant differences were observed between pre- and post-exercise neurophysiological and F wave values in the group of controls. Given the observed absence of conventional neurophysiological abnormalities, the detection of dynamic F wave changes supports the view of an increased diagnostic sensitivity of this method in patients with mild PAD.

  14. Determinants of Peripheral Arterial Stiffness in Patients With Chronic Kidney Disease in Southern Taiwan

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    Jui-Hsin Chen

    2009-07-01

    Full Text Available High prevalences of peripheral artery occlusive disease (PAOD and increased arterial stiffness have been reported in patients with chronic kidney disease (CKD. However, these have not been assessed in Taiwan where the prevalence of CKD is high. The aim of this study was to investigate the determinants of PAOD and arterial stiffness in patients with CKD in southern Taiwan. We enrolled 169 patients with stage 3–5 CKD in one regional hospital. Ankle-brachial index (ABI and brachial-ankle pulse wave velocity were measured using an ABI-form device (Colin VP1000. In multivariate analysis, ABI < 0.9 was positively correlated with the presence of diabetes mellitus (p = 0.014 and negatively correlated with the estimated glomerular filtration rate (eGFR (p = 0.049, and increased brachial-ankle pulse wave velocity was correlated with increased age, diabetes mellitus, increased systolic blood pressure, decreased pulse pressure and decreased eGFR. This study identified determinants of PAOD and arterial stiffness in patients with CKD in one hospital in southern Taiwan. In addition to the traditional atherosclerotic risk factors, decreased eGFR was also correlated with PAOD and increased arterial stiffness in these patients.

  15. Target-controlled infusion and population pharmacokinetics of landiolol hydrochloride in patients with peripheral arterial disease

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    Kunisawa T

    2015-01-01

    Full Text Available Takayuki Kunisawa,1 Akio Yamagishi,2 Manabu Suno,3 Susumu Nakade,4 Naoki Honda,4 Atsushi Kurosawa,2 Ami Sugawara,2 Yoshikazu Tasaki,5 Hiroshi Iwasaki2 1Surgical Operation Department, Asahikawa Medical University Hospital, Asahikawa, Japan; 2Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Japan; 3Department of Oncology Pharmaceutical Care and Sciences, Okayama University, Okayama, Japan; 4Pharmacokinetic Research Laboratories, Ono Pharmaceutical Co., Ltd., Osaka, Japan; 5Department of Hospital Pharmacy and Pharmacology, Asahikawa Medical University, Asahikawa, Japan Purpose: We previously determined the pharmacokinetic (PK parameters of landiolol in healthy male volunteers and gynecological patients. In this study, we determined the PK parameters of landiolol in patients with peripheral arterial disease. Methods: Eight patients scheduled to undergo peripheral arterial surgery were enrolled in the study. After inducing anesthesia, landiolol hydrochloride was administered at target plasma concentrations of 500 and 1,000 ng/mL for 30 minutes each. A total of 112 data points of plasma concentration were collected from the patients and used for the population PK analysis. A population PK model was developed using a nonlinear mixed-effect modeling software program (NONMEM.Results: The patients had markedly decreased heart rates at 2 minutes after initiation of landiolol hydrochloride administration; however, systolic blood pressures were lower than the baseline values at only five time points. The concentration time course of landiolol was best described by a two-compartment model with lag time. The estimates of PK parameters were as follows: total body clearance, 30.7 mL/min/kg; distribution volume of the central compartment, 65.0 mL/kg; intercompartmental clearance, 48.3 mL/min/kg; distribution volume of the peripheral compartment, 54.4 mL/kg; and lag time, 0.633 minutes. The predictive performance of

  16. Plasma osteoprotegerin is related to carotid and peripheral arterial disease, but not to myocardial ischemia in type 2 diabetes mellitus

    Science.gov (United States)

    2011-01-01

    Background Cardiovascular disease (CVD) is frequent in type 2 diabetes mellitus patients due to accelerated atherosclerosis. Plasma osteoprotegerin (OPG) has evolved as a biomarker for CVD. We examined the relationship between plasma OPG levels and different CVD manifestations in type 2 diabetes. Methods Type 2 diabetes patients without known CVD referred consecutively to a diabetes clinic for the first time (n = 305, aged: 58.6 ± 11.3 years, diabetes duration: 4.5 ± 5.3 years) were screened for carotid arterial disease, peripheral arterial disease, and myocardial ischemia by means of carotid artery ultrasonography, peripheral ankle and toe systolic blood pressure measurements, and myocardial perfusion scintigraphy (MPS). In addition, plasma OPG concentrations and other CVD-related markers were measured. Results The prevalence of carotid arterial disease, peripheral arterial disease, and myocardial ischemia was 42%, 15%, and 30%, respectively. Plasma OPG was significantly increased in patients with carotid and peripheral arterial disease compared to patients without (p < 0.001, respectively), however, this was not the case for patients with myocardial ischemia versus those without (p = 0.71). When adjusted for age, HbA1c and U-albumin creatinine ratio in a multivariate logistic regression analysis, plasma OPG remained strongly associated with carotid arterial disease (adjusted OR: 2.12; 95% CI: 1.22-3.67; p = 0.008), but not with peripheral arterial disease or myocardial ischemia. Conclusions Increased plasma OPG concentration is associated with carotid and peripheral arterial disease in patients with type 2 diabetes, whereas no relation is observed with respect to myocardial ischemia on MPS. The reason for this discrepancy is unknown. Trial registration number at http://www.clinicaltrial.gov: NCT00298844 PMID:21838881

  17. Connective Tissue Reflex Massage for Type 2 Diabetic Patients with Peripheral Arterial Disease: Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Adelaida María Castro-Sánchez

    2011-01-01

    Full Text Available The objective of this study was to evaluate the efficacy of connective tissue massage to improve blood circulation and intermittent claudication symptoms in type 2 diabetic patients. A randomized, placebo-controlled trial was undertaken. Ninety-eight type 2 diabetes patients with stage I or II-a peripheral arterial disease (PAD (Leriche-Fontaine classification were randomly assigned to a massage group or to a placebo group treated using disconnected magnetotherapy equipment. Peripheral arterial circulation was determined by measuring differential segmental arterial pressure, heart rate, skin temperature, oxygen saturation and skin blood flow. Measurements were taken before and at 30 min, 6 months and 1 year after the 15-week treatment. After the 15-week program, the groups differed (P<.05 in differential segmental arterial pressure in right lower limb (lower one-third of thigh, upper and lower one-third of leg and left lower limb (lower one-third of thigh and upper and lower one-third of leg. A significant difference (P<.05 was also observed in skin blood flow in digits 1 and 4 of right foot and digits 2, 4 and 5 of left foot. ANOVA results were significant (P<.05 for right and left foot oxygen saturation but not for heart rate and temperature. At 6 months and 1 year, the groups differed in differential segmental arterial pressure in upper third of left and right legs. Connective tissue massage improves blood circulation in the lower limbs of type 2 diabetic patients at stage I or II-a and may be useful to slow the progression of PAD.

  18. Flow-mediated dilation and peripheral arterial tonometry are disturbed in preeclampsia and reflect different aspects of endothelial function

    OpenAIRE

    Mannaerts, Dominique; Faes, Ellen; Goovaerts, Inge; Stoop, Tibor; Cornette, Jerome; Gyselaers, Wilfried; Spaanderman, Marc; Craenenbroeck, van, Emeline M.; Jacquemyn, Yves

    2017-01-01

    Abstract: Endothelial function and arterial stiffness are known to be altered in preeclamptic pregnancies. Previous studies have shown conflicting results regarding the best technique for assessing vascular function in pregnancy. In this study, we made a comprehensive evaluation of in vivo vascular function [including flow-mediated dilatation (FMD), peripheral arterial tonometry (PAT), and arterial stiffness] in preeclamptic patients and compared them with normal pregnancies. In addition, we ...

  19. The accuracy of the physical examination for the detection of lower extremity peripheral arterial disease

    Science.gov (United States)

    Armstrong, David WJ; Tobin, Colleen; Matangi, Murray F

    2010-01-01

    BACKGROUND: Peripheral arterial disease (PAD) is a major risk factor for adverse cardiovascular events. There has been a definite push for wider use of the ankle-brachial index (ABI) as a simple screening tool for PAD. Perhaps this has occurred to the detriment of a thorough physical examination. OBJECTIVE: To assess the accuracy of the physical examination to detect clinically significant PAD compared with the ABI. METHODS: PADfile, the PAD module of CARDIOfile (the Kingston Heart Clinic’s cardiology database [Kingston, Ontario]), was searched for all patients who underwent peripheral arterial testing. Of 1619 patients, 1236 had all of the necessary data entered. Patients’ lower limbs were divided into two groups: those with a normal ABI between 0.91 and 1.30, and those with an abnormal ABI of 0.90 or lower. Peripheral pulses were graded as either absent or present. Absent was graded as 0/3, present but reduced (1/3), normal (2/3) or bounding (3/3). Femoral bruits were graded as either present (1) or absent (0). Using the ABI as the gold standard, the sensitivity, specificity, negative predictive value (NPV), positive predictive value and overall accuracy were calculated for the dorsalis pedis pulse, the posterior tibial pulse, both pedal pulses, the presence or absence of a femoral bruit and, finally, for a combination of both pedal pulses and the presence or absence of a femoral bruit. RESULTS: In 1236 patients who underwent PAD testing and who underwent a complete peripheral vascular physical examination (all dorsalis pedis and posterior tibial pulses palpated and auscultation for a femoral bruit), the sensitivity, specificity, NPV, positive predictive value and accuracy for PAD were 58.2%, 98.3%, 94.9%, 81.1% and 93.8%, respectively. CONCLUSIONS: The clinical examination of the peripheral arterial foot pulses and the auscultation for a femoral bruit had a high degree of accuracy (93.8%) for the detection or exclusion of PAD compared with the ABI using the

  20. Severity of peripheral arterial disease is associated with aortic pressure augmentation and subendocardial viability ratio.

    Science.gov (United States)

    Mosimann, Kathrin; Jacomella, Vincenzo; Thalhammer, Christoph; Meier, Thomas O; Kohler, Malcolm; Amann-Vesti, Beatrice; Husmann, Marc

    2012-12-01

    Peripheral arterial disease (PAD) is associated with increased cardiovascular mortality that correlates with peripheral perfusion impairment as assessed by the ankle-brachial arterial pressure index (ABI). Furthermore, PAD is associated with arterial stiffness and elevated aortic augmentation index (AIx). The purpose of this study was to investigate whether ABI impairment correlates with AIx and subendocardial viability ratio (SEVR), a measure of cardiac perfusion during diastole. AIx and SEVR were assessed by radial applanation tonometry in 65 patients with stable PAD (Rutherford stage I-III) at a tertiary referral center. AIx corrected for heart rate and SEVR were tested in a multivariate linear and logistic regression model to determine the association with ABI. Mean ABI was 0.8±0.2, AIx 31%±7%, and SEVR 141%±26%. Multiple linear regression with AIx as a dependent variable revealed that AIx was significantly negatively associated with ABI (β=-11.5; 95% confidence interval [CI], -18.6 to -4.5; P=.002). Other variables that were associated with AIx were diastolic blood pressure (β=0.2; 95% CI, 0.1-0.4; Psubendocardial viability ratio. This may be a potential pathophysiologic link that impacts cardiac prognosis in patients with PAD. © 2012 Wiley Periodicals, Inc.

  1. Quality of life in elderly diabetic patients with peripheral arterial disease.

    Science.gov (United States)

    Amer, Moatassem S; Alsadany, Mohamad A; Tolba, Mohammad F; Omar, Omar H

    2013-04-01

    To study the impact of peripheral arterial disease (PAD) on quality of life and functional status in Egyptian elderly diabetic patients. This case-control study included 90 non-demented patients aged 60 years and older. Quality of life assessment was carried out using the Short Form 36 health survey (SF-36), Arterial duplex for diagnosis of peripheral arterial disease; Mini-Mental State Examination, Geriatric Depression Scale, Activity of Daily Living and Instrumental Activity of Daily Living were used. SF-36 domains (except emotional well-being) were significantly affected in diabetic patients with PAD compared with the diabetic patients without PAD. Most of functional assessment items were significantly affected in diabetic patients with PAD compared with diabetic patients without PAD. Increasing PAD severity and presence of PAD symptoms had a significant negative impact on SF-36 scores. Among diabetic complications in PAD patients, cardiovascular disease or stroke significantly affected quality of life. PAD significantly affects quality of life and functional status in elderly diabetic patients. © 2012 Japan Geriatrics Society.

  2. Endothelial dysfunction in obstructive sleep apnea measured by peripheral arterial tone response in the finger to reactive hyperemia.

    Science.gov (United States)

    Itzhaki, Sarah; Lavie, Lena; Pillar, Giora; Tal, Galit; Lavie, Peretz

    2005-05-01

    The aim of this study was to investigate endothelial functioning in sleep apnea patients using a novel plethysmographic device that monitors peripheral arterial tone response in the finger to reactive hyperemia induced by forearm ischemia. Forty-six sleep apnea patients, 74.0% men, mean age 46.8 +/- 9.3 years, and 17 control subjects without sleep apnea, 64.7% men, mean age 47.1 +/- 6.7 years. Eight-bed Technion Sleep Medicine Center in Haifa, Israel. Endothelial functioning assessed by the reactive hyperemia peripheral arterial tone index was measured twice, before sleep and after waking from sleep monitored by polysomnography in the laboratory. The reactive hyperemia peripheral arterial tone index was calculated as the average amplitude of the peripheral arterial tone signal after the cuff deflation divided by the average amplitude before the cuff inflation. Morning index of endothelial functioning was significantly lower in patients with moderate to severe sleep apnea (apnea-hypopnea index > or = 30) than in patients with mild sleep apnea (30 disease had significantly lower morning and evening indexes of endothelial functioning than patients without such a history. Multivariate analysis revealed that apnea-hypopnea index and sleep efficiency were significant predictors of the morning index. Measurements of the response of the peripheral arterial tone in the finger to reactive hyperemia can be used as a substitute for the brachial artery ultrasound technique to measure endothelial functioning in patients with sleep apnea.

  3. The role of peripheral vascular resistance in determining the infrainguinal arterial reconstruction patency.

    Science.gov (United States)

    Cheshmedzhiev, Mihail V; Knyazhev, Victor V; Radev, Radoslav S; Yordanov, Emil D

    2011-01-01

    To find if there is any correlation between the peripheral vascular resistance, its change following an intragraft prostaglandin infusion and the infrainguinal reconstruction patency. Ninety-seven patients with infrainguinal reconstructions were included in the study: in 48 patients they were compromised (32 with graft thrombosis and 16 with stenosis of the distal anastomoses); 49 patients had their bypasses patent for no less than 12 months. Intraoperative flowmetry was performed on the target artery under the distal anastomosis, after declamping, and after a five-minute intragraft prostaglandin infusion. We measured the peripheral vascular resistance (PVR) by two methods - as a ratio of the invasively measured average pressure to the average blood flow volume (mmHg/ml/min. = peripheral resistance unit [PRU]) and by using the readings by the flowmeter (ohms). The decrease of peripheral resistance was calculated in the functioning and the compromised reconstructions after administration of prostaglandin. We found that if PVR decreases 4.5 times (in ohms) the prognosis is good; we can make the same positive prognosis when the ratio of the mean invasively measured pressure to the mean blood flow volume (Pmean/Qmean) decreases more than four times. Values greater than 1.07 ohms, after peripheral vasodilatation, are indicative of high peripheral vascular resistance, at a level of specificity of 86%, and values greater than 0.57 PRU - at a level of specificity of 87%. Although PVR measurements cannot predict with absolute certainty that bypasses under the inguinal ligament shall stay patent for a long time, it is a valuable indicator showing the immediate outcome of reconstruction work carried out with the patient on the operating table. Finding Any technical errors and dealing with them saves time and money, as well as prevents the stress on the part of patients caused by the required additional revisions and multiple operations.

  4. Gait and balance assessments as early indicators of frailty in patients with known peripheral artery disease.

    Science.gov (United States)

    Thiede, Rebecca; Toosizadeh, Nima; Mills, Joseph L; Zaky, Mahmoud; Mohler, Jane; Najafi, Bijan

    2016-02-01

    Peripheral artery disease is associated with increased morbidity and mortality, and frailty syndrome may mediate the risk of these adverse health outcomes to predict intervention results. The aim of this study was to determine the association between motor performance impairments based on in-clinic gait and balance measurements with frailty at intermediate stages (pre-frailty) in peripheral artery disease patients. Seventeen participants with peripheral artery disease (≥ 55 years) were recruited and frailty assessed using Fried criteria. Gait and balance were quantified using wearable sensor technologies in the clinical setting. Between-group differences in frailty were assessed using analysis of variance, and independent associations between gait and balance parameters with frailty were determined using logistic regression models. Based on Fried index nine (53%), participants were pre-frail and eight (47%) were non-frail. Although no between-group differences in demographics or clinical parameters was observed, gait parameters were worse among pre-frail compared to non-frail participants. The highest effect sizes for between-group differences were observed in double support during habitual normal walking (effect size=1.86, pdual-task (effect size=1.26, p=0.03), and trunk sway during fast walking (effect size=1.43, p=0.02). No significant difference was observed in balance parameters (p>0.07). The regression model using gait parameters demonstrated a high sensitivity and specificity in predicting pre-frailty. A short 25-step sensor-based in-clinic overground gait test objectively identified pre-frailty independent of age. Double support was the most sensitive parameter in identifying pre-frail aging adults. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Conformally integrated stent cell resonators for wireless monitoring of peripheral artery disease

    KAUST Repository

    Viswanath, Anupam

    2013-01-01

    This paper presents the design and in vitro evaluation of magnetoelastic sensors intended for wireless monitoring of tissue accumulation in peripheral artery stents. The sensors, shaped like stent cells, are fabricated from 28-μm thick foils of magnetoelastic Ni-Fe alloy and are conformally integrated with the stent. The typical sensitivity to viscosity is 427 ppm/cP over a 1.1-8.6 cP range. The sensitivity to mass loading is typically 63,000-65000 ppm/mg with resonant frequency showing an 8.1% reduction for an applied mass that is 15% of the unloaded mass of the sensor. © 2013 IEEE.

  6. Fourier Analysis of Peripheral Blood Pressure and Flow in Intraoperative Assessment of Infrainguinal Arterial Reconstructions

    Directory of Open Access Journals (Sweden)

    Cheshmedzhiev Mihail V.

    2014-08-01

    Full Text Available AIM: To assess infrainguinal arterial reconstructions by intraoperative flowmetry under the distal anastomosis using a fast Fourier transformation; calculate and compare the amplitude ratios of peripheral arterial blood pressure and volume flow before and after drug-induced vasodilation of occluded bypass grafts and bypass grafts that have been patent at least for 1 year. To find what magnitude of the change of these ratios indicate a long-term patency of the bypass grafting. PATIENTS AND METHODS: We compared the results of the intraoperative flowmetry tests of 97 patients with infrainguinal arterial reconstructions. The patients were divided into two groups based on the graft status: the grafts in 49 patients were patent for at least a year, and 48 patients had failed bypass. We used a fast Fourier transform (FFT of the pressure and blood flow waves and compared the ratios of their amplitudes before and after administration of a vasodilator drug into the graft. Comparing the ratios obtained before and those after administration of the drug we quantified their change in each group and analysed them. RESULTS: After a drug-induced vasodilation, the blood pressure and flow amplitude ratios for the group with compromised reconstructions were less than 1.9 times smaller than those before drug infusion, while for the group with bypass grafts that had been functional for at least 12 months the ratios declined by more than 1.9≈2 times. CONCLUSION: The magnitude of the change of amplitude ratios of the peripheral pressure and volume flow after drug-induced vasodilation can be used to make an assessment of the bypass graft and the distal arterial segment.

  7. Sex Differences in Peripheral Augmentation Index and Arterial Reservoir Pressure during Upper Limb Postural Shifts

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    Kevin S. Heffernan

    2014-01-01

    Full Text Available We examined the peripheral hemodynamic response to passive arm postural changes in young men and women. Radial artery pulse waveforms were captured using applanation tonometry in 20 men (age 27 ± 2 yrs, BMI 25 ± 1 kg/m2 and 20 women (age 27 ± 2 yrs, BMI 23±1 kg/m2. Arm position was maintained at either heart level or supported 14 cm above/below heart level in a randomized fashion. Systolic augmentation index (sAIx and diastolic augmentation index (dAIx were used as estimates of pressure from wave reflections arriving in systole and diastole, respectively. A novel reservoir-wave separation technique was used to obtain arterial reservoir pressure (pressure generated by arterial capacitance. Women showed a significant reduction in radial diastolic pressure-time integral (DPTI (P0.05 or dAIx (P>0.05 when moving the arm from below to above heart level. Conversely, men showed an attenuated change in radial DPTI (P>0.05 concomitant with significant increases in reservoir pressure (P<0.05, sAIx (P<0.05, and dAIx (P<0.05. Gravity-mediated changes in regional hemodynamics produced by passive arm postural shifts are sex specific. Men demonstrate less change in regional diastolic pressure concomitant with increased augmentation index and arterial reservoir pressure.

  8. Disease location is associated with survival in patients with peripheral arterial disease.

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    Chen, Qian; Smith, Carin Y; Bailey, Kent R; Wennberg, Paul W; Kullo, Iftikhar J

    2013-10-21

    We investigated whether disease location influences survival in patients with peripheral arterial disease. Patients (n = 12,731; mean age, 67.5 ± 12.7 years; 57.4% male) who underwent outpatient noninvasive lower extremity arterial evaluation were followed up for 5.9 ± 3.1 years for all-cause mortality. Peripheral arterial disease (n = 8930) was defined as a resting or postexercise ankle-brachial index (ABI) ≤ 0.90, and normal ABI (n = 3,801) was defined as a resting and postexercise ABI of 1.00 to 1.30. Presence or absence of disease at the proximal location or distal location was determined on the basis of Doppler signals in leg arteries; 42% had no PD or DD, 45% had proximal (14% postexercise PD only), 30% had distal disease, 17% had both proximal and distal disease, 28% had proximal only and 14% had distal only. We performed multivariable logistic regression to identify factors associated with disease location, and Cox proportional hazard regression to assess the respective effects of proximal or distal disease on survival. Older age, male sex, diabetes, heart failure, and critical limb ischemia were associated with distal disease, whereas female sex, smoking, hypertension, dyslipidemia, coronary heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, and critical limb ischemia were associated with proximal disease. Over a mean follow-up of 5.9 ± 3.1 years, 3039 patients (23.9%) died. After adjustment for potential confounders, the hazard ratios (HRs) of death associated with PD only and DD only were 1.3 (1.3 to 1.4) and 1.5 (1.4 to 1.6), respectively. After additional adjustment for resting ABI, there was no significant association between proximal disease and death, whereas the association of distal disease with death remained significant (HR, 1.2; 95% CI, 1.1 to 1.3). In patients with peripheral arterial disease, proximal and distal disease locations were associated with distinctive risk factor and comorbidity profiles. Distal

  9. The impact of omega-3 polyunsaturated fatty acid supplementation on the incidence of cardiovascular events and complications in peripheral arterial disease: a systematic review and meta-analysis.

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    Enns, Jennifer E; Yeganeh, Azadeh; Zarychanski, Ryan; Abou-Setta, Ahmed M; Friesen, Carol; Zahradka, Peter; Taylor, Carla G

    2014-05-31

    Individuals with peripheral arterial disease are at higher risk for cardiovascular events than the general population. While supplementation with omega-3 polyunsaturated fatty acids (PUFA) has been shown to improve vascular function, it remains unclear if supplementation decreases serious clinical outcomes. We conducted a systematic review and meta-analysis to determine whether omega-3 PUFA supplementation reduces the incidence of cardiovascular events and complications in adults with peripheral arterial disease. We searched five electronic databases (MEDLINE, EMBASE, CENTRAL, Scopus and the International Clinical Trials Registry Platform) from inception to 6 December 2013 to identify randomized trials of omega-3 PUFA supplementation (from fish or plant oils) that lasted ≥12 weeks in adults with peripheral arterial disease. No language filters were applied. Data on trial design, population characteristics, and health outcomes were extracted. The primary outcome was major adverse cardiac events; secondary outcomes included myocardial infarction, cardiovascular death, stroke, angina, amputation, revascularization procedures, maximum and pain-free walking distance, adverse effects of the intervention, and quality of life. Trial quality was assessed using the Cochrane Risk of Bias tool. Of 741 citations reviewed, we included five trials enrolling 396 individuals. All included trials were of unclear or high risk of bias. There was no evidence of a protective association of omega-3 PUFA supplementation against major adverse cardiac events (pooled risk ratio 0.73, 95% CI 0.22 to 2.41, I2 75%, 2 trials, 288 individuals) or other serious clinical outcomes. Adverse events and compliance were poorly reported. Our results showed that insufficient evidence exists to suggest a beneficial effect of omega-3 PUFA supplementation in adults with peripheral arterial disease with regard to cardiovascular events and other serious clinical outcomes.

  10. Serum paraoxonase-3 concentration is associated with insulin sensitivity in peripheral artery disease and with inflammation in coronary artery disease.

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    Rull, Anna; García, Raúl; Fernández-Sender, Laura; García-Heredia, Anabel; Aragonès, Gerard; Beltrán-Debón, Raúl; Marsillach, Judit; Alegret, Josep M; Martín-Paredero, Vicente; Mackness, Bharti; Mackness, Michael; Joven, Jorge; Camps, Jordi

    2012-02-01

    There are no data on the relationship between serum paraoxonase-3 (PON3) concentration and atherosclerosis in humans. Our aim was to investigate possible associations, using recently developed methods, in patients with peripheral artery disease (PAD) or coronary artery disease (CAD). We studied 118 PAD and 72 CAD patients and 175 healthy volunteers. Serum PON3 was determined by in-house ELISA using polyclonal antibodies generated against a synthetic peptide with a sequence specific to PON3. Polymorphisms of the PON3 promoter were analysed by the Iplex Gold MassArray™ method. There was a significant increase in serum PON3 concentration in both groups of patients with respect to the control group. In PAD patients, we observed significant positive correlations between PON3, insulin levels and HOMA index. These associations were not observed in CAD. There were significant positive associations between serum PON3 and β-2-microglobulin, CCL2 and high-sensitivity C-reactive protein in CAD patients, but not in PAD. We did not find any significant differences in PON3 gene promoter polymorphisms and their haplotypes between patients and controls, indicating that associations were not genetically determined. In both atherosclerotic phenotypes, serum PON3 concentration was increased, but this was associated with decreased insulin sensitivity in PAD and with inflammation in CAD. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  11. Peripheral obstructive arterial disease and carotid artery stenosis in end stage renal disease: a case-control study.

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    Bilancini, S; Lucchi, M; Mangiafico, R A; Medolla, A; Ferazzoli, F; Bianchi, C; Salvatori, E

    2008-12-01

    Cardiovascular diseases are an important cause of morbidity and mortality in end stage renal disease (ESRD) patients. The purpose of this study was to evaluate the predominance of carotid stenosis and peripheral obstructive arterial disease (POAD) in a group of patients subject to dialysis compared with a control group. It is a control-case study performed on patients at different hemodialysis facilities; the exams were carried out in ambulatory care. Two groups of patients were examined, the first group was made up of 40 dialysis patients (46.6% men, average age 58.8), the second was the control group made up of 58 subjects matched by age, sex, arterial pressure, presence of diabetes and smoking habits. All patients underwent an Eco-Color Doppler exam on the over aortal trunks and lower extremities and had their Ankle-Brakial-Index (ABI) measured. Carotid stenosis was considered only if equal or over 50%. Twenty percent of dialysis patients showed carotid stenosis (CS) versus 12% in the control group, with an OR of 7.9 (CI 95% 1.3-47.7) adjusted to sex, age and hypertension. The ultrasound picture of the lesions showed large amounts of calcium deposits. Predominance of POAD in dialysis patients was 20% versus 9% in the control group. In dialysis patients the OR adjusted to age, sex and arterial pressure was 6.3 (CI 95%, 1.2-32.6). The ultrasound picture of the lesions showed mainly underpopliteal lesions with ''rosary bead'' calcifications. In diabetic dialysis patients the OR was 7.6 (CI 95% 1.4-46.3).

  12. The importance of community screening of asymptomatic elderly for peripheral arterial disease by Doppler ultrasound and ankle-brachial index.

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    Keven, Ayşe; Durmaz, Mehmet Sedat

    2017-12-01

    Peripheral arterial disease is an atherosclerotic disease characterized by an increase in morbidity and mortality. For these reasons early diagnosis of peripheral arterial disease is important. Ankle-brachial systolic pressure index measurement is frequently used in screening studies. Evaluating waveforms of distal lower extremities with Doppler ultrasound can be used as a screening program and provides more accurate information on peripheral arterial disease. We investigate the prevalence of peripheral arterial disease, compare the efficacy of Doppler ultrasound evaluation of distal lower extremity waveforms and ankle-brachial systolic pressure index measurement in screening programs, and discuss the importance of early diagnosis of asymptomatic cases. A total of 457 patients over the age of 65 (between 65 and 94, mean age: 71.4) including 270 males and 187 females were examined with Doppler ultrasound, had ankle-brachial systolic pressure index measurement taken and were screened for peripheral arterial disease. The correlation between Doppler ultrasound findings and ankle-brachial systolic pressure index was examined. According to the Doppler ultrasound findings, in the aortoiliac ( r = 0.648) and femoropopliteal ( r = 0.564) area, there is a medium level of correlation between severe stenosis and occlusions and a low ankle-brachial systolic pressure index value, and a low level of correlation between such abnormalities in the tibioperoneal region ( r = 0.116) and a low ankle-brachial systolic pressure index value. Therefore, while the sensitivity of ankle-brachial systolic pressure index increases in proximal stenosis, it decreases in distal stenosis. Despite the fact that ankle-brachial systolic pressure index is a diagnostic test commonly used in screening studies, evaluation of distal arteries by means of Doppler ultrasound provides more accurate information in terms of the identification of peripheral arterial disease.

  13. Evaluation of peripheral arterial occlusive disease and postsurgical viability using reflectance spectroscopy of skin.

    Science.gov (United States)

    Bykowski, J; Kollias, N; LaMuraglia, G M

    2004-03-01

    Stress-induced changes in skin microcirculation allow staging of peripheral arterial vascular pathology using diffuse reflectance spectroscopy (DRS) of the skin. The changes in relative concentration of oxyhemoglobin and deoxyhemoglobin in the cutaneous microvasculature were assessed at rest, during limb elevation, dependency, and cuff-mediated reactive hyperemia for the forearm of 25 normal subjects and 105 feet of patients with peripheral arterial occlusive disease (PAOD) (normal=28, claudication=34, limb threatening ischemia=44). Thirty-four patients who had revascularization procedures were again evaluated within the first week postoperatively. Two measurements correlated with clinical staging: (1) the relative absorbance of oxyhemoglobin after 225 s of limb dependency and (2) the time to reach 50% of peak reactive hyperemia response (Spearman's rank: rs=0.625, P<0.001). Using these criteria alone, ischemic limbs were identified to a sensitivity of 69% and specificity of 95%. Significant post-revascularization improvement was identified in 14 of 34 patients' legs which had previously been classified as limb-threatening ischemia (n=14, W=105, P<0.001). These simple bedside evaluations of the superficial skin microvasculature allow staging of large vessel vascular insufficiency and may suggest and differentiate focal areas of tissue at risk for ulceration or necrosis.

  14. Evaluation of MR angiography and blood flow measurement in abdominal and peripheral arterial occlusive disease

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    Tabuchi, Kenji [Dokkyo Univ. School of Medicine, Mibu, Tochigi (Japan)

    2000-03-01

    To assess the characteristics of blood flow measurement with MR Angiography (MRA) to evaluate the status of vascular stenoses, two or three dimensional time-of-flight MRA and velocity-encoded cine MR were performed in the 230 segments of 35 patients, with abdominal and peripheral arterial occlusive diseases. In 11 of these 35 patients digital subtraction angiography was additionally underwent, and the stenotic findings was compared with MRA. There were 17 segments in which the velocity could not be measured, because the blood flow exceeded the upper limit of peak-encoded velocity (VENC) which was set at 120 cm/sec. Therefore, it is necessary to set the upper limit of VENC at higher than 120 cm/sec. There were 11 stenotic findings in DSA and 20 stenotic findings in MRA. Pulsatility Index (PI=(max velocity-min. velocity)/average velocity) were used for evaluating the blood flow waveform, and there were significant difference between the 11 stenotic findings of DSA and the others'. In summery, MRA was considered as useful examination to assess the degree of the vascular stenoses in abdominal and peripheral arterial occlusive disease. (author)

  15. New developments in the clinical use of drug-coated balloon catheters in peripheral arterial disease

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    Naghi J

    2016-06-01

    Full Text Available Jesse Naghi, Ethan A Yalvac, Ali Pourdjabbar, Lawrence Ang, John Bahadorani, Ryan R Reeves, Ehtisham Mahmud, Mitul Patel Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, CA, USA Abstract: Peripheral arterial disease (PAD involving the lower extremity is a major source of morbidity and mortality. Clinical manifestations of PAD span the spectrum from lifestyle limiting claudication to ulceration and gangrene leading to amputation. Advancements including balloon angioplasty, self-expanding stents, drug-eluting stents, and atherectomy have resulted in high technical success rates for endovascular therapy in patients with PAD. However, these advances have been limited by somewhat high rates of clinical restenosis and clinically driven target lesion revascularization. The recent introduction of drug-coated balloon technology shows promise in limiting neointimal hyperplasia induced by vascular injury after endovascular therapies. This review summarizes the contemporary clinical data in the emerging area of drug-coated balloons. Keywords: drug-coated balloons, endovascular, percutaneous transluminal angioplasty, paclitaxel, peripheral arterial disease

  16. Safety and efficacy of rivaroxaban compared with warfarin in patients undergoing peripheral arterial procedures.

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    Talukdar, Anjan; Wang, S Keisin; Czosnowski, Lauren; Mokraoui, Nassim; Gupta, Alok; Fajardo, Andres; Dalsing, Michael; Motaganahalli, Raghu

    2017-10-01

    Rivaroxaban is a United States Food and Drug Administration-approved oral anticoagulant for venous thromboembolic disease; however, there is no information regarding the safety and its efficacy to support its use in patients after open or endovascular arterial interventions. We report the safety and efficacy of rivaroxaban vs warfarin in patients undergoing peripheral arterial interventions. This single-institution retrospective study analyzed all sequential patients from December 2012 to August 2014 (21 months) who were prescribed rivaroxaban or warfarin after a peripheral arterial procedure. Our study population was then compared using American College of Chest Physicians guidelines with patients then stratified as low, medium, or high risk for bleeding complications. Statistical analyses were performed using the Student t-test and χ 2 test to compare demographics, readmissions because of bleeding, and the need for secondary interventions. Logistic regression models were used for analysis of variables associated with bleeding complications and secondary interventions. The Fisher exact test was used for power analysis. There were 44 patients in the rivaroxaban group and 50 patients in the warfarin group. Differences between demographics and risk factors for bleeding between groups or reintervention rate were not statistically significant (P = .297). However, subgroup evaluation of the safety profile suggests that patients who were aged ≤65 years and on warfarin had an overall higher incidence of major bleeding (P = .020). Patients who were aged >65 years, undergoing open operation, had a significant risk for reintervention (P = .047) when they received rivaroxaban. Real-world experience using rivaroxaban and warfarin in patients after peripheral arterial procedures suggests a comparable safety and efficacy profile. Subgroup analysis of those requiring an open operation demonstrated a decreased bleeding risk when rivaroxaban was used (in those aged <65

  17. Detection of peripheral artery disease by duplex ultrasonography among hemodialysis patients.

    Science.gov (United States)

    Ogata, Hiroaki; Kumata-Maeta, Chiaki; Shishido, Kanji; Mizobuchi, Masahide; Yamamoto, Masahiro; Koiwa, Fumihiko; Kinugasa, Eriko; Akizawa, Tadao

    2010-12-01

    Peripheral arterial disease (PAD) is a known predictor of cardiovascular morbidity and mortality among hemodialysis patients. Although ankle-brachial BP index (ABI) is a simple and reliable test for PAD screening, its sensitivity has been suggested to decrease among dialysis patients. We performed a cross-sectional outpatient cohort study to examine prevalence of PAD among hemodialysis patients using duplex ultrasonography of the lower extremity artery. We also evaluate the influence of increased arterial stiffness on impaired accuracy of ABI for PAD screening. Of 315 total patients, 23.8% had PAD. PAD was associated with younger age, diabetes, current smoking, atherosclerotic comorbidities, increased total cholesterol levels, increased triglyceride levels, and lower Kt/V. The receiver operating characteristic analysis (area under the receiver operating characteristic curve = 0.846) showed that sensitivity and specificity of ABI values for PAD were 49.0 and 94.8%, respectively. An ABI cut-off value of 1.05 resulted in the best sensitivity (74.5%) and specificity (84.4%). There was a significant difference in sensitivity of ABI levels hemodialysis patients and that the diagnostic value of ABI for PAD was affected by various factors.

  18. Adaptation of the main peripheral artery and vein to long term confinement (Mars 500).

    Science.gov (United States)

    Arbeille, Philippe; Provost, Romain; Vincent, Nicole; Aubert, Andre

    2014-01-01

    The objective was to check if 520 days in confinement (MARS 500), may affect the main peripheral arterial diameter and wall thickness and the main vein size. Common carotid (CC) femoral artery (FA) portal vein (PV), jugular (JG), femoral vein (FV) and tibial vein were assessed during MARS 500 by echography, performed by the subjects. A hand free volumic echographic capture method and a delayed 3D reconstruction software developed by our lab were used for collecting and measuring the vascular parameters. During the MARS 500 experiment the subjects performed 6 sessions among which 80% of the echographic data were of sufficient quality to be processed. No significant change was found for the Common carotid, Jugular vein, femoral artery, femoral vein, portal vein, and tibial vein diameter. CC and FA IMT (intima media thickness) were found significantly increased (14% to 28% PMARS 500. The experiment confirmed that even untrained to performing echography the subjects were able to capture enough echographic data to reconstruct the vessel image from which the parameters were measured. The increase in both CC and FA IMT should be in relation with the stress generated by the confined environment or absence of solar radiation, as there was no change in gravity, temperature and air in the MARS 500 module, and minor changes in physical exercise and nutrition.

  19. [Peripheral artery disease in patients younger than 50 years old: Which etiology?].

    Science.gov (United States)

    Cotard, S; Nouni, A; Jaquinandi, V; Gladu, G; Kaladji, A; Mahé, G

    2016-09-01

    Peripheral arterial disease (PAD) encompasses disease of all arteries of the body except the coronary arteries. The main etiology whatever the patient's age is atherosclerosis. Different etiologies can induce PAD especially when patients are younger than 50 years old and have no cardiovascular risk factors (smoking, hypertension, diabetes…). PAD that appears before 50 years old can be named juvenile PAD (JPAD) although there is no consensus about the definition. The aim of this work is to present the different etiologies of JPAD according to their hereditary, acquired or mixed origins. The following hereditary causes are addressed: Marfan syndrome, Ehlers-Danlos syndrome, homocystinuria, pseudoxanthoma elasticum, osteogenesis imperfecta "mid-aortic" syndrome. Among the acquired etiologies, inflammatory JPADs without extravascular signs such as atherosclerosis and Buerger's disease, inflammatory JPADs with extravascular signs as Takayasu's disease, Behçet's disease and Cogan's syndrome, JPADs like aortitis, embolic JPADs, iatrogenic JPADs, and mechanical or traumatic JPADs are described. Finally, mixed origins as thrombotic disease and fibromuscular dysplasia are presented. This work will assist clinicians in the diagnosis of JPAD. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  20. High prevalence of peripheral arterial disease in patients with obstructive sleep apnoea.

    Science.gov (United States)

    Schaefer, C A; Adam, L; Weisser-Thomas, J; Pingel, S; Vogel, G; Klarmann-Schulz, U; Nickenig, G; Pizarro, C; Skowasch, D

    2015-09-01

    Obstructive sleep apnoea (OSA) merits increasing attention as cardiovascular risk factor. Whereas carotid and coronary artery disease have been associated with OSA, occurrence of peripheral arterial disease (PAD) in OSA remains undefined. We screened 100 patients with suspected OSA for PAD. After polysomnography, each patient underwent standardized angiological testing including ankle-brachial index (ABI), central pulse wave velocity, pulse wave index and duplex sonography. Among total study population, PAD prevalence accounted for 88%, of those 68% had asymptomatic plaques and 20% were symptomatic Fontaine ≥ IIa. In confirmed OSA, prevalence raised up to 98%. Except for smoking habits, distribution of established risk factors did not differ between OSA groups (patients without, mild, intermediate and severe OSA). Presence of plaque, Fontaine PAD stages and intermittent claudication exhibited significant gain with increasing AHI. A logistic regression model revealed that age (OR = 1.199, 95% CI [1.066; 1.348]) and the logarithmically transformed AHI (OR = 5.426, 95% CI [1.068; 27.567]) had the strongest influence on plaque presence. Central pulse wave velocity as marker of arterial stiffness was positively correlated with AHI. OSA is associated with a high prevalence of PAD. This implies substantial diseasés under-recognition and a presumable atherogenic role of OSA in the pathogenesis of PAD. However, vasoprotective impact of OSA treatment remains to be determined.

  1. Utility of Toe-brachial Index for Diagnosis of Peripheral Artery Disease

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    Seong Chul Park

    2012-05-01

    Full Text Available BackgroundThe ankle brachial pressure index (ABI is a simple, useful method for diagnosing peripheral artery disease (PAD. Although the ABI is an objective diagnostic method, it has limited reliability in certain scenarios. The aim of the present study was to determine the accuracy and reliability of the toe brachial index (TBI as a diagnostic tool for detecting stenosis in PAD, associated with normal or low ABI values.MethodsABI and TBI values were measured in 15 patients with diabetic gangrene who were suspected of having lower extremity arterial insufficiency. The ABI and TBI values were measured using a device that allowed the simultaneous measurement of systolic blood pressure in the upper and lower extremities. In addition, the ABI and TBI values were compared pre- and post-angiography.ResultsPatients with an ABI of 0.9-1.3 showed almost no difference between the 2 measurements. The patients with TBI >0.6 had no arterial insufficiency. The patients with TBI <0.6 required vascular intervention with ballooning. After the angiography, the gangrenous wounds decreased in size more rapidly than they did prior to the intervention.ConclusionsOur findings suggest that TBI is the method of choice for evaluating lower limb perfusion disorders. This result requires further studies of TBI in a larger number of patients. Future long-term studies should therefore evaluate the utility of TBI as a means of screening for PAD and the present findings should be regarded as preliminary outcomes.

  2. Underrecognized Peripheral Arterial Disease in Patients With Diabetes Mellitus in Thailand: We Must Consider Neuroischemic Foot Ulcers From This Fallout.

    Science.gov (United States)

    Rerkasem, Kittipan; Kosachunhanun, Natapong; Sony, Kiran; Inpankaew, Nimit; Mani, Raj

    2015-06-01

    A range of prevalence of peripheral artery disease in diabetic patients has been estimated using the measurement of ankle brachial pressure index and clinical features in Asian countries. These data may be underestimates and hence underrecognized, raising questions about the numbers of patients with neuroischemic feet who are also at risk of diabetic foot ulcers. Underrecognition of these lesions may well increase the high levels of chronic wound burden resulting from peripheral artery disease as well as neuroischemic foot lesions. Improved education and training of clinical staff (nurses and family physicians) is required to combat these serious issues. © The Author(s) 2015.

  3. Concomitant use of proton pump inhibitors and clopidogrel in patients with coronary, cerebrovascular, or peripheral artery disease in the factores de Riesgo y ENfermedad Arterial (FRENA) registry.

    Science.gov (United States)

    Muñoz-Torrero, Juan Francisco Sánchez; Escudero, Domingo; Suárez, Carmen; Sanclemente, Carmen; Pascual, Ma Teresa; Zamorano, José; Trujillo-Santos, Javier; Monreal, Manuel

    2011-01-01

    Among patients receiving clopidogrel for coronary artery disease, concomitant therapy with proton pump inhibitors (PPIs) has been associated with an increased risk for recurrent coronary events. Factores de Riesgo y ENfermedad Arterial (FRENA) is an ongoing, multicenter, observational registry of consecutive outpatients with coronary artery disease, cerebrovascular disease, or peripheral artery disease. We retrospectively examined the influence of concomitant use of PPIs on outcome in patients receiving clopidogrel. As of March 2009, 1222 patients were using clopidogrel: 595 had coronary artery disease, 329 cerebrovascular disease, and 298 had peripheral artery disease. Of these, 519 (42%) were concomitantly using PPIs. Over a mean follow-up of 15 months, 131 patients (11%) had 139 subsequent ischemic events: myocardial infarction 44, ischemic stroke 40, and critical limb ischemia 55. Seventeen of them (13%) died within 15 days of the subsequent event. PPI users had a higher incidence of myocardial infarction (rate ratio, 2.5; 95% confidence interval [CI], 1.3-4.8), ischemic stroke (rate ratio, 1.9; 95% CI, 1.03-3.7), and a nonsignificantly higher rate of critical limb ischemia (rate ratio, 1.6; 95% CI, 0.95-2.8) than nonusers. On multivariate analysis, concomitant use of clopidogrel and PPIs was independently associated with an increased risk for subsequent ischemic events both in the whole series of patients (hazard ratio, 1.8; 95% CI, 1.1-2.7) and in those with cerebrovascular disease or peripheral artery disease (hazard ratio, 1.5; 95% CI, 1.01-2.4). In patients with established arterial disease, concomitant use of PPIs and clopidogrel was associated with a nearly doubling of the incidence of subsequent myocardial infarction or ischemic stroke. This higher incidence persisted after multivariate adjustment.

  4. Dual Energy CT Angiography of Peripheral Arterial Disease: Feasibility of Using Lower Contrast Medium Volume.

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    Abdulrahman Almutairi

    Full Text Available One of the main drawbacks associated with Dual Energy Computed Tomography Angiography (DECTA is the risk of developing contrast medium-induced nephropathy (CIN. The aim of the present study was firstly, to design an optimal CT imaging protocol by determining the feasibility of using a reduced contrast medium volume in peripheral arterial DECTA, and secondly, to compare the results with those obtained from using routine contrast medium volume.Thirty four patients underwent DECTA for the diagnosis of peripheral arterial disease. They were randomly divided into two groups: Group 1 (routine contrast volume group with n = 17, injection rate 4-5 ml/s, and 1.5 ml/kg of contrast medium, and Group 2 ((low contrast volume group, with n = 17, injection rate 4-5ml/s, and contrast medium volume 0.75 ml/kg. A fast kilovoltage-switching 64-slice CT scanner in the dual-energy mode was employed for the study. A total of 6 datasets of monochromatic images at 50, 55, 60, 65, 70 and 75 keV levels were reconstructed with adaptive statistical iterative reconstruction (ASIR at 50%. A 4-point scale was the tool for qualitative analysis of results. The two groups were compared and assessed quantitatively for image quality on the basis of signal-to-noise ratio (SNR and contrast-to-noise-ratio (CNR. Radiation and contrast medium doses were also compared.The overall mean CT attenuation and mean noise for all lower extremity body parts was significantly lower for the low volume contrast group (p<0.001, and varied significantly between groups (p = 0.001, body parts (p<0.001 and keVs (p<0.001. The interaction between group body parts was significant with CT attenuation and CNR (p = 0.002 and 0.003 respectively, and marginally significant with SNR (p = 0.047, with minimal changes noticed between the two groups. Group 2 (low contrast volume group displayed the lowest image noise between 65 and 70 keV, recorded the highest SNR and CNR at 65 keV, and produced significantly lower

  5. Correlation of atherosclerotic changes in peripheral arteries with pathological involvement of aortic arch in coronary bypass patients

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    Eshraghi N

    2010-10-01

    Full Text Available "nBackground: A correlation between coronary artery disease (CAD and atherosclerosis of peripheral arteries and the determination of noninvasive indexes for its existence and extent have been sought by many researchers. Some studies report that the intima-media thickness (IMT of peripheral arteries could play this role. This study evaluated the correlation between the IMTs of common carotid and common femoral arteries and the degree of atherosclerosis in aortic arch and to evaluate the severity of CAD in candidates of coronary artery bypass grafting (CABG."n "nMethods: In a cross-sectional analytic-descriptive study, The severity of CAD, the grade of atherosclerosis of the aortic arch, and the IMTs of the common carotid and common femoral arteries were determined."n "nResults: There was a significant weak positive correlation between the IMT of common carotid artery (ρ = 0.193, p = 0.039 and common femoral artery (ρ = 0.206, p = 0.028 with the number of involved carotid vessels; the mean of these two parameters was not significantly different between the three CAD groups. There was not any significant relation between the IMTs of common carotid and common femoral arteries with the severity of atherosclerosis in the aortic arch too. There was not any significant relation between the presences of atherosclerotic plaque in the common carotid or the common femoral arteries with the severity of CAD. The severe atherosclerosis of the aortic arch was significantly higher in patients with three vessel disease."n "nConclusion: According to our results, the IMTs of common carotid and/or common femoral arteries may increase with the severity of CAD; however, these parameters are not a surrogate for predicting the CAD severity.

  6. Increasing prevalence of peripheral artery occlusive disease in hemodialysis patients: a 2-year follow-up.

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    Chen, Szu-Chia; Su, Ho-Ming; Chang, Jer-Ming; Liu, Wan-Chun; Tsai, Jer-Chia; Tsai, Yi-Chun; Lin, Ming-Yen; Hwang, Shang-Jyh; Chen, Hung-Chun

    2012-06-01

    Peripheral artery occlusive disease (PAOD) has been reported to be prevalent in hemodialysis patients and influence their mortality. Ankle-brachial index (ABI) hemodialysis patients. This study enrolled 237 routine hemodialysis patients and 154 patients completed the 2-year follow-up. The ABI was measured by an ABI-form device at baseline and at the first and second year follow-up. The change in ABI (ΔABI) was defined as ABI measured at the second year follow-up minus ABI measured at baseline. The prevalence of ABI hemodialysis patients. The ABI progression was associated with high fasting glucose level, high calcium-phosphorous product, high-sensitivity C-reactive protein and low homocysteine levels.

  7. Prevalence of peripheral artery disease and its associated risk factors in Spain: The ESTIME Study.

    Science.gov (United States)

    Blanes, J I; Cairols, M A; Marrugat, J

    2009-02-01

    Several studies have demonstrated that patients with peripheral arterial disease (PAD), are at an increased risk of morbidity and mortality compared with those without PAD. However, few population-based studies have addressed the prevalence of PAD and intermittent claudication (IC). We assessed the prevalence of and the factors associated with PAD and IC in the Spanish population. A cross sectional study with 1324 participants aged 55 to 84 years randomly selected from the census was conducted in 12 Spanish regions. The presence of PAD and IC was determined by an ankle-brachial index (ABI) ESTIME study confirms the high prevalence of asymptomatic PAD, and its relation with typical cardiovascular risk factors. ABI provides early diagnosis before claudication symptoms in a high proportion of patients. ABI could contribute to developing early prevention programmes.

  8. Regional variation in racial disparities among patients with peripheral artery disease.

    Science.gov (United States)

    O'Donnell, Thomas F X; Powell, Chloe; Deery, Sarah E; Darling, Jeremy D; Hughes, Kakra; Giles, Kristina A; Wang, Grace J; Schermerhorn, Marc L

    2018-02-16

    Prior studies identified significant racial disparities as well as regional variation in outcomes of patients with peripheral artery disease (PAD). We aimed to determine whether regional variation contributes to these racial disparities. We identified all white or black patients who underwent infrainguinal revascularization or amputation in 15 deidentified regions of the Vascular Quality Initiative between 2003 and 2017. We excluded three regions with racial group, we found significant variation in the adjusted rates of all outcomes between regions (all P racial groups across regions. Significant racial disparities exist in outcomes after lower extremity procedures in patients with PAD, with regional variation contributing to perioperative but not long-term outcome disparities. Underperforming regions should use these data to generate quality improvement projects, as understanding the etiology of these disparities is critical to improving the care of all patients with PAD. Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  9. Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease

    DEFF Research Database (Denmark)

    Anand, Sonia S; Bosch, Jackie; Eikelboom, John W

    2018-01-01

    . The use of the rivaroxaban plus aspirin combination increased major bleeding compared with the aspirin alone group (77 [3%] of 2492 vs 48 [2%] of 2504; HR 1·61, 95% CI 1·12-2·31, p=0·0089), which was mainly gastrointestinal. Similarly, major bleeding occurred in 79 (3%) of 2474 patients with rivaroxaban 5...... mg, and in 48 (2%) of 2504 in the aspirin alone group (HR 1·68, 95% CI 1·17-2·40; p=0·0043). INTERPRETATION: Low-dose rivaroxaban taken twice a day plus aspirin once a day reduced major adverse cardiovascular and limb events when compared with aspirin alone. Although major bleeding was increased......, fatal or critical organ bleeding was not. This combination therapy represents an important advance in the management of patients with peripheral artery disease. Rivaroxaban alone did not significantly reduce major adverse cardiovascular events compared with asprin alone, but reduced major adverse limb...

  10. Contribution of infection and peripheral artery disease to severity of diabetic foot ulcers in Chinese patients.

    Science.gov (United States)

    Hao, D; Hu, C; Zhang, T; Feng, G; Chai, J; Li, T

    2014-09-01

    The objective of the current ongoing study was to evaluate the characteristics of diabetic patients with newly diagnosed foot ulcer in Burn & Plastic Hospital of PLA General Hospital. A total of 1002 consecutive patients presenting with a new foot ulcer between March 2007 and September 2013 were enrolled. All enrolled patients were classified based on presence or absence of collateral infection, disabling comorbidities and peripheral arterial disease (PAD). Of patients, 70.05% had PAD, which occurred significantly more in elderly adults. Patients with PAD had higher incidence of infection (58.9% vs. 41.5% in non-PAD group) and disabling comorbidities (79% in PAD and 61% in non-PAD; p foot ulcers between the PAD and non-PAD group of enrolled diabetic patients. Diabetic foot ulcer is more prominent in patients with PAD that is further reflected by significantly more underlying cases of infection and disabling comorbidity. © 2014 John Wiley & Sons Ltd.

  11. Use of prostheses in lower limb amputee patients due to peripheral arterial disease.

    Science.gov (United States)

    Chamlian, Therezinha Rosane

    2014-01-01

    To evaluate the indication of prosthesis during rehabilitation and the maintenance of their use or abandonment rate after discharge, as well as mortality of lower limb amputees due to peripheral arterial disease. A retrospective and cross-sectional study carried out with lower limb amputee patients, at transfemoral and transtibial levels, due to vascular conditions. The sample was composed of 310 patients (205 men, 105 women, mean age 61.8 years), transfemoral (142) and transtibial (150) levels, unilateral or bilateral (18). A total of 217 were fitted with prosthesis and 93 did not. Nonparametric statistical tests with equality of two proportions, 95% confidence interval and p value amputees, due to vascular conditions, during rehabilitation is high. However, maintenance of prosthesis is not frequent after discharge. Early and high mortality is observed mainly among diabetic patients.

  12. Treatment with pharmacological agents in peripheral arterial disease patients does not result in biomechanical gait changes.

    Science.gov (United States)

    Huisinga, Jessie M; Pipinos, Iraklis I; Stergiou, Nicholas; Johanning, Jason M

    2010-08-01

    Pharmacological treatment has been used to alleviate the claudication symptoms and improve walking performance in peripheral arterial disease (PAD) patients. However, the effects of claudication treatments on gait mechanics have not been objectively identified with biomechanical techniques. For this study, 20 PAD patients were assigned to take either pentoxifylline (n=11) or cilostazol (n=9), the two FDA-approved pharmacological therapies used to treat intermittent claudication symptoms. All patients completed a gait evaluation protocol that involved the acquisition of kinematic and kinetic gait data before use of the medication and after 12 weeks of treatment. Results showed that treatment with either pentoxifylline or cilostazol resulted in limited overall improvement in gait parameters including joint angles and joint moments. Walking speed was unchanged, in either treatment group, as a result of the medication. These results suggest that to improve biomechanical walking parameters of PAD patients, clinicians cannot rely on drug therapies alone.

  13. Oscillometric blood pressure measurement: a simple method in screening for peripheral arterial disease

    DEFF Research Database (Denmark)

    Mehlsen, Jesper; Wiinberg, Niels; Bruce, Christopher

    2008-01-01

    Blood pressure at the ankle level is a reliable indicator of peripheral arterial disease (PAD) and the ankle brachial index (ABI) is a useful non-invasive screening tool for the early detection of atherosclerosis. In the first part of the study, systolic blood pressures obtained by oscillometry...... and plethysmography were compared in 80 subjects referred for possible vascular disease. In the second part of the study, 31 general practitioners enrolled 1258 consecutive patients aged more than 60 years. ABI was estimated by oscillometry. Patients with an ABI lower than 0.9 were referred to the local hospital......, the oscillometry showed a positive predictive value of 47%. The presence of PAD was significantly correlated to exercise related leg pain, a diagnosis of hypertension and smoking, whereas no correlation could be found with a diagnosis of heart disease, stroke, or with the presence of diabetes. The prevalence...

  14. Altered monocyte CD44 expression in peripheral arterial disease is corrected by fish oil supplementation.

    Science.gov (United States)

    Madden, J; Shearman, C P; Dunn, R L; Dastur, N D; Tan, R M; Nash, G B; Rainger, G Ed; Brunner, A; Calder, P C; Grimble, R F

    2009-05-01

    CD44 and its splice variants can be expressed on all leukocytes, conferring adhesive properties and enhancing cellular recruitment to the endothelium during inflammation. CD44 expression is increased in inflammatory conditions such as rheumatoid arthritis and CD44 variant 3 (CD44v3) expression may be associated with inflammation. We have examined CD44 and CD44v3 expression on peripheral blood monocytes from patients with peripheral arterial disease (PAD) and healthy controls. We have also examined the effect of fish oil supplementation on these markers. CD44 and CD44v3 were assessed at baseline and following dietary supplementation with fish oil for 12 weeks in both PAD and control groups. Monocytes from PAD patients had higher CD44 expression than those from controls (median intensity fluorescence (MIF): 480+/-278 vs 336+/-251 (mean+/-SD); p<0.001). Following 12 weeks' dietary supplementation with fish oil, CD44 expression was reduced in PAD patients (MIF: 480+/-278 vs 427+/-262; p=0.05) but not in controls (336+/-251 vs 355+/-280; ns). Monocyte CD44v3 expression was lower in cultured monocytes from PAD patients compared to those from controls (0.15+/-0.15 vs 0.22+/-0.14 OD units; p<0.02). This was increased in the PAD group following fish oil supplementation (0.15+/-0.14 to 0.27+/-0.23 OD units; p<0.001). Monocyte CD44 and CD44v3 expression are altered in arterial disease but are returned towards levels seen in control subjects by dietary fish oil supplementation.

  15. Relationship between education and atherosclerotic disease risk factors in patients with peripheral arterial disease.

    Science.gov (United States)

    Maksimovic, M; Vlajinac, H; Radak, D; Marinkovic, J; Maksimovic, J; Jorga, J

    2010-08-01

    The aim of the present study was to investigate whether different levels of education are associated with different atherosclerotic disease risk factors. The cross-sectional study, involving 388 consecutive patients with verified peripheral arterial disease, was performed in Belgrade. Formal education level was used as a proxy for socioeconomic status. Anthropometric parameters and data on cardiovascular risk factors were analyzed in participants with different levels of education. In the analysis, univariate and multivariate logistic regressions were used. Multivariate analysis showed that low education was significantly positively related to alcohol consumption (Odds Ratio - OR, 4.67; 95% confidence interval - CI, 1.80-12.12), increased triglycerides (OR, 2.73; 95% CI, 1.13-6.61), and physical activity during work (OR, 43.10; 95% CI 14.37-129.28), and negatively related to former smoking (OR, 0.11; 95% CI, 0.03-0.46) and sports and leisure - time physical activity (OR, 0.13; 95% CI, 0.04-0.41 and OR, 0.25; 95% CI, 0.11-0.57). Medium education was significantly positively related to increased triglycerides (OR, 1.74; 95% CI 1.01-2.98) and increased LDL-cholesterol (OR 2.37; 95% CI, 1.35-4.18), and to physical activity during work (OR, 2.22; 95% CI, 1.34-3.67), and negatively related to age (OR, 0.95; 95% CI, 0.92-0.98) and leisure - time physical activity (OR, 0.47; 95% CI, 0.30-0.74). It can be concluded that if there are differences in the risk of the occurrence of peripheral arterial disease by education status, they could be only partly explained by differences in the observed atherosclerotic disease risk factors.

  16. The prevalence of peripheral arterial disease in diabetic subjects in south-west Nigeria

    Directory of Open Access Journals (Sweden)

    Bolaji O. Oyelade

    2012-02-01

    Full Text Available Background: Peripheral arterial disease (PAD is rarely sought for and generally underdiagnosed even in diabetics in developing countries like Nigeria. PAD is easily detected and diagnosed by the ankle-brachial index, a simple and reliable test. Objectives: To determine the prevalence of PAD in diabetic subjects aged 50–89 years and the value of ankle-brachial index measurement in the detection of PAD.Method: A cross-sectional descriptive study of 219 diabetic subjects aged 50–89 years was carried out. The participants were administered a pre-tested questionnaire and measurement of ankle-brachial index (ABI was done. The ankle-brachial index < 0.90 was considered equivalent to peripheral arterial disease.Results: The overall prevalence of PAD was 52.5%. The prevalence of symptomatic PAD was 28.7% whilst that of asymptomatic PAD was 71.3%. There were a number of associations with PAD which included, age (p < 0.05, sex (p < 0.05, and marital status (p < 0.05. The use of the ankle-brachial index in the detection of PAD was clearly more reliable than the clinical methods like history of intermittent claudication and absence or presence of pedal pulses.Conclusion: The prevalence of PAD is relatively high in diabetic subjects in the southwestern region of Nigeria. Notable is the fact that a higher proportion was asymptomatic. Also the use of ABI is of great value in the detection of PAD as evidenced by a clearly more objective assessment of PAD compared to both intermittent claudication and absent pedal pulses.

  17. The association of visceral adiposity with cardiovascular events in patients with peripheral artery disease.

    Directory of Open Access Journals (Sweden)

    Oliver Cronin

    Full Text Available BACKGROUND: Previous studies have suggested that patients with peripheral artery disease (PAD suffer from a high incidence of cardiovascular events (CVE. Visceral adiposity has been implicated in promoting CVEs. This study aimed to assess the association of relative visceral adipose volume with incident cardiovascular events in patients with peripheral artery disease. METHODS: This was a prospective cohort study including 260 patients with PAD who presented between 2003 and 2012. Cases were patients with diagnosed PAD including symptomatic lower limb athero-thrombosis and asymptomatic abdominal aortic aneurysm. All patients underwent computed tomography angiography (CTA. Abdominal visceral to total adipose volume ratio (relative visceral adipose volume was estimated from CTAs using a previously validated workstation protocol. Cardiovascular risk factors were recorded at entry. The association of visceral adiposity with major CVEs (death, non-fatal myocardial infarction or stroke was examined using Kaplan Meier and Cox proportional hazard analyses. RESULTS: A total of 92 major CVEs were recorded in 76 patients during a median follow-up of 2.8 (IQR 1.2 to 4.8 years, including myocardial infarction (n = 26, stroke (n = 10 and death (n = 56. At 3 years the incidence of major CVEs stratified by relative visceral adipose volume quartiles were 15% [Quartile (Q 1], 17% (Q2, 11% (Q3 and 15% (Q4 (P = 0.517. Relative visceral adipose volume was not associated with major CVEs after adjustment for other risk factors. CONCLUSION: This study suggests that visceral adiposity does not play a central role in the predisposition for major CVEs in patients with PAD.

  18. Peripheral ARtery Atherosclerotic DIsease and SlEep disordered breathing (PARADISE) trial - protocol for an observational cohort study.

    Science.gov (United States)

    Szymański, Filip M; Gałązka, Zbigniew; Płatek, Anna E; Górko, Dariusz; Ostrowski, Tomasz; Adamkiewicz, Karolina; Łęgosz, Paweł; Ryś, Anna; Semczuk-Kaczmarek, Karolina; Celejewski, Krzysztof; Filipiak, Krzysztof J

    2017-01-01

    Peripheral arterial disease (PAD) is in fact a group of disease entities with different symptoms and course but a common underlying cause, i.e. atherosclerosis. Atherosclerosis is known to be aggravated by several cardiovascular risk factors, including obstructive sleep apnoea (OSA). Following paper is a protocol for the Peripheral ARtery Atherosclerotic DIsease and SlEep disordered breathing (PARADISE) trial, which aims to describe the prevalence of OSA in PAD patients scheduled for revascularisation, and to determine the effect of OSA on the procedure outcomes. The PARADISE study is an observational cohort trial. It plans to include 200 consecutive patients hospitalised for revascularisation due to PAD. In every patient an overnight sleep study will be performed to diagnose sleep disorders. Accord¬ing to the results of the test, patients will be divided into two groups: group A - patients with OSA, and group B - patients without OSA (control group). All patients will also be screened for classical and non-classical cardiovascular risk factors. In some of the patients, during surgery, a fragment of atherosclerotic plaque will be collected for further testing. Patients will be followed for one year for adverse events and end-points. Primary end-point of the study will be the failure of revascularisa¬tion defined as recurrence or new onset of the symptoms of ischaemia from the treated region, a need for re-operation or procedure revision, or recurrence of ischaemia signs on the imaging tests. The data obtained will help determine the incidence of OSA in the population of patients with PAD. The au¬thors expect to show that, as with other cardiovascular diseases associated with atherosclerosis, also in patients with PAD the incidence of undiagnosed OSA is high and its presence is associated with elevated cholesterol, inflammatory markers, and higher prevalence of arterial hypertension and poor control of other cardiovascular risk factors. In addition, due to

  19. Comparing Survival between peritoneal dialysis and hemodialysis patients with subclinical peripheral artery disease: a 6-year follow-up.

    Science.gov (United States)

    Liu, Jiung-Hsiun; Chen, Jan-Yow; Lin, Shih-Yi; Lin, Hsin-Hung; Ting, I-Wen; Liang, Chih-Chia; Wang, I-Kuan; Kuo, Huey-Liang; Chang, Chiz-Tzung; Huang, Chiu-Ching; Sung, Fung-Chang

    2013-01-01

    Peripheral artery disease (PAD) is known to be an increased mortality risk in patients with end-stage renal disease (ESRD). The aim of this study was to compare patient survival between patients with subclinical PAD undergoing peritoneal dialysis (PD) and hemodialysis (HD). Subclinical peripheral artery was defined as an ankle-brachial index of less than 0.9. This study was conducted from April 2005, and the observation period ended on 30 June 2011. At the end of the follow-up, the status of all patients was assessed and data on mortality were obtained for the entire cohort. A total of 91 patients (61 HD and 30 PD) were included for analyses in this study. Mortality rate was 60.0% (18/30) for PD and 52.5% (32/61) for HD. Kaplan-Meier estimate demonstrate that PD patients had a higher mortality rate than those underwent HD (log-rank p = 0.0039). Cox regression model demonstrated that PD was an independent predictor for further mortality in ESRD patients with subclinical peripheral artery disease.(p = 0.012, HR: 1.776, 95% CI: 1.136-2.775). In multivariate analysis, the HD group still had a greater survival than PD group (p = 0.005, HR:1.916, 95% CI: 1.218-3.015). In patients with subclinical peripheral artery disease, the patient survival is better in HD patients as compared with PD patients.

  20. Invasive and non-invasive evaluation of spontaneous arteriogenesis in a novel porcine model for peripheral arterial obstructive disease

    NARCIS (Netherlands)

    Buschmann, Ivo R.; Voskuil, Michiel; van Royen, Niels; Hoefer, Imo E.; Scheffler, Klaus; Grundmann, Sebastian; Hennig, Jürgen; Schaper, Wolfgang; Bode, Christoph; Piek, Jan J.

    2003-01-01

    Our current knowledge regarding the efficacy of factors stimulating collateral artery growth in the peripheral circulation primarily stems from models in small animals. However, experimental models in large sized animals are a prerequisite for extrapolation of growth factor therapy to patients with

  1. Soluble CD40 ligand impairs the function of peripheral blood angiogenic outgrowth cells and increases neointimal formation after arterial injury

    NARCIS (Netherlands)

    Hristov, Mihail; Gümbel, Denis; Lutgens, Esther; Zernecke, Alma; Weber, Christian

    2010-01-01

    Recent work has revealed an essential involvement of soluble CD40 ligand (sCD40L) in inflammation and atherosclerosis. We investigated whether sCD40L functionally affects peripheral blood-derived angiogenic early outgrowth cells (EOCs) and neointimal remodeling after arterial injury. Besides myeloid

  2. Diabetes mellitus and chronic kidney disease amplify accumulation of tissue advanced glycation end products in patients with peripheral artery disease

    NARCIS (Netherlands)

    Lefrandt, J.D.; De Vos, L.C.; Mulder, D.J.; Dullaart, R.P.F.; Lutgers, H.L.; Lambers Heerspink, H.J.; Smit, A.J.; Kamphuisen, P.W.; Zeebregts, C.J.

    2013-01-01

    Backgrounds and aims: Diabetes mellitus (DM) and chronic kidney disease (CKD) are important risk factors for peripheral artery disease (PAD) and associated with a severely increased cardiovascular (CV) risk in these patients. DM increases production of AGEs and CKD decreases their clearance, while

  3. Whole-body magnetic resonance angiography at 3 tesla using a hybrid protocol in patients with peripheral arterial disease

    DEFF Research Database (Denmark)

    Nielsen, Yousef W; Eiberg, Jonas P; Logager, Vibeke B

    2009-01-01

    The purpose of this study was to determine the diagnostic performance of 3T whole-body magnetic resonance angiography (WB-MRA) using a hybrid protocol in comparison with a standard protocol in patients with peripheral arterial disease (PAD). In 26 consecutive patients with PAD two different proto...

  4. Effect of exercise training on clot strength in patients with peripheral artery disease and intermittent claudication: An ancillary study.

    Science.gov (United States)

    Mauer, Karin; Exaire, J Emilio; Stoner, Julie A; Saucedo, Jorge F; Montgomery, Polly S; Gardner, Andrew W

    2015-01-01

    Patients with peripheral artery disease have walking impairment, greater thrombotic risk, and are often treated with exercise training. We sought to determine the effect of a 3-month-long exercise program on clot strength among patients with peripheral artery disease and intermittent claudication. Twenty-three symptomatic peripheral artery disease patients were randomly assigned to a walking exercise program or to an attention control group who performed light resistance exercise. We investigated the effect of exercise training on clot strength and time to clot formation was assessed by thromboelastography. After 3 months of exercise, clot strength (maximal amplitude) and time to clot formation (R) did not change significantly from baseline, even after improvements in claudication onset time (p < 0.01) and peak walking time (p < 0.05). Furthermore, changes in clot formation parameters were not significantly different between groups. Among the 10 individuals demonstrating a reduction in clot strength (reduced maximal amplitude), one was a smoker (10%) compared to 9 of 13 non-responders (69%) whose maximal amplitude was unchanged or increased (p = 0.0097). In this ancillary study, a 12-week walking program improved ambulatory function in peripheral artery disease patients with claudication, but does not modify clot strength or time to clot formation. Larger studies are needed to confirm these hypothesis generating findings and to determine whether a different amount or type of exercise may induce a change in clotting in this patient population.

  5. Effect of exercise training on clot strength in patients with peripheral artery disease and intermittent claudication: An ancillary study

    Directory of Open Access Journals (Sweden)

    Karin Mauer

    2015-03-01

    Full Text Available Objectives: Patients with peripheral artery disease have walking impairment, greater thrombotic risk, and are often treated with exercise training. We sought to determine the effect of a 3-month-long exercise program on clot strength among patients with peripheral artery disease and intermittent claudication. Methods: Twenty-three symptomatic peripheral artery disease patients were randomly assigned to a walking exercise program or to an attention control group who performed light resistance exercise. We investigated the effect of exercise training on clot strength and time to clot formation was assessed by thromboelastography. Results: After 3 months of exercise, clot strength (maximal amplitude and time to clot formation (R did not change significantly from baseline, even after improvements in claudication onset time (p < 0.01 and peak walking time (p < 0.05. Furthermore, changes in clot formation parameters were not significantly different between groups. Among the 10 individuals demonstrating a reduction in clot strength (reduced maximal amplitude, one was a smoker (10% compared to 9 of 13 non-responders (69% whose maximal amplitude was unchanged or increased (p = 0.0097. Conclusion: In this ancillary study, a 12-week walking program improved ambulatory function in peripheral artery disease patients with claudication, but does not modify clot strength or time to clot formation. Larger studies are needed to confirm these hypothesis generating findings and to determine whether a different amount or type of exercise may induce a change in clotting in this patient population.

  6. LOWER EXTREMITY MANIFESTATIONS OF PERIPHERAL ARTERY DISEASE: THE PATHOPHYSIOLOGIC AND FUNCTIONAL IMPLICATIONS OF LEG ISCHEMIA

    Science.gov (United States)

    McDermott, Mary McGrae

    2015-01-01

    Lower extremity peripheral artery disease (PAD) is frequently under-diagnosed, in part because of the wide variety of leg symptoms manifested by patients with PAD and in part because of the high prevalence of asymptomatic PAD. In primary care medical practices, 30% to 60% of PAD patients report no exertional leg symptoms and approximately 45–50% report exertional leg symptoms that are not consistent with classic intermittent claudication. The prevalence and extent of functional impairment and functional decline in PAD may also be underappreciated. Functional impairment and functional decline is common in PAD, even among those who are asymptomatic. Lower extremity ischemia is also associated with pathophysiologic changes in calf skeletal muscle including smaller calf muscle area, increased calf muscle fat content, impaired leg strength, and impaired metabolic function. People with severe PAD have poorer peroneal nerve conduction velocity compared to people with mild PAD or no PAD. The degree of ischemia-related pathophysiologic changes in lower extremity muscles and peripheral nerves of people with PAD are associated with the degree of functional impairment. New interventions are needed to improve functional performance and prevent mobility loss in the large number of PAD patients, including in those who are asymptomatic or who have exertional leg symptoms other than claudication. PMID:25908727

  7. The scientific evidence of arterial line filtration in cardiopulmonary bypass.

    Science.gov (United States)

    Johagen, Daniel; Svenmarker, Staffan

    2016-09-01

    The indication for arterial line filtration (ALF) is to inhibit embolisation during cardiopulmonary bypass. Filtration methods have developed from depth filters to screen filters and from a stand-alone component to an integral part of the oxygenator. For many years, ALF has been a standard adopted by a majority of cardiac centres worldwide. The following review aims to summarize the available evidence in support for ALF and report on its current practice in Europe. The principles and application of ALF in Europe was investigated using a survey conducted in 2014. The scientific evidence for ALF was examined by performing a systematic literature search in six different databases, using the following search terms: "Cardiopulmonary bypass AND filters AND arterial". The primary endpoint was protection against cerebral injury verified by the degree of cerebral embolisation or cognitive tests. The secondary endpoint was improvement of the clinical outcome verified elsewise. Only randomised clinical trials were considered. The response rate was 31% (n=112). The great majority (88.5%) of respondents were using ALF, following more than 10 years of experience. Integrated arterial filtration was used by 55%. Of respondents not using ALF, fifty-four percent considered starting using integrated arterial filtration. The systematic literature database search returned 180 unique publications where 82 were specifically addressing ALF in cardiopulmonary bypass. Only four out of the 82 identified publications fulfilled our inclusion criteria. Of these, three were more than 20 years old and based on the use of bubble oxygenation. ALF is a standard implemented in a majority of cardiopulmonary bypass procedures in Europe. The level of scientific evidence available in support of current arterial line filtration methods in cardiopulmonary bypass is, however, poor. Large, well-designed, randomised trials are warranted. © The Author(s) 2015.

  8. Does peripheral arterial occlusive disease influence muscle strength and exercise capacity in COPD patients?

    Directory of Open Access Journals (Sweden)

    Natacha Angélica da Fonseca Miranda

    Full Text Available Abstract Background The pathophysiology of chronic obstructive pulmonary disease (COPD is complex and understanding of it has been changing in recent years, with regard to its multisystemic manifestations, especially peripheral dysfunction and its influence on intolerance to exercise. Objectives To evaluate the relationship between peripheral arterial occlusive disease (PAOD and peripheral muscle strength and exercise capacity in COPD patients. Methods We conducted a cross-sectional study of 35 patients with COPD who were evaluated with the Ankle-Brachial Index, handgrip strength test, 1 repetition maximum (1RM of knee extensors and flexors, and distance covered in the incremental shuttle walking test (dISWT. Results COPD patients with coexisting PAOD had lower dominant handgrip strength test results (33.00 vs. 26.66 kgf, p = 0.02 and worse performance in the dISWT (297.32 vs. 219.41 m, p = 0.02 when compared to the COPD patients without PAOD. Strong correlations were found between the result of the handgrip strength test and both the dISWT (r = 0.78; p < 0.001 and the 1RM/knee extension (r = 0.71; p = 0.03; and also between the dISWT and both the 1RM/knee extension (r = 0.72; p = 0.02 and the 1RM/knee flexion (r = 0.92; p < 0.001. The linear regression model showed that the dISWT variable alone explains 15.3% of the Ankle-Brachial Index result (p = 0.01. Conclusion COPD patients with PAOD exhibit reduced muscle strength and lower exercise capacity than COPD patients without PAOD.

  9. Initial experience with a new quantitative assessment tool for fluorescent imaging in peripheral artery disease.

    Science.gov (United States)

    Rieß, Henrik Christian; Duprée, Anna; Behrendt, Christian-Alexander; Kölbel, Tilo; Debus, Eike Sebastian; Larena-Avellaneda, Axel; Russ, Detlef; Wipper, Sabine

    2017-08-01

    Perioperative evaluation in peripheral artery disease (PAD) by common vascular diagnostic tools is limited by open wounds, medial calcinosis or an altered collateral supply of the foot. Indocyanine green fluorescent imaging (ICG-FI) has recently been introduced as an alternative tool, but so far a standardized quantitative assessment of tissue perfusion in vascular surgery has not been performed for this purpose. The aim of this feasibility study was to investigate a new software for quantitative assessment of tissue perfusion in patients with PAD using indocyanine green fluorescent imaging (ICG-FI) before and after peripheral bypass grafting. Indocyanine green fluorescent imaging was performed in seven patients using the SPY Elite system before and after peripheral bypass grafting for PAD (Rutherford III-VI). Visual and quantitative evaluation of tissue perfusion was assessed in an area of low perfusion (ALP) and high perfusion (AHP), each by three independent investigators. Data assessment was performed offline using a specially customized software package (Institute for Laser Technology, University Ulm, GmbH). Slope of fluorescent intensity (SFI) was measured as time-intensity curves. Values were compared to ankle-brachial index (ABI), slope of oscillation (SOO), and time to peak (TTP) obtained from photoplethysmography (PPG). All measurements before and after surgery were successfully performed, showing that ABI, TTP, and SOO increased significantly compared to preoperative values, all being statistically significant (P < 0.05), except for TTP (p = 0.061). Further, SFI increased significantly in both ALP and AHP (P < 0.05) and correlated considerably with ABI, TTP, and SOO (P < 0.05). In addition to ABI and slope of oscillation (SOO), the ICG-FI technique allows visual assessment in combination with quantitative assessment of tissue perfusion in patients with PAD. Ratios related to different perfusion patterns and SFI seem to be useful tools to reduce factors

  10. Large mobile thrombus in non-atherosclerotic thoracic aorta as the source of peripheral arterial embolism

    Directory of Open Access Journals (Sweden)

    Brkovic Zoran

    2005-11-01

    Full Text Available Abstract The presence of thrombi in the atherosclerotic and/or aneurysmatic aorta with peripheral arterial embolism is a common scenario. Thrombus formation in a morphologically normal aorta, however, is a rare event. A 50 years old woman was admitted to the mergency department for pain, coldness, and anesthesia in the the left foot. She had a 25 years history of cigarette smoking, a history of postmenopausal hormone replacement therapy (HRT, hypercholesterolemia and hyperfibrinogenemia. An extensive serologic survey for hypercoagulability, including antiphospholipid antibodies, and vasculitis disorders was negative. Transesophageal echocardiography revealed a large, pedunculated and hypermobile thrombus attached to the aortic wall 5 cm distal of the left subclavian artery. The patient was admitted to the surgery department, where a 15 cm long fresh, parietal thrombus could be removed from the aorta showing no macroscopic wall lesions or any other morphologic abnormalities. This case report demonstrates the possibility of evolving a large, pedunculated thrombus in a morphologically intact aorta in a postmenopausal woman with thrombogenic conditions such as hyperfibrinogenemia, hypercholesterolemia, smoking and HRT. For these patients, profiling the individual risk and weighing the benefits against the potential risks is warranted before prescribing HRT.

  11. Dark chocolate acutely improves walking autonomy in patients with peripheral artery disease.

    Science.gov (United States)

    Loffredo, Lorenzo; Perri, Ludovica; Catasca, Elisa; Pignatelli, Pasquale; Brancorsini, Monica; Nocella, Cristina; De Falco, Elena; Bartimoccia, Simona; Frati, Giacomo; Carnevale, Roberto; Violi, Francesco

    2014-07-02

    NOX-2, the catalytic subunit of NADPH oxidase, has a key role in the formation of reactive oxidant species and is implicated in impairing flow-mediated dilation (FMD). Dark chocolate exerts artery dilatation via down-regulating NOX2-mediated oxidative stress. The aim of this study was to investigate whether dark chocolate improves walking autonomy in peripheral artery disease (PAD) patients via an oxidative stress-mediated mechanism. FMD, serum levels of isoprostanes, nitrite/nitrate (NOx) and sNOX2-dp, a marker of blood NOX2 activity, maximal walking distance (MWD) and maximal walking time (MWT) were studied in 20 PAD patients (14 males and 6 females, mean age: 69±9 years) randomly allocated to 40 g of dark chocolate (>85% cocoa) or 40 g of milk chocolate (≤35% cocoa) in a single blind, cross-over design. The above variables were assessed at baseline and 2 hours after chocolate ingestion. Dark chocolate intake significantly increased MWD (+11%; Pchocolate intake. Serum epicatechin and its methylated metabolite significantly increased only after dark chocolate ingestion. Multiple linear regression analysis showed that Δ of MWD was independently associated with Δ of MWT (Pchocolate acutely improves walking autonomy with a mechanism possibly related to an oxidative stress-mediated mechanism involving NOX2 regulation. http://www.clinicaltrials.gov. Unique identifier: NCT01947712. © 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  12. Progenitor cell release plus exercise to improve functional performance in peripheral artery disease: the PROPEL Study.

    Science.gov (United States)

    Domanchuk, Kathryn; Ferrucci, Luigi; Guralnik, Jack M; Criqui, Michael H; Tian, Lu; Liu, Kiang; Losordo, Douglas; Stein, James; Green, David; Kibbe, Melina; Zhao, Lihui; Annex, Brian; Perlman, Harris; Lloyd-Jones, Donald; Pearce, William; Taylor, Doris; McDermott, Mary M

    2013-11-01

    Functional impairment, functional decline, and mobility loss are major public health problems in people with lower extremity peripheral artery disease (PAD). Few medical therapies significantly improve walking performance in PAD. We describe methods for the PROgenitor cell release Plus Exercise to improve functionaL performance in PAD (PROPEL) Study, a randomized controlled clinical trial designed to determine whether granulocyte-macrophage colony stimulating factor (GM-CSF) combined with supervised treadmill walking exercise improves six-minute walk distance more than GM-CSF alone, more than supervised treadmill exercise alone, and more than placebo plus attention control in participants with PAD, respectively. PROPEL Study participants are randomized to one of four arms in a 2 by 2 factorial design. The four study arms are GM-CSF plus supervised treadmill exercise, GM-CSF plus attention control, placebo plus supervised exercise therapy, or placebo plus attention control. The primary outcome is change in six-minute walk distance at 12-week follow-up. Secondary outcomes include change in brachial artery flow-mediated dilation (FMD), change in maximal treadmill walking time, and change in circulating CD34+ cells at 12-week follow-up. Outcomes are also measured at six-week and six-month follow-up. Results of the PROPEL Study will have important implications for understanding mechanisms of improving walking performance and preventing mobility loss in the large and growing number of men and women with PAD. © 2013.

  13. Dark Chocolate Acutely Improves Walking Autonomy in Patients With Peripheral Artery Disease

    Science.gov (United States)

    Loffredo, Lorenzo; Perri, Ludovica; Catasca, Elisa; Pignatelli, Pasquale; Brancorsini, Monica; Nocella, Cristina; De Falco, Elena; Bartimoccia, Simona; Frati, Giacomo; Carnevale, Roberto; Violi, Francesco

    2014-01-01

    Background NOX‐2, the catalytic subunit of NADPH oxidase, has a key role in the formation of reactive oxidant species and is implicated in impairing flow‐mediated dilation (FMD). Dark chocolate exerts artery dilatation via down‐regulating NOX2‐mediated oxidative stress. The aim of this study was to investigate whether dark chocolate improves walking autonomy in peripheral artery disease (PAD) patients via an oxidative stress‐mediated mechanism. Methods and Results FMD, serum levels of isoprostanes, nitrite/nitrate (NOx) and sNOX2‐dp, a marker of blood NOX2 activity, maximal walking distance (MWD) and maximal walking time (MWT) were studied in 20 PAD patients (14 males and 6 females, mean age: 69±9 years) randomly allocated to 40 g of dark chocolate (>85% cocoa) or 40 g of milk chocolate (≤35% cocoa) in a single blind, cross‐over design. The above variables were assessed at baseline and 2 hours after chocolate ingestion. Dark chocolate intake significantly increased MWD (+11%; Pchocolate intake. Serum epicatechin and its methylated metabolite significantly increased only after dark chocolate ingestion. Multiple linear regression analysis showed that Δ of MWD was independently associated with Δ of MWT (Pchocolate acutely improves walking autonomy with a mechanism possibly related to an oxidative stress‐mediated mechanism involving NOX2 regulation. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01947712. PMID:24990275

  14. The fibrinogen gamma 10034C>T polymorphism is not associated with Peripheral Arterial Disease.

    Science.gov (United States)

    Bahadori, Babak; Uitz, Elisabeth; Dehchamani, Dadbeh; Pilger, Ernst; Renner, Wilfried

    2010-10-01

    Conversion of fibrinogen to fibrin plays an essential role in hemostasis and results in stabilization of the fibrin clot. Fibrinogen consists of three pairs of non-identical polypeptide chains, encoded by different genes (fibrinogen alpha [FGA], fibrinogen beta [FGB] and fibrinogen gamma [FGG]). A functional single nucleotide polymorphism (SNP) in the 3' untranslated region of the FGG gene (FGG 10034C>T, rs2066865) has been associated with deep venous thrombosis and myocardial infarction. Aim of the present study was to analyze the role of this polymorphism in peripheral arterial disease (PAD). The study was designed as case-control study including 891 patients with documented PAD and 777 control subjects. FGG genotypes were determined by exonuclease (TaqMan) assays. FGG genotype frequencies were not significantly different between PAD patients (CC: 57.3%, CT: 36.7%, TT: 5.8%) and control subjects (CC: 60.9%, CT: 33.5%, TT 5.6%; p=0.35). In a multivariate logistic regression analysis including age, sex, smoking, diabetes, arterial hypertension and hypercholesterolemia, the FGG 10034 T variant was not significantly associated with the presence of PAD (Odds ratio 1.07, 95% confidence interval 0.84 - 1.37; p = 0.60). The FGG 10034C>T polymorphism was furthermore not associated with age at onset of PAD. We conclude that the thrombophilic FGG 10034 T gene variant does not contribute to the genetic susceptibility to PAD. Copyright © 2010 Elsevier Ltd. All rights reserved.

  15. Invasive and non-invasive evaluation of spontaneous arteriogenesis in a novel porcine model for peripheral arterial obstructive disease.

    Science.gov (United States)

    Buschmann, Ivo R; Voskuil, Michiel; van Royen, Niels; Hoefer, Imo E; Scheffler, Klaus; Grundmann, Sebastian; Hennig, Jürgen; Schaper, Wolfgang; Bode, Christoph; Piek, Jan J

    2003-03-01

    Our current knowledge regarding the efficacy of factors stimulating collateral artery growth in the peripheral circulation primarily stems from models in small animals. However, experimental models in large sized animals are a prerequisite for extrapolation of growth factor therapy to patients with peripheral atherosclerotic obstructive disease. Therefore, we have developed a novel porcine femoral artery ligation model using non-invasive and invasive evaluation techniques. In 12 young farm pigs and nine older minipigs, a ligation of the superficial femoral artery was performed. Using an intra-arterial catheter, phosphate buffered saline (PBS) was administered with a first-pass over the collateral vascular bed. Directly after ligation as well as after 2 weeks of continuous infusion of PBS, perfusion of the leg was measured using various flow and pressure parameters. Using a pump driven extracorporal system, collateral conductance was determined under maximal vasodilatation. Conductance decreased after acute ligation to similar levels in both young farm pigs as well as the older minipigs (both 9.3% of normal perfusion) and recovered after 2 weeks to a higher value in farm pigs compared with minipigs (22.4 vs. 12.7% of normal; Parteries. To the best of our knowledge this is the first in vivo pig model for hemodynamic assessment of growth of collateral arteries in the peripheral circulation, that is suitable for evaluation of arteriogenic effects of growth factors or genes.

  16. Association of foot ulcer with tibial artery calcification is independent of peripheral occlusive disease in type 2 diabetes.

    Science.gov (United States)

    Guzman, Raul J; Bian, Aihua; Shintani, Ayumi; Stein, C Michael

    2013-03-01

    To determine the relationship between foot ulcers, arterial calcification, and peripheral occlusive disease in patients with type 2 diabetes. We performed a cross-sectional study on 162 patients with type 2 diabetes who underwent assessment of tibial artery calcification (TAC) by non-contrasted CT scan. Peripheral artery occlusive disease was assessed by angiography. Foot status including the presence or absence of ulcers was documented at presentation. A multivariable logistic regression model was used to evaluate the association between foot ulcers, arterial calcification, and the extent of peripheral atherosclerotic occlusive disease. Patients with foot ulcers (N=31) were more likely to be older and have a history of tobacco use. They were also more likely to have higher TAC scores (median [IQR]: 4324.6 [609.9, 11163.6] vs. 9.4 [0.0, 343.9], PFoot ulcer was strongly associated with elevated TAC scores in a multivariable regression model (odds ratio [95% CI]=2.76 [1.61, 4.75], P=0.0002). There is a strong association between arterial calcification and diabetic foot ulcers that persists after adjusting for the extent of atherosclerosis in patients with type 2 diabetes. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  17. [Recent Knowledge of Smoking and Peripheral Arterial Disease in Lower Extremities].

    Science.gov (United States)

    Sotoda, Yoko; Hirooka, Shigeki; Orita, Hiroyuki; Wakabayashi, Ichiro

    2015-01-01

    Peripheral arterial disease (PAD) is an atherosclerotic obstructive disease of the arteries in lower extremities. Patients with PAD show high rates of mortality from coronary artery disease (CAD) and stroke. Smoking as well as diabetes is an important risk factor for PAD. A lesion of PAD in the lower extremities tends to be more proximal in smokers than in nonsmokers and to be more distal in patients with diabetes than in nondiabetics. By a systematic review, the odds ratio for PAD of smokers vs nonsmokers has been reported to be in the range of 1.7-7.4. Previous epidemiological studies suggest a stronger association of smoking with PAD than that with CAD. Nitric oxide (NO) is an important molecule suppressing the progression of atherosclerosis, but this function is compromised by smoking. Smoking decreases the bioactivity of NO and the expression level of NO synthase. In addition, smoking results in deteriorations of risk factors for atherosclerosis such as decreases in blood HDL (high-density lipoprotein) cholesterol and tissue plasminogen activator levels and increases in the levels of blood triglycerides, LDL (low-density lipoprotein) cholesterol, fibrinogen and the von Willebrand factor. Thus, smoking increases blood coagulability and deteriorates the blood lipid profile, resulting in thrombogenetic proneness and dyslipidemia. Smoking also increases the generation of atherogenic oxidized LDL in blood and decreases antiatherogenic prostacyclin production in the vascular endothelium. Smoking cessation is important for the prevention and therapy of PAD, and to this end, counseling by physicians and nicotine replacement therapy are useful and strongly recommended for patients with PAD.

  18. PADPIN: protein-protein interaction networks of angiogenesis, arteriogenesis, and inflammation in peripheral arterial disease

    Science.gov (United States)

    Vijay, Chaitanya G.; Annex, Brian H.; Bader, Joel S.; Popel, Aleksander S.

    2015-01-01

    Peripheral arterial disease (PAD) results from an obstruction of blood flow in the arteries other than the heart, most commonly the arteries that supply the legs. The complexity of the known signaling pathways involved in PAD, including various growth factor pathways and their cross talks, suggests that analyses of high-throughput experimental data could lead to a new level of understanding of the disease as well as novel and heretofore unanticipated potential targets. Such bioinformatic analyses have not been systematically performed for PAD. We constructed global protein-protein interaction networks of angiogenesis (Angiome), immune response (Immunome), and arteriogenesis (Arteriome) using our previously developed algorithm GeneHits. The term “PADPIN” refers to the angiome, immunome, and arteriome in PAD. Here we analyze four microarray gene expression datasets from ischemic and nonischemic gastrocnemius muscles at day 3 posthindlimb ischemia (HLI) in two genetically different C57BL/6 and BALB/c mouse strains that display differential susceptibility to HLI to identify potential targets and signaling pathways in angiogenesis, immune, and arteriogenesis networks. We hypothesize that identification of the differentially expressed genes in ischemic and nonischemic muscles between the strains that recovers better (C57BL/6) vs. the strain that recovers more poorly (BALB/c) will help for the prediction of target genes in PAD. Our bioinformatics analysis identified several genes that are differentially expressed between the two mouse strains with known functions in PAD including TLR4, THBS1, and PRKAA2 and several genes with unknown functions in PAD including EphA4, TSPAN7, SLC22A4, and EIF2a. PMID:26058837

  19. [Hearing disorders in peripheral arterial vascular diseases. A contribution on hearing loss in the aged].

    Science.gov (United States)

    Böhme, G

    1987-12-01

    Otologic-audiologic examination was carried out in 171 patients (aged between 37-86; average age 64) with confirmed internal angiologic peripheral arterial vascular disease. Additional findings were observed in 94 of these patients who revealed an obliteration of the internal carotid artery or cerebral ischaemic stroke. Diseases of the ear were excluded clinically and audiologically. The mean hearing loss shows a sensory-neural high-tone loss in the tone audiogram. The range of scatter increases proportionately to the increase in tone loss. If compared with the physiologic examination of geriatric patients, the total word comprehension and minimal discrimination loss in the speech audiogram point towards a pathologic impairment of hearing in old age. The total word comprehension amounts to 251.20% in the 51-60 age group, 250.40% in the persons 61-70 years of age, 180.96% for the 71-80 age group and 131.67% for those over 80 years of age. The minimal discrimination loss comprises 4.00% for the 51-60 age group, 4.19% for the 61-70 group, 21.35% for 71-80 age bracket and 35.62% for those over 80. On the strength of these findings, an arterial sclerotic vascular disease should be considered as one of the multifactorial genesis of hearing impairment in old age. Special attention should be focussed on decompensation of the total word comprehension and minimal discrimination loss before the age of eighty. This would contribute towards a differentiation of physiologic and pathologic hearing diseases in old age.

  20. Muscle afferent receptors engaged in augmented sympathetic responsiveness in peripheral artery disease

    Directory of Open Access Journals (Sweden)

    Jianhua eLi

    2012-07-01

    Full Text Available The exercise pressor reflex (EPR is a neural control mechanism responsible for the cardiovascular responses to exercise. As exercise is initiated, thin fiber muscle afferent nerves are activated by mechanical and metabolic stimuli arising in the contracting muscles. This leads to reflex increases in arterial blood pressure and heart rate primarily through activation of sympathetic nerve activity (SNA. Studies of humans and animals have indicated that the EPR is exaggerated in a number of cardiovascular diseases. For the last several years, studies have specifically employed a rodent model to examine the mechanisms at receptor and cellular levels by which responses of SNA and blood pressure to static exercise are heightened in peripheral artery disease (PAD, one of the most common cardiovascular disorders. A rat model of this disease has well been established. Specifically, femoral artery occlusion is used to study intermittent claudication that is observed in human PAD. The receptors on thin fiber muscle afferents that are engaged in this disease include transient receptor potential vanilloid type 1 (TRPV1, purinergic P2X and acid sensing ion channel (ASIC. The role played by nerve growth factor (NGF in regulating those sensory receptors in the processing of amplified EPR was also investigated. The purpose of this review is to focus on a theme namely that PAD accentuates autonomic reflex responses to exercise and further address regulatory mechanisms leading to abnormal sympathetic responsiveness. This review will present some of recent results in regard with several receptors in muscle sensory neurons in contribution to augmented autonomic reflex responses in PAD. Review of the findings from recent studies would lead to a better understanding in integrated processing of sympathetic nervous system in PAD.

  1. Selected endothelial hemostatic markers in patients with peripheral arterial disease after endovascular revascularization and restenosis formation

    Directory of Open Access Journals (Sweden)

    Daniel Kotschy

    2015-08-01

    Full Text Available Surgical and endovascular revascularization of ischemic legs in patients with peripheral arterial disease (PAD can damage the arterial wall (endothelial and smooth muscle cells. Hemostatic factors released during endothelial dysfunction can lead to restenosis.1. Determination of selected endothelial hemostatic factors in PAD patients and a reference group.2. Prospective observation of new restenosis appearance in PAD patients after endovascular revascularization.3. Comparison of selected endothelial hemostatic factors between non-restenotic and restenotic PAD patients.150 PAD patients after endovascular revascularization – 90 men and 60 women, aged 44-88 (mean 65.5 years – were examined. During one-year observation after the revascularization procedures in 38 PAD patients restenosis occurred, when blood samples were also collected. The reference group consisted of 53 healthy persons – 44 men and 9 women, aged 20-56 years. Blood was drawn in the morning into 3.2% sodium citrate at a ratio of 9:1. Tissue factor (TF, tissue factor pathway inhibitor (TFPI, thrombomodulin (TM, von Willebrand factor (vWF and tissue plasminogen activator (t-PA were measured in plasma with commercial tests using the enzyme immunoassay.In the plasma of PAD patients after revascularization, the concentrations of TF and vWF were significantly higher, TM lower, TFPI and t-PA similar compared to the reference group. Six months after revascularization the level of TF had increased and vWF had significantly decreased. The endothelial hemostatic factors before and after restenosis did not significantly differ except TF, which after restenosis was higher.Increased TF and vWF levels in PAD patients indicate arterial endothelial cell damage, by atherosclerotic and revascularization processes. In PAD patients with restenosis compared to these patients before restenosis the determined endothelial hemostatic factors, except TF level, did not significantly differ. Perhaps TF

  2. CT angiography and magnetic resonance angiography findings after surgical and interventional radiology treatment of peripheral arterial obstructive disease.

    Science.gov (United States)

    Anzidei, Michele; Lucatelli, Pierleone; Napoli, Alessandro; Jens, Sjoerd; Saba, Luca; Cartocci, Gaia; Sedati, Pietro; d'Adamo, Alessandro; Catalano, Carlo

    2015-01-01

    In the last years, technical innovations in the field of CT angiography (CTA) and magnetic resonance angiography (MRA) have allowed accurate and highly detailed evaluation of peripheral vascular pathologies. This has dramatically changed the diagnostic approach in treatment planning of peripheral arterial obstructive disease and also enabling early identification of treatment failure or treatment-related complications after surgical or endovascular procedures. Although Doppler Ultrasound is the first-line imaging modality during follow-up after treatment, its role is currently diminishing in importance mostly because of the proliferation of high-end CT and MR scanners capable of fast, reproducible, and highly reliable vascular imaging. The aim of this study is to review the various surgical and endovascular procedures for peripheral arterial obstructive disease and to provide CTA and MRA samples of common and uncommon complications related to treatment. Copyright © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  3. Immediate effects of electrical stimulation, diathermy, and physical exercise on lower limb arterial blood flow in diabetic women with peripheral arterial disease: a randomized crossover trial.

    Science.gov (United States)

    Guirro, Elaine Caldeira de Oliveira; Guirro, Rinaldo Roberto de Jesus; Dibai-Filho, Almir Vieira; Pascote, Siane Cristina Santarosa; Rodrigues-Bigaton, Delaine

    2015-01-01

    The purpose of this study was to assess the effects of high-voltage electrical stimulation (HVES), continuous short wave diathermy, and physical exercise on arterial blood flow in the lower limbs of diabetic women with peripheral arterial disease. A crossover study was carried out involving 15 diabetic women (mean age of 77.87 ± 6.20 years) with a diagnosis of peripheral arterial disease. One session of each therapeutic resource was held, with a 7-day washout period between protocols. Blood flow velocity was evaluated before each session and 0, 20, 40 and 60 minutes after the administration of each protocol. Two-way repeated-measures analysis of variance with Bonferroni post hoc test was used for the intragroup and intergroup comparisons. In the intragroup analysis, a significant reduction (P .05). Proximal blood circulation in the lower limb of diabetic women with peripheral arterial disease was increased by a single session of HVES and physical exercise, whereas distal circulation was only increased with physical exercise. Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

  4. Whole-body magnetic resonance angiography with additional steady-state acquisition of the infragenicular arteries in patients with peripheral arterial disease

    DEFF Research Database (Denmark)

    Nielsen, Yousef W; Eiberg, Jonas P; Løgager, Vibeke B

    2010-01-01

    The purpose of this investigation was to determine if addition of infragenicular steady-state (SS) magnetic resonance angiography (MRA) to first-pass imaging improves diagnostic performance compared with first-pass imaging alone in patients with peripheral arterial disease (PAD) undergoing whole-body.......03 mmol/kg body weight. Ten minutes after injection of the contrast agent, high-resolution (0.7-mm isotropic voxels) SS-MRA of the infragenicular arteries was performed. Using DSA as the "gold standard," sensitivities and specificities for detecting significant arterial stenoses (>/=50% luminal narrowing......) with first-pass WB-MRA, SS-MRA, and combined first-pass and SS-MRA were calculated. Kappa statistics were used to determine intermodality agreement between MRA and DSA. Overall sensitivity and specificity for detecting significant arterial stenoses with first-pass WB-MRA was 0.70 (95% confidence interval 0...

  5. Association between 1p13 polymorphisms and peripheral arterial disease in a Chinese population with diabetes.

    Science.gov (United States)

    Qin, Jiangyuan; Tian, Jinli; Liu, Guanhua; Zhang, Yazhong; Tian, Luobing; Zhen, Yanfeng; Zhang, Hewei; Xu, Jing; Sun, Xueling; Fang, Hui

    2018-01-22

    Variants on chromosome 1p13 have been associated with coronary artery disease and acute myocardial infarction risk in different ethnics. This study was aimed to investigate the association between 1p13 polymorphisms and the development of peripheral artery disease (PAD) in a Chinese population with type 2 diabetic mellitus (T2DM). 1p13 polymorphisms rs599839, rs646776 and rs12740374 were assessed in a cohort of 882 T2DM cases including 440 T2DM with PAD (DM+PAD group) and 442 cases without PAD (DM group). Genotyping was performed using TaqMan assay. Compared with DM group,frequencies of minor G allele of both rs599839 and rs646776 and minor T allele of rs12740374 decreased(P=0.013, P=0.019 and P=0.005 respectively), and the frequencies of rs599839 AG+GG, rs646776 AG+GG, rs12740374 CT+TT genotypes were statistically significantly decreased as well (P=0.017, P=0.011 and P=0.007 respectively) in the dominant model in DM+PAD group than in DM group. Multivariate unconditional logistic regression analyses adjusted for age, HbA1C, TG, LDL-C, smoking, hypertension, diabetes duration, coronary heart disease, cerebral infarction showed that the genotypic distribution of rs599839 AG+GG, rs646776 AG+GG and rs12740374 CT+TT remained statistically different between DM and DM+PAD group (P=0.014, P=0.003 and P=0.004 respectively). Frequencies of haplotype GGT were statistically significantly different between groups (P = 0.08). Our study strongly supports that genotypes of rs599839, rs646776 and rs12740374 on 1p13 were protective factors for diabetic peripheral arterial disease in a Chinese population. Haplotype GGT generated by rs599839, rs646776 and rs12740374 may also decrease the risk of the disease. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  6. Risk Stratification of Patients with Peripheral Arterial Disease and Abdominal Aortic Aneurysm Using Aortic Augmentation Index.

    Science.gov (United States)

    Beckmann, Marianne; Jacomella, Vincenzo; Kohler, Malcom; Lachat, Mario; Salem, Amr; Amann-Vesti, Beatrice; Husmann, Marc

    2015-01-01

    Central augmentation index (cAIx) is an indicator for vascular stiffness. Obstructive and aneurysmatic vascular disease can affect pulse wave propagation and reflection, causing changes in central aortic pressures. To assess and compare cAIx in patients with peripheral arterial disease (PAD) and / or abdominal aortic aneurysm (AAA). cAIx was assessed by radial applanation tonometry (Sphygmocor) in a total of 184 patients at a tertiary referral centre. Patients were grouped as having PAD only, AAA only, or both AAA and PAD. Differences in cAIx measurements between the three patient groups were tested by non-parametric tests and stepwise multivariate linear regression analysis to investigate associations with obstructive or aneurysmatic patterns of vascular disease. In the study sample of 184 patients, 130 had PAD only, 20 had AAA only, and 34 patients had both AAA and PAD. Mean cAIx (%) was 30.5 ± 8.2 across all patients. It was significantly higher in females (35.2 ± 6.1, n = 55) than males (28.4 ± 8.2, n = 129), and significantly higher in patients over 80 years of age (34.4 ± 6.9, n = 22) than in those under 80 years (30.0 ± 8.2, n = 162). Intergroup comparison revealed a significant difference in cAIx between the three patient groups (AAA: 27.3 ± 9.5; PAD: 31.4 ± 7.8; AAA & PAD: 28.8 ± 8.5). cAIx was significantly lower in patients with AAA, higher in patients with both AAA and PAD, and highest in patients with PAD only (beta = 0.21, p = 0.006). Non-invasive assessment of arterial stiffness in high-risk patients indicates that cAIx differs according to the pattern of vascular disease. Measurements revealed significantly higher cAIx values for patients with obstructive peripheral arterial disease than for patients with aneurysmatic disease.

  7. Risk Stratification of Patients with Peripheral Arterial Disease and Abdominal Aortic Aneurysm Using Aortic Augmentation Index.

    Directory of Open Access Journals (Sweden)

    Marianne Beckmann

    Full Text Available Central augmentation index (cAIx is an indicator for vascular stiffness. Obstructive and aneurysmatic vascular disease can affect pulse wave propagation and reflection, causing changes in central aortic pressures.To assess and compare cAIx in patients with peripheral arterial disease (PAD and / or abdominal aortic aneurysm (AAA.cAIx was assessed by radial applanation tonometry (Sphygmocor in a total of 184 patients at a tertiary referral centre. Patients were grouped as having PAD only, AAA only, or both AAA and PAD. Differences in cAIx measurements between the three patient groups were tested by non-parametric tests and stepwise multivariate linear regression analysis to investigate associations with obstructive or aneurysmatic patterns of vascular disease.In the study sample of 184 patients, 130 had PAD only, 20 had AAA only, and 34 patients had both AAA and PAD. Mean cAIx (% was 30.5 ± 8.2 across all patients. It was significantly higher in females (35.2 ± 6.1, n = 55 than males (28.4 ± 8.2, n = 129, and significantly higher in patients over 80 years of age (34.4 ± 6.9, n = 22 than in those under 80 years (30.0 ± 8.2, n = 162. Intergroup comparison revealed a significant difference in cAIx between the three patient groups (AAA: 27.3 ± 9.5; PAD: 31.4 ± 7.8; AAA & PAD: 28.8 ± 8.5. cAIx was significantly lower in patients with AAA, higher in patients with both AAA and PAD, and highest in patients with PAD only (beta = 0.21, p = 0.006.Non-invasive assessment of arterial stiffness in high-risk patients indicates that cAIx differs according to the pattern of vascular disease. Measurements revealed significantly higher cAIx values for patients with obstructive peripheral arterial disease than for patients with aneurysmatic disease.

  8. Validity of the Edinburgh claudication questionnaire for diagnosis of peripheral artery disease in patients with type 2 diabetes.

    Science.gov (United States)

    Pita-Fernández, Salvador; Modroño-Freire, María José; Pértega-Díaz, Sonia; Herrera-Díaz, Lizbeth; Seoane-Pillado, Teresa; Paz-Solís, Adriana; Varela Modroño, José Luis

    2017-11-01

    To assess the prevalence of peripheral artery disease and the validity of clinical signs for its diagnosis in patients with type 2 diabetes. Setting: Health center (Mariñamansa,Orense). January 2011-January 2013. Patients with type 2 diabetes, informed consent. Age, sex, diabetes duration, body mass index, Charlson index, blood pressure, ankle-brachial index (ABI), cholesterol levels, smoking. Cardiovascular risk (UKPDS). Edinburgh Claudication Questionnaire. n=323 (± 5.5% accuracy, 95% confidence). multivariate logistic regression analysis. Sensitivity, specificity, predictive values, and agreement were estimated. Informed consent and ethics committee approval were obtained (2010/278). Mean patient age was 71.56±12.73 years, and mean diabetes duration 12.38±9.96 years. Symptoms of intermittent claudication were reported by 26,4% of patients, ABI was normal (0.9-1.1) in 37.2% of patients, less than 0.9 in 26,5%, and higher than 1.10 in 36.2% of patients. The kappa index of agreement of peripheral artery disease according to the Edinburgh Claudication Questionnaire and the ankle-brachial index was 0.33). The questionnaire showed a sensitivity of 50.7% for predicting the diagnosis of peripheral artery disease (ABI 2.6%, with positive and negative predictive values of 48.6% and 83.8% respectively. One-fourth of patients with type 2 diabetes had peripheral artery disease. There was a low level of agreement between the evaluation of symptoms of intermittent claudication and the results of the ankle-brachial index. Presence or absence of symptoms of claudication did not allow for confirming or ruling out peripheral artery disease. Copyright © 2017 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Plasma essential fatty acids, cigarette smoking, and dietary antioxidants in peripheral arterial disease. A population-based case-control study.

    Science.gov (United States)

    Leng, G C; Horrobin, D F; Fowkes, F G; Smith, F B; Lowe, G D; Donnan, P T; Ells, K

    1994-03-01

    The aim of this study was to determine the levels of plasma fatty acids in patients with peripheral arterial disease and in control subjects and to identify whether any risks of disease related to these differences were influenced by smoking and antioxidant intake. A random sample of 1592 men and women aged 55 to 74 years was selected from the general population (the Edinburgh Artery Study), from which 153 cases of peripheral arterial disease were identified by the presence of intermittent claudication and low ankle systolic pressures at rest and during reactive hyperemia; these were matched by age and sex to 153 control subjects with no evidence of cardiovascular disease. In 113 case and 122 control subjects, fatty acid levels were measured in three plasma fractions (triglyceride, cholesteryl ester, and phospholipid), and smoking habits and dietary antioxidant intake were determined by questionnaire. Arachidonic acid, eicosapentaenoic acid, docosahexaenoic acid, and docosapentaenoic acid (DPA/n-3) were significantly lower in the cases than controls (P case than control subjects were current or exsmokers (86% versus 50%; P case subjects had lower vitamin C intake (64.8 mg versus 71.1 mg; P < .05). By logistic regression adjustment for smoking and vitamin C intake, only DPA/n-3 (odds ratio, 0.19; P < .01) and arachidonic acid (odds ratio, 0.44; P < .05) remained significantly related to disease; only DPA/n-3 reduced the risk associated with smoking. We conclude that in subjects with peripheral arterial disease compared with healthy control subjects, the largest differences occurred in fatty acids of the n-3 series, particularly DPA/n-3.(ABSTRACT TRUNCATED AT 250 WORDS)

  10. Amino acids stimulate leg muscle protein synthesis in peripheral arterial disease.

    Science.gov (United States)

    Killewich, Lois A; Tuvdendorj, Demidmaa; Bahadorani, John; Hunter, Glenn C; Wolfe, Robert R

    2007-03-01

    Older patients with peripheral arterial disease (PAD) and intermittent claudication have impaired walking ability resulting from reduced lower extremity blood flow. Evidence suggests that leg muscle abnormalities may also contribute to walking intolerance in claudicants. In healthy elderly people, leg muscle protein synthesis can be augmented by nutritional supplementation with amino acids; preliminary data suggest that this increases muscle mass, walking ability, and functional status. In this study, we investigated whether amino acid supplementation would improve leg muscle protein synthesis in elderly PAD subjects, given that reduced leg blood flow might restrict the availability of amino acids to muscle. Two groups participated in the study: a group of 11 claudicants (mean age, 62 years; mean ankle-brachial index, 0.62; 46% male) and a group of 9 age- and sex-matched healthy controls (mean ankle-brachial index, 1.1). Both groups underwent measurement of leg blood flow by using strain gauge plethysmography, as well as measurement of baseline and amino acid-stimulated protein synthesis in leg muscle. Protein synthesis was quantified from calf muscle biopsy samples by measurement of the fractional synthetic rate (FSR) of protein, by using the incorporation of the stable isotope l-[ring-(2)H(5)]-phenylalanine into muscle protein. Total protein was extracted from muscle samples, and gas chromatography/mass spectroscopy methodology was used to measure incorporation rates. After measurement of basal FSR, all subjects were given an oral drink of 15 g of essential amino acids, and the measurements of FSR were repeated. Data are expressed as mean +/- SD; statistical analysis of differences between the two groups (with and without amino acid supplementation) was performed by using analysis of variance with repeated measures. Calf blood flow was reduced in the PAD subjects compared with controls (1.44 +/- 0.53 mL/min per 100 mg of tissue vs 2.40 +/- 0.57 mL/min per 100 mg

  11. Evidence for a Peripheral Olfactory Memory in Imprinted Salmon

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    Nevitt, Gabrielle A.; Dittman, Andrew H.; Quinn, Thomas P.; Moody, William J., Jr.

    1994-05-01

    The remarkable homing ability of salmon relies on olfactory cues, but its cellular basis is unknown. To test the role of peripheral olfactory receptors in odorant memory retention, we imprinted coho salmon (Oncorhynchus kisutch) to micromolar concentrations of phenyl ethyl alcohol during parr-smolt transformation. The following year, we measured phenyl ethyl alcohol responses in the peripheral receptor cells using patch clamp. Cells from imprinted fish showed increased sensitivity to phenyl ethyl alcohol compared either to cells from naive fish or to sensitivity to another behaviorally important odorant (L-serine). Field experiments verified an increased behavioral preference for phenyl ethyl alcohol by imprinted salmon as adults. Thus, some component of the imprinted olfactory homestream memory appears to be retained peripherally.

  12. Morphological, histochemical, and interstitial pressure changes in the tibialis anterior muscle before and after aortofemoral bypass in patients with peripheral arterial occlusive disease

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    Grigoriadis Nikolaos

    2002-02-01

    Full Text Available Abstract Background Morphological and electrophysiological studies of ischemic muscles in peripheral arterial disease disclosed evidence of denervation and fibre atrophy. The purpose of the present study is to describe morphological changes in ischemic muscles before and after reperfusion surgery in patients with peripheral occlusive arterial disease, and to provide an insight into the effect of reperfusion on the histochemistry of the reperfused muscle. Methods Muscle biopsies were obtained from the tibialis anterior of 9 patients with chronic peripheral arterial occlusive disease of the lower extremities, before and after aortofemoral bypass, in order to evaluate the extent and type of muscle fibre changes during ischemia and after revascularization. Fibre type content and muscle fibre areas were quantified using standard histological and histochemical methods and morphometric analysis. Each patient underwent concentric needle electromyography, nerve conduction velocity studies, and interstitial pressure measurements. Results Preoperatively all patients showed muscle fibre atrophy of both types, type II fibre area being more affected. The mean fibre cross sectional area of type I was 3,745 μm2 and of type II 4,654 μm2 . Fibre-type grouping, great variation in fibre size and angular fibres were indicative of chronic dennervation-reinnervation, in the absence of any clinical evidence of a neuropathic process. Seven days after the reperfusion the areas of both fibre types were even more reduced, being 3,086 μm2 for type I and 4,009 μm2 for type II, the proportion of type I fibres, and the interstitial pressure of tibialis anterior were increased. Conclusions The findings suggest that chronic ischemia of the leg muscles causes compensatory histochemical changes in muscle fibres resulting from muscle hypoxia, and chronic dennervation-reinnervation changes, resulting possibly from ischemic neuropathy. Reperfusion seems to bring the oxidative

  13. Peripheral Revascularization in Patients With Peripheral Artery Disease With Vorapaxar: Insights From the TRA 2°P-TIMI 50 Trial.

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    Bonaca, Marc P; Creager, Mark A; Olin, Jeffrey; Scirica, Benjamin M; Gilchrist, Ian C; Murphy, Sabina A; Goodrich, Erica L; Braunwald, Eugene; Morrow, David A

    2016-10-24

    The aim of this study was to determine whether the reduction in peripheral revascularization with vorapaxar in patients with peripheral artery disease (PAD) is directionally consistent across indications, including acute limb ischemia, progressively disabling symptoms, or both. The protease-activated receptor-1 antagonist vorapaxar reduces peripheral revascularization in patients with PAD. The TRA 2°P-TIMI 50 (Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events-Thrombolysis in Myocardial Infarction 50) trial randomized 26,449 patients with histories of myocardial infarction, stroke, or symptomatic PAD to vorapaxar or placebo on a background of standard therapy. A total of 5,845 patients had a known history of PAD at randomization. Peripheral revascularization procedures reported by the site were a pre-specified outcome. We explored whether the benefit of vorapaxar was consistent across indication and type of procedure. Of the 5,845 patients with known PAD, a total of 934 (16%) underwent at least 1 peripheral revascularization over 2.5 years (median). More than one-half (55%) were for worsening claudication, followed by critical limb ischemia (24%), acute limb ischemia (16%), and asymptomatic severe stenosis (4%). Vorapaxar significantly reduced peripheral revascularization (19.3% for placebo, 15.4% for vorapaxar; hazard ratio: 0.82; 95% confidence interval: 0.72 to 0.93; p = 0.003), with a consistent pattern of efficacy across indication. Vorapaxar reduces peripheral revascularization in patients with PAD. This benefit of vorapaxar is directionally consistent across type of procedure and indication. (Trial to Assess the Effects of Vorapaxar [SCH 530348; MK-5348] in Preventing Heart Attack and Stroke in Patients With Atherosclerosis [TRA 2°P - TIMI 50] [P04737]; NCT00526474). Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  14. Transcutaenous electrical nerve stimulation to manage a lower extremity wound complicated by peripheral arterial disease: a case report.

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    Yarboro, Douglas D; Smith, Robert

    2014-07-01

    Transcutaneous electrical nerve stimulation (TENS) is used to alleviate muscle pain, and there is some evidence it may affect healing in chronic wounds. An 80-year-old male patient with a chronic left lower extremity wound and a history of peripheral arterial disease, type 2 diabetes, hypertension, chronic obstructive pulmonary disease, and lung cancer presented for treatment. Previous protocols of care, mainly consisting of sharp debridement and daily dressing changes, had not resulted in a decrease in wound size. The patient had right and left iliac artery stenosis - not amenable to surgical intervention - and an ankle brachial index (ABI) of 0.63 on the left and 0.59 on the right lower extremities. On presentation, the wound measured 3.0 cm x 2.0 cm with a depth of 0.3 cm and a 0.5-cm tract at the 5 o'clock position. Treatment was changed to application of an ionic silver-containing Hydrofiber™ dressing and low-frequency TENS. Electrodes were applied 2 cm superior and inferior to the wound margin at a frequency of 2 Hz with a pulse width of 250 microseconds and amplitude of 33 mA. Treatment time was 45 minutes, twice daily, for 3 months, performed at home by the patient and his caregiver. After 4 weeks, wound dimensions decreased by 1.51% per day, and the wound was completely healed (100% epithelialized) after 12 weeks. At that time, the ABI of the left (treated) leg had increased to 0.71. Research is needed to determine the efficacy and effectiveness of low-frequency TENS to help clinicians provide evidenced-based treatment for wounds complicated by decreased blood flow.

  15. Effects of cardiac timing and peripheral resistance on measurement of pulse wave velocity for assessment of arterial stiffness.

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    Xiao, Hanguang; Butlin, Mark; Tan, Isabella; Avolio, Alberto

    2017-07-20

    To investigate the effects of heart rate (HR), left ventricular ejection time (LVET) and wave reflection on arterial stiffness as assessed by pulse wave velocity (PWV), a pulse wave propagation simulation system (PWPSim) based on the transmission line model of the arterial tree was developed and was applied to investigate pulse wave propagation. HR, LVET, arterial elastic modulus and peripheral resistance were increased from 60 to 100 beats per minute (bpm), 0.1 to 0.45 seconds, 0.5 to 1.5 times and 0.5 to 1.5 times of the normal value, respectively. Carotid-femoral PWV (cfPWV) and brachial-ankle PWV (baPWV) were calculated by intersecting tangent method (cfPWVtan and baPWVtan), maximum slope (cfPWVmax and baPWVmax), and using the Moens-Korteweg equation ([Formula: see text] and [Formula: see text]). Results showed cfPWV and baPWV increased significantly with arterial elastic modulus but did not increase with HR when using a constant elastic modulus. However there were significant LVET dependencies of cfPWVtan and baPWVtan (0.17 ± 0.13 and 0.17 ± 0.08 m/s per 50 ms), and low peripheral resistance dependencies of cfPWVtan, cfPWVmax, baPWVtan and baPWVmax (0.04 ± 0.01, 0.06 ± 0.04, 0.06 ± 0.03 and 0.09 ± 0.07 m/s per 10% peripheral resistance), respectively. This study demonstrated that LVET dominates the effect on calculated PWV compared to HR and peripheral resistance when arterial elastic modulus is constant.

  16. Effect of cilostazol on platelet reactivity among patients with peripheral artery disease on clopidogrel therapy.

    Science.gov (United States)

    Hernandez-Suarez, Dagmar F; Núñez-Medina, Hector; Scott, Stuart A; Lopez-Candales, Angel; Wiley, Jose M; Garcia, Mario J; Melin, Kyle; Nieves-Borrero, Karid; Rodriguez-Ruiz, Christina; Marshall, Lorraine; Duconge, Jorge

    2018-02-06

    Antiplatelet therapy with clopidogrel is recommended to reduce cardiovascular events in patients with peripheral artery disease (PAD); however, clopidogrel efficacy has not been adequately studied in this patient population. Therefore, we aimed to determine the effects of cilostazol therapy on platelet reactivity among PAD patients on clopidogrel. We performed a cross-sectional pilot study of 46 Puerto Rican patients diagnosed with PAD. The cohort was divided based on use of clopidogrel and cilostazol (n=24) or clopidogrel alone (n=22). Platelet function was measured ex vivo using the VerifyNow P2Y12 assay. Genomic DNA was extracted from peripheral blood samples using the QIAamp DNA Blood Midi Kit, which was subjected to candidate variant genotyping (CYP2C19, ABCB1, PON1 and P2RY12) using TaqMan quantitative polymerase chain reaction assays. All analyses were performed using SAS version 9.4 (SAS Institute). Among all enrolled patients, 18 (39%) had high on-treatment platelet reactivity (HTPR). The mean platelet reactivity was 207±53 (range, 78-325) with higher P2Y12 reaction units in the non-cilostazol group, 224±45 vs. 191±55 on the cilostazol group (p=0.03). No significant differences were observed in the clinical or genetic variables between the two groups. A multiple regression analysis determined that history of diabetes mellitus (p=0.03), use of cilostazol (p=0.03) and hematocrit (p=0.02) were independent predictors of platelet reactivity. In Puerto Rican PAD patients on clopidogrel therapy, history of diabetes mellitus, use of cilostazol and hematocrit are independent predictors of platelet reactivity. Adjunctive cilostazol therapy may enhance clopidogrel efficacy among PAD patients with HTPR.

  17. Prevalence and risk factors associated with peripheral artery disease in elderly patients undergoing peritoneal dialysis

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    Kuang DW

    2012-10-01

    Full Text Available Ding-Wei Kuang,1,2,* Chiu-Leong Li,1,* Un-I Kuok,1 Kin Cheung,1 Weng-In Lio,1 Jing Xin1,21Department of Nephrology, Centro Hospitalar Conde de São Januário, Macao, China; 2Department of Nephrology, Huashan Hospital, Shanghai, China*These authors contributed equally to this workBackground: Rapid growth of the elderly peritoneal dialysis (PD population is posing a special challenge for renal teams. Peripheral artery disease (PAD has been reported to be an independent predictor of cardiovascular and all-cause mortality in hemodialysis patients. However, the prevalence and associated risk factors for PAD in elderly PD patients have not yet been fully investigated.Methods: A total of 69 elderly PD patients were included in the present study. PAD was defined as either an ankle-brachial index < 0.9 or a history of intermittent claudication, lower-limb amputation, foot ulcers, or gangrene. On enrollment, clinical and biochemical characteristics were collected.Results: The overall prevalence of PAD was 31.9%. Compared with non-PAD patients, PAD patients were significantly older and more likely to be female and have longer PD duration and lower diastolic blood pressure (P < 0.001, = 0.002, 0.018, and 0.007, respectively. Serum albumin level (P < 0.001 and residual renal Kt/V value (P < 0.001 were significantly lower, but the serum C-reactive protein level (P = 0.005 was significantly higher, in PAD patients compared with non-PAD patients. Logistic regression analysis showed that serum albumin level (odds ratio = 1.485, P = 0.040 and residual renal Kt/V value (odds ratio = 1.725, P = 0.016 were independently associated with PAD.Conclusion: A high prevalence of PAD appeared among elderly PD patients in Macao. Serum albumin level and residual renal Kt/V value were independently related to PAD.Keywords: ankle-brachial index, atherosclerosis, elderly, peripheral artery disease, peritoneal dialysis

  18. Short vs prolonged dual antiplatelet treatment upon endovascular stenting of peripheral arteries

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    Kronlage M

    2017-10-01

    Full Text Available Mariya Kronlage,1 Maximilian Wassmann,1 Britta Vogel,1 Oliver J Müller,1 Erwin Blessing,2 Hugo Katus,1,3 Christian Erbel1 1Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, 2SRH Klinikum Karlsbad Langensteinbach, Karlsbad, 3DZHK German Center for Cardiovascular Research, Partner Site Heidelberg/Mannheim, Mannheim, Germany Introduction: Peripheral artery disease (PAD is a highly prevalent disorder with a substantial economical burden. Dual antiplatelet treatment (DAPT upon endovascular stenting to prevent acute thrombotic reocclusions is an universally accepted practice for postinterventional management of PAD patients. However, the optimal period of time for DAPT upon endovascular stenting is not known.Methods: In the current nonrandomized, retrospective monocentric study, we evaluated the duration of DAPT upon endovascular stenting. A total of 261 endovascular SFA and iliac stenting procedures were performed on 214 patients and these patients were subdivided into a short (4–6 weeks or a prolonged (8–12 weeks DAPT regime group. More than 65% of the patients included were male, approximately 35% were diabetic, and 61% had a history of smoking. Of all the patients, 90% exhibited a Rutherford stage 2–3, and approximately half of the patients had a moderate-to-severe calcified target lesion with a length of >13 cm. Major safety end points were defined as any bleeding, compartment syndrome, and ischemic events. In addition to this, patency, all-cause mortality, as well as amputation were followed up over a period of 12 months upon intervention.Results: Twelve months after endovascular stenting, primary patency in our cohort was comparable between the groups (83.94% short vs 79.8% long DAPT, P>0.05. Major bleeding occurred in 18 cases without any difference between the groups (P>0.05. In addition, during the 12-month follow-up, 6 (3.4% patients in the short and 3 (3.5% in the prolonged DAPT regime

  19. Treatment for peripheral arterial obstructive disease: An appraisal of the economic outcome of complications.

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    Flu, Hans; van der Hage, Jos H; Knippenberg, Bob; Merkus, Jos W; Hamming, Jaap F; Lardenoye, Jan Willem H

    2008-08-01

    This study determined the average estimated total costs after treatment for peripheral arterial occlusive disease (PAOD) and evaluated the effect of postoperative complications and their consequences for the total costs. Cost data on all admissions involving treatment for PAOD from January 2007 until July 2007 were collected. A prospective analysis was made using the patient-related risk factor and comorbidity (Society for Vascular Surgery/International Society of Cardiovascular Surgeons) classification, primary and secondary treatment, and prospectively registered complications. At admission, patients without complications were placed in group A, and those with complications were in group B. Prospectively registered complications were divided into patient management (I), surgical technique (II), patient's disease (III), and outside surgical department (IV). The consequences of these were divided into minor complication, no long-term consequence (1A), additional medication or transfusion (1B), surgical reoperation (2A), prolonged hospital stay (2B), irreversible physical damage (3), and death (4). The main outcome measures were total costs of patients and costs per patient (PP), with or without the presence of complications, cost of complications and costs per complication (PC), and the costs of their consequences calculated in euros (euro). Ninety patients (mean age, 71.4 years; 59% men) were included. Group B patients had a significantly higher American Society of Anesthesiologists (4) and Fontaine (3) classification and more secondary procedures. Total costs were euro 1,716,852: group A, euro 512,811 (PP euro 12,820); and group B, euro 1,204,042 (PP euro 24,081). The costs of the 115 complications were euro 568,500 (PC euro 4943). Split by the cause of the complication, costs were I, euro 95,924 (PC euro 2998); II, euro 163,137 (PC euro 8157); III, euro 289,578 (PC euro 5171); and IV, euro 19,861 (PC euro 2837). The increase of costs in group B was mainly caused

  20. Is asymptomatic peripheral arterial disease associated with walking endurance in patients with COPD?

    Directory of Open Access Journals (Sweden)

    Sun KS

    2015-07-01

    Full Text Available Kuo-Shao Sun,1,2* Ming-Shian Lin,1,2* Yi-Jen Chen,1,2 Yih-Yuan Chen,3 Solomon Chih-Cheng Chen,4 Wei Chen1,5,6 1Division of Pulmonary and Critical Care Medicine, 2Department of Respiratory Care, Chang Gung University of Science and Technology, 3Department of Internal Medicine, 4Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, 5College of Nursing, Dayeh University, Changhua, 6Department of Respiratory Therapy, China Medical University, Taichung, Taiwan, Republic of China *These authors contributed equally to this work Objective: Symptomatic peripheral arterial disease (PAD is associated with impaired walking endurance in patients with chronic obstructive pulmonary disease (COPD. However, it is unknown whether asymptomatic PAD is associated with impaired walking endurance in patients with COPD. Methods: This prospective cross-sectional study enrolled 200 COPD patients (mean age: 70.9 years who volunteered to perform ankle-brachial index (ABI and 6-minute walk test (6MWT consecutively. Demographic data, lung function, dyspnea scales, and cardiovascular risk factors were recorded. The ABI was used to detect PAD (ABI <0.90. All patients were free of PAD symptoms at enrollment. Results: Of the 200 COPD patients, 17 (8.5% were diagnosed with asymptomatic PAD. The COPD patients without asymptomatic PAD did not walk significantly further on the 6MWT than the COPD patients with asymptomatic PAD (439±86 m vs 408±74 m, P=0.159. The strongest correlation with the distance walked on the 6MWT was Medical Research Council dyspnea scale (r2=-0.667, P<0.001, followed by oxygen-cost diagram (r2=0.582, P<0.001 and forced expiratory volume in 1 second (r2=0.532, P<0.001. In multivariate linear regression analysis, only age, forced expiratory volume in 1 second, and baseline pulse oximetry were independently correlated with the distance covered on the 6MWT (P<0.05. However, body mass index, baseline heart rate, and

  1. Day-Case Treatment of Peripheral Arterial Disease: Results from a Multi-Center European Study

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    Spiliopoulos, Stavros, E-mail: stavspiliop@med.uoa.gr, E-mail: stavspiliop@upatras.gr; Karnabatidis, Dimitrios, E-mail: karnaby@med.upatras.gr [Patras University Hospital, Department of Interventional Radiology (Greece); Katsanos, Konstantinos, E-mail: katsanos@med.upatras.gr; Diamantopoulos, Athanasios, E-mail: adiamantopoulos@gmail.com [Guy’s and St Thomas’ Hospitals, NHS Foundation Trust, King’s Health Partners, Department of Interventional Radiology (United Kingdom); Ali, Tariq, E-mail: tariq.ali@addenbrookes.nhs.uk [Addenbrooke’s University Hospital, NHS Foundation Trust, Department of Interventional Radiology (United Kingdom); Kitrou, Panagiotis, E-mail: panoskitrou@gmail.com [Patras University Hospital, Department of Interventional Radiology (Greece); Cannavale, Alessandro, E-mail: alessandro.cannavale@hotmail.com; Krokidis, Miltiadis, E-mail: miltiadis.krokidis@addenbrookes.nhs.uk [Addenbrooke’s University Hospital, NHS Foundation Trust, Department of Interventional Radiology (United Kingdom)

    2016-12-15

    PurposeThe purpose of the study was to investigate safety and feasibility of day-case endovascular procedures for the management of peripheral arterial disease.Materials and MethodsThis was a multi-center, retrospective study including all patients treated over a 30-month period with endovascular angioplasty or stenting for intermittent claudication (IC) or critical limb ischemia (CLI) on a day-case basis, in Interventional Radiology (IR) departments of three European tertiary hospitals. Exclusion criteria were not related to the type of lesion and included unavailability of an adult able to take care of patient overnight; high bleeding risk and ASA score ≥4. Primary efficacy outcome was the rate of procedures performed on an outpatient basis requiring no further hospitalization and primary safety outcome was freedom from 30-day major complications’ rate.ResultsThe study included 652 patients (male 75 %; mean age 68 ± 10 years; range: 27–93), 24.6 % treated for CLI. In 53.3 % of the cases a 6Fr sheath was used. Technical success was 97.1 %. Haemostasis was obtained by manual compression in 52.4 % of the accesses. The primary efficacy outcome occurred in 95.4 % (622/652 patients) and primary safety outcome in 98.6 % (643/652 patients). Major complications included five (0.7 %) retroperitoneal hematomas requiring transfusion; one (0.1 %) common femoral artery pseudoaneurysm successfully treated with US-guided thrombin injection, two cases of intra-procedural distal embolization treated with catheter-directed local thrombolysis and one on-table cardiac arrest necessitating >24 h recovery. No major complication was noted after same-day discharge.ConclusionsDay-case endovascular procedures for the treatment of IC or CLI can be safely and efficiently performed in experienced IR departments of large tertiary hospitals.

  2. Ankle-brachial index, a screening for peripheral obstructive arterial disease, and migraine - a controlled study.

    Science.gov (United States)

    Jurno, Mauro Eduardo; Chevtchouk, Liliana; Nunes, Aida Aguilar; de Rezende, Dilermando Fazito; Jevoux, Carla da Cunha; de Souza, Jano Alves; Moreira Filho, Pedro Ferreira

    2010-04-01

    Epidemiological studies support the association between migraine, especially migraine with aura, and vascular disorders. The ankle-brachial index (ABI) is largely used as a surrogate of peripheral obstructive arterial disorders (POAD). Accordingly, in this study we contrasted the ABI in individuals with migraine and in controls. We investigated 50 migraineurs and 38 controls and obtained the ABI (ratio between the systolic arterial pressure obtained in the legs and in the arms) using digital sphygmomanometry. As per validation studies, we used the cut-off of 0.9 as the normal limit for the ABI. We adjusted for gender, use of contraceptive hormones, tabagism, and other cardiovascular risk factors. We found abnormal values of ABI, suggestive of mild or moderate POAD, in 31 individuals (35.2%). Mean value was 0.96 (standard deviation = 0.10). None of our patients had ABI < 0.4, which would suggest severe POAD. Mean ABI for migraineurs was 0.94 (0.11), and for controls it was 0.99 (0.09). Difference was significant (t = 2.21 and P = .022). After adjustments, ABI remained significantly associated with migraine status (P = .024). Adjustments were reasonably effective (chi(2) of Hosmer-Lemeshow = 1.06, P = .590). Our findings suggest that decreased values of ABI are more common in migraineurs than in controls. Although causality was not assessed by us, the relationship is of importance per se. Doctors should measure the ABI in individuals with migraine as an easy way to screen for cardiovascular risk.

  3. Sleep apnoea is associated with major cardiac events in peripheral arterial disease.

    Science.gov (United States)

    Utriainen, Karri T; Airaksinen, Juhani K; Polo, Olli; Laitio, Ruut; Pietilä, Mikko J; Scheinin, Harry; Vahlberg, Tero; Leino, Kari A; Kentala, Erkki S; Jalonen, Jouko R; Hakovirta, Harri; Parkkola, Riitta; Virtanen, Sami; Laitio, Timo T

    2014-06-01

    Obstructive sleep apnoea (OSA) is associated with atherosclerosis and cardiovascular events. Peripheral arterial disease (PAD) represents severe atherosclerosis with a high mortality after vascular surgery. The role of OSA in the prognosis of these patients is not yet established. 84 patients (aged 67 ± 9 years) scheduled for sub-inguinal surgical revascularisation were enrolled for preoperative polysomnography. The threshold for significant OSA was an apnoea/hypopnoea index ≥ 20 events·h(-1). Major adverse cardiovascular and cerebrovascular events (MACCE), including cardiac death, myocardial infarction, coronary revascularisation, angina pectoris requiring hospitalisation and stroke, were used as a combined end-point. During follow-up (median 52 months), 17 out of 39 patients with and six out of 45 patients without significant OSA suffered MACCE. In the multivariate Cox regression, the primary predictors of MACCE were significant OSA (hazard ratio (HR) 5.1 (95% CI 1.9-13.9); p=0.001) and pre-existing coronary artery disease (HR 4.4 (95% CI 1.8-10.6); p=0.001). Other significant predictors were a ≥ 4 year history of PAD (HR 3.8 (95% CI 1.3-11.5); p=0.02) and decreasing high-density lipoprotein/total cholesterol ratio (HR 0.95 per percentage (95% CI 0.90-1.00); p=0.048). OSA is associated with poor long-term outcome in patients with PAD following revascularisation. OSA might have an important role in the pathogenesis of cardiovascular morbidity and mortality in these patients. ©ERS 2014.

  4. Improving Compliance with Statins in Patients with Peripheral Arterial Disease: A Quality Improvement Study.

    Science.gov (United States)

    Agha, Riaz A; Camm, Christian F; Edison, Eric; Browning, Neil

    2012-01-01

    Atherosclerosis is an inflammatory disease affecting medium sized arteries. The prevalence, health, and financial impact of the disease has made it a key target for public health and large scale intervention. The statin class of drugs improve morbidity and mortality for patients with peripheral arterial disease (PAD) through polymodal actions. This quality improvement study aimed to determine, and subsequently reduce, the percentage of patients with PAD discharged without statins. According to the Vascular Society of Great Britain and Ireland, and draft National Institute of Health and Clinical Excellence guidance, all patients undergoing major vascular procedures should be prescribed a statin. A baseline audit of patients with PAD under the care of the vascular team at our instituted was undertaken for the period Dec 2009-July 2010. Electronic discharge letters (EDLs) were analysed and compliance with statin prescription were recorded. A number of interventions aimed at improving compliance were then enacted and monitored through weekly PDSA cycles. Junior doctor leadership was key to identifying the problem and conceiving, implementing, and measuring changes. A second cycle was run, using similar data collection methods to the first, for the period August-October 2010. In the first cycle, EDLs pertaining to 113 patient admissions, involving 96 patients with PAD, were examined. Statins were not prescribed in 30.1%. In the second cycle, 86 patient admissions, involving 76 patients, were examined. Statins were not prescribed in 24.4%, representing an 18.9% decrease. Poorly compliant sub-groups included patients presenting with embolism or those for elective angioplasty.

  5. Aspirin and clopidogrel high on-treatment platelet reactivity and genetic predictors in peripheral arterial disease.

    Science.gov (United States)

    Yeo, Khung-Keong; Armstrong, Ehrin J; López, Javier E; Chen, Debbie C; Westin, Gregory G; Li, Chin-Shang; Anderson, David; Hua, Amy; Singapuri, Anil; Amsterdam, Ezra A; Chiamvimonvat, Nipavan; Laird, John R

    2018-02-07

    Our aims were to examine the prevalence and genetic predictors of aspirin and clopidogrel high on-treatment platelet reactivity (HoTPR), and associated adverse cardiovascular outcomes in patients with peripheral arterial disease (PAD). The association of aspirin and clopidogrel HoTPR with outcomes in PAD remains unclear. This is a prospective cohort study of patients with angiographically documented PAD involving carotid and lower extremity arteries. Aspirin and clopidogrel HoTPR (using the VerifyNow Assay) and associated genetic predictors were compared to clinical outcomes. The primary end-point was a composite of major adverse cardiovascular events: all-cause mortality, myocardial infarction, stroke, target vessel revascularization (TVR) and limb-loss in patients who underwent extremity intervention. The study was stopped prematurely due to slow patient enrolment. Of 195 patients enrolled, the primary analysis was performed in 154 patients taking both drugs. Aspirin HoTPR was present in 31 (20%) and clopidogrel HoTPR in 76 (49%) patients. There was a trend toward more primary composite outcome events with PRU ≥ 235 (52% freedom-from-event rate vs. 70% for PRU < 235; P = 0.09). TVR was higher in those with PRU ≥ 235 (20 vs. 6%, unadjusted P = 0.02). There was no association between aspirin HoTPR and combined outcomes. Single nucleotide polymorphisms in serum paraoxonase/arylesterase 1 (PON1) gene was associated with aspirin HoTPR (P = 0.005) while SNP in phospholipase A2, group III (PLA2G3) gene was associated with clopidogrel HoTPR (P = 0.002). Clopidogrel HoTPR was significantly associated with TVR, while aspirin HoTPR was not associated with adverse clinical outcomes in patients with PAD. © 2018 Wiley Periodicals, Inc.

  6. Association of osteoprotegerin with peripheral artery disease in patients with type 2 diabetes.

    Science.gov (United States)

    Esteghamati, Alireza; Aflatoonian, Maryam; Rad, Mona Vahidi; Mazaheri, Tina; Mousavizadeh, Mostafa; Nakhjavani, Manouchehr; Noshad, Sina

    2015-01-01

    Osteoprotegerin plays a critical role in the pathogenesis of atherosclerosis. Elevated osteoprotegerin concentrations have been reported in microvascular complications of diabetes. Patients with diabetes are at increased risk of macrovascular complications, particularly peripheral artery disease (PAD). To investigate the association between osteoprotegerin concentration and PAD in diabetes. In a cross-sectional setting, patients with type 2 diabetes for>5 years and no apparent diabetic foot ulcer were recruited. Patients underwent colour Doppler ultrasonography of lower limbs and were designated PAD+ if arterial narrowing was detected. Ankle-brachial index (ABI) was measured. Serum osteoprotegerin concentrations were determined. Ninety-eight patients (47 PAD+, 51 PAD-) were recruited. Osteoprotegerin concentrations (median [interquartile range]) were significantly higher in PAD+ versus PAD- patients (0.80 [0.50-1.95] ng/mL vs 0.30 [0.25-0.40] ng/mL; Posteoprotegerin was a predictor of PAD in univariate and multivariable analyses. In the final multivariable model, adjusting for age, sex, body mass index, smoking, hypertension, glycaemic control, lipid profile, renal function and C-reactive protein, one standard deviation increase in log-osteoprotegerin was associated with a more than twofold increase in the risk of having PAD (odds ratio 2.26, 95% confidence interval 1.50-3.40). In PAD+ patients, osteoprotegerin was a significant predictor of disease severity, determined by ABI and percentage of vessel occlusion in univariate and multivariable models. Osteoprotegerin concentrations are increased in patients with diabetes and PAD. Osteoprotegerin is an independent predictor of the presence and severity of PAD in diabetic patients. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  7. Platelet-Derived MRP-14 Induces Monocyte Activation in Patients With Symptomatic Peripheral Artery Disease.

    Science.gov (United States)

    Dann, Rebecca; Hadi, Tarik; Montenont, Emilie; Boytard, Ludovic; Alebrahim, Dornaszadat; Feinstein, Jordyn; Allen, Nicole; Simon, Russell; Barone, Krista; Uryu, Kunihiro; Guo, Yu; Rockman, Caron; Ramkhelawon, Bhama; Berger, Jeffrey S

    2018-01-02

    Peripheral artery disease (PAD), a diffuse manifestation of atherothrombosis, is a major cardiovascular threat. Although platelets are primary mediators of atherothrombosis, their role in the pathogenesis of PAD remains unclear. The authors sought to investigate the role of platelets in a cohort of symptomatic PAD. The authors profiled platelet activity, mRNA, and effector roles in patients with symptomatic PAD and in healthy controls. Patients with PAD and carotid artery stenosis were recruited into ongoing studies (NCT02106429 and NCT01897103) investigating platelet activity, platelet RNA, and cardiovascular disease. Platelet RNA sequence profiling mapped a robust up-regulation of myeloid-related protein (MRP)-14 mRNA, a potent calcium binding protein heterodimer, in PAD. Circulating activated platelets were enriched with MRP-14 protein, which augmented the expression of the adhesion mediator, P-selectin, thereby promoting monocyte-platelet aggregates. Electron microscopy confirmed the firm interaction of platelets with monocytes in vitro and colocalization of macrophages with MRP-14 confirmed their cross talk in atherosclerotic manifestations of PAD in vivo. Platelet-derived MRP-14 was channeled to monocytes, thereby fueling their expression of key PAD lesional hallmarks and increasing their directed locomotion, which were both suppressed in the presence of antibody-mediated blockade. Circulating MRP-14 was heightened in the setting of PAD, significantly correlated with PAD severity, and was associated with incident limb events. The authors identified a heightened platelet activity profile and unraveled a novel immunomodulatory effector role of platelet-derived MRP-14 in reprograming monocyte activation in symptomatic PAD. (Platelet Activity in Vascular Surgery and Cardiovascular Events [PACE]; NCT02106429; and Platelet Activity in Vascular Surgery for Thrombosis and Bleeding [PIVOTAL]; NCT01897103). Copyright © 2018 American College of Cardiology Foundation

  8. Transverse versus Longitudinal Incisions for Femoral Artery Exposure in Treating Patients with Peripheral Vascular Disease.

    Science.gov (United States)

    Parikh, Punam P; Rubio, Gustavo A; Patel, Kunal; Gupta, Kapil; Jones, Keith; Rey, Jorge; Robinson, Handel

    2017-09-08

    This study evaluates differences in wound complication rate when transverse versus longitudinal incision is utilized to expose femoral vessels in managing patients with peripheral vascular disease. A retrospective review from 2013 to 2015 was conducted of 150 patients undergoing 156 lower extremity revascularizations with femoral artery exposure through a groin incision. Patients were stratified into 2 groups, transverse versus longitudinal groin incision. Data were reviewed for 3 surgeons that utilize either transverse or longitudinal groin incision in patients undergoing common or iliofemoral endarterectomies, or where femoral artery was used as inflow and/or outflow vessel for limb revascularization. Each group had a comparative outcomes analysis based on incision type. The primary outcome was wound complication, defined as any wound infection, lymphocele, hematoma, dehiscence, pseudoaneurysm, or necrosis. Other outcomes studied included unplanned return to operating room for wound complication, wound vacuum therapy, and soft-tissue flap closure. Data were analyzed using 2-tailed chi-squared test and Student's t-test. Patients in the transverse (n = 85 cases) versus longitudinal (n = 71 cases) cohorts were similar in relation to demographics and comorbidities. Overall mean follow-up was 220 days. Patients with a transverse as compared to longitudinal incision had a significantly lower overall wound complication rate, 7% vs. 42%, respectively (P operating room to manage wound complications than patients with a longitudinal incision (5% vs. 23%, respectively; P exposure may offer a lower risk of wound complications for open procedures as compared to a longitudinal incision. While longitudinal incisions may have higher wound complication rates, incisional approach is contingent on anatomical circumstance and treated disease pattern. Patients should undergo appropriate preoperative counseling regarding wound healing in preparation for limb revascularization

  9. An unequal social distribution of peripheral arterial disease and the possible explanations: results from a population-based study.

    Science.gov (United States)

    Kröger, Knut; Dragano, Nico; Stang, Andreas; Moebus, Susanne; Möhlenkamp, Stefan; Mann, Klaus; Siegrist, Johannes; Jöckel, Karl-Heinz; Erbel, Raimund

    2009-11-01

    A low socioeconomic status (SES) is associated with higher cardiovascular mortality and morbidity. It has remained unclear whether such a social gradient is evident in peripheral artery disease (PAD) because both diseases show different clinical courses. We looked at the association between education and income with PAD within the population of the Heinz Nixdorf Recall Study (HNRS) including 4738 individuals. In both men and women, the ankle-brachial index (ABI) decreased and the prevalence of PAD (ABI education and income. Looking only at participants without cardiovascular disease, doctor-diagnosed PAD and media calcinosis participants with low (odds ratio 2.58, 95% confidence interval 1.53-4.34) and median education (1.90, 1.27-2.85) had higher odds for suffering from PAD compared to participants with high education. Additional adjustment for classical arteriosclerosis risk factors reduced the strength of the association while the odds ratios remained elevated. Current smoking, diabetes and BMI seem to be the most relevant mediators. Income does not significantly correlate with events when adjustments for all other risk factors are made. In conclusion, our study demonstrates that PAD is more pronounced in men and women with lower socioeconomic status. Diabetes prevention and smoking prevention and cessation programs need to specifically target individuals of lower income and education. According to our findings, prevention of PAD would benefit extraordinarily.

  10. Correlation between Patient-Reported Symptoms and Ankle-Brachial Index after Revascularization for Peripheral Arterial Disease

    Science.gov (United States)

    Je, Hyung Gon; Kim, Bo Hyun; Cho, Kyoung Im; Jang, Jae Sik; Park, Yong Hyun; Spertus, John

    2015-01-01

    Improvement in quality of life (QoL) is a primary treatment goal for patients with peripheral arterial disease (PAD). The current study aimed to quantify improvement in the health status of PAD patients following peripheral revascularization using the peripheral artery questionnaire (PAQ) and ankle-brachial index (ABI), and to evaluate possible correlation between the two methods. The PAQ and ABI were assessed in 149 symptomatic PAD patients before, and three months after peripheral revascularization. Mean PAQ summary scores improved significantly three months after revascularization (+49.3 ± 15 points, p revascularization. The smallest increases were seen in reported treatment satisfaction (all p’s revascularization (p revascularization correlated with patient-reported changes in the physical function and QoL domains of the PAQ. Twenty-two percent of PAD patients were identified as having a poor response to revascularization (increase in ABI 0.15 following revascularization. In conclusion, data from the current study suggest a significant correlation between improvement in patient-reported outcomes assessed by PAQ and ABI in symptomatic PAD patients undergoing peripheral revascularization. PMID:25993299

  11. Ticagrelor for Prevention of Ischemic Events After Myocardial Infarction in Patients With Peripheral Artery Disease.

    Science.gov (United States)

    Bonaca, Marc P; Bhatt, Deepak L; Storey, Robert F; Steg, Ph Gabriel; Cohen, Marc; Kuder, Julia; Goodrich, Erica; Nicolau, José C; Parkhomenko, Alexander; López-Sendón, José; Dellborg, Mikael; Dalby, Anthony; Špinar, Jindřich; Aylward, Philip; Corbalán, Ramón; Abola, Maria Teresa B; Jensen, Eva C; Held, Peter; Braunwald, Eugene; Sabatine, Marc S

    2016-06-14

    Peripheral artery disease (PAD) is associated with heightened ischemic and bleeding risk in patients with prior myocardial infarction (MI). This study evaluated the efficacy and safety of ticagrelor on major cardiovascular (CV) events and major adverse limb events in patients with PAD and a prior MI. PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis In Myocardial Infarction 54) randomized 21,162 patients with prior MI (1 to 3 years) to ticagrelor 90 mg twice daily, ticagrelor 60 mg twice daily, or placebo, all on a background of low-dose aspirin. History of PAD was obtained at baseline. Occurrences of major adverse cardiovascular events (MACE) (defined as CV death, MI, or stroke) and major adverse limb events (MALE) (defined as acute limb ischemia or peripheral revascularization for ischemia) were recorded in follow-up. A total of 1,143 patients (5%) had known PAD. In the placebo arm, those with PAD (n = 404) had higher rates of MACE at 3 years than those without (n = 6,663; 19.3% vs. 8.4%; p < 0.001), which persisted after adjusting for baseline differences (adjusted hazard ratio: 1.60; 95% confidence interval: 1.20 to 2.13; p = 0.0013), and higher rates of acute limb ischemia (1.0% vs. 0.1%) and peripheral revascularization procedures (9.15% vs. 0.46%). Whereas the relative risk reduction in MACE with ticagrelor was consistent, regardless of PAD, patients with PAD had a greater absolute risk reduction of 4.1% (number needed to treat: 25) due to their higher absolute risk. The absolute excess of TIMI major bleeding was 0.12% (number needed to harm: 834). The 60-mg dose had particularly favorable outcomes for CV and all-cause mortality. Ticagrelor (pooled doses) reduced the risk of MALE (hazard ratio: 0.65; 95% confidence interval: 0.44 to 0.95; p = 0.026). Among stable patients with prior MI, those with concomitant PAD have heightened ischemic

  12. Adiponectin--an independent marker of coronary artery disease occurrence rather than a degree of its advancement in comparison to the IMT values in peripheral arteries.

    Science.gov (United States)

    Lisowska, A; Tycinska, A; Knapp, M; Sawicki, R; Lisowski, P; Musiał, W J; Dobrzycki, S

    2012-04-11

    The aim of the study was to establish whether adiponectin may act as an independent risk factor of coronary artery disease (CAD) and if adiponectin has potential relations with a new marker of cardiovascular risk -intima-media thickness (IMT). 165 patients, who had undergone coronary angiography due to symptoms of CAD were enrolled. Selected clinical and biochemical risk factors were assessed, adiponectin concentrations and IMT were measured. A significantly lower adiponectin concentrations in the CAD group, as compared to the controls, were found. Adiponectin concentration did not correlate with a degree of coronary vessels changes advancement. No correlation between adiponectin concentrations and IMT values in the studied peripheral arteries were found. The value of 9.8 ug/ml has been assigned as a cut-off value. Adiponectin concentrations coronary artery disease occurrence, but not its advancement. No correlation between adiponectin concentration and IMT values in peripheral arteries was shown. Copyright © 2012 Elsevier B.V. All rights reserved.

  13. Evaluation of hyperspectral technology for assessing the presence and severity of peripheral artery disease.

    Science.gov (United States)

    Chin, Jason A; Wang, Edward C; Kibbe, Melina R

    2011-12-01

    Hyperspectral imaging is a novel technology that can noninvasively measure oxyhemoglobin and deoxyhemoglobin concentrations to create an anatomic oxygenation map. It has predicted healing of diabetic foot ulcers; however, its ability to assess peripheral arterial disease (PAD) has not been studied. The aims of this study were to determine if hyperspectral imaging could accurately assess the presence or absence of PAD and accurately predict PAD severity. This prospective study included consecutive consenting patients presenting to the vascular laboratory at the Jesse Brown VA Medical Center during a 10-week period for a lower extremity arterial study, including ankle-brachial index (ABI) and Doppler waveforms. Patients with lower extremity edema were excluded. Patients underwent hyperspectral imaging at nine angiosomes on each extremity. Additional sites were imaged when tissue loss was present. Medical records of enrolled patients were reviewed for demographic data, active medications, surgical history, and other information pertinent to PAD. Patients were separated into no-PAD and PAD groups. Differences in hyperspectral values between the groups were evaluated using the two-tailed t test. Analysis for differences in values over varying severities of PAD, as defined by triphasic, biphasic, or monophasic Doppler waveforms, was conducted using one-way analysis of variance. Hyperspectral values were correlated with the ABI using a Pearson bivariate linear correlation test. The study enrolled 126 patients (252 limbs). After exclusion of 15 patients, 111 patients were left for analysis, including 46 (92 limbs) no-PAD patients and 65 (130 limbs) PAD patients. Groups differed in age, diabetes, coronary artery disease, congestive heart failure, tobacco use, and insulin use. Deoxyhemoglobin values for the plantar metatarsal, arch, and heel angiosomes were significantly different between patients with and without PAD (P Oxyhemoglobin values did not predict the presence or

  14. Advanced Noncontrast Magnetic Resonance Angiography of the Thoracic and Peripheral Arteries

    Science.gov (United States)

    Lindley, Marc Daniel

    The gold standard for evaluation of arterial disease using MR continues to be contrast-enhanced MR angiography (MRA) with gadolinium-based contrast agents (Gd-MRA). There has been a recent resurgence in interest in methods that do not rely on gadolinium for enhancement of blood vessels due to associations Gd-MRA has with nephrogenic systemic fibrosis (NSF) in patients with impaired renal function. The risk due to NSF has been shown to be minimized when selecting the appropriate contrast type and dose. Even though the risk of NSF has been shown to be minimized, demand for noncontrast MRA has continued to rise to reduce examination cost, and improve patient comfort and ability to repeat scans. Several methods have been proposed and used to perform angiography of the aorta and peripheral arteries without the use of gadolinium. These techniques have had limitations in transmit radiofrequency field (B1+) inhomogeneities, acquisition time, and specific hardware requirements, which have stunted the utility of noncontrast enhanced MRA. In this work feasibility of noncontrast (NC) MRA at 3T of the femoral arteries using dielectric padding, and using 3D radial stack of stars and compressed sensing to accelerate acquisitions in the abdomen and thorax were tested. Imaging was performed on 13 subjects in the pelvis and thighs using high permittivity padding, and 11 in the abdomen and 19 in the thorax using 3D radial stack of stars with tiny golden angle using gold standards or previously published techniques. Qualitative scores for each study were determined by radiologists who were blinded to acquisition type. Vessel conspicuity in the thigh and pelvis showed significant increase when high permittivity padding was used in the acquisition. No significant difference in image quality was observed in the abdomen and thorax when using undersampling, except for the descending aorta in thoracic imaging. All image quality scores were determined to be of diagnostic quality. In this

  15. Polymorphism in the methylenetetrahydrofolate reductase (C677T) gene and homocysteine levels: a comparison in Brazilian patients with coronary arterial disease, ischemic stroke and peripheral arterial obstructive disease.

    Science.gov (United States)

    Sabino, Adriano; Fernandes, Ana Paula; Lima, Luciana Moreira; Ribeiro, Daniel Dias; Sousa, Marinez Oliveira; de Castro Santos, Maria Elizabeth Rennó; Mota, Ana Paula Lucas; Dusse, Luci Maria Sant'Ana; das Graças Carvalho, Maria

    2009-01-01

    This study aimed to compare plasma levels of total homocysteine (tHcy) in different arterial events as well as to investigate an association between homocysteine levels and C677T polymorphism in Brazilian patients. A total of 145 subjects were enrolled in this study including 43 patients with coronary arterial disease (CAD), 21 with ischemic stroke (IS), 44 with peripheral arterial obstructive disease (PAOD) and 37 control subjects. A preliminary analysis showed significant difference for tHcy plasma levels between patients with CAD (P = 0.003) or PAOD (P = 0.03) compared to controls. However, after adjustment for sex, age, total cholesterol, LDL, diabetes, tabagism or C677T polymorphism, no significant differences were detected in tHcy levels among patients groups and controls. No significant correlation was demonstrated for C677T polymorphism and homocysteine levels. These results indicate that increased Hcy levels may not be considered an independent risk factor for atherothrombotic diseases in Brazilian patients.

  16. Deformation mechanisms of prototype composite braided stent-grafts in bending fatigue for peripheral artery application.

    Science.gov (United States)

    Xue, Wen; Gao, Jing; Lin, Jing; Wang, Fujun; Guan, Guoping; Wang, Lu

    2017-10-31

    Stent-grafts in peripheral arteries suffer from complex cyclic loadings in vivo, including pulsatile, axial bending and torsion. Normal fatigue durability evaluation technologies, however, are majorly based on pulsation and thus are short of accuracy under the complicated stress conditions experienced physiologically. While there is a little research focused on the cyclic fatigue of stent-grafts in bending, it remains an almost total lack of deformation or fatigue mechanisms. In this work, composite braided stent-grafts incorporating Nitinol (NiTi) yarns and polyethylene terephthalate (PET) multifilament yarns were cycled in bending by the self-developed testing system to investigate their deformation behaviors. Deformation mechanisms at the yarn level were discussed, and NiTi yarn crossover structure was considered the primary factor affecting the deformation modes. Four yarn-crossover-based deformation modes (accordion buckling, diamond-shaped buckling, neck propagation and microbuckling) revealed the mechanisms of energy absorption of braided stent-grafts on the mesoscopic scale. Further, mechanical modes were applied to help regulate stent designs. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Peripheral artery disease in peritoneal dialysis and hemodialysis patients: single-center retrospective study in Taiwan

    Directory of Open Access Journals (Sweden)

    Lee Chun-Chuan

    2012-09-01

    Full Text Available Abstract Background Peripheral artery disease (PAD is a condition characterized by restricted blood flow to the extremities, and is especially common in the elderly. PAD increases the risk for mortality and morbidity in patients with end-stage renal disease (ESRD, especially those on hemodialysis (HD. Methods The records of 484 patients with end-stage renal disease who were on HD or peritoneal dialysis (PD were reviewed. PAD was diagnosed based on the ankle-brachial pressure index (ABI. Demographic and clinical characteristics were analyzed. Results PAD had an overall prevalence of 18.2% and was significantly more common in HD patients (21.8% than in PD patients (4.8%. Advanced age, diabetes mellitus, smoking, low parathyroid hormone level, elevated serum ferritin, elevated serum glucose, and low serum creatinine levels increased the risk for PAD. PAD was independently associated with advanced age, diabetes mellitus, duration of dialysis, low serum creatinine, and hyperlipidemia. PD patients had a significantly lower prevalence of PAD than HD patients, maybe due to their younger age and lower prevalence of diabetes mellitus in this present study. Conclusions The prevalence of PAD was greater in the HD group than the PD group. Most of the risk factors for PAD were specific to HD, and no analyzed factor was significantly associated with PAD in PD patients.

  18. Peripheral artery disease in peritoneal dialysis and hemodialysis patients: single-center retrospective study in Taiwan.

    Science.gov (United States)

    Lee, Chun-Chuan; Wu, Chih-Jen; Chou, Li-Hua; Shen, Su-Mei; Chiang, Sheng-Fang; Jen, Pi-Chu; Yeh, Mei-Ching; Pan, Chi-Feng

    2012-09-03

    Peripheral artery disease (PAD) is a condition characterized by restricted blood flow to the extremities, and is especially common in the elderly. PAD increases the risk for mortality and morbidity in patients with end-stage renal disease (ESRD), especially those on hemodialysis (HD). The records of 484 patients with end-stage renal disease who were on HD or peritoneal dialysis (PD) were reviewed. PAD was diagnosed based on the ankle-brachial pressure index (ABI). Demographic and clinical characteristics were analyzed. PAD had an overall prevalence of 18.2% and was significantly more common in HD patients (21.8%) than in PD patients (4.8%). Advanced age, diabetes mellitus, smoking, low parathyroid hormone level, elevated serum ferritin, elevated serum glucose, and low serum creatinine levels increased the risk for PAD. PAD was independently associated with advanced age, diabetes mellitus, duration of dialysis, low serum creatinine, and hyperlipidemia. PD patients had a significantly lower prevalence of PAD than HD patients, maybe due to their younger age and lower prevalence of diabetes mellitus in this present study. The prevalence of PAD was greater in the HD group than the PD group. Most of the risk factors for PAD were specific to HD, and no analyzed factor was significantly associated with PAD in PD patients.

  19. Social cognitive constructs and the promotion of physical activity in patients with peripheral artery disease.

    Science.gov (United States)

    Rejeski, W Jack; Tian, Lu; Liao, Yihua; McDermott, Mary M

    2008-01-01

    The purpose of this study was to provide measures and accompanying psychometric support for key constructs from social cognitive theory relevant to the promotion of physical activity in patients with peripheral artery disease (PAD). Patients (n = 205) were identified from 2 ongoing studies involving PAD, who completed the Geriatric Depression Scale, a 6-minute walk, and the social cognitive measures of interest: pain acceptance, self-efficacy, desire for physical competence, perceived control for walking, and satisfaction with function. Psychometric support for each measure included factor analyses, test-retest reliability, and an evaluation of construct validity by investigating how each measure was related to depression and performance on the 6-minute walk test. The measures of interest had good structural integrity, were reliable, and shared expected variance with depressed affect; most had significant linear trends with the 6-minute walk test, suggesting that compromised psychological status is related to poorer mobility. Constructs from social cognitive theory are clearly relevant to the promotion of physical activity in PAD patients. To this end, this study offers measures of relevant constructs that can now be implemented into intervention research.

  20. Peripheral Arterial Disease in Patients Presenting with Acute Coronary Syndrome in Six Middle Eastern Countries

    Directory of Open Access Journals (Sweden)

    Hassan A. Al-Thani

    2011-01-01

    Full Text Available To describe prevalence and impact of peripheral arterial disease (PAD in patients with acute coronary syndrome (ACS, data were collected over 5 months from 6 Middle Eastern countries. Patients were divided into 2 groups (with and without PAD. Out of 6705 consecutive ACS patients, PAD was reported in 177 patients. In comparison to non-PAD, PAD patients were older and more likely to have cardiovascular risk factors. They were more likely to have high Killip class, high GRACE risk score, and non-ST elevation ACS (NSTEACS at presentation. Thrombolytics, antiplatelet use, and coronary intervention were comparable in both groups. When presented with ST-elevation myocardial infarction (STEMI, patients with PAD had worse outcomes, while in NSTEACS; PAD was associated with higher rate of heart failure in comparison to non-PAD patients. In diabetics, PAD was associated with 2-fold increase in mortality when compared to non-PAD (P=0.028. After adjustment, PAD was associated with high mortality in STEMI (adjusted OR 2.6; 95% CI 1.23–5.65, P=0.01. Prevalence of PAD in ACS in the Gulf region is low. Patients with PAD and ACS constitute a high risk group and require more attention. PAD in patients with STEMI is an independent predictor of in-hospital death.

  1. Small infrarenal aortic diameter associated with lower-extremity peripheral artery disease in Chinese hypertensive adults.

    Science.gov (United States)

    Liu, Jie; Jia, Xin; Jia, Senhao; Qin, Xianhui; Zhang, Tao; Liu, Lishun; Li, Haibo; Rong, Dan; Zhou, Ziyi; Song, Yuxiang; Zuo, Shangwei; Duan, Chen; Wu, Zhongyin; Wei, Ren; Ge, Yangyang; Wang, Xian; Kong, Wei; Xu, Xiping; Khalil, Raouf A; Huo, Yong; Guo, Wei

    2017-11-06

    Several studies suggest that infrarenal aortic diameter is associated with lower-extremity peripheral artery disease (LE-PAD). However, data regarding the associations between infrarenal aortic diameter and LE-PAD are limited, especially in large sample populations and Asian or Chinese populations. Our analysis included 17279 Chinese hypertensive adults comprising 6590 men and 10689 women with a mean age of 64.74 ± 7.41 years. Participants were selected from 22693 candidates from two large population-based cohort-studies. The primary noninvasive test for diagnosis of LE-PAD is the ankle-brachial index (ABI) at rest and typically an ABI ≤ 0.90 is used to define LE-PAD. The prevalence of LE-PAD was found to significantly decrease as the aortic diameter increased according to the tertile of the aortic diameter. LE-PAD was significantly more prevalent in the lowest tertile (OR = 1.58, 95% CI = 1.29-1.94, p  0.05). In conclusion, Small aortic diameter (as opposed to large aortic diameter) is significantly associated with LE-PAD in Chinese hypertensive adults.

  2. Isokinetic strength and endurance in proximal and distal muscles in patients with peripheral artery disease.

    Science.gov (United States)

    Câmara, Lucas Caseri; Ritti-Dias, Raphael Mendes; Menêses, Annelise Lins; D'Andréa Greve, Júlia Maria; Filho, Wilson Jacob; Santarém, José Maria; Forjaz, Cláudia Lúcia de Moraes; Puech-Leão, Pedro; Wolosker, Nelson

    2012-11-01

    The objective of this study was to analyze the muscle strength and endurance of the proximal and distal lower-extremity muscles in peripheral artery disease (PAD) patients. Twenty patients with bilateral PAD with symptoms of intermittent claudication and nine control subjects without PAD were included in the study, comprising 40 and 18 legs, respectively. All subjects performed an isokinetic muscle test to evaluate the muscle strength and endurance of the proximal (knee extension and knee flexion movements) and distal (plantar flexion and dorsiflexion movements) muscle groups in the lower extremity. Compared with the control group, the PAD group presented lower muscle strength in knee flexion (-14.0%), dorsiflexion (-26.0%), and plantar flexion (-21.2%) movements (P strength in knee extension movements (P > 0.05). The PAD patients presented a 13.5% lower knee flexion/extension strength ratio compared with the control subjects (P lower muscle endurance in dorsiflexion (-28.1%) and plantar flexion (-17.0%) movements (P muscle endurance in knee flexion and knee extension movements was similar between PAD patients and the control subjects (P > 0.05). PAD patients present lower proximal and distal muscle strength and lower distal muscle endurance than control patients. Therefore, interventions to improve muscle strength and endurance should be prescribed for PAD patients. Copyright © 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

  3. Validity of Peripheral Arterial Disease Diagnoses in the Danish National Patient Registry.

    Science.gov (United States)

    Lasota, A N; Overvad, K; Eriksen, H H; Tjønneland, A; Schmidt, E B; Grønholdt, M-L M

    2017-05-01

    The objective was to validate the diagnoses of peripheral arterial disease (PAD) in the legs, obtained from national registers in Denmark. In total, 1435 registered cases of PAD were identified in the Danish National Patient Registry among 57,053 middle aged participants from the Danish Diet, Cancer and Health cohort study. Validation was performed by reviewing all medical records using pre-specified criteria for a diagnosis of PAD. The overall positive predictive value (PPV) of PAD diagnoses was 69.4% [95% confidence interval (CI) 67.0-71.7]. The PPV of diagnoses given in departments of vascular surgery was significantly higher than diagnoses given in other departments: 71.9% (95% CI 69.2-74.4) versus 58.3% (95% CI 52.2-64.2), respectively. In a sub-study, 141 potential cases of PAD also registered in the Danish National Vascular Registry were evaluated, and a PPV of 87.9% (95% CI 81.4-92.4) was found for these diagnoses. More than 30% of the diagnoses of PAD notified in the Danish National Patient Registry were not valid, stressing the importance of validation when using register information for research purposes. In contrast, diagnoses obtained from the Danish National Vascular Registry had a high validity ready for use without further validation. Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  4. Plasma S100A12 Levels and Peripheral Arterial Disease in End-Stage Renal Disease

    Directory of Open Access Journals (Sweden)

    Yayoi Shiotsu

    2011-12-01

    Full Text Available Background: S100A12 is an endogenous ligand of the receptor for advanced glycation end products (RAGE. Plasma S100A12 levels are high in end-stage renal disease (ESRD patients undergoing maintenance hemodialysis (HD. Peripheral arterial disease (PAD is common in HD patients and is associated with increased cardiovascular morbidity and mortality rates in this population. To date, however, no study has specifically assessed the relationship between plasma S100A12 and PAD in HD patients. Methods: We conducted a cross-sectional study of 152 HD patients in our affiliated hospital. We investigated PAD history and patient characteristics and quantified plasma S100A12 levels in all participants. Results: HD patients with PAD (n = 26; 21.9 [13.6–33.4] ng/ml showed significantly higher plasma S100A12 levels than HD patients without PAD (n = 126; 11.8 [7.5–17.6]ng/ml; p Conclusion: These results suggest that plasma S100A12 levels are strongly associated with PAD prevalence in ESRD patients undergoing HD.

  5. Deep tissue near infrared second derivative spectrophotometry for the assessment of claudication in peripheral arterial disease.

    Science.gov (United States)

    Koutsiaris, Aristotle G

    2017-01-01

    The purpose of this study was the application of a second derivative near infrared spectrophotometric (NIRS) technique to the human calf muscle in order to see if peripheral arterial disease (PAD) patients can be discriminated from control subjects, before, during and after a standard treadmill exercise test. Three groups of human subjects were studied: group A consisted of 10 control subjects and groups B and C were formed by PAD patients classified as Fontaine's stage 2a (5 patients) and 2b (10 patients), respectively. The measurement protocol for all groups was 9.75 minutes of standing up (phase 1), 1 minute of exercise (phase 2) and 1 minute of rest (phase 3). Seven variables were defined at different times from the onset of the measurement protocol. All variables were significantly higher (p derivative NIRS technique can discriminate (p = 0.003) healthy subjects from PAD patients, in just 15 seconds of standing, with no exercise requirement. More experiments are required in order to uncover the full potential of the technique in the diagnosis of the PAD.

  6. The effect of exercise on coagulation and fibrinolysis factors in patients with peripheral arterial disease.

    Science.gov (United States)

    Patelis, Nikolaos; Karaolanis, Georgios; Kouvelos, Georgios N; Hart, Collin; Metheiken, Sean

    2016-09-01

    Peripheral arterial disease is a widely prevalent atherosclerotic occlusive disorder. Symptoms commence with exercise-induced pain in the lower extremities, known as claudication. Despite the fact that exercise has been shown to improve fibrinolytic profile some patients, the effect of exercise on coagulation and fibrinolysis cascades in claudicants has not been comprehensively defined. Literature search in English language yielded 13 studies of exercise on claudicants, including 420 patients. Claudicants tend to have a higher coagulation activity at rest compared to healthy individuals, a trend that persists even after exercise. Post-exercise coagulation activity of claudicants is increased when compared to their respective baseline levels, but it is so in a non-consistent manner. From the available data, it has been suggested that claudicants have a functional and effective fibrinolytic mechanism in place, operating continuously at a relatively higher activity level compared to healthy individuals. Fibrinolysis seems to be activated by exercise; a positive outcome with a prolonged effect as shown by a few of the studies. A final conclusion whether coagulation or fibrinolysis activity is affected mostly by exercise type and intensity in claudicants could not be answered. All conclusions regarding the effect of exercise on the coagulation and fibrinolysis mechanisms should be taken under cautious consideration, due to the limited number of studies, the small number of patients and the different exercise strategies employed in each study. Further randomized studies with similar exercise protocols could provide safer conclusions in the future. © 2016 by the Society for Experimental Biology and Medicine.

  7. Gaps in awareness of peripheral arterial disease in Sri Lanka: a cross sectional study

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    Janaka Weragoda

    2016-10-01

    Full Text Available Abstract Background Peripheral arterial disease (PAD is an emerging problem in Sri Lanka, particularly with the ageing population. A considerable number of patients are detected at a late stage with severe limb ischemia or chronic non-healing leg ulceration. Public awareness about PAD is important in developing preventive strategies. Methods A cross sectional study was conducted to assess awareness of PAD among adults aged 40–74 years in a district in Sri Lanka. In total, 2912 adults were selected for the study using a multistage probability proportionate to size sampling technique. Data were collected by an interviewer-administered questionnaire. Participants who were aware of PAD were asked about common risk factors, possible consequences of untreated PAD, and sources of information. Multivariate logistic regression analysis was used to assess the independent predictors of PAD awareness. Results We found that 4.1 % of participants were aware of PAD (95 % confidence interval: 3.4–4.8, which was significantly lower than awareness of other cardiovascular diseases such as cerebrovascular accidents (67.3 % and myocardial infarction (57.6 % (p < 0.001. Being male, an urban resident, and having a higher level of education were independent predictors of high PAD awareness. Conclusions Our findings suggest that a comprehensive PAD awareness program that covers risk factors, consequences, and preventative strategies is needed to enhance public awareness of PAD.

  8. Pneumoconiosis increases the risk of peripheral arterial disease: a nationwide population-based study.

    Science.gov (United States)

    Shen, Chih-Hao; Lin, Te-Yu; Huang, Wen-Yen; Chen, Hsuan-Ju; Kao, Chia-Hung

    2015-05-01

    This nationwide population-based retrospective cohort study was used to evaluate the association between pneumoconiosis and peripheral arterial disease (PAD). We identified 3374 patients with pneumoconiosis from the catastrophic illness registry who were newly diagnosed from 2000 to 2005; 13,496 patients without pneumoconiosis from Longitudinal Health Insurance Database 2000 (LHID2000) were randomly frequency matched according to sex, age, and index year and used as a nonpneumoconiosis group. Multivariate Cox proportional hazards regression was used to calculate adjusted hazard ratios (HRs) of PAD in the pneumoconiosis group compared with the nonpneumoconiosis group. The mean follow-up years were 7.44 years in the pneumoconiosis group and 8.17 years in the nonpneumoconiosis group. The incidence density rate of PAD was 1.25 times greater in the pneumoconiosis group than in the nonpneumoconiosis group (8.37 vs 6.70 per 1000 person-years). After adjusting for sex, age, and comorbidities, the adjusted HRs of PAD for the pneumoconiosis group were 1.30 (95% CI = 1.08-1.57), compared with the nonpneumoconiosis group. The combined impacts of patients with pneumoconiosis and diabetes, hyperlipidemia, hypertension, ischemic heart disease, chronic obstructive pulmonary disease, and asthma showed a significant by joint association with PAD risk compared with patients with no pneumoconiosis and no counterpart comorbidity. Patients with pneumoconiosis have an independently higher risk of developing PAD. Physicians should include pneumoconiosis in evaluating PAD risk.

  9. Role of thrombophilia in premature peripheral arterial obstructive disease - experience of a vascular centre in China.

    Science.gov (United States)

    Ni, L; Liu, C-W; Ricco, J-B; Dick, F; Liu, B; Ye, W

    2012-08-01

    To evaluate aetiology profile and role of thrombophilia in patients with premature peripheral arterial obstructive disease (PAOD) in China. Between January 2000 and January 2010, among 368 patients presenting with PAOD, but not Buerger's disease, at an age of less than 45 years, 150 patients have been screened for thrombophilia and the data analysed retrospectively. Aetiologies of thrombophilia which involved in premature PAOD were assessed and surgical outcomes were stratified for presence of thrombophilia. In 57 of 150 patients (38%), laboratory assay results suggested thrombophilia, and the rest of them presented with other aetiology (62%). A total of 108 patients, including 38 patients with thrombophilia (35%), needed some type of revascularisation. At 30 days, recurrent thrombosis (29% vs. 9%; p = 0.005) and major amputations (11% vs. 1%; p = 0.032) were more common in patients with thrombophilia. At 1 year, primary patency (56% vs. 75%, p = 0.043), secondary patency (68% vs. 92%, p = 0.036) and limb salvage (74% vs. 96%, p = 0.038) were significantly lower in patients with thrombophilia. Thrombophilia is frequently diagnosed among premature PAOD in China and adversely affects outcome after revascularisation. Clinicians should be aware of its high prevalence and aim at screening and sustained thrombophilia treatment. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

  10. Unrecognised obstructive sleep apnoea is common in severe peripheral arterial disease.

    Science.gov (United States)

    Utriainen, Karri T; Airaksinen, Juhani K; Polo, Olli; Raitakari, Olli T; Pietilä, Mikko J; Scheinin, Harry; Helenius, Hans Y; Leino, Kari A; Kentala, Erkki S; Jalonen, Jouko R; Hakovirta, Harri; Salo, Tiina M; Laitio, Timo T

    2013-03-01

    Patients needing surgery for peripheral arterial disease (PAD) represent a severe form of atherosclerosis with an overall 5-yr mortality of 30% after revascularisation. The aetiology for poor post-operative clinical outcome in these high-risk patients is not fully established. Obstructive sleep apnoea (OSA) is associated with atherosclerosis and is an independent risk factor for fatal and nonfatal cardiac events. Here, we determine the prevalence of undiagnosed OSA in a homogenous group of PAD patients undergoing subinguinal surgical revascularisation. 82 consecutive patients (mean age 67±9 yrs, 52 males) with sinus rhythm and without congestive heart failure or previously diagnosed OSA were enrolled for pre-operative polysomnography and echocardiography. OSA was present in 70 (85%) patients (95% CI 75-93%), of whom 24 (34%) had severe OSA. OSA was mostly asymptomatic, and age- and sex-adjusted multivariate regression analysis showed no relation to obesity, metabolic syndrome or any manifestation of atherosclerosis, other than PAD. Left ventricular ejection fraction (p = 0.002) and high-density lipoprotein/total cholesterol ratio (p = 0.03) were the only independent predictors for the severity of OSA. Thus, prevalence of OSA is unexpectedly high in patients with PAD and is not related to classical risk factors of sleep apnoea.

  11. Recruiting older patients with peripheral arterial disease: evaluating challenges and strategies

    Directory of Open Access Journals (Sweden)

    Brostow DP

    2015-08-01

    Full Text Available Diana P Brostow,1 Alan T Hirsch,2 Mindy S Kurzer3,4 1Veterans Affairs Eastern Colorado Health Care System, Denver, CO, USA; 2Department of Medicine, Vascular Medicine Program, University of Minnesota, Twin Cities, Minneapolis, MN, USA; 3Department of Food Science and Nutrition, University of Minnesota, Twin Cities, 4Healthy Lives Institute, St Paul, MN, USA Abstract: Peripheral arterial disease (PAD is a group of syndromes characterized by chronic and progressive atherosclerosis with a high burden of physical disability and cardiovascular morbidity and mortality. Recruiting patients for clinical research is therefore challenging. In this article, we describe and evaluate our methods for recruiting participants for a cross-sectional feasibility study of PAD, nutritional status, and body composition. We used convenience and purposive sampling approaches to identify potential participants. Between May 2012 and April 2013, 1,446 patients were identified, and 165 patients (11.4% responded to recruitment requests. The final enrollment was 64 participants (64/1,446; 4.4%, and four subjects (6.3% subsequently withdrew from the study. Recruiting PAD patients presents a variety of challenges, due largely to the burdens of living with coexistent illnesses, and patients’ reluctance or inability to travel for research. In this article, we delineate suggestions for improving the efficacy of recruitment methods in future PAD studies. Keywords: community-based programs, depression, ethnicity, geriatrics, progressive illness and disease, mental health and illness, minorities

  12. Increased risk of peripheral arterial occlusive disease in patients with Bell's palsy using population data.

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    Li-Syue Liou

    Full Text Available This population-based cohort study investigated the risk of developing peripheral arterial occlusive disease (PAOD in patients with Bell's palsy.We used longitudinal claims data of health insurance of Taiwan to identify 5,152 patients with Bell's palsy newly diagnosed in 2000-2010 and a control cohort of 20,608 patients without Bell's palsy matched by propensity score. Incidence and hazard ratio (HR of PAOD were assessed by the end of 2013.The incidence of PAOD was approximately 1.5 times greater in the Bell's palsy group than in the non-Bell's palsy controls (7.75 vs. 4.99 per 1000 person-years. The Cox proportional hazards regression analysis measured adjusted HR was 1.54 (95% confidence interval (CI = 1.35-1.76 for the Bell's palsy group compared to the non-Bell's palsy group, after adjusting for sex, age, occupation, income and comorbidities. Men were at higher risk of PAOD than women in the Bell's palsy group, but not in the controls. The incidence of PAOD increased with age in both groups, but the Bell's palsy group to control group HR of PAOD decreased as age increased. The systemic steroid treatment reduced 13% of PAOD hazard for Bell's palsy patients, compared to those without the treatment, but not significant.Bell's palsy appears to be associated with an increased risk of developing PAOD. Further pathophysiologic, histopathology and immunologic research is required to explore the underlying biologic mechanism.

  13. Amputation Rates for Patients with Diabetes and Peripheral Arterial Disease: The Effects of Race and Region.

    Science.gov (United States)

    Newhall, Karina; Spangler, Emily; Dzebisashvili, Nino; Goodman, David C; Goodney, Philip

    2016-01-01

    It remains unknown whether care of high-risk vascular patients with both diabetes and peripheral arterial disease (PAD) is improving. We examined national trends in care of patients with both PAD and diabetes. A cohort of patients diagnosed with PAD and diabetes between 2007 and 2011 undergoing open or endovascular diagnostic or revascularization procedures was analyzed using Medicare claims data. Main outcome measure was amputation-free survival measured from time of initial revascularization procedure to 24 months, stratified by race and hospital referral region (HRR). From 2007 to 2011, 2.3 per 1,000 patients underwent a major amputation with the higher rate among black patients (5.5 per 1,000 vs. 1.9 per 1,000; P amputation rates in black patients (2.1-16.1 per 1,000). Overall, amputation-free survival was approximately 74.6% at 2 years, 68.4% among black patients, and 75.4% among nonblack patients, with the disparity between the 2 groups increasing over time. Prevalence of concurrent PAD and diabetes is increasing, but amputation rates and amputation-free survival vary significantly by both race and HRR. Prevention and care coordination effort should aim to limit racial disparities in the treatment and outcomes of these high-risk patients. Published by Elsevier Inc.

  14. Clinical outcomes and medical care costs among medicare beneficiaries receiving therapy for peripheral arterial disease.

    Science.gov (United States)

    Jaff, Michael R; Cahill, Kevin E; Yu, Andrew P; Birnbaum, Howard G; Engelhart, Luella M

    2010-07-01

    Peripheral arterial disease (PAD) is a common disorder with multiple options for treatment, ranging from medical interventions, surgical revascularization, and endovascular therapy. Despite the explosive advances in endovascular therapy, cost-effective methods of care have not been well defined. We analyze therapeutic strategies, outcomes, and medical cost of treatment among Medicare patients with PAD. Patients who underwent therapy for PAD were identified from a 5% random sample of Medicare beneficiaries from Medicare Standard Analytic Files for the period 1999-2005. Clinical outcomes (death, amputation, new clinical symptoms related to PAD) and direct medical costs were examined by chosen revascularization options (endovascular, surgical, and combinations). One-year PAD prevalence increased steadily from 8.2% in 1999 to 9.5% in 2005. The risk-adjusted time to first post-treatment clinical outcome was lowest in those treated with "percutaneous transluminal angioplasty (PTA) or atherectomy and stents" (HR, 0.829; 95% CI, 0.793-0.865; p PAD population and was associated with higher risks of clinical events and higher medical costs compared with PAD patients without diabetes. The clinical and economic burden of PAD in the Medicare population is substantial, and the interventions used to treat PAD are associated with differences in clinical and economic outcomes. Prospective cost-effectiveness analyses should be included in future PAD therapy trials to inform payers and providers of the relative value of available treatment options. Copyright (c) 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

  15. Gait kinematics and kinetics are affected more by peripheral arterial disease than age

    Science.gov (United States)

    Myers, Sara A.; Applequist, Bryon C.; Huisinga, Jessie M.; Pipinos, Iraklis I.; Johanning, Jason M.

    2016-01-01

    Peripheral arterial disease (PAD) produces abnormal gait and disproportionately affects older individuals. The current study investigated PAD gait biomechanics in young and older subjects. Sixty-one (31 PAD and 52 healthy age matched controls were included. Patients with PAD were tested during pain free walking and compared to matched healthy controls. Joint kinematics and kinetics (torques) were compared using a 2 × 2 ANOVA (Groups: PAD vs. Control, Age: Younger vs. Older). Patients with PAD had significantly increased ankle and decreased hip range of motion during the stance phase as well as decreased ankle dorsiflexor torque compared to controls. Gait changes in older individuals are largely constrained to time-distance parameters. Joint kinematics and kinetics are significantly altered in patients with PAD during pain free ambulation. Symptomatic PAD produces a consistent ambulatory deficit across ages definable by advanced biomechanical analysis. The most important finding of the current study is that gait, in the absence of PAD and other ambulatory comorbidities, does not decline significantly with age based on advanced biomechanical analysis. Therefore, previous studies must be examined in the context of potential PAD patients being present in the population and future ambulatory studies must include PAD as a confounding factor when assessing the gait function of elderly individuals. PMID:27149635

  16. Low-grade albuminuria is associated with peripheral artery disease in Chinese diabetic patients.

    Science.gov (United States)

    Xu, Baihui; Dai, Meng; Li, Mian; Sun, Kan; Zhang, Jie; Wang, Tiange; Sun, Jichao; Chen, Yuhong; Xu, Min; Lu, Jieli; Bi, Yufang

    2014-02-01

    Increasing studies have suggested that albuminuria might be an important risk factor for peripheral artery disease (PAD). However, studies focusing on the association between low-grade albuminuria and PAD are limited. It would be of great interest to elucidate the association between low-grade albuminuria and PAD in diabetic subjects. A cross-sectional study was conducted in 1386 diabetic subjects (age ≥ 40 years) with normal urinary albumin levels from Shanghai, China. A first voided early morning spot urine sample was obtained for urinary albumin and creatinine measurements. Subjects were divided into three groups according to sex-specific cutoff points of urinary albumin-creatinine ratio (UACR) tertiles. Subjects in the upper tertile of UACR were classified as having low-grade albuminuria. PAD was defined by ankle-brachial index (ABI) 1.4. Overall, 106 (7.7%) of the study population had PAD. The prevalence of PAD in tertile 3 of UACR was higher than the prevalence in tertile 2 and tertile 1 (10.2%, 6.4% and 6.4%, respectively; P albuminuria might be an early marker for the detection of PAD in diabetic patients. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  17. Racial differences in functional decline in peripheral artery disease and associations with socioeconomic status and education.

    Science.gov (United States)

    McDermott, Mary M; Polonsky, Tamar S; Kibbe, Melina R; Tian, Lu; Zhao, Lihui; Pearce, William H; Gao, Ying; Guralnik, Jack M

    2017-09-01

    The objective of this study was to determine whether blacks with lower extremity peripheral artery disease (PAD) have faster functional decline than whites with PAD. Participants with ankle-brachial index education (P = .229). Among 844 participants without baseline mobility impairment, black participants had a higher rate of mobility loss (64/209 [30.6%] vs 164/635 [25.8%]; log-rank, P = .009). Black race was associated with increased mobility loss, adjusting for potential confounders (hazard ratio, 1.42; 95% confidence interval, 1.04-1.94; P = .028). This association was attenuated after additional adjustment for income and education (P = .392) and physical activity (P = .113). There were no racial differences in average annual declines in 6-minute walk, usual-paced 4-meter walking velocity, or fast-paced 4-meter walking velocity. Black PAD patients have higher rates of mobility loss and becoming unable to walk for 6 minutes continuously. These differences appear related to racial differences in socioeconomic status and physical activity. Copyright © 2017 Society for Vascular Surgery. All rights reserved.

  18. The effect of pharmacological treatment on gait biomechanics in peripheral arterial disease patients

    Science.gov (United States)

    2010-01-01

    Background Pharmacological treatment has been advocated as a first line therapy for Peripheral Arterial Disease (PAD) patients suffering from intermittent claudication. Previous studies document the ability of pharmacological treatment to increase walking distances. However, the effect of pharmacological treatment on gait biomechanics in PAD patients has not been objectively evaluated as is common with other gait abnormalities. Methods Sixteen patients were prescribed an FDA approved drug (Pentoxifylline or Cilostazol) for the treatment of symptomatic PAD. Patients underwent baseline gait testing prior to medication use which consisted of acquisition of ground reaction forces and kinematics while walking in a pain free state. After three months of treatment, patients underwent repeat gait testing. Results Patients with symptomatic PAD had significant gait abnormalities at baseline during pain free walking as compared to healthy controls. However, pharmacological treatment did not produce any identifiable alterations on the biomechanics of gait of the PAD patients as revealed by the statistical comparisons performed between pre and post-treatment and between post-treatment and the healthy controls. Conclusions Pharmacological treatment did not result in statistically significant improvements in the gait biomechanics of patients with symptomatic PAD. Future studies will need to further explore different cohorts of patients that have shown to improve significantly their claudication distances and/or their muscle fiber morphology with the use of pharmacological treatment and determine if this is associated with an improvement in gait biomechanics. Using these methods we may distinguish the patients who benefit from pharmacotherapy and those who do not. PMID:20529284

  19. Patient outcomes following lower leg major amputations for peripheral arterial disease: A series review.

    Science.gov (United States)

    Monaro, Susan; West, Sandra; Gullick, Janice

    2017-06-01

    Despite improvements in revascularization, major amputation remains a significant part of the case-mix in vascular surgical units. These patients tend to be elderly with complex pathology, resulting in poor outcomes and longer lengths of stay (LOS). This series review provides a description of the patient complexities and outcomes in an Australian cohort undergoing major lower limb amputation for peripheral arterial disease. Medical records coded for major amputation between July 2012 and June 2013 in an Australian government funded, tertiary hospital were retrospectively reviewed and descriptively analyzed. Twenty-five patients had 29 major amputations including four conversions from below to above knee. Seventeen had multiple vascular procedures before amputation. The average LOS exceeded the national target, and there was substantial morbidity and 30-day mortality. Major amputation continues to present challenges because of patient frailty and the high rate of complications. These issues need to be considered in a robust care planning framework that includes consideration of cognitive decline and other markers of frailty. Opportunities to optimize the physical condition of these patients and to reduce delays in proceeding to surgery require further investigation. Copyright © 2016 Society for Vascular Nursing, Inc. All rights reserved.

  20. [Preliminary analysis of the relationship between peripheral arterial disease and other atherosclerosis markers and diabetic nephropathy].

    Science.gov (United States)

    Rioja, José; Moreno, Tamara; Coca, Inmaculada; Jiménez-Villodres, Manuel; Rodríguez-Morata, Alejandro; Valdivielso, Pedro

    2014-01-01

    To determine lipid serum levels, lipoproteins and other markers related to nephropathy and peripheral arterial disease (PAD) in a type 2 diabetes population stratified according to their level of renal dysfunction. A cross-sectional study was conducted on 72 type 2 diabetic patients followed-up in outpatient clinics. Patients were divided into 4 groups according to their estimated glomerular filtration rate (eGFR, mL/min) and albumin/creatinine ratio (ACR, mg/g) (eGFR > 60 and ACR 60 and ACR > 30 [n = 12], eGFR30-60 [n = 23] and eGFR renal and hematology parameters were measured. Finally, a multivariate Wald stepwise logistic regression statistic analysis was performed to determine variables independently associated with the presence of renal dysfunction. The univariate statistical analysis showed that the higher renal dysfunction, the higher the prevalence of hypertension, smoking habit and triglycerides levels, and the lower hemoglobin levels (P renal dysfunction (eGFR < 60 mL/min.). The further inclusion of the presence of PAD in the statistical model did not modify those associations. The results confirm the relationship between triglycerides levels and diabetic nephropathy, independently of the presence of PAD. Copyright © 2013 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  1. Peripheral artery disease, redox signaling, oxidative stress – Basic and clinical aspects

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    Sebastian Steven

    2017-08-01

    Full Text Available Reactive oxygen and nitrogen species (ROS and RNS, e.g. H2O2, nitric oxide confer redox regulation of essential cellular signaling pathways such as cell differentiation, proliferation, migration and apoptosis. At higher concentrations, ROS and RNS lead to oxidative stress and oxidative damage of biomolecules (e.g. via formation of peroxynitrite, fenton chemistry. Peripheral artery disease (PAD is characterized by severe ischemic conditions in the periphery leading to intermittent claudication and critical limb ischemia (end stage. It is well known that redox biology and oxidative stress play an important role in this setting. We here discuss the major pathways of oxidative stress and redox signaling underlying the disease progression with special emphasis on the contribution of inflammatory processes. We also highlight therapeutic strategies comprising pharmacological (e.g. statins, angiotensin-converting enzyme inhibitors, phosphodiesterase inhibition and non-pharmacological (e.g. exercise interventions. Both of these strategies induce potent indirect antioxidant and anti-inflammatory mechanisms that may contribute to an improvement of PAD associated complications and disease progression by removing excess formation of ROS and RNS (e.g. by ameliorating primary complications such as hyperlipidemia and hypertension as well as the normalization of the inflammatory phenotype suppressing the progression of atherosclerosis.

  2. The Genetic Basis of Peripheral Arterial Disease: Current Knowledge, Challenges and Future Directions

    Science.gov (United States)

    Kullo, Iftikhar J.; Leeper, Nicholas J.

    2015-01-01

    Several risk factors for atherosclerotic peripheral arterial disease (PAD) such as dyslipidemia, diabetes and hypertension, are heritable. However, predisposition to PAD may be influenced by genetic variants acting independently of these risk factors. Identification of such genetic variants will provide insights into underlying pathophysiologic mechanisms and facilitate the development of novel diagnostic and therapeutic approaches. In contrast to coronary heart disease, relatively few genetic variants that influence susceptibility to PAD have been discovered. This may be in part due to greater clinical and genetic heterogeneity in PAD. In this review, we a) provide an update on the current state of knowledge about the genetic basis of PAD including results of family studies and candidate gene, linkage as well as genome-wide association studies; b) highlight the challenges in investigating the genetic basis of PAD and possible strategies to overcome these challenges; and c) discuss the potential of genome sequencing, RNA sequencing, differential gene expression, epigenetic profiling and systems biology in increasing our understanding of the molecular genetics of PAD. PMID:25908728

  3. Peripheral artery disease in peritoneal dialysis and hemodialysis patients: single-center retrospective study in Taiwan

    Science.gov (United States)

    2012-01-01

    Background Peripheral artery disease (PAD) is a condition characterized by restricted blood flow to the extremities, and is especially common in the elderly. PAD increases the risk for mortality and morbidity in patients with end-stage renal disease (ESRD), especially those on hemodialysis (HD). Methods The records of 484 patients with end-stage renal disease who were on HD or peritoneal dialysis (PD) were reviewed. PAD was diagnosed based on the ankle-brachial pressure index (ABI). Demographic and clinical characteristics were analyzed. Results PAD had an overall prevalence of 18.2% and was significantly more common in HD patients (21.8%) than in PD patients (4.8%). Advanced age, diabetes mellitus, smoking, low parathyroid hormone level, elevated serum ferritin, elevated serum glucose, and low serum creatinine levels increased the risk for PAD. PAD was independently associated with advanced age, diabetes mellitus, duration of dialysis, low serum creatinine, and hyperlipidemia. PD patients had a significantly lower prevalence of PAD than HD patients, maybe due to their younger age and lower prevalence of diabetes mellitus in this present study. Conclusions The prevalence of PAD was greater in the HD group than the PD group. Most of the risk factors for PAD were specific to HD, and no analyzed factor was significantly associated with PAD in PD patients. PMID:22943313

  4. Plasma nitric oxide level is correlated with microvascular functions in the peripheral arterial disease.

    Science.gov (United States)

    Akkoca, Muzaffer; Usanmaz, Suzan Emel; Koksoy, Cuneyt; Bengisun, Ugur; Demirel-Yilmaz, Emine

    2017-01-01

    At present there is no widely accepted biomarker for monitoring of vascular functions. The purpose of this prospective study was to investigate the association of some blood biomarkers with vascular reactivity in patients with peripheral arterial diseases (PAD). A prospective evaluation was made of 3 groups comprising a control group of healthy individuals, and patients with PAD caused by either atherosclerosis or Buerger's disease. Microvascular perfusion was examined using laser Doppler imaging of cutaneous erythrocyte flux after iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP). The correlation of microvascular reactivity with endothelium-related biomarkers was assessed. ACh-induced and SNP-induced vasodilations were significantly diminished in the PAD groups. The plasma nitric oxide (NO) levels of PAD patients were significantly higher than those of the control group, but asymmetric dimethylarginine, total antioxidant capacity and hydrogen sulphide levels were similar. Plasma NO level was negatively correlated with ACh and SNP-stimulated microvascular flow increase, whereas a positive correlation was detected with blood glucose and glycated hemoglobin (HbA1c) levels in all groups. These results indicate that a high plasma level of NO in PAD patients is associated with diminished endothelium-dependent and independent flow increase in the microvascular bed. An excessive amount of NO-induced nitrosative stress in an inflammatory condition that might be a reason for vascular dysfunction should be taken into consideration in the diagnostic and therapeutic approaches to PAD.

  5. A near infrared spectroscopy-based test of calf muscle function in patients with peripheral arterial disease

    DEFF Research Database (Denmark)

    Pedersen, Brian Lindegaard; Bækgaard, Niels; Quistorff, Bjørn

    2015-01-01

    Background The study aims to test a new, simple, and reliable apparatus and procedure for the diagnostics and treatment evaluation of peripheral arterial disease (PAD). The test apparatus involves near infrared spectroscopy (NIRS) of a main part of the lower leg muscles during isometric flexion...... and two age-matched patients without claudication. Each patient was tested with an isometric ergometer pedal test and a treadmill test applying NIRS measurements of the anterior tibial and the gastrocnemius muscles (GAS). Tests were repeated three times with randomly selected intervals between individual.......92-0.95 (foot-pedal) and 0.70-0.98 (tread mill) and of the anterior tibial muscle was between 0.87-0.96 (foot-pedal) and 0.67-0.79 (tread mill). Conclusion In this study, we contribute a new apparatus and test protocol for peripheral arterial disease (PAD) applying NIRS technique and controlled physical...

  6. Health-related quality of life predicts long-term survival in patients with peripheral artery disease

    DEFF Research Database (Denmark)

    Issa, Samson M; Hoeks, Sanne E; Scholte op Reimer, Wilma J M

    2010-01-01

    We examined whether health-related quality of life (HRQoL) predicts long-term survival in patients with peripheral artery disease (PAD) independent of established prognostic risk factors. In 2004, data on 711 consecutive patients with PAD undergoing vascular surgery were collected from 11 hospitals...... prognostic factors. In conclusion, the study indicates that poor HRQoL predicts long-term survival in patients with PAD, and provides prognostic value above established risk factors....

  7. Intra-arterial infusion of prostaglandin E1 in normal subjects and patients with peripheral arterial disease

    DEFF Research Database (Denmark)

    Nielsen, P E; Nielsen, S L; Holstein, P

    1976-01-01

    Acute vasodilatation was produced by infusion of prostaglandin E1 (PGE1) in the femoral artery in 6 patients with occlusive arterial disease of the legs and in 3 normal subjects. The effect on blood flow and on blood pressure was measured at different segments of the leg with the strain gauge...

  8. Diagnostic accuracy of three-dimensional contrast-enhanced automatic moving-table MR angiography in patients with peripheral arterial occlusive disease in comparison with digital subtraction angiography

    Directory of Open Access Journals (Sweden)

    Hazem Soliman

    2015-03-01

    Conclusion: Our prospective comparison shows that three-dimensional contrast-enhanced automatic moving-table MRA is a noninvasive imaging modality that has a diagnostic accuracy comparable to DSA for the assessment of peripheral arterial occlusive disease.

  9. Asymptomatic peripheral artery disease can limit maximal exercise capacity in chronic obstructive pulmonary disease patients regardless of airflow obstruction and lung hyperinflation.

    Science.gov (United States)

    Crisafulli, Ernesto; Scelfo, Chiara; Tzani, Panagiota; Aiello, Marina; Bertorelli, Giuseppina; Chetta, Alfredo

    2017-06-01

    Background Silent/asymptomatic peripheral artery disease may occur in patients with chronic obstructive pulmonary disease, but it is poorly investigated. The primary aim of this study was to evaluate in chronic obstructive pulmonary disease patients the impact of asymptomatic/silent peripheral artery disease on maximal exercise capacity; the secondary aim was to search for predictors of peripheral artery disease. Methods We prospectively enrolled chronic obstructive pulmonary disease outpatients. Data on anthropometric characteristics, lung function, cardiopulmonary exercise test and ankle-brachial index were recorded. The cut-off of ankle-brachial index used to define patients with peripheral artery disease was ≤0.90. Results We studied 47 patients and found 24 patients (51%) who showed peripheral artery disease. As compared to patients without peripheral artery disease, patients with peripheral artery disease had lower values of peak oxygen uptake, peak workload, energy expenditure (metabolic equivalents) and heart rate recovery, but showed the same degree of airflow obstruction and static and dynamic hyperinflation. In a multivariate linear regression model performed to identify variables predicting metabolic equivalents, ankle-brachial index (β 2.59; 95% confidence interval 0.51-4.67; p = 0.016) was an independent variable. In the search for predictors of peripheral artery disease, heart rate recovery (odds ratio 8.80; 95% confidence interval 1.30-59.35; p = 0.026) increased the risk of peripheral artery disease, whereas metabolic equivalents (odds ratio 0.50; 95% confidence interval 0.26-0.94, p = 0.033) and inhaled corticosteroids+long-acting β 2 agonists (odds ratio 0.13; 95% confidence interval 0.02-0.83; p = 0.030) reduced this risk. Conclusions In chronic obstructive pulmonary disease outpatients, asymptomatic/silent peripheral artery disease affects the maximal exercise capacity regardless of airflow obstruction and lung

  10. Evaluation of patients’ adherence in accordance with guidelines for Peripheral Arterial Disease management

    Directory of Open Access Journals (Sweden)

    Michail Zografakis Sfakianakis

    2017-12-01

    Full Text Available Introduction: Peripheral Arterial Disease (PAD is a serious chronic disease of the lower limb circulatory system as it affects the activity daily living and reduces patients’ quality of life. Usually, patients have low adherence to medication and guidelines. Aim: To access patients’ adherence and attitude, after being given instructions for medication and guidelines on the modifiable risk factors. Methods: It is a descriptive cross-sectional observational study, with a sample of 101 patients, hospitalized in the vascular surgery ward of a tertiary hospital in Crete. Data were collected using a research datasheet that was constructed for the purpose of this study, following the current guidelines for PAD management. Also, the Medication Adherence Self-Efficacy Scale (MASES-R questionnaire was used. For the statistical analysis, the IBM SPSS 20.0 program was used with a significance level set to p<0,05. Results: Among 101 patients, 78 patients (77,2% were men. The mean age was 69(+13,5 years. Body Mass Index (BMI was 29(+5,2. From 72 patients (71,3% who were smokers, despite of recommendations, 41 (41,8% were non-compliant and continued smoking. Only 15.8% were fully aware (5/5 correct answers of their disease. The 52,5% of patients did not take their medication themselves. Intermittent claudication in the first 50 meters of walking was found in 70,4% of the sample. There was a statistically significant correlation between the period (in years that patients suffered from diabetes mellitus and the occurrence of peripheral neuropathy (p=0,038. A negative correlation between patients’ age and disease awareness was observed (Δ= -0,344. p<0,001 Somers’ d. Conclusions: Adherence to the guidelines deviates significantly from what is recommended, as patients were unable to follow a lot of the instructions given by healthcare professionals. Therefore, nurses should initially focus on adequate patients’ education about their disease

  11. The Effect of High Dose Cholecalciferol on Arterial Stiffness and Peripheral and Central Blood Pressure in Healthy Humans

    DEFF Research Database (Denmark)

    Bressendorff, Iain; Brandi, Lisbet; Schou, Morten

    2016-01-01

    BACKGROUND: Low levels of serum 25-hydroxy vitamin D are associated with increased arterial stiffness and hypertension. Supplementation with vitamin D precursors has been proposed as a treatment option for these conditions. We examined the effect of oral cholecalciferol on arterial stiffness...... and blood pressure in healthy normotensive adults. METHODS: 40 healthy adults were randomised in this double-blinded study to either oral cholecalciferol 3000 IU/day or matching placebo and were followed for 16 weeks to examine any effects on pulse wave velocity (PWV), augmentation index (AIx), peripheral...... the two groups. There was no correlation between serum 25-hydroxy vitamin D and any of these parameters. CONCLUSIONS: Oral cholecalciferol 3000 IU/day does not affect arterial stiffness or blood pressure after 16 weeks of treatment in healthy normotensive adults. TRIAL REGISTRATION: ClinicalTrials.gov NCT...

  12. Arteriopatía periférica crónica inducida por cocaína Chronic peripheral arterial disease induced by cocaine

    Directory of Open Access Journals (Sweden)

    Sonia Pankl

    2012-02-01

    Full Text Available La trombosis periférica aguda inducida por cocaína ha sido descripta en la literatura, siendo una complicación poco común. Si bien existen comunicaciones que reflejan los efectos crónicos de la cocaína sobre el sistema arterial periférico, no hay casos publicados de tal complicación en ausencia de otros factores de riesgo. Se presenta el caso de una mujer de 22 años de edad con antecedentes de consumo de cocaína intranasal de 3 gramos por semana durante un año, que consultó por claudicación intermitente a los 200 metros asociada a dolor y parestesias en miembro inferior izquierdo de 2 meses de evolución. El ecodoppler arterial evidenció una estenosis mayor del 70% en la arteria femoral superficial izquierda. Se realizaron estudios complementarios descartando otras etiologías probables. Se inició tratamiento con ácido acetilsalicílico, cilostazol y ejercicio reglado, asociado a terapia de apoyo para mantenimiento del cese del consumo de cocaína, con buena respuesta. Se destaca la importancia de la difusión de información a los pacientes, dado que la mayoría de la población desconoce las complicaciones cardiovasculares de dicha adicción. Es indispensable indagar sobre el consumo de cocaína en pacientes jóvenes con arteriopatía sin factores de riesgo aparentes.Cocaine induced acute peripheral thrombosis, though a rare complication, has been described in the literature. Although there are reports describing the chronic effects of cocaine on the peripheral arterial system, there are no published cases of this complication when other risk factors are lacking. We report on a 22 year old female patient, with intranasal consumption of 3 grams of cocaine per week for a year, who consulted for intermittent claudication at 200 meters, associated to left lower limb pain and paresthesiae for the last two months. Arterial Doppler ultrasonography showed a stenosis greater than 70% in the superficial left femoral artery. Other

  13. Cardiovascular risk profile of patients with peripheral arterial occlusive disease during nilotinib therapy.

    Science.gov (United States)

    Bondon-Guitton, E; Combret, S; Pérault-Pochat, M C; Stève-Dumont, M; Bagheri, H; Huguet, F; Despas, F; Pathak, A; Montastruc, J L

    2016-08-01

    Over the past few years, data have suggested that severe peripheral arterial occlusive disease (PAOD) is associated with nilotinib exposure. However, the characteristics of this adverse drug reaction are poorly described since its frequency is low. As far as we know, no study using a spontaneous adverse drug reactions reporting system was performed to describe the characteristics of cases of PAOD related to nilotinib. We performed a study to describe the cardiovascular risk profile of cases of PAOD in patients treated with nilotinib spontaneously reported to the French Pharmacovigilance Database (FPVD). We selected all cases of "vascular disorders," as the System Organ Class in MedDRA®, in which nilotinib was "suspected" and recorded in the French Pharmacovigilance Database between 2007 and 21 October 2014. We then identified cases of PAOD with a Low Level Term and through a detailed summary of the clinical description. We identified 25 cases of POAD. Most of the patients were older than 60 years (84 %) or had another cardiovascular risk factor such as hypercholesterolemia, arterial hypertension, overweight/obesity, smoking, or diabetes mellitus (72 %). Females (13 cases) and males (12 cases) were equally represented, but the presence of cardiovascular risk factors was more frequent in females than in males. The mean time from initiation of nilotinib to PAOD onset was 24 months and was significantly longer in patients aged less than 60 years compared with those aged over 60 years (33.8 ± 24.6 months vs. 22.6 ± 17.5 months, p = 0.002). Pre-existing cardiovascular risk factors, especially diabetes mellitus, also seem to accelerate its occurrence. The FPVD is a useful tool in describing the cardiovascular risk profile of patients with PAOD during nilotinib exposure. Physicians have to be particularly vigilant in patients older than 60 years of age; in patients younger than 60 years of age, long-term surveillance has to be maintained.

  14. Circulating soluble urokinase plasminogen activator receptor levels and peripheral arterial disease outcomes.

    Science.gov (United States)

    Samman Tahhan, Ayman; Hayek, Salim S; Sandesara, Pratik; Hajjari, Jamal; Hammadah, Muhammad; O'Neal, Wesley T; Kelli, Heval M; Alkhoder, Ayman; Ghasemzadeh, Nima; Ko, Yi-An; Aida, Hiroshi; Gafeer, Mohamad Mazen; Abdelhadi, Naser; Mohammed, Kareem Hosny; Patel, Keyur; Arya, Shipra; Reiser, Jochen; Vaccarino, Viola; Sperling, Laurence; Quyyumi, Arshed

    2017-09-01

    Circulating soluble urokinase plasminogen activator receptor (suPAR) is a marker of immune activation associated with atherosclerosis. Whether suPAR levels are associated with prevalent peripheral arterial disease (PAD) and its adverse outcomes remains unknown and is the aim of the study. SuPAR levels were measured in 5810 patients (mean age 63 years, 63% male, 77% with obstructive coronary artery disease [CAD]) undergoing cardiac catheterization. The presence of PAD (n = 967, 17%) was classified as carotid (36%), lower/upper extremities (30%), aortic (15%) and multisite disease (19%). Multivariable logistic and Cox regression models were used to determine independent predictors of prevalent PAD and outcomes including all-cause death, cardiovascular death and PAD-related events after adjustment for age, gender, race, body mass index, smoking, diabetes, hypertension, hyperlipidemia, renal function, heart failure history, and obstructive CAD. Plasma suPAR levels were 22.5% (p < 0.001) higher in patients with PAD compared to those without PAD. Plasma suPAR was higher in patients with more extensive PAD (≥2 compared to single site) p < 0.001. After multivariable adjustment, suPAR was associated with prevalent PAD; odds ratio (OR) for highest compared to lowest tertile of 2.0, 95% CI (1.6-2.5) p < 0.001. In Cox survival analyses adjusted for clinical characteristics and medication regimen, suPAR (in the highest vs. lowest tertile) remained an independent predictor of all-cause death [HR 3.1, 95% CI (1.9-5.3)], cardiovascular death [HR 3.5, 95% CI (1.8-7.0)] and PAD-related events [HR = 1.8, 95% CI (1.3-2.6) p < 0.001 for all]. Plasma suPAR level is predictive of prevalent PAD and of incident cardiovascular and PAD-related events. Whether SuPAR measurement can help screen, risk stratify, or monitor therapeutic responses in PAD requires further investigation. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Smoking cessation has no influence on quality of life in patients with peripheral arterial disease 5 years post-vascular surgery

    DEFF Research Database (Denmark)

    Hoogwegt, M T; Hoeks, S E; Pedersen, Susanne S.

    2010-01-01

    Smoking is an important modifiable risk factor in patients with peripheral arterial disease (PAD). We investigated differences in quality of life (QoL) between patients who quitted smoking during follow-up and persistent smokers.......Smoking is an important modifiable risk factor in patients with peripheral arterial disease (PAD). We investigated differences in quality of life (QoL) between patients who quitted smoking during follow-up and persistent smokers....

  16. Muscle function in individuals with peripheral arterial obstructive disease: A systematic review

    OpenAIRE

    Menêses, Annelise Lins; Farah, Breno Quintella; Ritti-Dias, Raphael Mendes

    2012-01-01

    O objetivo do presente estudo foi sintetizar as evidências sobre a força e resistência muscular de indivíduos com doença arterial obstrutiva periférica (DAOP). Foi realizada revisão sistemática de artigos originais nas bases de dados MEDLINE, LILACS e SciELO, até 2009. A maioria dos estudos que comparou a força muscular da perna ou quadril/coxa de indivíduos com DAOP com a de indivíduos controle reportou menor força nos indivíduos com DAOP. A maioria dos estudos que comparou a força muscular ...

  17. Sarcopenia in Peripheral Arterial Disease: Prevalence and Impact on Functional Status.

    Science.gov (United States)

    Addison, Odessa; Prior, Steven J; Kundi, Rishi; Serra, Monica C; Katzel, Leslie I; Gardner, Andrew W; Ryan, Alice S

    2017-11-11

    To determine the prevalence of sarcopenia in older men with peripheral arterial disease (PAD) and to compare to a subset of the group to age, race, sex, and body mass index (BMI)-matched non-PAD control counterparts. We also sought to compare the functional status of those with PAD with and without sarcopenia. Cohort study. A Veterans Affairs medical center. Sedentary, community dwelling men age 50+ years with a confirmed diagnosis of PAD (N=108; 44% black; BMI 27.8 ± 0.4 kg/m2; ABI:0.62 ± 0.01; mean ±SEM). Not applicable. Dual-energy x-ray absorptiometry scans were used to assess appendicular lean mass (ALM) and determine the prevalence of sarcopenia by ALM/height2 (ALM/ht2). Treadmill tests were used to determine claudication onset time (COT), peak walking time (PWT), and claudication recovery time (CRT). Six-minute walk distance (6MWD) was also measured. Sarcopenia prevalence in our PAD cohort was 25%. The PAD subset (N=42) matched with control counterparts for race, sex, age, and BMI had higher prevalence rates compared with their non-PAD counter parts (23.8% vs 2.4%, P<0.05). Individuals with sarcopenia (N=28) had lower 6MWD (p<0.05; 326± 18.8 vs 380 ± 9.7 meters) and higher CRT (p<0.05; 592 ± 98 vs 395 ± 29 seconds) compared to individuals with PAD but without sarcopenia (N=80). There was no difference in COT or PWT between the PAD groups. Men with PAD demonstrate a high prevalence of sarcopenia. Those with sarcopenia and PAD demonstrate decreased mobility function. Copyright © 2017. Published by Elsevier Inc.

  18. Serum ferritin is associated with progression of peripheral arterial disease in hemodialysis patients.

    Science.gov (United States)

    Lien, Chen-Tung; Lin, Kao-Chang; Tsai, Yueh-Feng; Yu, Lai-King; Huang, Li-Hsueh; Chen, Chien-An

    2015-10-01

    Dialysis patients received intravenous iron to treat anemia and had high prevalence of peripheral artery disease (PAD). We hypothesized that high iron status might associate with the progression of PAD among hemodialysis patients. Therefore, we evaluated the relationship between iron status and progression of PAD. We measured iron status in 74 hemodialysis patients and studied the association with clinical, biochemical, and vascular parameters including progression of PAD measured by ankle-brachial index (ABI) over 3 years. Mean baseline ABI was 1.03 ± 0.18. Mean ABI at 3 years was 0.95 ± 0.20. Mean ∆ABI (change in ABI after 3 years) was -0.08 ± 0.14. Serum ferritin was negatively correlated with baseline ABI (r = -0.232, p = 0.046). After 3 years, ∆ABI was negatively associated with 3-year averaged serum ferritin, phosphorus, and calcium-phosphate product (Ca × P) (r = -0.253, p = 0.029; r = -0.278, p = 0.016; r = -0.288, p = 0.013; respectively). After an adjusted model, 3-year averaged serum ferritin and Ca × P remained the significant determinants of ∆ABI (β = -0.234, p = 0.038; β = -0.271, p = 0.017; respectively). ∆ABI was significantly different between 3-year averaged serum ferritin level ≥600 and hemodialysis patients, high serum ferritin associates with progression of PAD, especially among those with high Ca x P level.

  19. Prevalence and risk factors associated with peripheral artery disease in elderly patients undergoing peritoneal dialysis.

    Science.gov (United States)

    Kuang, Ding-Wei; Li, Chiu-Leong; Kuok, Un-I; Cheung, Kin; Lio, Weng-In; Xin, Jing

    2012-01-01

    Rapid growth of the elderly peritoneal dialysis (PD) population is posing a special challenge for renal teams. Peripheral artery disease (PAD) has been reported to be an independent predictor of cardiovascular and all-cause mortality in hemodialysis patients. However, the prevalence and associated risk factors for PAD in elderly PD patients have not yet been fully investigated. A total of 69 elderly PD patients were included in the present study. PAD was defined as either an ankle-brachial index < 0.9 or a history of intermittent claudication, lower-limb amputation, foot ulcers, or gangrene. On enrollment, clinical and biochemical characteristics were collected. The overall prevalence of PAD was 31.9%. Compared with non-PAD patients, PAD patients were significantly older and more likely to be female and have longer PD duration and lower diastolic blood pressure (P < 0.001, = 0.002, 0.018, and 0.007, respectively). Serum albumin level (P < 0.001) and residual renal Kt/V value (P < 0.001) were significantly lower, but the serum C-reactive protein level (P = 0.005) was significantly higher, in PAD patients compared with non-PAD patients. Logistic regression analysis showed that serum albumin level (odds ratio = 1.485, P = 0.040) and residual renal Kt/V value (odds ratio = 1.725, P = 0.016) were independently associated with PAD. A high prevalence of PAD appeared among elderly PD patients in Macao. Serum albumin level and residual renal Kt/V value were independently related to PAD.

  20. Association of peripheral artery disease and long-term mortality in hemodialysis patients.

    Science.gov (United States)

    Otsubo, Shigeru; Kitamura, Mariko; Wakaume, Takako; Yajima, Aiji; Ishihara, Miwa; Takasaki, Masayo; Ueda, Syuitsu; Sugimoto, Hisayuki; Otsubo, Kimiko; Kimata, Naoki; Akiba, Takashi; Nitta, Kosaku

    2012-04-01

    Peripheral artery disease (PAD) is a common complication in hemodialysis patients. The ankle-brachial blood pressure index (ABI) has been widely used to screen for subclinical PAD. In the present study, we investigated the association between ABI and long-term (up to 8.8 years) mortality among hemodialysis patients. A total of 86 consecutive patients receiving maintenance hemodialysis who underwent an ABI examination between 2001 and 2003 were retrospectively enrolled in this study. Patients with an ABI of less than 0.9 were considered as having PAD; those with an ABI of more than 0.9 in both legs were considered as being free from PAD. We examined the relationship between mortality and several risk factors. During the follow-up period, 43 deaths were recorded. In the univariate regression analysis, the mortality hazard ratio (HR) of patients with PAD was 1.67 (95% confidence interval [CI], 1.18-2.28). Other predictive variables for mortality included male gender, age, and diabetes mellitus (P = 0.006, P = 0.024, and P = 0.023, respectively). A multivariate Cox analysis identified PAD and male gender as independent predictors of mortality (P = 0.033 and P = 0.028, respectively). The impact of age and diabetes mellitus on mortality was no longer significant in the multivariate analysis. After a relatively long-term observation period, a multivariate analysis indicated that PAD acted independently of other risk factors, including advanced age and the presence of diabetes mellitus. ABI measurements can be used to identify high-risk hemodialysis patients requiring intensive follow-up care.

  1. Prevalence and risk factors associated with peripheral arterial disease in an adult population from Colombia.

    Science.gov (United States)

    Urbano, Lorena; Portilla, Eliana; Muñoz, Wilson; Hofman, Albert; Sierra-Torres, Carlos H

    2017-06-13

    Cardiovascular diseases (CVD) are the most important cause of mortality in Latin America, while peripheral arterial disease (PAD) is the third leading cause of atherosclerotic cardiovascular morbidity. To establish the prevalence of PAD and the distribution of traditional CVD risk factors in a population from the Department of Cauca, Colombia. A cross-sectional study was conducted on a total of 10,000 subjects aged ≥40 years, from 36 municipalities. An ankle-brachial index (ABI) ≤ 0.9 in either leg was used as diagnostic criterion of PAD. Overall PAD prevalence was 4.4% (4.7% females vs. 4.0% males), with diabetes being the most prevalent risk factor (23%). Among individuals self-reporting a history of acute myocardial infarction or stroke, PAD prevalence was 31.0% and 8.1%, respectively. After adjusting for potential confounders, PAD was significantly associated with hypertension (OR 4.6; 95% CI; 3.42-6.20), diabetes (4.3; 3.17-5.75), dyslipidaemia (3.1; 2.50-3.88), obesity (1.8; 1.37-2.30), and cigarette smoking (1.6; 1.26-1.94). Analysis for the interaction of risk factors showed that diabetes, dyslipidaemia, and obesity accounted for 13.2 times the risk for PAD (6.9-25.4), and when adding hypertension to the model, the risk effect was the highest (17.2; 8.4-35.1). Hypertension, diabetes, dyslipidaemia, and obesity, but not smoking were strong predictors of PAD. ABI measurement should be routinely performed as a screening test in intermediate and high-risk patients for CVD prevention. This could lead to an early intervention and follow-up on populations at risk, thus, contributing to improve strategies for reducing CVD burden. Copyright © 2017. Publicado por Masson Doyma México S.A.

  2. The use of machine learning for the identification of peripheral artery disease and future mortality risk.

    Science.gov (United States)

    Ross, Elsie Gyang; Shah, Nigam H; Dalman, Ronald L; Nead, Kevin T; Cooke, John P; Leeper, Nicholas J

    2016-11-01

    A key aspect of the precision medicine effort is the development of informatics tools that can analyze and interpret "big data" sets in an automated and adaptive fashion while providing accurate and actionable clinical information. The aims of this study were to develop machine learning algorithms for the identification of disease and the prognostication of mortality risk and to determine whether such models perform better than classical statistical analyses. Focusing on peripheral artery disease (PAD), patient data were derived from a prospective, observational study of 1755 patients who presented for elective coronary angiography. We employed multiple supervised machine learning algorithms and used diverse clinical, demographic, imaging, and genomic information in a hypothesis-free manner to build models that could identify patients with PAD and predict future mortality. Comparison was made to standard stepwise linear regression models. Our machine-learned models outperformed stepwise logistic regression models both for the identification of patients with PAD (area under the curve, 0.87 vs 0.76, respectively; P = .03) and for the prediction of future mortality (area under the curve, 0.76 vs 0.65, respectively; P = .10). Both machine-learned models were markedly better calibrated than the stepwise logistic regression models, thus providing more accurate disease and mortality risk estimates. Machine learning approaches can produce more accurate disease classification and prediction models. These tools may prove clinically useful for the automated identification of patients with highly morbid diseases for which aggressive risk factor management can improve outcomes. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  3. Diabetes, renal dysfunction, inflammation, and anemia: the deadly quartet in peripheral artery disease

    Directory of Open Access Journals (Sweden)

    Mislav Vrsalović

    2016-03-01

    Full Text Available The article reviews the burden of peripheral artery disease (PAD and its association with diabetes, renal dysfunction, inflammation, and anemia. PAD is a marker of advanced atherosclerotic disease and is associated with a poor quality of life, ischemic events, and mortality. Polyvascular involvement is often observed in PAD patients (pts, and contributes to the greater risk of all-cause and cardiovascular mortality. Diabetes is a major risk factor for PAD, and the presence of PAD in diabetic pts is associated with unfavorable cardiovascular outcomes. In comparison to nondiabetic PAD pts, diabetic pts often have severe forms of PAD such as foot ulcers and gangrene, and more often have involvement of the distal extremities. Diabetes is often accompanied by anemia, particularly in the presence of impaired renal function. Chronic kidney disease and PAD share some common risk factors and frequently coexist. In PAD pts, renal dysfunction has been associated with an increased risk of major adverse cardiovascular events and mortality. Anemia is quite prevalent in PAD pts, especially in those with critical limb ischemia. The severity of anemia has been identified as an independent predictor of limb loss and mortality. C-reactive protein (CRP is associated with the development of PAD and diabetes. Increased levels of CRP in diabetic pts intensify the risk for PAD development. Data regarding the prognostic role of CRP in PAD pts suggest that CRP is a better prognostic marker for short-term rather than long-term mortality. Considering the close relationship between diabetes, renal dysfunction, inflammation, and anemia in PAD pts, a multidisciplinary approach is needed in order to improve quality of life and prevent ischemic events and fatal outcomes.

  4. The PANDORA study: peripheral arterial disease in patients with non-high cardiovascular risk.

    Science.gov (United States)

    Cimminiello, Claudio; Kownator, Serge; Wautrecht, Jean-Claude; Carvounis, Christos P; Kranendonk, Stefanus Eliza; Kindler, Beat; Mangrella, Mario; Borghi, Claudio

    2011-12-01

    Few studies are available with sufficient sample size to accurately describe the prevalence of low ankle-brachial index (ABI) in patients at 'non-high' cardiovascular (CV) risk. The aim of this study was to evaluate the prevalence of asymptomatic peripheral arterial disease (PAD), as determined by using ABI, in this patient population. A non-interventional, cross-sectional, pan-European study was conducted in patients with ≥1 CV risk factor in addition to age, evaluating the prevalence of asymptomatic PAD (ABI ≤ 0.90). Secondary objectives included assessing the prevalence and treatment of CV risk factors. Patients were consecutively recruited during scheduled visits to the physician's office, or were randomly selected by the physician from a list of eligible patients. Patients with diabetes were excluded as this condition was deemed to be a secondary prevention risk. 10,287 patients were enrolled (9,816 evaluable: mean age 64.3 years; 53.5% male). Prevalence of asymptomatic PAD was 17.8% (99% CI 16.84-18.83). Factors significantly associated with asymptomatic PAD included hypertension, age, alcohol intake, family history of coronary heart disease, low levels of high-density lipoprotein-cholesterol, and smoking (p < 0.0001). Patients treated with statins were significantly less likely to have asymptomatic PAD than those who were not (odds ratio 0.62; 95% CI 0.50-0.76; p < 0.0001). Asymptomatic PAD was highly prevalent in patients with non-high CV risk, the majority of whom would not typically be candidates for ABI assessment. These patients should be carefully screened, and ABI measured, so that therapeutic interventions known to diminish their increased CV risk may be offered.

  5. Factors affecting the validity of the oscillometric ankle brachial index to detect peripheral arterial disease.

    Science.gov (United States)

    Herráiz-Adillo, Ángel; Cavero-Redondo, Iván; Álvarez-Bueno, Celia; Martínez-Vizcaíno, Vicente; Pozuelo-Carrascosa, Diana P; Notario-Pacheco, Blanca

    2017-09-08

    The use of oscillometric ankle brachial index (ABI) to diagnose peripheral arterial disease (PAD) has raised concern, especially due to a lack of agreement and sensitivity. This study aimed to evaluate those factors affecting the validity of oscillometric ABI in comparison to Doppler ABI to detect PAD. Through univariate and multivariate linear regression, we studied those factors affecting the differences between oscillometric and Doppler ABI; through univariate and multivariate logistic regression we analyzed the false negative rate of oscillometric ABI to detect PAD. We analyzed 197 consecutive subjects (394 legs) from two settings: Primary Care and Vascular Service. The means of oscillometric ABI and Doppler ABI were 1.094 (95%CI: 0.843-1.345) and 1.073 (95%CI: 0.769-1.374) (poscillometric and Doppler ABI were Doppler ankle blood pressure (β=‒0.610, poscillometric brachial blood pressure (β=0.136, p=0.037); in women, those were weight (β=0.351, pblood pressure (β=‒0.318, poscillometric ABI to detect PAD were 80.6% and 97.4%, respectively, and covariates explaining the rate of false negatives in PAD population were setting (Exp(β)=17.21, p=0.009) and tobacco (packs/year) (Exp(β)=1.049, p=0.002). Although some factors influencing the lack of agreement between oscillometric and Doppler ABI were identified, the correction of oscillometric ABI seems impractical, since Doppler is needed, the bias is not always uniformly distributed and its clinical relevance is small. According to sensitivity, borderline oscillometric ABI in Primary Care settings and smokers suggest PAD.

  6. Prevalence and risk factors of asymptomatic peripheral arterial disease in patients with COPD in Taiwan.

    Directory of Open Access Journals (Sweden)

    Ming-Shian Lin

    Full Text Available AIM: Chronic obstructive pulmonary disease (COPD is an independent risk factor for cardiovascular morbidity and mortality. The aim of this study was to determine the prevalence of asymptomatic peripheral arterial disease (PAD and the associated risk factors for patients with COPD. METHODS: This prospective cross-sectional study enrolled 427 COPD patients (mean age: 70.0 years without PAD symptoms consecutively. Demographic data, lung function and cardiovascular risk factors were recorded. The ankle-brachial index (ABI was used to detect PAD (ABI<0.90. RESULTS: The overall prevalence of asymptomatic PAD in the COPD patients was 8% (2.5% in the younger participants (<65 years of age, n = 118 and 10% in the elderly participants (≥65 years of age, n = 309. The COPD patients with asymptomatic PAD had a significantly higher rate of hyperlipidemia (47.1% vs. 10.4% and hypertension (79.4% vs. 45.8% than those without asymptomatic PAD (p<0.05. There was no significant difference in lung function (forced vital capacity and forced expiratory volume in one second between the two groups. In multivariate logistic regression, hyperlipidemia was the strongest independent factor for PAD (odds ratio (OR: 6.89, p<0.005, followed by old age (OR: 4.80, hypertension (OR: 3.39 and smoking burden (pack-years, OR: 1.02. CONCLUSIONS: The prevalence of asymptomatic PAD among COPD patients in Taiwan is lower than in Western countries. Hyperlipidemia, old age, hypertension, and smoking burden were the associated cardiovascular risk factors. However, there was no association between lung function and PAD in the COPD patients.

  7. Biomarkers of inflammation may be of use for identification of more severe peripheral arterial occlusive disease

    Directory of Open Access Journals (Sweden)

    Luciana Garofolo

    2014-09-01

    Full Text Available Background:Atherosclerosis is a multifactorial disease with an inflammatory pathophysiological basis. Cytokines released during the atherosclerotic process induce production of C-reactive protein (CRP in the liver, which is an important marker of inflammation.Objective:We tested whether inflammatory biomarkers were associated with deterioration of peripheral arterial occlusive disease (PAOD in a population at high cardiovascular risk.Methods:1,330 subjects ≥30 years of age underwent clinical and laboratory examinations as part of a population-based study of the prevalence of diabetes. PAOD was defined as an ankle-brachial index (ABI ≤0.90. After application of exclusion criteria, the sample comprised 1,038 subjects. Traditional risk factors, CRP and interleukin 6 (IL-6 were also compared across three ABI categories (≤0.70; 0.71-0.90; ≥0.90. Mean values for these variables were compared by presence/absence of DAOP (Student's t test and by ABI categories (ANOVA. Poisson regression and logistic regression models were used to test for associations between risk factors and DAOP and between risk factors and the ABI categories. Pearson's linear correlation coefficients were calculated for the relationship between CRP and IL-6 levels.Results:Mean age was 56.8±12.9 years, 54% of the sample were women and the prevalence of DAOP was 21.0% (95%CI 18.4-24.1. Individuals with ABI ≤0.70 had higher concentrations of CRP-us (2.1 vs. 1.8 and of IL-6 (1.25 vs. 1.17. Concentrations of CRP and IL-6 were only correlated in patients with DAOP, (p=0.004.Conclusions:The finding that CRP and IL-6 levels were only elevated among people with advanced DAOP may suggest that these biomarkers have a role to play as indicators of more severe disease. Prospective studies are needed to test this hypothesis.

  8. Is asymptomatic peripheral arterial disease associated with walking endurance in patients with COPD?

    Science.gov (United States)

    Sun, Kuo-Shao; Lin, Ming-Shian; Chen, Yi-Jen; Chen, Yih-Yuan; Chen, Solomon Chih-Cheng; Chen, Wei

    2015-01-01

    Symptomatic peripheral arterial disease (PAD) is associated with impaired walking endurance in patients with chronic obstructive pulmonary disease (COPD). However, it is unknown whether asymptomatic PAD is associated with impaired walking endurance in patients with COPD. This prospective cross-sectional study enrolled 200 COPD patients (mean age: 70.9 years) who volunteered to perform ankle-brachial index (ABI) and 6-minute walk test (6MWT) consecutively. Demographic data, lung function, dyspnea scales, and cardiovascular risk factors were recorded. The ABI was used to detect PAD (ABI <0.90). All patients were free of PAD symptoms at enrollment. Of the 200 COPD patients, 17 (8.5%) were diagnosed with asymptomatic PAD. The COPD patients without asymptomatic PAD did not walk significantly further on the 6MWT than the COPD patients with asymptomatic PAD (439±86 m vs 408±74 m, P=0.159). The strongest correlation with the distance walked on the 6MWT was Medical Research Council dyspnea scale (r (2)=-0.667, P<0.001), followed by oxygen-cost diagram (r (2)=0.582, P<0.001) and forced expiratory volume in 1 second (r (2)=0.532, P<0.001). In multivariate linear regression analysis, only age, forced expiratory volume in 1 second, and baseline pulse oximetry were independently correlated with the distance covered on the 6MWT (P<0.05). However, body mass index, baseline heart rate, and ABI were not correlated with the distance covered on the 6MWT. Asymptomatic PAD is not associated with walking endurance in patients with COPD. Therefore, it is important to detect and treat asymptomatic PAD early so that COPD patients do not progress to become exercise intolerant. Limited by the small sample size and predominantly male (99%) population in the study, further large-scale prospective studies are needed to verify the results.

  9. [Analysis of peripheral arterial obstructive disease related factors among diabetic population aged > or = 50].

    Science.gov (United States)

    Guan, Heng; Liu, Zhi-Min; Li, Guang-Wei; Guo, Xiao-Hui; Xu, Zhang-Rong; Zou, Da-Jin; Xing, Hui-Li; Liu, Wei; Sheng, Zheng-Yan; Tian, Hao-Ming; Zhu, Da-Long; Yu, De-Min; Zhuang, Wei-Te; Chen, Lu-Lu; Weng, Jian-Ping

    2007-01-02

    To analyze the peripheral arterial obstructive disease (PAD) related factors among diabetic population aged > or = 50 in China. The clinical data of 1397 diabetic patients aged > or = 50 with at least one of the following risk factors: smoking, hypertension, and hyperlipidemia, from 15 Class III Grade A hospitals in 7 major cities of China were collected. Diagnosis of PAD was based on the ankle brachial index (ABI) 1400 cm/s. Regression studies were made to analyze the relations among PAD and various risk factors: age, sex, body mass index (BMI), smoking, hypertension, hyperlipidemia, history of cerebral vascular disease (CVD), history of ischemia heart disease (IHD) etc. The current prevalence rate of PAD was 19.47% among the 1397 patients, 18.3% (122/664) among the male patients, and 20.4% (150/733) among the female patients. The prevalence of PAD in the patients aged > or = 70 was as high as 31.9%. The duration of diabetes course was positively correlated with the prevalence of PAD (chi2 = 11.9, P = 0.0026). The ABI abnormality rate was 15.78% among those with a diabetic course of 5 years and was 23.84% among those with a diabetic course of 10 years. The abnormal ABI rate of the patients with CVD was 30.57%, significantly higher than that of hose without CVD (17.29%, chi2 = 21.49, P or = 50 in China suffer from PAD. Age, course of diabetes, blood glucose level, SBP, IHD, and CVD are risk factors for PAD. Early intervention and treatment of hypertension and hyperglycemia, and quitting smoking are important in reducing the occurrence of PAD. ABI and PWV are not only diagnostic means for PAD, but also alarm guide indexes for cerebral vascular disease (CVD).

  10. Propionyl-L-carnitine in Leriche-Fontaine stage II peripheral arterial obstructive disease.

    Science.gov (United States)

    Allegra, Claudio; Antignani, Pier Luigi; Schachter, Ilana; Koverech, Aleardo; Messano, Masa; Virmani, Ashraf

    2008-01-01

    Peripheral arterial obstructive disease (PAOD) of the lower limbs affects 5% of the adult population. Uncontrolled arteriopathy is established due to a microcirculatory deficit, which may be present despite a good Winsor index and which leads to exhaustion of the functional microcirculatory reserve. The target of this study was to examine possible improvements in microvascular and tissue homeostasis by the administration of propionyl-L-carnitine (PLC). A total of 26 patients were enrolled in this study, aged 65 +/- 15 years; two males were diagnosed at stage IIA and 17 males and seven females at stage IIB PAOD. The main criterion of inclusion was the worsening of walking distance during the last month. In this study the duration of therapy was 33 days. PLC was administered in three flasks, each containing 300 mg in 250 cc saline by continuous infusion. The following parameters were measured before and after treatment: pain-free and maximum walking distance (measured on a treadmill at 3.2 km/hr with a gradient of 12%), recovery time from pain after maximum walking distance, ankle-brachial index by means of the Doppler apparatus, and evaluation of the microcirculation using capillaroscopy. The results showed that therapy with PLC was effective at restoring activity of skeletal muscle in ischemic conditions. In particular, capillaroscopy showed improvement in the angioarchitecture in the microcirculation fields, expressed as increased numbers of visible capillaries and diminution in the time of loss of sodium fluorescein marker. The clinical data showed increased walking distance and diminished time to recover from pain, and the clinical improvement correlated with improved microcirculatory function. From these preliminary data has emerged an indication of therapy with PLC for chronic obstructive arteriopathy of the lower limbs at stage II. Further studies with higher numbers of patients and more controlled variables are planned.

  11. Prevalence and risk factors of asymptomatic peripheral arterial disease in patients with COPD in Taiwan.

    Science.gov (United States)

    Lin, Ming-Shian; Hsu, Kun-Yen; Chen, Yi-Jen; Chen, Cheng-Ren; Chen, Chuan-Mu; Chen, Wei

    2013-01-01

    Chronic obstructive pulmonary disease (COPD) is an independent risk factor for cardiovascular morbidity and mortality. The aim of this study was to determine the prevalence of asymptomatic peripheral arterial disease (PAD) and the associated risk factors for patients with COPD. This prospective cross-sectional study enrolled 427 COPD patients (mean age: 70.0 years) without PAD symptoms consecutively. Demographic data, lung function and cardiovascular risk factors were recorded. The ankle-brachial index (ABI) was used to detect PAD (ABI<0.90). The overall prevalence of asymptomatic PAD in the COPD patients was 8% (2.5% in the younger participants (<65 years of age, n = 118) and 10% in the elderly participants (≥65 years of age, n = 309). The COPD patients with asymptomatic PAD had a significantly higher rate of hyperlipidemia (47.1% vs. 10.4%) and hypertension (79.4% vs. 45.8%) than those without asymptomatic PAD (p<0.05). There was no significant difference in lung function (forced vital capacity and forced expiratory volume in one second) between the two groups. In multivariate logistic regression, hyperlipidemia was the strongest independent factor for PAD (odds ratio (OR): 6.89, p<0.005), followed by old age (OR: 4.80), hypertension (OR: 3.39) and smoking burden (pack-years, OR: 1.02). The prevalence of asymptomatic PAD among COPD patients in Taiwan is lower than in Western countries. Hyperlipidemia, old age, hypertension, and smoking burden were the associated cardiovascular risk factors. However, there was no association between lung function and PAD in the COPD patients.

  12. Gait deficiencies associated with peripheral artery disease are different than chronic obstructive pulmonary disease.

    Science.gov (United States)

    McCamley, John D; Pisciotta, Eric J; Yentes, Jennifer M; Wurdeman, Shane R; Rennard, Stephen I; Pipinos, Iraklis I; Johanning, Jason M; Myers, Sara A

    2017-09-01

    Previous studies have indicated that patients with peripheral artery disease (PAD), display significant differences in their kinetic and kinematic gait characteristics when compared to healthy, aged-matched controls. The ability of patients with chronic obstructive pulmonary disease (COPD) to ambulate is also limited. These limitations are likely due to pathology-driven muscle morphology and physiology alterations establish in PAD and COP, respectively. Gait changes in PAD were compared to gait changes due to COPD to further understand how altered limb muscle due to disease can alter walking patterns. Both groups were independently compared to healthy controls. It was hypothesized that both patients with PAD and COPD would demonstrate similar differences in gait when compared to healthy controls. Patients with PAD (n=25), patients with COPD (n=16), and healthy older control subjects (n=25) performed five walking trials at self-selected speeds. Sagittal plane joint kinematic and kinetic group means were compared. Peak values for hip flexion angle, braking impulse, and propulsive impulse were significantly reduced in patients with symptomatic PAD compared to patients with COPD. After adjusting for walking velocity, significant reductions (ppropulsion force, braking impulse, and propulsive impulse were found in patients with PAD compared to healthy controls. No significant differences were observed between patients with COPD and controls. The results of this study demonstrate that while gait patterns are impaired for patients with PAD, this is not apparent for patients with COPD (without PAD). PAD (without COPD) causes changes to the muscle function of the lower limbs that affects gait even when subjects walk from a fully rested state. Altered muscle function in patients with COPD does not have a similar effect. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Periodontitis is associated with the risk of subclinical atherosclerosis and peripheral arterial disease in Korean adults.

    Science.gov (United States)

    Ahn, Yoo-Been; Shin, Myung-Seop; Han, Dong-Hun; Sukhbaatar, Munkhzaya; Kim, Mi-Sun; Shin, Hye-Sun; Kim, Hyun-Duck

    2016-08-01

    We aimed to evaluate the association of periodontitis with the development of early atherosclerotic vascular disease in Korean adults. In this cross-sectional study, a total of 1343 adults aged over 40 years were recruited from a community-based cohort of Yangpyeong county, Korea, during the period 2010-2014. Only dentate individuals were included in the study. Subclinical atherosclerosis (SA) was defined as carotid intima-media thickness (cIMT)≥0.754 mm, as assessed bilaterally by B-mode ultrasound. Peripheral arterial disease (PAD) was defined as ankle-brachial index (ABI)≤1.0, as measured by Doppler. History of periodontitis was assessed by measuring the radiographic alveolar bone loss (RABL) on a digital dental panorama and was classified into three groups: normal, moderate and severe periodontitis (≥2 non-adjacent interproximal sites with RABL≥4 mm and 6 mm, respectively). The associations of periodontitis with SA and PAD were evaluated by multivariable logistic regression analysis and analysis of covariance, adjusted for age, sex, education level, tooth loss, smoking, drinking, exercise, obesity, triglycerides, HDL, LDL, hs-CRP, diabetes and hypertension. Stratified analyses were performed to identify specific risk groups. After controlling for confounders, severe periodontitis was associated with SA [adjusted odds ratio (aOR) = 1.55; 95% confidence interval (CI): 1.07-2.24] and PAD (aOR = 2.03; 95% CI: 1.05-3.93). These associations were highlighted in never-smokers. For increasing severity of periodontitis, the adjusted mean cIMT increased (p = 0.011) while that of ABI decreased (p = 0.033). Our data showed that periodontitis is a substantially important risk factor for atherosclerotic vascular disease among Korean adults. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  14. Physical activity in the prevention of peripheral artery disease in the elderly

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    Gabriele Giacomo Schiattarella

    2014-03-01

    Full Text Available Aging is a well-known cardiovascular risk factor and cardiovascular diseases (CVD are estimated to be the most common cause of death in the elderly. Peripheral arterial disease (PAD represents an important clinical manifestation of CVD leading to increase morbidity and mortality, especially in elderly population. The correct management of PAD population includes the prevention of cardiovascular events and relief of symptoms, most commonly intermittent claudication. Progressive physical activity is an effective treatment to improve walking distance and to reduce mortality and cardiovascular events in patients with PAD, however the ability to effectively engage in physical activity often declines with increasing age. The maintenance and increase of reserve functional capacity are important concepts in the elderly population. Ultimately, the goal in participation of physical activity in the healthy elderly population is maintenance and development of physical functional reserve capacity. Therefore, for individuals suffering of PAD, appropriate physical activity in the form of supervised exercise may serve as a primary therapy. Although there are few direct comparisons of therapeutic exercise programs versus pharmacological or surgical interventions, these increases in walking distance are greater than those reported for the most widely used agents for claudication, pentoxyphylline and cilostazol. Despite a reduction in mortality and improvement of quality of life caused by physical activity in the PAD population, the molecular, cellular, and functional changes that occur during physical activity are not completely understood. Therefore, this review paper aims at presenting an overview of recent established clinical and molecular findings addressing the role of physical activity on PAD in the older population.

  15. Mining peripheral arterial disease cases from narrative clinical notes using natural language processing.

    Science.gov (United States)

    Afzal, Naveed; Sohn, Sunghwan; Abram, Sara; Scott, Christopher G; Chaudhry, Rajeev; Liu, Hongfang; Kullo, Iftikhar J; Arruda-Olson, Adelaide M

    2017-06-01

    Lower extremity peripheral arterial disease (PAD) is highly prevalent and affects millions of individuals worldwide. We developed a natural language processing (NLP) system for automated ascertainment of PAD cases from clinical narrative notes and compared the performance of the NLP algorithm with billing code algorithms, using ankle-brachial index test results as the gold standard. We compared the performance of the NLP algorithm to (1) results of gold standard ankle-brachial index; (2) previously validated algorithms based on relevant International Classification of Diseases, Ninth Revision diagnostic codes (simple model); and (3) a combination of International Classification of Diseases, Ninth Revision codes with procedural codes (full model). A dataset of 1569 patients with PAD and controls was randomly divided into training (n = 935) and testing (n = 634) subsets. We iteratively refined the NLP algorithm in the training set including narrative note sections, note types, and service types, to maximize its accuracy. In the testing dataset, when compared with both simple and full models, the NLP algorithm had better accuracy (NLP, 91.8%; full model, 81.8%; simple model, 83%; P NLP, 92.9%; full model, 74.3%; simple model, 79.9%; P NLP, 92.5%; full model, 64.2%; simple model, 75.9%; P NLP algorithm for automatic ascertainment of PAD cases from clinical notes had greater accuracy than billing code algorithms. Our findings highlight the potential of NLP tools for rapid and efficient ascertainment of PAD cases from electronic health records to facilitate clinical investigation and eventually improve care by clinical decision support. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  16. Leukocyte count in peripheral arterial disease: A simple, reliable, inexpensive approach to cardiovascular risk prediction.

    Science.gov (United States)

    Giugliano, Giuseppe; Brevetti, Gregorio; Lanero, Simona; Schiano, Vittorio; Laurenzano, Eugenio; Chiariello, Massimo

    2010-05-01

    An elevated leukocyte count is widely proven to predict cardiovascular risk in healthy subjects and coronary patients, but its prognostic role in peripheral arterial disease (PAD) has received scarce attention. To assess the impact of leukocyte count on the incidence of major cardiovascular events in PAD, and verify whether it adds to the prognostic power of the ankle/brachial index (ABI). The occurrence of myocardial infarction and stroke was prospectively assessed in 259 consecutive PAD patients. Receiver-operating characteristic analysis and the bootstrap approach were used to identify the best cut-offs to predict the outcome, and hazard ratios (HRs) and c-statistics to assess the ability to classify risk. During a median follow-up of 30.0 months, 28 patients had an event. Adjusted Cox analyses performed on total and differential leukocyte counts, showed that only total leukocyte count (TLC) and neutrophil count (NC), considered as continuous variables, were associated with increased cardiovascular risk (HR=1.35, p7.7 x10(9)/L or NC>4.6 x 10(9)/L had a higher risk of about 5-fold vs patients with ABI>0.63 plus TLC< or =7.7 x 10(9)/L (p<0.01) or NC < or = 4.6 x 10(9)/L (p<0.01). The c-statistic for ABI was 0.61, similar to those for TLC (0.63) and NC (0.66). However, it significantly increased to 0.70 and 0.69 for the models incorporating ABI and TLC or ABI and NC, respectively (p<0.05 for both vs ABI alone). TLC and NC, which are inexpensive and reliable tests, predict major cardiovascular events in PAD, and add to the prognostic power of ABI, currently the most powerful prognostic indicator in these patients. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

  17. Total Contact Cast Use in Patients With Peripheral Arterial Disease: A Case Series and Systematic Review.

    Science.gov (United States)

    Tickner, Anthony; Klinghard, Cheri; Arnold, Jonathan F; Marmolejo, Valerie

    2018-02-01

    As the majority of diabetic foot ulcerations (DFUs) occur on the plantar foot, excessive pressure is a major contributing factor to delayed healing. The gold standard for offloading is the total contact cast (TCC); yet, TCC use is contraindicated in patients with ischemia. Lower extremity ischemia typically presents in the more severe end stages of peripheral arterial disease (PAD). As PAD exists on a severity spectrum from mild to severe, designation of a clear cutoff where TCC use is an absolute contraindication would assist those who treat DFUs on a daily basis. The aim of this study is to determine if a potential cutoff value for PAD where TCC use would be an absolute contraindication could be ascertained from a retrospective case series and a systematic literature review of patients with PAD in which treatment included TCC use. A retrospective cases series and systematic review of patients with mild to moderate PAD treated with a TCC was performed. All reports of TCC use in patients with PAD and a neuropathic ulceration that included results of noninvasive vascular studies were included. Results suggested that TCC use is a viable treatment modality for pressure-related DFUs in patients with an ankle pressure ≥ 80 mm Hg, a toe pressure ≥ 74 mm Hg, an ankle-brachial index ≥ 0.55, or a toe-brachial index ≥ 0.55. Vascular evaluation, individual risk/benefit analysis, close follow-up, and patient education are essential components of TCC use in these patients. Repeat vascular evaluation is recommended if the wound fails to progress towards resolution with TCC use.

  18. Supervised exercise therapy in the management of peripheral arterial disease - an assessment of compliance.

    Science.gov (United States)

    Aherne, Thomas M; Kheirelseid, Elrasheid A H; Boland, Michael; Carr, Shane; Al-Zabi, Thekra; Bashar, Khalid; Moneley, Daragh; Leahy, Austin; McCaffrey, Noel; Naughton, Peter

    2017-05-01

    Supervised exercise therapy (SET) is an effective option in the management of peripheral arterial disease (PAD). Unfortunately, poor compliance remains prevalent. This study aimed to assess patient exercise compliance and to identify factors influencing symptomatic improvement and SET participation. Data regarding attendance at SET for this cohort study were extracted from a prospectively maintained database of patients with claudication attending SET at Dublin City University. All patients had ankle brachial index confirmed PAD with associated intermittent claudication. Exercise performance and symptomatic data were gathered retrospectively using patient charts and interviews. Ninety-eight patients were referred for SET during the study period. The mean age was 69.2 (± 10.1) with 18 % being female. Median follow-up was 25.1 months (IQ range 17.0-31.6). Overall, the mean number of sessions attended per patient was 19.5. Exercise compliance was associated with a significant improvement in symptoms (p = 0.001). Other factors including anatomical level of claudication (P = 0.042) and educational level (p = 0.007) were found to affect the outcome of SET. Multivariate analysis revealed hypertension as a predictor of symptomatic outcome after SET (p = 0.045). Furthermore, ex-smokers (p = 0.021) and those previously diagnosed with hypercholesterolaemia (p = 0.020) or ischaemic heart disease (p = 0.029) had superior exercise compliance. Using linear regression, smoking history (p = 0.024) was identified as a predictor of compliance to SET. Establishing exercise compliance remains challenging in the PAD cohort. Pre-exercise patient education and personalised exercise prescriptions may result in improvements in function and compliance.

  19. [Concordance between 3 methods of measurement the ankle-brachial index to diagnose peripheral artery disease].

    Science.gov (United States)

    Forés, Rosa; Alzamora, Maria Teresa; Pera, Guillem; Torán, Pere; Urrea, Magalí; Heras, Antonio

    2014-10-21

    To determine the concordance of the ankle-brachial index (ABI) determined by automatic measurements (sphygmomanometer Omron and the triple cuff device) using doppler as the gold-standard, computing as well as sensitivity and specificity. ARTPER population cohort subjects, classified as peripheral arterial disease (PAD) if ABI<0.9, calcified if ABI≥1.4 and healthy otherwise. To asses concordance we used kappa index using the 3 categories and the intraclass correlation coefficient (ICC) for ABI continuous values. Eighty-eight participants, 52% women, 57-87 years. It was possible to calculate the ABI using doppler for 100%, 97% using Omron and 95% using triple. ABI means (standard deviation) were: doppler 1.089 (0.236), Omron 1.082 (0.110), triple 1.146 (0.134), with poor agreement (ICC doppler/Omron=0.27, doppler/triple=0.13, and triple/Omron=0.39). Categorizing ABI as PAD-healthy-calcified 13.6% (doppler), 6.8% (Omron) and 3.4% (triple) were PAD and 9.1% (doppler), 1.1% (Omron) and 9.1% (triple) were calcified. Kappa indexes were weak (doppler/Omron=0.22, doppler/triple=0.01, triple/Omron=0.17). Both triple and Omron were highly specific (97%) but had very low sensitivity (8 and 33%, respectively) compared to doppler. Concordance of ABI automatic measurements as Omron and triple with doppler was poor, and they do not seem suitable for screening for PAD in primary care consultations. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  20. Peripheral Blood Lymphocyte Depletion After Hepatic Arterial {sup 90}Yttrium Microsphere Therapy for Hepatocellular Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Carr, Brian I., E-mail: brianicarr@hotmail.com [Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA and Department of Nutrition and Exptl Biology, Saverio De Bellis Medical Research Institute, Castellana Grotte, Bari (Italy); Metes, Diana M. [Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA and Department of Nutrition and Exptl Biology, Saverio De Bellis Medical Research Institute, Castellana Grotte, Bari (Italy)

    2012-03-01

    Purpose: The short- and long-term effects of {sup 90}Yttrium microspheres therapy for hepatocellular carcinoma (HCC) on peripheral blood lymphocytes are unknown and were therefore examined. Methods and Materials: Ninety-two HCC patients were enrolled in a {sup 90}Yttrium therapy study and routine blood counts were examined as part of standard clinical monitoring. Results: We found an early, profound, and prolonged lymphopenia. In a subsequent cohort of 25 additional HCC patients, prospective flow cytometric immune-monitoring analysis was performed to identify specific changes on distinct lymphocyte subsets (i.e., CD3, CD4, CD8 T, and CD19 B lymphocytes) and NK cells absolute numbers, in addition to the granulocytes and platelets subsets. We found that the pretreatment lymphocyte subset absolute numbers (with the exception of NK cells) had a tendency to be lower compared with healthy control values, but no significant differences were detected between groups. Posttherapy follow-up revealed that overall, all lymphocyte subsets, except for NK cells, were significantly (>50% from pretherapy values), promptly (as early as 24 h) and persistently (up to 30 months) depleted post-{sup 90}Yttrium microspheres therapy. In contrast, granulocytes increased rapidly (24 h) to compensate for lymphocyte depletion, and remained increased at 1-year after therapy. We further stratified patients into two groups, according to survival at 1 year. We found that lack of recovery of CD19, CD3, CD8, and especially CD4 T cells was linked to poor patient survival. No fungal or bacterial infections were noted during the 30-month follow-up period. Conclusions: The results show that lymphocytes (and not granulocytes, platelets, or NK cells) are sensitive to hepatic arterial {sup 90}Yttrium without associated clinical toxicity, and lack of lymphocyte recovery (possibly leading to dysregulation of adaptive cellular immunity) posttherapy indicates poor survival.

  1. The association of race with quality of health in peripheral artery disease following peripheral vascular intervention: The Q-PAD Study.

    Science.gov (United States)

    Zaitoun, Anwar; Al-Najafi, Saif; Musa, Thaer; Szpunar, Susan; Light, Dawn; Lalonde, Thomas; Yamasaki, Hiroshi; Mehta, Rajendra H; Rosman, Howard S

    2017-12-01

    Black patients have a higher prevalence of peripheral artery disease (PAD) than white patients, and also tend to have a greater extent and severity of disease, and poorer outcomes. The association of race with quality of health (QOH) after peripheral vascular intervention (PVI), however, is less well-known. In our study, we hypothesized that after PVI, black patients experience worse QOH than white patients. We retrospectively assessed racial differences in health status using responses to the Peripheral Arterial Questionnaire (PAQ) at baseline (pre-PVI) and up to 6 months following PVI among 387 patients. We used the PAQ summary score (which includes physical limitation, symptoms, social function and quality of life) as a measure of QOH. We compared QOH scores at baseline and at follow-up after PVI between black ( n=132, 34.1%) and white ( n=255, 65.9%) patients. We then computed the change in score from baseline to follow-up for each patient (the delta) and compared the median delta between the two groups. Multivariable regression was used to model the delta QOH after controlling for factors associated with race or with the delta QOH. There was no significant difference in mean QOH by race either at baseline ( p=0.09) or at follow-up ( p=0.45). There was no significant difference in the unadjusted median delta by race (white 25.3 vs black 21.5, p=0.28) and QOH scores improved significantly at follow-up in both groups, albeit the improvement was marginally lower in black compared with white patients after adjustment for baseline confounders ( b = -6.6, p=0.05, 95% CI -13.2, -0.11).

  2. Very rapid effect of pitavastatin on microvascular function in comparison to rosuvastatin: reactive hyperemia peripheral arterial tonometric study

    Directory of Open Access Journals (Sweden)

    Kono Y

    2013-05-01

    Full Text Available Yasushi Kono,1 Shota Fukuda,1 Kenei Shimada,2 Koki Nakanishi,2 Kenichiro Otsuka,2 Tomoichiro Kubo,1 Satoshi Jissho,1 Haruyuki Taguchi,1 Junichi Yoshikawa,3 Minoru Yoshiyama21Department of Medicine, Osaka Ekisaikai Hospital, Nishi-ku, Osaka, Japan; 2Department of Internal Medicine and Cardiology, Osaka City University School of Medicine, Abeno-ku, Osaka, Japan; 3Nishinomiya Watanabe Cardiovascular Center, Nishinomiya, JapanBackground: It has been reported that pitavastatin improves endothelial function faster than other statins. Recently introduced reactive hyperemia peripheral arterial tonometry (RH-PAT provides objective and quantitative assessment of peripheral microvascular function.Purpose: This study aimed to investigate whether peripheral microvascular function improved 2 hours after pitavastatin in subjects with coronary artery disease (CAD using RH-PAT, and the results were compared with those of rosuvastatin.Methods: This study included 94 subjects with CAD, assigned to a group given 2 mg of pitavastatin (n = 36, a group given 2.5 mg of rosuvastatin (n = 38, and a control group (n = 20. RH-PAT examinations were performed before and 2 hours after statin administration.Results: The RH-PAT index increased 2 hours after pitavastatin administration from 1.82 ± 0.45 to 2.16 ± 0.62 (P = 0.02, whereas there were no differences in the RH-PAT index in the rosuvastatin group (1.79 ± 0.71 to 1.91 ± 0.53, P = 0.09 and the control group (1.68 ± 0.36 to 1.84 ± 0.58, P = 0.4. No significant changes were observed at 2 hours in serum cholesterol levels in each group.Conclusion: The present study demonstrated that peripheral microvascular function improved 2 hours after a single clinical dose of pitavastatin, but not after rosuvastatin.Keywords: coronary artery disease, statin, microvascular function

  3. Polimorfismo genético do fibrinogênio na doença arterial periférica Genetic polymorphisms of fibrinogen in peripheral artery disease

    Directory of Open Access Journals (Sweden)

    Antônio C. Brandão

    2004-01-01

    Full Text Available O objetivo do presente estudo foi analisar freqüências alélicas e genotípicas para o gene codificador da cadeia beta do fibrinogênio em pacientes com doença arterial periférica (DAP. Foram estudados 44 pacientes caucasóides do sexo masculino com sintomas clínicos e comprovação angiográfica de DAP, com idade entre 38 e 79 anos (62±8,6 anos. Entre eles, 22 apresentaram obstrução aterosclerótica nas artérias ilíacas, femorais e/ou carótidas e 22 tinham aneurisma de aorta torácica, abdominal ou tóraco-abdominal. O grupo controle foi constituído por 56 indivíduos, sem história clínica de DAP ou alterações ao exame clínico, com idades variando de 43 a 80 anos (59±9,2 anos. Foram excluídos os indivíduos com doença renal, doença hepática ou diabetes mellitus. A análise do polimorfismo genético da cadeia do fibrinogênio foi realizada por PCR (polimerase chain reaction e RFLP (restriction fragment lenght polimorphism com a endonuclease Bcl I, identificando-se três genótipos: B1/B1, B1/B2 e B2/B2. A análise estatística incluiu teste exato de Fisher, calculo do odds ratio, teste de Kruskal Wallis e análise de variância (ANOVA. Admitiu-se erro a igual a 5%, com nível de significância para PThe objective of this study was to analyze the frequencies of the alleles and genotypes of the gene encoder of the fibrinogen b-chain in patients suffering from peripheral artery disease. A total of 62 male Caucasoid patients with ages varying from 38 to 79 years old were studied. All the patients had clinical symptoms of peripheral artery disease, which was later confirmed by angiography. Forty of the patients had atherosclerotic obstructions of the iliac, femoral or carotid arteries and 22 suffered from aneurysms of the thoracic, abdominal or thoracoabdominal aortas. All the patients were submitted to surgery. A control group was formed of 62 individuals, with ages ranging from 43 to 80 years old, without clinical histories or

  4. Statin Therapy Reduces Future Risk of Lower-Limb Amputation in Patients With Diabetes and Peripheral Artery Disease.

    Science.gov (United States)

    Hsu, Chien-Yi; Chen, Yung-Tai; Su, Yu-Wen; Chang, Chun-Chin; Huang, Po-Hsun; Lin, Shing-Jong

    2017-07-01

    Although there is evidence to support the beneficial effects of statins on major cardiovascular events, few studies address the protective effect of statins on limb outcome. To investigate whether the use of statin is associated with a risk reduction in lower-extremity amputation in type 2 diabetes mellitus (DM) patients with peripheral arterial disease (PAD). Observational cohort study. A nationwide DM database in Taiwan from 2000 to 2011. A total of 69,332 patients aged ≥20 years with DM and PAD were identified. Patients were divided into three groups: 11,409 patients were statin users, 4430 patients used nonstatin lipid-lowering agents, and 53,493 patients were nonusers. The primary outcome was lower-extremity amputation. Secondary outcomes were in-hospital cardiovascular death and all-cause mortality. Compared with nonusers, statin users were associated with lower risks of lower-extremity amputation [adjusted hazard ration (aHR), 0.75; 95% confidence interval (CI), 0.62 to 0.90], in-hospital cardiovascular death (aHR, 0.78; 95% CI, 0.69 to 0.87), and all-cause mortality (aHR, 0.73; 95% CI, 0.69 to 0.77). In the propensity score matching analysis, the effect of statin on the risk of lower-extremity amputation was consistent. Only statin users were associated with the risk reduction of lower-extremities amputation (HR, 0.77; 95% CI, 0.61 to 0.97) and cardiovascular death (HR, 0.78; 95% CI, 0.68 to 0.89) when taking competing risk of death into consideration. Compared with statin nonusers who were never treated with lipid-lowering drugs, this study found that statin users had a lower risk of lower-extremity amputation and cardiovascular death in patients with DM and PAD.

  5. Ultrastructure and composition of thrombi in coronary and peripheral artery disease: correlations with clinical and laboratory findings.

    Science.gov (United States)

    Kovács, András; Sótonyi, Péter; Nagy, Anikó Ilona; Tenekedjiev, Kiril; Wohner, Nikolett; Komorowicz, Erzsébet; Kovács, Eszter; Nikolova, Natalia; Szabó, László; Kovalszky, Ilona; Machovich, Raymund; Szelid, Zsolt; Becker, David; Merkely, Béla; Kolev, Krasimir

    2015-04-01

    Fibrin structure and cellular composition of thrombi profoundly affect the clinical outcomes in ischemic coronary and peripheral artery disease. Our study addressed the interrelations of structural features of thrombi and routinely measured laboratory parameters. Thrombi removed by thromboaspiration following acute myocardial infarction (n=101) or thrombendarterectomy of peripheral arteries (n=50) were processed by scanning electron microscopy and immunostaining for fibrin and platelet antigen GPIIb/IIIa to determine fibrin fibre diameter and relative occupancy by fibrin and cells. Correlations between the structural characteristics and selected clinical parameters (age, sex, vascular localization, blood cell counts, ECG findings, antiplatelet medication, accompanying diseases, smoking) were assessed. We observed significant differences in mean fibre diameter (122 vs. 135 nm), fibrin content (70.5% vs. 83.9%), fluorescent fibrin/platelet coverage ratio (0.18 vs. 1.06) between coronary and peripheral thrombi. Coronary thrombi from smokers contained more fibrin than non-smokers (78.1% vs. 62.2% mean occupancy). In the initial 24 h, fibrin content of coronary thrombi decreased with time, whereas in peripheral thrombi platelet content increased in the first 7 days. In coronaries, higher platelet content and smaller vessel diameter were associated with thinner fibrin fibres, whereas hematocrit higher than 0.35 correlated with larger intrathrombotic platelet occupancy. Smoking and dyslipidaemia strengthened the dependence of clot platelet content on systemic platelet count (the adjusted determination coefficient increased from 0.33 to 0.43 and 0.65, respectively). Easily accessible clinical parameters could be identified as significant determinants of ultrastructure and composition of coronary and peripheral thrombi. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Ankle-brachial pressure index estimated by laser Doppler in patients suffering from peripheral arterial obstructive disease.

    Science.gov (United States)

    Ludyga, Tomasz; Kuczmik, Waclaw B; Kazibudzki, Marek; Nowakowski, Przemyslaw; Orawczyk, Tomasz; Glanowski, Michal; Kucharzewski, Marcin; Ziaja, Damion; Szaniewski, Krzysztof; Ziaja, Krzysztof

    2007-07-01

    Ankle-brachial index (ABI) measurements are widely used for evaluating the functional state of circulation in the lower limbs. However, there is some evidence that the value of ABI does not accurately reflect the degree of walking impairment in symptomatic patients with peripheral arterial obstructive disease (PAOD). We investigated the diagnostic value of ABI estimated by means of laser Doppler flowmetry (IT) for evaluating limb ischemia. We wanted to know whether laser Doppler could be more sensitive than the Doppler method in predicting walking capacity in patients with stable intermittent claudication. We analyzed a group of 30 patients with intermittent claudication (Fontain II, II/III) who were admitted for reconstructive treatment. There were 21 men and 9 women, aged 46-74 (mean 61) years. All patients underwent the treadmill test, and pain-free walking distances were measured. In each patient, we measured ABI using the two different methods: Doppler ultrasound device (ABI-Doppler) and laser Doppler (ABI-laser Doppler). The claudication distances were 25-200 m (mean 73 +/- 50.2 m). ABI-Doppler was 0.2-0.7 (0.582 +/- 0.195). ABI-laser Doppler measurements were 0.581 (+/-0.218). A correlation was found between ABI-Doppler and claudication distance (r = 0.46, P = 0.009). Also, ABI-laser Doppler values significantly correlated with claudication distances (r = 0.536, P = 0.002). The ABI evaluated by laser Doppler correlated well with claudication distances in patients with PAOD. Comparison of Doppler and laser Doppler measurements used for determining ABI showed that both methods have similar predictive power for walking capacity; however, higher correlation was observed between claudication distances and ABI measured by laser Doppler flowmetry. ABI-laser Doppler measurements are easier, are quicker, and seem to be better suited for noncompliant patients. Further investigation should be undertaken to determine whether laser Doppler is superior to the Doppler

  7. Effects of percutaneous lower-extremity arterial interventions on endothelial function and inflammation response in patients with both type 2 diabetes and lower-extremity peripheral arterial disease.

    Science.gov (United States)

    Du, Yaping; Wang, Fujun; Qi, Huiqing; Ding, Haixia; Hou, Lin; Gao, Qian; Tan, Miao; Liu, Yueqin; Xing, Na; Sun, Jin

    2015-01-01

    The high incidence and damage of PAD in people with diabetes has aroused wide attention. We aimed to examine effects of percutaneous lower-extremity arterial interventions (PLEAIs) on endothelial function and inflammation response in type 2 diabetes (T2D) patients with lower-extremity peripheral arterial disease (PAD). 78 T2D inpatients with PAD were selected into the treatment group. Their venous levels of von Willebrand Factor (vWF) and high sensitivity C reactive protein (hsCRP) were measured. Blood samples were collected from the arterial sheath for vWF and hsCRP tests. Venous levels of vWF and hsCRP were monitored at 24 hours, 48 hours, 1 week, and 2 weeks post PLEAIs. Prior to PLEAIs, venous levels of vWF and hsCRP in the treatment group were significantly higher than the control group. The arterial levels of vWF and hsCRP were 117.9%±15.1% and 5.19±0.76 mg/L in the control group, while those levels in the treatment group before intervention were also significantly higher than in the control group. In the treatment group prior to inventions, vWF and hsCRP levels of arterial ischemic regions were significantly higher than the non-ischemic regions. The vWF level of arterial ischemic regions after treatment was significantly higher than that prior to treatment. PLEAIs applied to those patients may lead to worse endothelial dysfunction and activated inflammatory response during treatment and 1 week after treatment, which indicates an emerging necessary of early protection or care on endothelial function and inflammatory reaction during and post PLEAIs.

  8. Association between physical activity and peripheral artery disease and carotid artery stenosis in a self-referred population of 3 million adults.

    Science.gov (United States)

    Stein, Richard A; Rockman, Caron B; Guo, Yu; Adelman, Mark A; Riles, Thomas; Hiatt, William R; Berger, Jeffrey S

    2015-01-01

    Although the relationship between physical activity and coronary heart disease is well characterized, a paucity of data exists on physical activity and vascular disease in other arterial territories. This study examined the prevalence of peripheral artery disease (PAD) and carotid artery stenosis (CAS) in association with physical activity. The association between physical activity and vascular disease was examined in >3 million self-referred US participants in the United States from 2003 to 2008 who completed a medical and lifestyle questionnaire in the Life Line screening program. All subjects were evaluated by screening ankle brachial indices 50%. Multivariable logistic regression modeling was used to estimate odds of disease. Among 3 250 350 subjects, 63% of the population engaged in some leisure time vigorous physical activity. After adjustment for age, sex, race/ethnicity, hypertension, hypercholesterolemia, smoking status, diabetes mellitus, body mass index, and family history of cardiovascular disease, subjects who reported any physical activity had a significantly lower odds of PAD (odds ratio, 0.64; 95% confidence interval, 0.63-0.65) and CAS (odds ratio, 0.80; 95% confidence interval, 0.79-0.81). The association between physical activity with PAD and CAS was robust when stratified by sex, race, and age categories. Physical activity intensity frequency was associated with lower PAD and CAS in a graded manner (P trend physical activity were independently associated with lower odds of vascular disease in the lower extremities and carotid arteries. © 2014 American Heart Association, Inc.

  9. Routine Use of Surgical Retrograde Transtibial Endovascular Approach for Failed Attempts at Antegrade Recanalization of Chronic Peripheral Artery Total Occlusions

    Energy Technology Data Exchange (ETDEWEB)

    Liang, GangZhu; Zhang, FuXian, E-mail: gangzhuliang@126.com; Luo, XiaoYun; Zhang, ChangMing; Feng, YaPing; Niu, LuYuan; Zhang, Huan; Hu, Lu; Zhao, Hui; Cheng, Long; Zhang, MingYi [Capital Medical University, Department of Vascular Surgery, Beijing Shijitan Hospital (China)

    2016-12-15

    PurposeOur aim was to describe the technical aspects and clinical outcomes of an open surgical approach to retrograde transtibial endovascular therapy for recanalization of chronic total occlusions (CTOs) of peripheral arteries because of inability to acquire antegrade intravascular access across the occlusion.Materials and MethodsBetween January 2011 and May 2014, conventional antegrade revascularization failed in 15 limbs of 15 patients (11 males, 4 females) with complex CTOs. The mean age of the patients was 74 years (range 48–83 years). Five patients had severe claudication (Rutherford Category 3), and 10 patients had critical limb-threatening ischemia (Rutherford Categories 4–5). For each of these cases of antegrade failure, an open surgical exposure of the tibial or dorsalis pedis artery was used to allow a safe retrograde transtibial endovascular approach to recanalize the CTO.ResultsSurgical retrograde access from the tibial artery was achieved successfully in 14 of the 15 patients. In the 14 successful retrograde endovascular approaches, surgical retrograde transtibial access was achieved from the dorsalis pedis artery in 8 patients and from the posterior tibial artery in 6. The average time to obtain retrograde access was 5 min (range 2–11 min). No stenosis or occlusion occurred in the tibial or dorsalis pedis arteries used for the retrograde access sites during follow-up.ConclusionsRoutine surgical exposure can be a safe and an effective method for retrograde transtibial access to the more proximal occluded arterial segments in selected patients with CTO.

  10. Intra-arterial infusion of prostaglandin E1 in normal subjects and patients with peripheral arterial disease

    DEFF Research Database (Denmark)

    Nielsen, P E; Nielsen, S L; Holstein, P

    1976-01-01

    Acute vasodilatation was produced by infusion of prostaglandin E1 (PGE1) in the femoral artery in 6 patients with occlusive arterial disease of the legs and in 3 normal subjects. The effect on blood flow and on blood pressure was measured at different segments of the leg with the strain gauge...... technique, isotope clearance technique, and photoelectric technique. Skin temperature was measured at different levels by using thermocouples. The blood pressure on the legs decreased at all segments during vasodilatation as well in patients as in controls. The blood flow increased in all segments in normal...

  11. Combined Dietary Nitrate and Exercise Intervention in Peripheral Artery Disease: Protocol Rationale and Design.

    Science.gov (United States)

    Woessner, Mary N; VanBruggen, Mitch D; Pieper, Carl F; O'Reilly, Erin K; Kraus, William E; Allen, Jason D

    2017-10-03

    Peripheral artery disease (PAD) is caused by atherosclerotic occlusions in the legs. It affects approximately 8-12 million people in the United States alone, one-third of whom suffer from intermittent claudication (IC), defined as ischemic leg pain that occurs with walking and improves with rest. Patients with IC suffer a markedly impaired quality of life and a high perception of disability. Improving pain-free walking time is a primary goal of rehabilitation in this population. The nitric oxide (NO)-PAD trial is designed to compare the effects that 12 weeks of supervised exercise training, in combination with a high inorganic nitrate-content (beetroot [BR] juice) beverage or placebo (PL) beverage, has on clinical outcomes of exercise and functional capacity in two groups of PAD+IC patients: exercise training plus beetroot (EX+BR) and exercise training plus placebo (EX+PL). The primary aims of this randomized controlled, double-blind pilot study are to determine group differences following 12 weeks of EX+BR versus EX+PL in the changes for (1) exercise capacity: pain-free walking time (claudication onset time, COT), peak walk time (PWT), and maximal exercise capacity (peak oxygen uptake, VO2peak) during a maximal-graded cardiopulmonary exercise test (max CPX) and (2) functional capacity: 6-minute walk (6MW) distance. The secondary aims will provide mechanistic insights into the exercise outcome measures and will include (1) gastrocnemius muscle oxygenation during exercise via near-infrared spectroscopy (NIRS); (2) gastrocnemius muscle angiogenesis: capillaries per unit area and per muscle fiber, and relative fraction of type I, IIa, IIb, and IId/x fibers; and (3) vascular health/function via brachial artery flow-mediated dilation, lower-limb blood flow via plethysmography, and pulse wave velocity and reflection. A total of 30 subjects between 40 and 80 years of age with PAD who are limited by IC will undergo exercise training 3 days per week for 12 weeks (ie, 36

  12. Gender-related long-term outcome of primary femoropopliteal stent placement for peripheral artery disease.

    Science.gov (United States)

    Stavroulakis, Konstantinos; Donas, Konstantinos P; Torsello, Giovanni; Osada, Nani; Schönefeld, Eva

    2015-02-01

    To evaluate gender-related long-term outcomes in patients undergoing stent treatment of femoropopliteal peripheral artery disease. Between September 2006 and August 2010, all 517 patients (333 men and 184 women; mean age 70.6 years) undergoing primary stent placement in femoropopliteal atherosclerotic lesions at 2 European vascular centers were prospectively enrolled in the study. The main study outcome was primary stent patency. Secondary outcomes included secondary patency, limb salvage, and all-cause mortality. Women had a higher incidence of critical limb ischemia (32.1% vs. 16.9%, pSociety Consensus (TASC) classification were comparable in both genders (p=0.52), although total occlusions and popliteal involvement were observed more frequently in female patients (p=0.043 and p=0.001, respectively). Both genders showed similar 5-year primary patency rates (64.3% men vs. 58.1% women, p=0.11). A statistically significant difference was observed concerning the secondary patency rates in favor of men (71.9% vs. 66.8% at 5 years, p=0.005). Limb salvage rates did not vary between the groups (p=0.83). Survival rates were comparable at 5 years (83.3% and 82.6% for men and women, respectively; p=0.63), although female patients were older at their presentation (68.5 vs. 74.3 years, pgender was an independent risk factor for restenosis for TASC C/D lesions (primary patency rate 39.8% in women vs. 62.0% in men; p=0.002). Finally, critical limb ischemia was an independent risk factor for restenosis in women (odds ratio 1.5). Female gender was associated with a higher prevalence of critical limb ischemia, poorer secondary patency, and more frequent restenosis in TASC C/D lesions. Endovascular treatment of femoropopliteal lesions provides equal results between genders in terms of primary stent patency in the long term. © The Author(s) 2015.

  13. Clinical and radiological characteristics of concomitant peripheral arterial obstructive disease in patients with lumbar spinal stenosis.

    Science.gov (United States)

    Han, Seung-Hwan; Jeon, Chang-Hoon; Lee, Doo-Hyung; Choo, Ho-Sik; Chung, Nam-Su

    2013-01-01

    Intermittent claudication is a typical symptom of lumbar spinal stenosis (LSS) and peripheral arterial obstructive disease (PAD). Because both LSS and PAD are predominantly associated with degenerative conditions, concomitant conditions are not uncommon. However, few reports of the demographic, clinical, and radiological characteristics of concomitant LSS and PAD (LSSPAD) have been published. To identify the demographic, clinical, and radiological risk factors for concomitant PAD in LSS. A retrospective matched-control study. This study involved a retrospective cohort of 43 consecutive patients with LSSPAD and a control cohort of 45 age- and gender-matched patients diagnosed with LSS without PAD. Each patient in both groups underwent plain lumbar radiographs, magnetic resonance imaging of the lumbar spine, and ankle-brachial index (ABI) measurement. Demographic and clinical parameters were obtained. The abdominal aorta calcification score (AACS) was evaluated on the lateral lumbar radiographs. Computed tomographic angiography (CTA) of the lower limb was performed to confirm PAD. The mean age of the LSSPAD group was 67.7 ± 10.7 years (52 - 88 years). The prevalence of diabetes mellitus (DM) was significantly higher in the LSSPAD group than in the LSS group (P = 0.022). The mean ABI was 0.71 ± 0.22 (0.32 - 0.91) for the LSSPAD group and 0.96 ± 0.18 (0.83 - 1.10) for LSS group (P < 0.001). The prevalence of aortic calcification was significantly higher in the LSSPAD group than in the LSS group (P < 0.001). The mean AACS was 10.2 ± 3.2 (2 - 18) for the LSSPAD group and 3.4 ± 4.1 (0 - 14) for the LSS group (P < 0.001). Retrospective design. We found that concomitant PAD in patients with LSS is associated with old age, DM, the presence of aortic calcification, and ABI < 0.9. When these risk factors exist, further work up is needed to exclude the concomitant PAD.

  14. Prediction of 6-minute walk performance in patients with peripheral artery disease.

    Science.gov (United States)

    Chen, Xi; Stoner, Julie A; Montgomery, Polly S; Casanegra, Ana I; Silva-Palacios, Federico; Chen, Sixia; Janitz, Amanda E; Gardner, Andrew W

    2017-10-01

    Peripheral artery disease (PAD) is a highly prevalent disease that impairs walking ability. Walking tests, such as the 6-minute walk test (6MWT) and 4-meter walk test, are commonly used to assess exercise endurance and ambulatory function over a short distance, respectively. The 6MWT performance is predictive of PAD severity and disease outcomes, but it is not feasible in many clinical settings because it requires a long walkway to serve as the test route and lengthens clinic visits. As an alternative, the 4-meter walk test is convenient, inexpensive, and repeatable, but whether it accurately predicts endurance performance in the long-distance 6MWT is not known. The goal of this study was to develop a statistical model to predict 6MWT gait speed from 4-meter walk test results and clinical characteristics among patients with PAD. Measures of 6MWT gait speed were derived from 183 patients with symptomatic PAD who were evaluated at the University of Oklahoma Health Sciences Center (2004-2012). The testing procedures and research personnel remained constant throughout the duration of the study. Independent variables included demographic and clinical information and 4-meter walk test gait speed. Fivefold cross validation and manual backward selection were used for model selection. Adjusted R 2 and corrected Akaike information criterion were applied to quantify the predictive performance of the regression models. A total of 183 people (54% male; mean age, 65 [standard deviation (SD), 10] years) with moderate PAD severity (ankle-brachial index [ABI]; mean, 0.72 [SD, 0.24]) performed the walking tests. Participants covered an average distance of 335 (SD, 97) m distance in the 6MWT. The 4-meter walk gait speed, ABI, and dyspnea were independent predictors of 6MWT speed in the multivariate model (adjusted R 2  = 0.55). The model resulted in 95% prediction interval widths of 30 m for mean and 260 m for individual predicted 6MWT distance measures. Slower 4-meter walking

  15. Predictors of change in omega-3 index with fish oil supplementation in peripheral artery disease.

    Science.gov (United States)

    Drudi, Laura M; Schaller, Melinda S; Hiramoto, Jade; Gasper, Warren; Harris, William S; Hills, Nancy K; Grenon, S Marlene

    2017-04-01

    The omega-3 index represents the red blood cell (RBC) content of two major long-chain n-3 polyunsaturated fatty acids (PUFAs), eicosapentaenoic acid, and docosahexaenoic acid. We sought to determine factors associated with a favorable response to fish oil treatment and to characterize changes in RBC PUFAs associated with fish oil supplementation. This study was a secondary analysis of the OMEGA-PAD I trial, a randomized, double-blinded, placebo-controlled trial investigating short-duration, high-dose n-3 PUFA oral supplementation on endothelial function and inflammation in subjects with peripheral arterial disease. Patients with mild to severe claudication received either 4.4 g of fish oil providing 2.6 g of eicosapentaenoic acid and 1.8 g of docosahexaenoic acid daily (n = 40) or placebo capsules (n = 40) for 1 mo. The RBC fatty acid content was measured by gas chromatography and expressed as a percent of total fatty acids. The change in omega-3 index was calculated as the difference between pre- and post-supplementation in the fish oil and placebo groups. Univariate analysis identified predictors of change in omega-3 index, with these variables included in our multivariable model. In the fish oil group, there was an increase in the omega-3 index (5.1± 1.3% to 9.0± 1.8%; P change in the control group. Factors associated with a favorable response (i.e., greater than the median change of 4.06%) included a lower body mass index and higher concentrations of low-density lipoproteins. Other demographic and/or lifestyle factors such as age, race, or smoking status were unrelated to the response. Oral n-3 PUFA supplementation also decreased the n-6 PUFA content in RBCs. Short-term, high-dose n-3 PUFA supplementation increases the omega-3 index to a greater extent in patients with a lower body mass index and higher total and low-density lipoprotein cholesterol levels. Published by Elsevier Inc.

  16. Amputation Risk in Patients with Diabetes Mellitus and Peripheral Artery Disease Using Statewide Data.

    Science.gov (United States)

    Humphries, Misty D; Brunson, Ann; Hedayati, Nasim; Romano, Patrick; Melnkow, Joy

    2016-01-01

    Conflicting data exist regarding changes in amputation rates in patients with ulcers because of diabetes mellitus (DM) and peripheral artery disease (PAD). This study focuses on how population-based amputation rates are changing in the current treatment era. Using the California Office of Statewide Health Planning and Development Patient Discharge database, all patients who underwent major nontraumatic lower extremity (LE) amputation in 2005 through 2011 were identified. Age-adjusted population-based amputation risk was determined by year. Gender and age trends in amputation risk were estimated separately for diabetes-related amputations and PAD-related amputations, treating all California residents as the population at risk. From 2005 to 2011, 32,025 qualifying amputations were performed in California. Of these, 11,896 were DM-associated (n = 1,095), PAD-associated (n = 4,335), or associated with both conditions (n = 6,466). PAD-associated amputation rates and combined PAD/DM-associated amputation rates have changed little since 2009 after decreasing substantially over the prior 5 years, but DM-associated amputation rates have continuously increased since 2005. California residents older than the age of 80 years had the most dramatic decrease in PAD-associated amputation rates from 2005 to 2011 (i.e., from 317 to 175 per million Californians). Men with PAD/DM had amputation rate 1.5 times higher than those of patients with PAD alone and 5 times higher than rates of DM patients. In women the difference between patient with PAD and PAD/DM was not seen; however, these rates were 2.5 times higher than patients with DM alone. Preventable amputations associated with high-risk diseases are no longer decreasing despite continuing advances in care and education. Octogenarians with PAD represent the highest risk group for amputation, but DM-associated amputations have increased since 2005. Further research to understand treatment pathways for patient with LE wounds may shed

  17. Classification of peripheral occlusive arterial diseases based on symptoms, signs and distal blood pressure measurements

    DEFF Research Database (Denmark)

    Tønnesen, K H; Noer, Ivan; Paaske, William

    1980-01-01

    Systolic blood pressures at toe and ankle were measured in 459 consecutive patients with occlusive arterial disease. Fifty-eight per cent had intermittent claudication with arterial disease of all degrees of severity. Seventeen per cent complained of rest pain having toe systolic pressures below 30...... occlusive arterial disease which was located distally on the legs. A classification in three groups is suggested: (1) ischemia only during exercise; (2) ischemia at rest with or without ulcerations: and (3) diabetics with chronic ulcerations....

  18. Intima-media thickness of peripheral arteries in asymptomatic cigarette smokers.

    Science.gov (United States)

    van den Berkmortel, F W; Smilde, T J; Wollersheim, H; van Langen, H; de Boo, T; Thien, T

    2000-06-01

    Although it is known that smoking is associated with an increase in arterial wall thickness, most studies have been performed in heterogeneous groups of older age, already suffering from atherosclerotic diseases or having additional cardiovascular risk factors. The purpose of this study is to assess the effect on arterial wall thickness of the carotid and femoral artery in cigarette smokers. In a cross-sectional study, intima-media thickness of the common and internal carotid artery, carotid bulb and common femoral artery was determined with the use of a B-mode ultrasound device, in 184 (44.3+/-9.0 years) cigarette smokers for whom smoking is the single cardiovascular risk factor. Comparisons were made with 56 non-smokers, matching in age and gender. The posterior walls of both carotid bulbs (right: P=0.0005; left: P=0.02) and of the internal carotid arteries (right: P=0.004; left: P=0.003) as well as the posterior wall of the right common carotid artery (P=0.02) and of the right common femoral artery (P<0.0001) were thicker in smokers. Cigarette smoking as the single cardiovascular risk factor causes wall thickening of the carotid and femoral arteries, which indicates that early atherosclerosis is already present in smokers entering middle age.

  19. Can augmentation index be used as an accurate tool in the diagnosis of peripheral obstructive arterial disease?

    Science.gov (United States)

    Coyle, P; Duff, G; Gavin, O; Clarke Moloney, M; Burke, P E; Kavanagh, E G; Grace, P A

    2012-09-01

    The use of radial augmentation index (rAI) as an indicator of vascular disease was investigated in the vascular imaging laboratory in a regional hospital. The aim of this study was to investigate whether a correlation exists between ankle-brachial pressure index (ABPI) and rAI in normal subjects, patients with peripheral obstructive arterial disease, and diabetic patients. A group of 46 patients and 14 controls had ABPI and rAI measured and factors affecting AI were assessed. rAI was found to have a negative correlation with ABPI (Spearman's ρ = -0.513, p peripheral obstructive vascular disease patients compared to normal (normal median 69% lower, p disease and may be a useful tool in the diagnosis of vascular pathology.

  20. Optimal Scanning Protocols for Dual-Energy CT Angiography in Peripheral Arterial Stents: An in Vitro Phantom Study

    Directory of Open Access Journals (Sweden)

    Abdulrahman Almutairi

    2015-05-01

    Full Text Available Objective: To identify the optimal dual-energy computed tomography (DECT scanning protocol for peripheral arterial stents while achieving a low radiation dose, while still maintaining diagnostic image quality, as determined by an in vitro phantom study. Methods: Dual-energy scans in monochromatic spectral imaging mode were performed on a peripheral arterial phantom with use of three gemstone spectral imaging (GSI protocols, three pitch values, and four kiloelectron volts (keV ranges. A total of 15 stents of different sizes, materials, and designs were deployed in the phantom. Image noise, the signal-to-noise ratio (SNR, different levels of adaptive statistical iterative reconstruction (ASIR, and the four levels of monochromatic energy for DECT imaging of peripheral arterial stents were measured and compared to determine the optimal protocols. Results: A total of 36 scans with 180 datasets were reconstructed from a combination of different protocols. There was a significant reduction of image noise with a higher SNR from monochromatic energy images between 65 and 70 keV in all investigated preset GSI protocols (p < 0.05. In addition, significant effects were found from the main effect analysis for these factors: GSI, pitch, and keV (p = 0.001. In contrast, there was significant interaction on the unstented area between GSI and ASIR (p = 0.015 and a very high significant difference between keV and ASIR (p < 0.001. A radiation dose reduction of 50% was achieved. Conclusions: The optimal scanning protocol and energy level in the phantom study were GSI-48, pitch value 0.984, and 65 keV, which resulted in lower image noise and a lower radiation dose, but with acceptable diagnostic images.

  1. The effect of inhibition of acyl coenzyme A-cholesterol acyltransferase (ACAT) on exercise performance in patients with peripheral arterial disease.

    Science.gov (United States)

    Hiatt, William R; Klepack, Ellen; Nehler, Mark; Regensteiner, Judith G; Blue, John; Imus, James; Criqui, Michael H

    2004-11-01

    This study tested the hypothesis that avasimibe, an inhibitor of acyl coenzyme A-cholesterol acyltransferase (ACAT), would improve treadmill exercise performance in patients with claudication secondary to peripheral arterial disease (PAD). Four hundred and forty-two patients with PAD (ankle-brachial index in the index leg of or =20% reduction post-exercise) were enrolled from 39 centers in the USA. Patients were randomized to receive oral avasimibe 50 mg, 250 mg, 750 mg or placebo for a treatment period of 12 months. Changes from baseline in peak walking time (PWT) using a graded treadmill protocol were compared among groups after 6 and 12 months of treatment. Individual group comparisons were considered statistically significant if p ACAT inhibitor avasimibe did not show clear evidence of benefit on treadmill exercise performance in patients with PAD, the results add to our knowledge of the impact of treatments directed at atherosclerosis on functional endpoints.

  2. The versatility of propeller flaps for lower limb reconstruction in patients with peripheral arterial obstructive disease: initial experience.

    Science.gov (United States)

    Jiga, Lucian P; Barac, Sorin; Taranu, Georgel; Blidisel, Alexandru; Dornean, Vlad; Nistor, Alexandru; Stoichitoiu, Teodora; Geishauser, Max; Ionac, Mihai

    2010-02-01

    In this study, we evaluate the feasibility of propeller flaps, for soft tissue reconstruction in patients with peripheral arterial obstructive disease (PAOD). Five patients (average age, 72 years old), presenting with necrosis of several foot units, were diagnosed with stage IV PAOD and diabetes mellitus. All underwent revascularization, followed by soft tissue reconstruction using propeller flaps. A total of 6 flaps were performed, with dimensions ranging from 4 x 7 cm to 8 x 31 cm. Perforator origin was the peroneal (5 flaps) or the tibial posterior artery (1 flap). Average operative time was 190 minutes. Overall patency was 83.3%; 1 case was complicated with total flap loss followed by below-knee amputation; 1 case developed partial necrosis necessitating skin grafting. All flaps developed mild postoperative edema, which resolved spontaneously. Propeller flaps prove to be useful tools for soft tissue reconstruction in patients with PAOD because of low operative morbidity, easy technique with fast learning curve, and low complications rate.

  3. Supplementation with orange and blackcurrant juice, but not vitamin E, improves inflammatory markers in patients with peripheral arterial disease

    DEFF Research Database (Denmark)

    Dalgård, Christine; Nielsen, Flemming Steen; Morrow, Jason D

    2009-01-01

    -inflammatory properties. We performed a randomised 2 x 2 factorial, crossover trial to determine the effect of orange and blackcurrant juice (500 ml/d) and vitamin E (15 mg RRR-alpha-tocopherol/d) supplementation on markers of inflammation and endothelial activation in forty-eight patients with peripheral arterial......-out period. Analysis of main effects showed that juice decreased C-reactive protein (CRP) by 11% and fibrinogen by 3% while the reference drink increased CRP by 13% and fibrinogen by 2% (P...

  4. Peripheral venous and arterial blood gas analysis in adults: are they comparable? A systematic review and meta-analysis.

    Science.gov (United States)

    Byrne, Anthony L; Bennett, Michael; Chatterji, Robindro; Symons, Rebecca; Pace, Nathan L; Thomas, Paul S

    2014-02-01

    Peripheral venous blood gas (PVBG) analysis is increasingly being used as a substitute for arterial blood sampling; however, comparability has not been clearly established. To determine if the pH, PCO2 and PO2 obtained from PVBG analysis is comparable with arterial blood gas (ABG) analysis. A search was conducted of electronic databases as well as hand-searching of journals and reference lists through December 2012 to identify studies comparing PVBG with ABG analysis in adult subjects. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A meta-analysis using a random effects model was used to calculate the average difference (bias) and the limits of agreement for the venous and arterial pH, PCO2 and PO2 . A total of 18 studies comprising 1768 subjects were included in the meta-analysis. There was considerable heterogeneity between studies with I(2) approaching 100%. There was little difference between the pH obtained from the PVBG and the ABG, with the arterial pH typically 0.03 higher than the venous pH (95% confidence interval 0.029-0.038). The venous and arterial PCO2 were not comparable because the 95% prediction interval of the bias for venous PCO2 was unacceptably wide, extending from -10.7 mm Hg to +2.4 mm Hg. The PO2 values compared poorly, the arterial PO2 typically 36.9 mm Hg greater than the venous with significant variability (95% confidence interval from 27.2 to 46.6 mm Hg). PVBG analysis compares well with ABG analysis for pH estimations in adults but not to the PCO2 or PO2 . These differences are sufficiently large to be of clinical significance. © 2014 The Authors. Respirology © 2014 Asian Pacific Society of Respirology.

  5. A Novel Index Using Ankle Hemodynamic Parameters to Assess the Severity of Peripheral Arterial Disease: A Pilot Study.

    Directory of Open Access Journals (Sweden)

    Jun Tanno

    Full Text Available In peripheral arterial disease (PAD of the lower extremities, the presence of flow-limiting stenoses can be objectively detected by the ankle-brachial index (ABI. However, the severity of ischemic symptoms is not necessarily associated with the ABI value. Atherosclerotic plaque in lower extremity PAD induces ankle arterial stiffness and reduces ankle vascular resistance, which may decrease ankle blood flow and cause ischemic symptoms. We hypothesized that the ankle hemodynamic index (AHI, defined as the ratio of ankle arterial stiffness to ankle vascular resistance, could be used to assess the blood supply deficiency in a diseased lower limb in patients with PAD. The 85 consecutive patients with PAD who were retrospectively analyzed in this study had Rutherford grade 1 to grade 6 ischemia diagnosed as PAD and significant stenotic lesions (>50% diameter stenosis of the lower extremity on contrast angiography. The AHI was calculated as the product of the ankle pulse pressure and the ratio of heart rate to ankle mean arterial pressure (ankle pulse pressure × heart rate/ankle mean arterial pressure. The Rutherford grade was significantly correlated with the AHI (r = 0.50, P < 0.001, but not with the ABI (r = 0.07, P = 0.52. Multiple ordinal regression analysis showed that anemia (odds ratio 0.66, P = 0.002 and AHI (odds ratio 1.04, P = 0.02 were independently associated with Rutherford grade. Our study shows that AHI, a novel parameter based on the ABI measurement, is well correlated with ischemic symptoms, and may be a useful means to assess the arterial blood supply of the lower extremities of patients with PAD.

  6. The role of antiendothelial cell antibodies in the development and follow-up of coronary and peripheral arterial diseases.

    Science.gov (United States)

    Aslim, Erdal; Hakki Akay, Tankut; Bastürk, Bilkay; Ozkan, Suleyman; Gültekin, Bahadir; Ozcobanoglu, Salih; Sirvan, Sale; Aslamaci, Sait

    2008-01-01

    Occlusive lesions in the arterial endothelium are often caused by formation of intimal hyperplasia and fibrinoid necrosis. The objective of this study was to investigate the association between antiendothelial cell antibodies (AECAs) and the development of coronary artery disease (CAD) and peripheral artery disease (PAD). In this study, 94 patients with CAD or PAD and 94 healthy volunteers serving as control subjects were examined. Frozen sections of human umbilical vein endothelial cells and primate smooth muscle cells were used to detect the presence of AECAs, which were found in 52 of 94 patients (55%) and in 15 of 94 controls (16%) (P < .001). Endothelial structure tissue damage is a major factor in arterial diseases. In the present study, a statistically significant relationship was found between AECAs and the development of CAD and PAD. The presence of AECAs has been identified as a risk factor for these diseases. According to this study, AECAs are reliable prognosticators for the development of CAD and PAD. Further studies with large numbers of serum samples are under way.

  7. Comparison of plaque morphology between peripheral and coronary artery disease (from the CLARITY and ADAPT-DES IVUS substudies).

    Science.gov (United States)

    Yin, Da; Matsumura, Mitsuaki; Rundback, John; Yoho, Jason A; Witzenbichler, Bernhard; Stone, Gregg W; Mintz, Gary S; Maehara, Akiko

    2017-08-01

    The aim of this study was to help understand the different outcomes when treating peripheral arterial disease (PAD) versus coronary artery disease (CAD). We compared plaque morphology between PAD and CAD using intravascular ultrasound. Complete Lesion Assessment with ffR and IVUS TechnologY (CLARITY) was a prospective, multicenter trial that enrolled 50 PAD patients with a lower extremity wound fed by a tibial or a peroneal artery with diameter stenosis more than 50%. Assessment of Dual AntiPlatelet Therapy With Drug Eluting Stents (ADAPT-DES) was a prospective, multicenter, registry that enrolled 8582 CAD patients. We compared preintervention intravascular ultrasound findings in 42 PAD lesions from CLARITY versus 79 matched CAD lesions from ADAPT-DES. Compared with CAD lesions, PAD lesions had (i) smaller mean vessel, plaque, and lumen volumes; (ii) twice the lesion length; (iii) greater maximum superficial calcium arc and plaque eccentricity (i.e. there was more concentric plaque) measured at the minimum lumen area site; (iv) calcium arc and plaque eccentricity were positively correlated to plaque burden in both PAD and CAD lesions; and (v) calcium arc and the presence of concentric plaque were greater in PAD compared with CAD independent of the degree of plaque burden. Compared with CAD lesions, PAD lesions in a tibial or a peroneal artery were longer; had more concentric, diffuse, and calcified plaque; and had smaller vessel volumes.

  8. The handling of peripheral venous catheters--from non-compliance to evidence-based needs.

    Science.gov (United States)

    Hasselberg, Daniella; Ivarsson, Bodil; Andersson, Roland; Tingstedt, Bobby

    2010-12-01

    To study nurses' compliance to national guidelines (Sweden) for peripheral venous catheters and to establish the complication frequency connected to time in situ and bore size. Worldwide, there are no standard peripheral venous catheters guidelines, and the need for elective replacement has been challenged. Furthermore, the time interval and need for elective change of peripheral venous catheters has cost implications for hospitals. Prospective register study. The health care professionals in one surgical ward in a university hospital in the south of Sweden prospectively registered peripheral venous catheters parameters. Four hundred and thirteen peripheral venous catheters were registered for time in situ, size and complications. A cost analysis was performed. Non-parametric statistics were used, and prisk of developing thrombophlebitis. Nor is it compatible with a greater risk to use a peripheral venous catheter of 1.1 mm/20 gauge instead of 0.9 mm/22 gauge. The change in guidelines would decrease money spent, 250 100 Euro in Sweden, thus allowing time for the nurses to do other tasks and save discomfort for the patients. National guidelines should be based on evidence and current facts, and evaluation of guidelines should be given priority. © 2010 Blackwell Publishing Ltd.

  9. Near-infrared vascular imaging in peripheral venous and arterial access

    NARCIS (Netherlands)

    Cuper, N.J.

    2012-01-01

    Venous and arterial access are among the most widespread medical procedures performed in children. Especially in young children venous and arterial access can be problematic due to tiny blood vessels that are difficult to localize beneath a layer of baby fat. This thesis describes the development

  10. Intra-arterial infusion of prostaglandin E1 in normal subjects and patients with peripheral arterial disease

    DEFF Research Database (Denmark)

    Nielsen, P E; Nielsen, S L; Holstein, P

    1976-01-01

    Acute vasodilatation was produced by infusion of prostaglandin E1 (PGE1) in the femoral artery in 6 patients with occlusive arterial disease of the legs and in 3 normal subjects. The effect on blood flow and on blood pressure was measured at different segments of the leg with the strain gauge...... technique, isotope clearance technique, and photoelectric technique. Skin temperature was measured at different levels by using thermocouples. The blood pressure on the legs decreased at all segments during vasodilatation as well in patients as in controls. The blood flow increased in all segments in normal...... controls. In patients the blood flow increased proximally in the legs. Distally, however, no increase could be demonstrated. As a good effect of PGE1, on ischaemic rest pains has been reported, mechanisms other than vasodilatation should probably be considered....

  11. Expressions of adenosine A2Areceptors in coronary arteries and peripheral blood mononuclear cells are correlated in coronary artery disease patients.

    Science.gov (United States)

    Gariboldi, Vlad; Vairo, Donato; Guieu, Régis; Marlingue, Marion; Ravis, Eléonore; Lagier, David; Mari, Alissa; Thery, Elsa; Collart, Frédéric; Gaudry, Marine; Bonello, Laurent; Paganelli, Franck; Condo, Jocelyne; Kipson, Nathalie; Fenouillet, Emmanuel; Ruf, Jean; Mottola, Giovanna

    2017-03-01

    Altered coronary blood flow occurs in patients with coronary artery disease (CAD). Adenosine strongly impacts blood flow mostly via adenosine A 2A receptor (A 2A R) expressed in coronary tissues. As part of a systemic regulation of the adenosinergic system, we compared A 2A R expression in situ, and on peripheral blood mononuclear cells (PBMC) in CAD patients. Aortic and coronary tissues, and PBMC were sampled in 20 CAD patients undergoing coronary artery bypass surgery and consecutively included. Controls were PBMC obtained from 15 healthy subjects. Expression and activity of A 2A R were studied by Western blotting and cAMP measurement, respectively. A 2A R expression on PBMC was lower in patients than in controls (0.83±0.31 vs 1.2±0.35 arbitrary units; pcoronary and aortic tissues (Pearson's r: 0.77 and 0.59, pcoronary artery and aortic tissues in CAD patients, A 2A R activity of PBMC matched that observed in aorta, and A 2A R expression and activity in PBMC were found reduced as compared to controls. Measuring the expression level of A 2A R on PBMC represents a good tool to address in situ expression in coronary tissues of CAD patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. Critical evaluation of stents in the peripheral arterial disease of the superficial femoral artery – focus on the paclitaxel eluting stent

    Directory of Open Access Journals (Sweden)

    Litsky J

    2014-05-01

    Full Text Available Jason Litsky,1 Arijit Chanda,2 Erik Stilp,1 Alexandra Lansky,1 Carlos Mena11Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA; 2Section of Cardiology, Department of Internal Medicine, Bridgeport Hospital, Bridgeport, CT, USAAbstract: The endovascular management of obstructive disease of the superficial femoral artery (SFA is challenging due to unique anatomical and biomechanical forces. Obstructive lesions of the SFA make up the largest proportion of lesions leading to symptomatic peripheral arterial disease. Accordingly, endovascular treatment of SFA disease is becoming increasingly common and, in many cases, is the preferred initial therapy. The use of self-expanding nitinol stents have proven superior to percutaneous transluminal balloon angioplasty in the treatment of intermediate length SFA stenosis. However, achieving durable results, as well as attaining adequate therapy for long occlusions typically seen in clinical practice, remains problematic. Newer technologies, such as paclitaxel eluting stents, seem promising in improving outcomes.Keywords: Zilver PTX, self-expanding stent, atherosclerotic disease, superficial femoral artery

  13. Evidence-Based Used, Yet Still Controversial: The Arterial Filter

    Science.gov (United States)

    Somer, Filip De

    2012-01-01

    Abstract: Arterial line filters are considered by many as an essential safety measure inside a cardiopulmonary bypass circuit. There is no doubt that this was true during the bubble oxygenator era, but we can question whether the existing arterial line filter design and positioning of the filter are still optimal seeing the tremendous progress in cardiopulmonary bypass circuit components. This overview gives a critical overview of existing arterial line filter design. PMID:22730869

  14. The LargPAD Trial: Phase IIA evaluation of l-arginine infusion in patients with peripheral arterial disease.

    Science.gov (United States)

    Kashyap, Vikram S; Lakin, Ryan O; Campos, Patricia; Allemang, Matthew; Kim, Ann; Sarac, Timur P; Hausladen, Alfred; Stamler, Jonathan S

    2017-07-01

    Endothelial function is improved by l-arginine (l-arg) supplementation in preclinical and clinical studies of mildly diseased vasculature; however, endothelial function and responsiveness to l-arg in severely diseased arteries is not known. Our objective was to evaluate the acute effects of catheter-directed l-arg delivery in patients with chronic lower extremity ischemia secondary to peripheral arterial disease. The study enrolled 22 patients (45% male) with peripheral arterial disease (mean age, 62 years) requiring lower extremity angiography. Endothelium-dependent relaxation of patent but atherosclerotic superficial femoral arteries was measured using a combination of intravascular ultrasound (IVUS) imaging and a Doppler FloWire (Volcano Corporation, Rancho Cordova, Calif) during the infusion of incremental acetylcholine (10-6 to 10-4 molar concentration) doses. Patients received 50 mg (n = 3), 100 mg (n = 10), or 500 mg (n = 9) l-arg intra-arterially, followed by repeat endothelium-dependent relaxation measurement (limb volumetric flow). IVUS-derived virtual histology of the culprit vessel was also obtained. Endothelium-independent relaxation was measured using a nitroglycerin infusion. Levels of nitrogen oxides and arginine metabolites were measured by chemiluminescence and mass spectrometry, respectively. Patients tolerated limb l-arg infusion well. Serum arginine and ornithine levels increased by 43.6% ± 13.0% and 23.2% ± 10.3%, respectively (P endothelium-independent relaxation, 137% ± 28% volume flow increase). IVUS-derived virtual histology indicated plaque volume was 14 ± 1.3 mm3/cm, and plaque stratification revealed a predominantly fibrous morphology (46.4%; necrotic core, 28.4%; calcium, 17.4%; fibrolipid, 6.6%). Plaque morphology did not correlate with l-arg responsiveness. Despite extensive atherosclerosis, endothelial function in diseased lower extremity human arteries can be enhanced by l-arg infusion secondary to increased

  15. Beta-blockers and health-related quality of life in patients with peripheral arterial disease and COPD.

    Science.gov (United States)

    van Gestel, Yvette R B M; Hoeks, Sanne E; Sin, Don D; Stam, Henk; Mertens, Frans W; Bax, Jeroen J; van Domburg, Ron T; Poldermans, Don

    2009-01-01

    Beta-blockers are frequently withheld in patients with cardiovascular disease who also have chronic obstructive pulmonary disease (COPD) because of concerns that they might provoke bronchospasm and cause deterioration in health status. Although beta1-selective beta-blockers are associated with reduced mortality in COPD patients, their effects on health status are unknown. The aim of this study was to investigate the relationship between beta-blockers and health-related quality of life (HRQOL) in patients with peripheral arterial disease and COPD. Of the original cohort of 3371 vascular surgery patients, 1310 had COPD of whom 469 survived during long-term follow-up. These COPD patients were sent the Short Form-36 (SF-36) health-related quality of life questionnaire, which was completed and returned by 326 (70%) patients. No significant differences in any of the SF-36 domains were observed between COPD patients who did and did not use beta-blockers (p > 0.05 for all). Furthermore, beta-blockers were not associated with any impairment in HRQOL among patients with COPD. Beta-blockers had no material impact on the HRQOL of patients with peripheral arterial disease who also had COPD. This suggests that beta-blockers can, in most circumstances, be administered to patients with COPD without impairment in HRQOL.

  16. Clinical importance of change in physical activity after endovascular treatment combined with exercise training in patients with peripheral arterial disease.

    Science.gov (United States)

    Otsuka, Shota; Morisawa, Tomoyuki; Yuguchi, Satoshi; Hojo, Yu; Matsuo, Tomohiro; Nakajima, Masaharu; Ishida, Atsuhisa; Takahashi, Tetsuya

    2017-02-01

    We aimed to investigate the characteristics of changes in amount of physical activity of patients with peripheral arterial disease (PAD) before/after endovascular treatment (EVT) combined with exercise training. Twenty-two patients with peripheral arterial disease at stage-II of the Fontaine classification who received EVT combined with exercise training were included in this study. A tri-axial accelerometer was used to record physical activity every day from the day before surgery to 3 months after discharge from hospital. The mean number of walking steps before surgery was 2664 steps (611 steps-5404 steps), whereas those after surgery was 3393 (567 steps-7578 steps). Ankle Brachial Index (from 0.69 to 1.03; p training. Among the 22 patients, the number of walking steps increased in 17 of them and decreased in 5 of them. Compared with the patients in the increased-steps group, those in the decreased-steps group were significantly older (p training is also important for short-term prognosis.

  17. [Peripheral perfusion in CAD patients with various-stage chronic heart failure undergoing coronary artery bypass grafting].

    Science.gov (United States)

    Kamenskaia, O V; Klinkova, A S; Khabarov, D V

    Using the orthostatic test, we examined peripheral perfusion by means of laser Doppler flowmetry (LDF) and transcutaneous oximetry in a total of 104 patients presenting with coronary artery disease and functional class II-IV chronic heart failure (CHF) prior to coronary artery bypass grafting (CABG) and in the remote terms thereafter. Volumetric velocity of the microcirculatory blood flow (MCB) of the lower limbs was measured by means of LDF in perfusion units; partial oxygen pressure (TcPO2, mmHg) was registered by means of transcutaneous oximetry. The patients with CAD were subdivided into two groups as follows: Group One comprised patients with FC II CHF and Group Two included those with FC III-IV CHF. Prior to CABG according to the findings of LDF, the lowest level of MCB of the lower limbs was revealed in Group Two, being by 57.9% (42.5-61.3) less as compared with Group One (p=0.008). In Group Two patients as compared with Group One there was a larger proportion of patients with impaired reactivity of the peripheral microcirculatory bed during the orthostatic test in the form of: 1) a paradoxical reaction of the MCB both before CABG (60.6 versus 13.9%, p=0.00001) and in the remote terms after the operation (64.3 versus 16.2%, p=0.00001); 2) lack of the reaction of the MCB prior to the operation (19.7 versus 4.7%, p=0.02) and in the remote period after CABG (16.7 versus 2.7%, p=0.04). Group Two patients both before and after CABG were found to have a decrease (compared with the norm) in the TcPO2 parameters at rest, as well as lower reactivity of tissue metabolism of peripheral tissues during the orthostatic test. An initial decrease in the left ventricular output fraction of MCB during the orthostatic test prior to CABG increases the chances for the development of surgically significant atherosclerotic lesions of lower-limb arteries after myocardial revascularization (OR=4.2; 95% CI 1.3-2.3; p=0.01). Hence, the most pronounced impairments of the mechanisms of

  18. Flow-mediated dilation and peripheral arterial tonometry are disturbed in preeclampsia and reflect different aspects of endothelial function.

    Science.gov (United States)

    Mannaerts, Dominique; Faes, Ellen; Goovaerts, Inge; Stoop, Tibor; Cornette, Jerome; Gyselaers, Wilfried; Spaanderman, Marc; Van Craenenbroeck, Emeline M; Jacquemyn, Yves

    2017-11-01

    Endothelial function and arterial stiffness are known to be altered in preeclamptic pregnancies. Previous studies have shown conflicting results regarding the best technique for assessing vascular function in pregnancy. In this study, we made a comprehensive evaluation of in vivo vascular function [including flow-mediated dilatation (FMD), peripheral arterial tonometry (PAT), and arterial stiffness] in preeclamptic patients and compared them with normal pregnancies. In addition, we assessed the relation between vascular function and systemic inflammation. Fourteen patients with preeclampsia (PE) and 14 healthy pregnant controls were included. Endothelial function was determined by FMD and PAT and arterial stiffness by carotid-femoral pulse-wave velocity and augmentation index. Systemic inflammation was assessed using mean platelet volume (MPV) and neutrophil-lymphocyte ratio (NLR). The reactive hyperemia index, assessed using PAT, is decreased at the third trimester compared with the first trimester in a normal, uncomplicated pregnancy (P = 0.001). Arterial stiffness is significantly higher in PE versus normal pregnancy (P function, obtained by FMD, is deteriorated in PE versus normal pregnancy (P = 0.015), whereas endothelial function assessment by PAT is improved in PE versus normal pregnancy (P = 0.001). Systemic inflammation (MPV and NLR) increases during normal pregnancy. FMD and PAT are disturbed in PE. Endothelial function, assessed by FMD and PAT, shows distinct results. This may indicate that measurements with FMD and PAT reflect different aspects of endothelial function and that PAT should not be used as a substitute for FMD as a measure of endothelial function in pregnancy. Copyright © 2017 the American Physiological Society.

  19. Outcomes after primary transcatheter therapy in infants and young children with severe bilateral peripheral pulmonary artery stenosis.

    Science.gov (United States)

    Cunningham, Jonathan W; McElhinney, Doff B; Gauvreau, Kimberlee; Bergersen, Lisa; Lacro, Ronald V; Marshall, Audrey C; Smoot, Leslie; Lock, James E

    2013-08-01

    Angioplasty and stent implantation have become accepted therapies for isolated peripheral pulmonary stenosis, and have been shown to increase vessel diameter and reduce right ventricular (RV) pressure acutely in patients with pulmonary artery (PA) stenosis. The purpose of this study was to assess long-term outcomes after primary transcatheter therapy for peripheral pulmonary stenosis. We studied 69 patients who underwent primary transcatheter intervention for severe isolated peripheral pulmonary stenosis at ≤ 5 years of age. Genetic/syndromic diagnoses included Williams syndrome (n=23), non-Williams familial arteriopathy (n=12), and Alagille syndrome (n=3). At the initial PA intervention, median RV:aortic pressure ratio decreased from 1.00 to 0.88 (median decrease, 0.18; Paortic pressure ratio had a greater reduction (Paortic stenosis. Freedom from any PA reintervention was 38 ± 6% at 1 year and 22 ± 6% at 5 years. The median RV:aortic pressure ratio decreased from 1.0 at baseline to 0.53 at the most recent catheterization (Pstenosis has become safer, regardless of genetic condition. Coupled with reintervention and surgical relief in selected cases, RV:aortic pressure ratios decrease substantially and most patients are asymptomatic at late follow-up.

  20. Endovascular treatment of peripheral arterial injury with covered stents: an experimental study in pigs

    Directory of Open Access Journals (Sweden)

    Sergio Belczak

    2011-01-01

    Full Text Available OBJECTIVE: To evaluate the feasibility of using endovascular repair to treat penetrating arterial injuries with covered stents. Feasibility was examined according to the circumferential extent of the injury. INTRODUCTION: Surgical trauma often increases the risk of major morbidity and mortality associated with vascular injury, and endovascular repair has many advantages in such situations. METHODS: Twenty white male domestic pigs weighing 28-38 kg with controlled vascular injuries were divided into four equal groups according to the circumferential extent of their vascular lesion (i.e., no lesion, lesion 50%, and complete lesion. The left common carotid artery was dissected with proximal and distal control, and this procedure was followed by controlled sectioning of the arterial wall. Local manual compression was applied for 10 min and was followed by endovascular repair with the placement of a 5x50 mm VIABHAN TM covered stent using the femoral approach. We also monitored additional variables, such as the duration of the procedures (the mean was 56.3 ± 19.1 min, ultrasound parameters (e.g., maximum arterial diameter, peak systolic and diastolic velocity, and resistance index, arteriography findings, and fluctuations in vital signs (e.g., cardiac output, arterial pressure, and central venous pressure. RESULTS: The experimental procedure was found to be feasible and reproducible. Repairs were successful in all animals in the control (no lesion and 50% group and in one pig in the complete lesion group. DISCUSSION: The endovascular repair of an arterial injury is possible, but success depends on the circumferential extent of the arterial lesion. The present experimental model, which involved endovascular techniques, highlighted important factors that must be considered in future studies involving similar animals and materials.

  1. Multicenter, intra-individual comparison of single dose gadobenate dimeglumine and double dose gadopentetate dimeglumine for MR angiography of the peripheral arteries (the Peripheral VALUE Study).

    Science.gov (United States)

    Wang, Jian; Yan, Fuhua; Liu, Jianyu; Lu, Jianping; Li, Dan; Luan, Jingyuan; Wang, Xiaoying; Li, Yuan; Iezzi, Roberto; De Cobelli, Francesco

    2013-10-01

    To prospectively compare single dose gadobenate dimeglumine with double dose gadopentetate dimeglumine for CE-MRA in patients with peripheral arterial occlusive disease (PAOD) using an intra-individual crossover study design in which all patients received both contrast agents in otherwise identical CE-MRA examinations. Institutional review board and regulatory approval were granted and all patients provided written informed consent. Sixty-eight patients (53M/15F; 62.4 ± 15.7 years) with mild-to-severe PAOD were enrolled for randomized 3-station CE-MRA with 0.1 mmol/kg gadobenate dimeglumine and 0.2 mmol/kg gadopentetate dimeglumine. Three blinded readers assessed images for vessel anatomical delineation, disease detection/exclusion, and global preference. Diagnostic performance for detection of ≥51% stenosis was determined for 53 patients who underwent DSA. Noninferiority was assessed using the Wilcoxon Signed Rank, McNemar, and Wald tests. Quantitative enhancement was compared. No differences (P ≥ 0.25) were noted for any qualitative parameter at any station. Equivalence was reported in at least 62/64 patients (93.8% 3-reader agreement) for diagnostic preference. Superiority for gadobenate dimeglumine was reported by all readers for diagnostic performance (sensitivity: 80.4-88.0% versus 75.2-85.8%; specificity: 89.8-96.0% versus 88.7-94.8%; accuracy: 87.4-91.7% versus 84.9-90.6%; PPV: 84.0-92.8% versus 82.3-90.8%; NPV: 88.5-92.4% versus 85.7-91.1%). Quantitative enhancement was similar in the pelvis but significantly (P dimeglumine in the thigh for two readers. Image quality and diagnostic performance on peripheral CE-MRA with 0.1 mmol/kg gadobenate dimeglumine is at least equivalent to that with 0.2 mmol/kg gadopentetate dimeglumine. Copyright © 2013 Wiley Periodicals, Inc.

  2. Oral buflomedil in the prevention of cardiovascular events in patients with peripheral arterial obstructive disease: a randomized, placebo-controlled, 4-year study.

    Science.gov (United States)

    Leizorovicz, A; Becker, F

    2008-02-12

    Cardiovascular-related morbidity and mortality in patients with peripheral arterial obstructive disease remain high. We performed an international, multicenter, randomized, double-blind, placebo-controlled trial to investigate whether long-term administration of oral buflomedil could reduce the rate of cardiovascular events in patients with intermittent claudication. Patients >40 years of age with documented peripheral arterial obstructive disease, intermittent claudication, and an ankle-brachial index between 0.30 and 0.80 were eligible for inclusion and were randomized to receive orally either buflomedil or placebo for 2 to 4 years. Aspirin was recommended for all patients (unless they were receiving other antithrombotic treatments at inclusion). The primary efficacy outcome was critical cardiovascular events, defined as the composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, symptomatic deterioration of peripheral arterial obstructive disease, or leg amputation. A total of 2078 patients were recruited. Mean treatment duration was 33 months. The rate of critical cardiovascular events was significantly lower in buflomedil-randomized patients than in placebo-randomized patients (9.1% versus 12.4%; hazard ratio, 0.742; 95% confidence interval, 0.603 to 0.915; P=0.0163). Ankle-brachial index increased by 9.2% in buflomedil-randomized patients and decreased by 3.6% in placebo-randomized patients (Pperipheral arterial disease. The use of buflomedil should be considered in addition to an antiplatelet agent in patients with peripheral arterial obstructive disease and intermittent claudication.

  3. Cardiovascular risk factor control and outcomes in peripheral artery disease patients in the Reduction of Atherothrombosis for Continued Health (REACH) Registry

    DEFF Research Database (Denmark)

    Cacoub, Patrice P; Abola, Maria Teresa B; Baumgartner, Iris

    2009-01-01

    OBJECTIVES: To examine differences in risk factor (RF) management between peripheral artery disease (PAD) and coronary artery (CAD) or cerebrovascular disease (CVD), as well as the impact of RF control on major 1-year cardiovascular (CV) event rates. METHODS: The REACH Registry recruited >68000...... with PAD (n=8322), compared with those with CAD or CVD (but no PAD, n=47492) [blood pressure; glycemia; total cholesterol; smoking cessation (each P...

  4. The current role of endovascular intervention in the management of diabetic peripheral arterial disease

    Directory of Open Access Journals (Sweden)

    Benjamin J. Pearce

    2012-10-01

    Full Text Available Poor arterial inflow continues to be a major contributing factor in the failure to heal diabetic foot wounds. Options for revascularization have significantly increased with the development of sophisticated endovascular techniques. However, the application of this technology is variable due to relatively little prospective, randomized data on newer techniques. Further, multiple specialties are capable of performing endovascular interventions and proper referral can be difficult. This article will review the basics of application of endovascular intervention in the diabetic patient with arterial disease and provide a broad understanding of the literature behind the decision-making on appropriate therapy.

  5. Dual-energy CTA in patients with symptomatic peripheral arterial occlusive disease. Study of diagnostic accuracy and impeding factors

    Energy Technology Data Exchange (ETDEWEB)

    Klink, Thorsten [Wuerzburg Univ. (Germany). Inst. of Diagnostic and Interventional Radiology; Bern Univ. (Switzerland). Univ. Inst. of Diagnostic, Interventional, and Pediatric Radiology; Wilhelm, Theresa; Roth, Christine [Univ. Hospital Giessen and Marburg, Marburg (Germany). Dept. of Diagnostic and Interventional Radiology; Heverhagen, Johannes T. [Bern Univ. (Switzerland). Univ. Inst. of Diagnostic, Interventional, and Pediatric Radiology

    2017-05-15

    The purpose of this study was to assess the diagnostic performance of dual-energy CT angiography (DE-CTA) in patients with symptomatic peripheral artery occlusive disease (PAOD) and to identify factors that impede its diagnostic accuracy. Dual-source DE-CTA scans of the lower extremities of 94 patients were retrospectively compared to the diagnostic reference standard, digital subtraction angiography (DSA). Two independent observers assessed PAOD incidence, image quality, artifacts, and diagnostic accuracy of DE-CTA in 1014 arterial segments on axial, combined 80/140 kVp reconstructions and on 3 D maximum intensity projections (MIP) after automated bone and plaque removal. The impact of calcifications, image quality, and image artifacts on the diagnostic accuracy was evaluated using Fisher's exact test. Furthermore, interobserver agreement was analyzed. Two observers achieved sensitivities of 98.0% and 93.9%, respectively, and specificities of 75.0% and 66.7%, respectively, for detecting stenoses of >50% of the lower extremity arteries. Calcifications impeded specificity, e.g. from 81.2% to 46.2% for reader 1 (p<0.001). Specificity increased with higher image quality, e.g. from 70.0% to 76.4% for reader 1 (p<0.001). Artifacts decreased the specificity of reader 2 (p<0.001). The overall interobserver agreement ranged between moderate and substantial for stenosis detection and calcified plaques. Conclusion DE-CTA is accurate in the detection of arterial stenoses of >50% in symptomatic PAOD patients. Calcified atherosclerotic plaques, image quality, and artifacts may impede specificity.

  6. Incident Type 2 Myocardial Infarction in a Cohort of Patients Undergoing Coronary or Peripheral Arterial Angiography

    NARCIS (Netherlands)

    Gaggin, H.K.; Liu, Y.; Lyass, A.; Kimmenade, R.R.J. van; Motiwala, S.R.; Kelly, N.P.; Mallick, A.; Gandhi, P.U.; Ibrahim, N.E.; Simon, M.L.; Bhardwaj, A.; Belcher, A.M.; Harisiades, J.E.; Massaro, J.M.; D'Agostino, R.B., Sr.; Januzzi, J.L., Jr.

    2017-01-01

    BACKGROUND: Despite growing recognition of type 2 myocardial infarction (T2MI; related to supply/demand mismatch), little is known about its risk factors or its association with outcome. METHODS: A single-center cohort of patients undergoing coronary or peripheral angiography with or without

  7. Peripheral venous blood gas analysis: An alternative to arterial blood gas analysis for initial assessment and resuscitation in emergency and intensive care unit patients.

    Science.gov (United States)

    Awasthi, Shilpi; Rani, Raka; Malviya, Deepak

    2013-01-01

    Arterial blood gas (ABG) analysis is the gold standard method for assessment of oxygenation and acid base analysis, yielding valuable information about a variety of disease process. This study is aimed to determine the extent of correlation between arterial and peripheral venous samples for blood gases and acid base status in critically ill and emergency department patients and to evaluate if venous sample may be a better alternative for initial assessment and resuscitation. The prospective study was conducted on 45 patients of either sex in the age group of 15-80 years of intensive care unit and emergency ward. Relevant history, presenting complaints, vital signs, and indication for testing were recorded. Arterial and peripheral venous samples were drawn simultaneously in a pre-heparinized syringe and analyzed immediately for blood gases and acid base status. Mean difference and Pearson's product moment correlation coefficient was used to compare the result. After statistical evaluation, the present study shows minimal mean difference and good correlation (r > 0.9) between arterial and peripheral venous sample for blood gases and acid base status. Correlation in PO2 measurement was poor (r blood may be a useful alternative to arterial blood during blood gas analysis obviating the need for arterial puncture in difficult clinical situation especially trauma patients, for initial emergency department assessment and early stages of resuscitation.

  8. A single serving of blueberry (V. corymbosum) modulates peripheral arterial dysfunction induced by acute cigarette smoking in young volunteers: a randomized-controlled trial.

    Science.gov (United States)

    Del Bo', Cristian; Porrini, Marisa; Fracassetti, Daniela; Campolo, Jonica; Klimis-Zacas, Dorothy; Riso, Patrizia

    2014-12-01

    Cigarette smoking causes oxidative stress, hypertension and endothelial dysfunction. Polyphenol-rich foods may prevent these conditions. We investigated the effect of a single serving of fresh-frozen blueberry intake on peripheral arterial function and arterial stiffness in young smokers. Sixteen male smokers were recruited for a 3-armed randomized-controlled study with the following experimental conditions: smoking treatment (one cigarette); blueberry treatment (300 g of blueberry) + smoking; control treatment (300 mL of water with sugar) + smoking. Each treatment was separated by one week of wash-out period. The blood pressure, heart rate, peripheral arterial function (reactive hyperemia and Framingham reactive hyperemia), and arterial stiffness (digital augmentation index, digital augmentation index normalized for a heart rate of 75 bpm) were measured before and 20 min after smoking with Endo-PAT2000. Smoking impaired the blood pressure, heart rate and peripheral arterial function, but did not affect the arterial stiffness. Blueberry consumption counteracted the impairment of the reactive hyperemia index induced by smoking (-4.4 ± 0.8% blueberry treatment vs. -22.0 ± 1.1% smoking treatment, p blueberry treatment vs. -42.8 ± 20.0% smoking treatment, p blueberry treatment vs. +13.1 ± 0.02% smoking treatment, mmHg, p blueberry on reactive hyperemia, Framingham reactive hyperemia, and systolic blood pressure in subjects exposed to smoke of one cigarette. Future studies are necessary to elucidate the mechanisms involved.

  9. Surgical treatment of chronic occlusive in peripheral arteries (Review of 100 cases

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    H. AHRARI

    1977-01-01

    Full Text Available The purpose of this article is to diseuse the philosophy of our approch to the severely ischemic extremity and ourcurrent methods of treatment. 1 - The natural history of artheriosclerotic arterial obstruction should always be borne in mind. There is no doubt that many people have some degree of arterial stenosis or obstrcction and never suffer symptoms, either because of the reduced demand due to senility or because they are prepared to tolerate minor inconveniences which do not significantly interfere with their lives or livelihood. It should also be remembered that a proportion of patients with claudication improve spontaneously ever a time scale extending to many months or years. Taylor and Cale (1962, in a long term follow up of patients with untreated intermittent claudication, found spontaneous relief of symptoms in 39 per cent of the cases, no change in 45% and 16% worsening. Because of this it is impossible to lay down precise rules concerning the treatment of patients with intermittent claudication. It would be wrong to advise major arterial surgery in an elderly patient with extensive main' vessel disease and relatively mild claudication, and equally wrong to deny surgical treatment to an active younger patient with a we 11 localized arterial lesion. It is superfuous to add that anyhow, the surgery must not make the patient worse. 2- In a survey of a decade of experience, the arterioplastie treatment of occlusive disease seems to fall int three groups based on the anatomic distribution of the lesion. (Ref, 13. A - These in whom the obstructive disease is limited to the aortoiliac segments of the arterial tree supplying the leg. B - Those with both aort-iliao and femoral arterial disease. C - These with only femoropopliteal or proximal part of the popliteal arteries. Results in both the aorto-iliac and femoral arterial disease operations were in general satisfactory. The good early results of aorto-iliac operations showed only a

  10. Cells, Biomarkers, and Posttraumatic Stress Disorder: Evidence for Peripheral Involvement in a Central Disease

    Science.gov (United States)

    2012-01-01

    Naval Health Research Center Cells, Biomarkers and Post -traumatic Stress Disorder: Evidence for Peripheral Involvement in A Central Disease ...factor- 1; TBI, traumatic brain injury; TNF, tumor necrosis factor. Naval Health Research Center, San Diego, California, USA Abstract Post -traumatic...microglia in comparison with those with spleens (Ajmo et al. 2008). After an ischemic stroke was induced, the rats with spleens showed more CNS tissue

  11. Obstrução arterial retiniana periférica associada com hiper-homocisteinemia: relato de caso Peripheral retinal arterial obstruction associated with hyperhomocysteinemia: case report

    Directory of Open Access Journals (Sweden)

    Alexandre Kazuo Misawa

    2008-10-01

    Full Text Available A hiperhomocisteinemia é fator de risco para fenômenos trombo-embólicos retinianos associados a quadro de oclusão vascular venosa e arterial. Descrevemos um paciente com obstrução arterial retiniana periférica, sem sinais de vasculite ativa, associada a proliferação de neovasos com tração vítreo-retiniana e hemorragia vítrea recidivante. O alto nível sérico de homocisteína decorrente de deficiência de vitamina B12 e ácido fólico, sem outras alterações na cascata da coagulação, inclusive com a pesquisa do fator V de Leiden, sugere que a hiper-homocisteinemia esteja diretamente ligada como fator causal deste quadro clínico. Embora apresentasse PPD elevado, o diagnóstico diferencial mais importante de doença de Eales foi menos considerado por ser diagnóstico de exclusão. O controle do quadro clínico foi feito com suplemento de vitaminas (B12 e ácido fólico e fotocoagulação retiniana periférica. A homocisteína plasmática total deve ser dosada em pacientes com obstrução vascular retiniana, já que a hiper-homocisteinemia é fator de risco modificável e de fácil tratamento por meio de dieta ou suplementação vitamínica.Hyperhomocysteinemia is a risk factor for thromboembolic events of the retina associated with vascular venous or arterial occlusion. We describe a patient with occlusion of the peripheral arteriolar network without active vasculitis, associated with neovascular proliferation, peripheral vitreous-retinal traction and relapsing vitreous hemorrhage. The high serum homocysteine level resulting from vitamin B12 and folic acid deficiency, without further changes in the coagulation cascade including the test for Leiden's Factor V, indicates hyperhomocysteinemia as a direct causal factor in this clinical condition. Despite a high PPD, Eales Disease, a major differential diagnosis, was not fully considered, since it is established by exclusion. The patient was treated with photocoagulation and vitamin

  12. Improvement of the diabetic foot upon testosterone administration to hypogonadal men with peripheral arterial disease. Report of three cases

    Directory of Open Access Journals (Sweden)

    Zemlyanoy Alexandr

    2009-03-01

    Full Text Available Abstract Background Lower extremity complications (neuropathy, ulceration, infection, and peripheral arterial disease are common in diabetes mellitus. There is an inverse relation between plasma testosterone and insulin sensitivity, type 2 diabetes mellitus and HbA1c concentrations. Methods We report the beneficial effects of administration of testosterone to three men with a diabetic foot whose serum testosterone was subnormal. Results Upon normalization of serum testosterone there was an improvement of hyperglycemia, a decrease of leukocytes and of fibrinogen levels, an increase of antithrombin III activity and of tissue oxygen pressure. The wound showed granulation. Conclusion Beneficial effects of administration of testosterone to hypogonadal with a diabetic foot may be due to improved vascularization and to anti-inflammatory action.

  13. Oxidative stress and inflammation: their role in the pathogenesis of peripheral artery disease with or without type 2 diabetes mellitus.

    Science.gov (United States)

    Signorelli, Salvatore Santo; Katsiki, Niki

    2017-07-31

    Peripheral artery disease (PAD), a common vascular disease, has been associated with increased cardiovascular (CV) morbidity and mortality as well as all-cause death. Type 2 diabetes mellitus (T2DM) predisposes to PAD development. In T2DM patients, PAD further increases the risk for CV disease and death as well as foot morbidity and microvascular complications. The present narrative review discusses the role of oxidative stress and inflammation in the pathophysiology of PAD with or without the presence of T2DM. The effects of lifestyle measures (i.e. diet, physical activity and smoking cessation) and drug treatment on markers of oxidative stress and inflammation are also considered. Further research should establish the clinical implications of such effects as well as the clinical use of antioxidants and anti-inflammatory drugs in PAD. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  14. A Retrograde Transvenous Embolization Technique with Balloon-Assisted Arterial Aspiration for a Peripheral Arteriovenous Malformation with a Venous Pouch

    Energy Technology Data Exchange (ETDEWEB)

    Kuhara, Asako, E-mail: kuhara-asako@med.kurume-u.ac.jp; Tanaka, Norimitsu; Koganemaru, Masamichi; Kugiyama, Tomoko [Kurume University School of Medicine, Department of Radiology (Japan); Kiyokawa, Kensuke [Kurume University School of Medicine, Department of Plastic & Reconstructive Surgery and Maxillofacial Surgery (Japan); Abe, Toshi [Kurume University School of Medicine, Department of Radiology (Japan)

    2017-05-15

    Management of arteriovenous malformations (AVMs) is challenging, and there is no consensus regarding either the ideal approach or the treatment timing. Percutaneous embolization is the most frequent approach currently used and is considered the first-line technique for AVMs. There is an ongoing discussion about the best technical approach to embolize AVMs. AVMs associated with a dominant outflow vein (DOV) are rare. Embolization of both the DOV and the nidus is considered more effective. Herein, we report a novel technique of transvenous embolization of a DOV under negative pressure from an arterial balloon catheter in a case of a peripheral AVM. This technique allows the embolization of the DOV and the nidus retrogradely.

  15. Prevalence of peripheral arterial disease in patients at non-high cardiovascular risk. Rationale and design of the PANDORA study

    Directory of Open Access Journals (Sweden)

    Cimminiello Claudio

    2010-08-01

    Full Text Available Abstract Background Lower extremity peripheral arterial disease (PAD is a marker of widespread atherosclerosis. Individuals with PAD, most of whom do not show typical PAD symptoms ('asymptomatic' patients, are at increased risk of cardiovascular ischaemic events. American College of Cardiology/American Heart Association guidelines recommend that individuals with asymptomatic lower extremity PAD should be identified by measurement of ankle-brachial index (ABI. However, despite its associated risk, PAD remains under-recognised by clinicians and the general population and office-based ABI detection is still poorly-known and under-used in clinical practice. The Prevalence of peripheral Arterial disease in patients with a non-high cardiovascular disease risk, with No overt vascular Diseases nOR diAbetes mellitus (PANDORA study has a primary aim of assessing the prevalence of lower extremity PAD through ABI measurement, in patients at non-high cardiovascular risk, with no overt cardiovascular diseases (including symptomatic PAD, or diabetes mellitus. Secondary objectives include documenting the prevalence and treatment of cardiovascular risk factors and the characteristics of both patients and physicians as possible determinants for PAD under-diagnosis. Methods/Design PANDORA is a non-interventional, cross-sectional, pan-European study. It includes approximately 1,000 primary care participating sites, across six European countries (Belgium, France, Greece, Italy, The Netherlands, Switzerland. Investigator and patient questionnaires will be used to collect both right and left ABI values at rest, presence of cardiovascular disease risk factors, current pharmacological treatment, and determinants for PAD under-diagnosis. Discussion The PANDORA study will provide important data to estimate the prevalence of asymptomatic PAD in a population otherwise classified at low or intermediate risk on the basis of current risk scores in a primary care setting. Trial

  16. Prevalence of peripheral arterial disease in patients at non-high cardiovascular risk. Rationale and design of the PANDORA study.

    Science.gov (United States)

    Cimminiello, Claudio; Borghi, Claudio; Kownator, Serge; Wautrecht, Jean Claude; Carvounis, Christos P; Kranendonk, Stefanus E; Kindler, Beat; Mangrella, Mario

    2010-08-05

    Lower extremity peripheral arterial disease (PAD) is a marker of widespread atherosclerosis. Individuals with PAD, most of whom do not show typical PAD symptoms ('asymptomatic' patients), are at increased risk of cardiovascular ischaemic events. American College of Cardiology/American Heart Association guidelines recommend that individuals with asymptomatic lower extremity PAD should be identified by measurement of ankle-brachial index (ABI). However, despite its associated risk, PAD remains under-recognised by clinicians and the general population and office-based ABI detection is still poorly-known and under-used in clinical practice. The Prevalence of peripheral Arterial disease in patients with a non-high cardiovascular disease risk, with No overt vascular Diseases nOR diAbetes mellitus (PANDORA) study has a primary aim of assessing the prevalence of lower extremity PAD through ABI measurement, in patients at non-high cardiovascular risk, with no overt cardiovascular diseases (including symptomatic PAD), or diabetes mellitus. Secondary objectives include documenting the prevalence and treatment of cardiovascular risk factors and the characteristics of both patients and physicians as possible determinants for PAD under-diagnosis. PANDORA is a non-interventional, cross-sectional, pan-European study. It includes approximately 1,000 primary care participating sites, across six European countries (Belgium, France, Greece, Italy, The Netherlands, Switzerland). Investigator and patient questionnaires will be used to collect both right and left ABI values at rest, presence of cardiovascular disease risk factors, current pharmacological treatment, and determinants for PAD under-diagnosis. The PANDORA study will provide important data to estimate the prevalence of asymptomatic PAD in a population otherwise classified at low or intermediate risk on the basis of current risk scores in a primary care setting. Clinical Trials.gov Identifier: NCT00689377.

  17. The Effects of Controlled Physical Training on Peripheral Circulation Following Interventional Treatment of Coronary Artery Disease.

    Science.gov (United States)

    Jurczak, Ireneusz; Jurczak, Ksenia; Irzmański, Robert

    2016-01-01

    Controlled physical training induces specific changes in the peripheral circulatory system and can lead to positive changes in the vascular perfusion of the lower extremities. The aim of the study was to evaluate changes in peripheral circulation in the calf in patients with acute coronary disease (ACD) undergoing controlled physical training. Impedance plethysmography was used to monitor peripheral circulation during the training. A total of 90 patients were divided into three study groups. Group 1 (n = 30) participated in a two-week cardiac rehabilitation program consisting of interval training on a cycle ergometer and exercise to improve the participants' general physical condition. Group 2 (n = 30) went through the same cardiac rehabilitation program for four weeks. The control group (n = 30) was assigned breathing exercises, active free exercises of the peripheral joints and different muscle groups, and relaxation exercises. All the patients underwent impedance plethysmography tests before and after the training sessions. In Group 1, the systolic slope (PSlope) increased by 2%, pulse wave amplitude (PAmpl) increased by 4.2%, crest time (CT) increased by 1.5% and propagation time (PT) decreased by 1.2% (p > 0.05). In Group 2, the PSlope and PAmpl increased by 19% and 17% respectively, while the CT and PT decreased by 8% and 6.5% respectively (p < 0.05). In the control group, only the CT decreased, by 5% (p < 0.05). The study confirmed that cardiac rehabilitation improves blood flow in lower limb vessels in patients with ACD. The results depend on the duration and the type of physical training. Impedance plethysmography allows for precise and repeatable monitoring of local blood flow.

  18. Hsa-circRNA11783-2 in peripheral blood is correlated with coronary artery disease and type 2 diabetes mellitus.

    Science.gov (United States)

    Li, Xuejie; Zhao, Zhenzhou; Jian, Dongdong; Li, Wentao; Tang, Haiyu; Li, Muwei

    2017-11-01

    The purpose of this study was to identify the expression characteristics of circular RNAs in the peripheral blood of coronary artery disease patients and type 2 diabetes mellitus patients. Circular RNA in the peripheral blood from 6 control individuals, 6 coronary artery disease patients, 6 type 2 diabetes mellitus patients and 6 coronary artery disease combined with type 2 diabetes mellitus patients was collected for microarray analysis, and a further independent cohort consisting of 20 normal individuals, 20 type 2 diabetes mellitus subjects and 20 coronary artery disease subjects was used to verify the expression of five circular RNAs chosen for further analysis. The findings were then tested in a third cohort using quantitative real-time polymerase chain reaction. In total, 40 circular RNAs differentially expressed between the three experimental groups and the control group were identified by microarray analysis: 13 were upregulated in the experimental groups, while 27 were downregulated. Of the five circular RNAs chosen for further analysis, three were significantly downregulated in the experimental groups. The crude odds ratios and adjusted odds ratios of hsa-circRNA11783-2 showed significant differences in both the coronary artery disease group and type 2 diabetes mellitus group. We then verified hsa-circRNA11783-2 in the third cohort, and it remained closely related to both coronary artery disease and type 2 diabetes mellitus. Hsa-circRNA11783-2 is closely related to both coronary artery disease and type 2 diabetes mellitus.

  19. Effects of age and cardiovascular risk factors on 18F-FDG PET/CT quantification of atherosclerosis in the aorta and peripheral arteries

    NARCIS (Netherlands)

    Pasha, Ahmed K.; Moghbel, Mateen; Saboury, Babak; Gharavi, Mohammed H.; Blomberg, Bjorn A.; Torigian, Drew A.; Kwee, TC; Basu, Sandip; Mohler, Emile R.; Alavi, Abass

    2015-01-01

    Objective: To quantify fluorine-18 fluorodeoxyglucose (18F-FDG) uptake in the aorta and peripheral arteries and assess the variation of 18F-FDG uptake with age and cardiovascular risk factors. Methods: The subject population of this retrospective study comprises melanoma patients who underwent

  20. C-Reactive Protein Predicts Progression of Peripheral Arterial Disease in Patients with Type 2 Diabetes: A 5-Year Follow-Up Study

    Directory of Open Access Journals (Sweden)

    Popović Ljiljana

    2014-09-01

    Full Text Available Background: Previous studies have indicated that high sensitivity C-reactive protein (hs-CRP is a risk factor for the peripheral arterial disease (PAD in diabetes. This study aimed to evaluate the possible predictive significance of hs-CRP for the development and progression of PAD in patients with type 2 diabetes (T2D.

  1. Summary receiver operating characteristic curves as a technique for meta-analysis of the diagnostic performance of duplex ultrasonography in peripheral arterial disease

    NARCIS (Netherlands)

    deVries, SO; Hunink, MGM; Polak, JF

    Rationale and Objectives. We summarized and compared the diagnostic performance of duplex and color-guided duplex ultrasonography in the evaluation of peripheral arterial disease. We present our research as an example of the use of summary receiver operating characteristic (ROC) curves in a

  2. Peripheral Arterial Disease in Older People with Intellectual Disability in The Netherlands Using the Ankle-Brachial Index: Results of the HA-ID Study

    Science.gov (United States)

    de Winter, C. F.; Bastiaanse, L. P.; Kranendonk, S. E.; Hilgenkamp, T. I. M.; Evenhuis, H. M.; Echteld, M. A.

    2013-01-01

    Older people with an intellectual disability (ID) have been shown to have similar to increased cardiovascular risks as compared to the general population. Peripheral arterial disease (PAD), atherosclerosis distal from the aortic bifurcation, is associated with increased cardiovascular morbidity and mortality. The prevalence of PAD has not been…

  3. Skin autofluorescence as a measure of tissue advanced glycation end products deposition is elevated in diabetic patients with peripheral artery disease

    NARCIS (Netherlands)

    De Vos, L.C.; Mulder, D.J.; Dullaart, R.P.F.; Lutgers, H.L.; Smit, A.J.; Kamphuisen, P.W.; Westra, Johanna; Zeebregts, C.J.; Lefrandt, J.D.

    Backgrounds and aims: Diabetes mellitus (DM) is an important risk factor for peripheral artery disease (PAD) and associated with a particularly poor prognosis in these patients. Increased glycemic and oxidative stress in DM enhance the accumulation of advanced glycation end products (AGEs), which

  4. Diagnosis and treatment of peripheral arterial disease in diabetic patients with a foot ulcer. A progress report of the International Working Group on the Diabetic Foot

    NARCIS (Netherlands)

    Schaper, N. C.; Andros, G.; Apelqvist, J.; Bakker, K.; Lammer, J.; Lepantalo, M.; Mills, J. L.; Reekers, J.; Shearman, C. P.; Zierler, R. E.; Hinchliffe, R. J.

    2012-01-01

    The International Working Group on the Diabetic Foot (IWDGF) has produced in 2011 a guideline on the diagnosis and treatment of peripheral arterial disease in patients with diabetes and a foot ulcer. This document, together with a systematic review that provided the background information on

  5. Ultrasound and review of evidence for lower extremity peripheral nerve blocks.

    Science.gov (United States)

    Salinas, Francis V

    2010-01-01

    This qualitative systematic review summarizes existing evidence from randomized controlled trials (RCTs) comparing ultrasound (US) to alternative techniques for lower extremity peripheral nerve block. There were 11 RCTs of sufficient quality for inclusion. Jadad scores ranged from 1 to 4 with a median of 3. For femoral nerve blocks, US provided shorter onset and improved quality of sensory and motor block, as well as a decrease in local anesthetic requirements. For sciatic nerve blocks, US resulted in a higher percentage of patients with complete sensory and motor block, as well as decreased local anesthetic requirements. In 2 of the studies for sciatic nerve block, US resulted in a shorter time to successfully complete the procedure. No study was powered to detect a difference in surgical block success. Overall, there was significant heterogeneity in the definitions of successful sensory and motor block. In 2 studies, the optimal peripheral nerve stimulation technique may have not been used, resulting in a potential bias. No RCT reported US as inferior to alternative techniques in any outcome. There is level Ib evidence to make a grade A recommendation that US guidance provides improvements in onset and success of sensory block, a decrease in local anesthetic requirements, and decreased time to perform lower extremity peripheral nerve blocks.

  6. Associations between lower extremity ischemia, upper and lower extremity strength, and functional impairment with peripheral arterial disease.

    Science.gov (United States)

    McDermott, Mary M; Tian, Lu; Ferrucci, Luigi; Liu, Kiang; Guralnik, Jack M; Liao, Yihua; Pearce, William H; Criqui, Michael H

    2008-04-01

    To identify associations between lower extremity ischemia and leg strength, leg power, and hand grip in persons with and without lower extremity peripheral arterial disease (PAD). To determine whether poorer strength may mediate poorer lower extremity performance in persons with lower arterial brachial index (ABI) levels. Cross-sectional. Academic medical centers. Four hundred twenty-four persons with PAD and 271 without PAD. Isometric knee extension and plantarflexion strength and handgrip strength were measured using a computer-linked strength chair. Knee extension power was measured using the Nottingham leg rig. ABI, 6-minute walk, and usual and fastest 4-m walking velocity were measured. Results were adjusted for potential confounders. Lower ABI values were associated with lower plantarflexion strength (P trend=.04) and lower knee extension power (P trend strength. Significant associations between ABI and measures of lower extremity performance were attenuated after additional adjustment for measures of strength. These results are consistent with the hypothesis that lower extremity ischemia impairs strength specifically in distal lower extremity muscles. Associations between lower extremity ischemia and impaired lower extremity strength may mediate associations between lower ABI values and greater functional impairment.

  7. Novel association between bone mineral density scores and the prevalence of peripheral artery disease in both sexes.

    Science.gov (United States)

    Baldwin, Melissa J; Policha, Aleksandra; Maldonado, Thomas; Hiramoto, Jade S; Honig, Stephen; Conte, Michael S; Berger, Jeffrey; Rockman, Caron B

    2017-02-01

    The purpose of the current study was to investigate the association between bone mineral density (BMD) scores and the prevalence of peripheral artery disease (PAD) in a large cohort of subjects who underwent arterial Doppler assessments and calcaneal bone densitometry. The study was performed using data obtained from Life Line Screening Inc. Subjects were self-selected and paid for screening tests. The prevalence of PAD was significantly higher in men with osteopenia (4.5%) and osteoporosis (10.9%) compared to men with normal BMD (3.0%) ( posteoporosis (OR 2.3) were found to be independent risk factors for the presence of PAD in men. The prevalence of PAD was significantly higher in women with osteopenia (4.8%) and osteoporosis (11.8%) compared to women with normal BMD (3.3%) ( posteoporosis (OR 1.8) were found to be independent risk factors for the presence of PAD in women. The current study reports a strong association of abnormal BMD analysis with the prevalence of PAD, which persists even when controlling for age and associated atherosclerotic risk factors. Although the mechanism by which these two disease processes is related is not completely elucidated, the presence of osteoporosis should make clinicians aware of the possibility of occult PAD or associated atherosclerotic disease in appropriate patients.

  8. Dark chocolate and vascular function in patients with peripheral artery disease: a randomized, controlled cross-over trial.

    Science.gov (United States)

    Hammer, Alexandra; Koppensteiner, Renate; Steiner, Sabine; Niessner, Alexander; Goliasch, Georg; Gschwandtner, Michael; Hoke, Matthias

    2015-01-01

    Flavonoid-rich dark chocolate has positive effects on vascular function in healthy subjects and in patients at risk of atherosclerosis. The impact of dark chocolate on endothelial and microvascular function in patients with symptomatic peripheral artery disease (PAD) has not been investigated so far. In an investigator blinded, randomized, controlled, cross-over trial we assessed the effect of flavonoid-rich dark chocolate and cocoa-free control chocolate on flow-mediated dilatation (FMD) of the brachial artery and on microvascular function (assessed by Laser Doppler fluxmetry) in 21 patients with symptomatic (Fontaine stage II) PAD. Measurements were done in each patient on 2 single days, with an interval of 7 days, at baseline and at 2 hours after ingestion of 50 g dark chocolate or 50 g white chocolate, respectively. FMD remained unchanged after intake of dark chocolate (baseline and 2 hours after ingestion, %: 5.1 [IQR 4.4 to 7.3] and 5.5 [IQR 3.9 to 10.4]; p = 0.57, and after intake of white chocolate (baseline and 2 hours after ingestion, %: 6.4 [IQR 4.5 to 11.4] and 4.4 [IQR 2.6 to 8.7]; p = 0.14. Similarly, microcirculatory parameters were not significantly altered after intake of any chocolate compared with the respective baseline values. In conclusion, a single consumption of 50 g dark chocolate has no effect on endothelial and microvascular function in patients with symptomatic PAD.

  9. Risk of Peripheral Arterial Occlusive Disease in Patients With Systemic Lupus Erythematosus: A Nationwide Population-Based Cohort Study.

    Science.gov (United States)

    Chuang, Ya-Wen; Yu, Mei-Ching; Lin, Cheng-Li; Yu, Tung-Min; Shu, Kuo-Hsiung; Kao, Chia-Hung

    2015-11-01

    Systemic lupus erythematosus (SLE) is associated with atherosclerosis, but the relationship between SLE and peripheral arterial occlusive disease (PAOD) remains unclear. We sought to investigate this relationship by comparing cardiovascular complications in patients with and without SLE.Data on patients from 2000 to 2011 were collected from the National Health Insurance Research Database of Taiwan. The SLE cohort was frequency-matched according to age, sex, and history of diabetes mellitus (DM) with patients without SLE (control cohort). We evaluated the risk of cardiovascular complications, including hypertension, DM, stroke, chronic obstructive pulmonary disease, heart failure, coronary artery disease, and hyperlipidemia.The study included 10,144 patients with SLE and 10,144 control patients. The incidence of PAOD was 9.39-fold higher (95% confidence interval [CI] = 7.70-11.15) in the SLE cohort than in the non-SLE cohort. Moreover, SLE was an independent risk factor for PAOD. The adjusted risk of PAOD was highest in patients with SLE who were aged ≤34 years (hazard ratio = 47.6, 95% CI = 26.8-84.4). The risk of PAOD was highest during the first year of follow-up and decreased over time.Patients with SLE exhibit a higher incidence and an independently higher risk of PAOD compared with the general population. The PAOD risk is markedly elevated in patients with SLE who are young and in whom the disease is at an early stage.

  10. Endothelial dysfunction assessment by noninvasive peripheral arterial tonometry in patients with chronic obstructive pulmonary disease compared with healthy subjects.

    Science.gov (United States)

    Malerba, Mario; Radaeli, Alessandro; Nardin, Matteo; Clini, Enrico; Carpagnano, Giovanna Elisiana; Sciatti, Edoardo; Salghetti, Francesca; Bonadei, Ivano; Platto, Fabio; Vizzardi, Enrico

    2017-08-05

    Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of cardiovascular disease. The endothelial dysfunction likely plays a central role in increasing cardiovascular risk. This cross-sectional, study investigated the prevalence and extent of endothelial dysfunction in patients with stable COPD. Peripheral arterial tonometry (PAT) was measured by post-ischemic reactive hyperemia index (RHI) in 16 COPD patients, 16 healthy controls and 16 subjects with treated systemic arterial hypertension (AH) and analysed with covariates condition (dyslipidemia, and medications). The prevalence of endothelial dysfunction was significantly higher in COPD group than in the other groups. Mean RHI was significantly lower in COPD patients compared with the other groups. At linear regression FEV 1 and RHI were directly correlated (Spearman index = 0.553; P = .026). COPD patients in groups C and D according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages showed lower RHI compared with patients classified as A and B (P < .01). At multiple regression analysis the presence of dyslipidemia, COPD and AH were associated with the presence of endothelial dysfunction. Endothelial dysfunction in stable COPD patients is probably implicated in the high cardiovascular comorbidity. This study suggests the potential utility of endothelial dysfunction evaluation in patients with COPD to a timely assessment and treatment for cardiac complications. © 2017 John Wiley & Sons Ltd.

  11. Size and blood flow of central and peripheral arteries in highly trained able-bodied and disabled athletes.

    Science.gov (United States)

    Huonker, M; Schmid, A; Schmidt-Trucksass, A; Grathwohl, D; Keul, J

    2003-08-01

    In a cross-sectional study, central and peripheral arteries were investigated noninvasively in high-performance athletes and in untrained subjects. The diastolic inner vessel diameter (D) of the thoracic and abdominal aorta, the subclavian artery (Sub), and common femoral artery (Fem) were determined by duplex sonography in 18 able-bodied professional tennis players, 34 able-bodied elite road cyclist athletes, 26 athletes with paraplegia, 17 below-knee amputated athletes, and 30 able-bodied, untrained subjects. The vessel cross-sectional areas (CSA) were set in relation to body surface area (BSA), and the cross-section index (CS-index = CSA/BSA) was calculated. Volumetric blood flow was determined in Sub and Fem via a pulsed-wave Doppler system and was set in relation to heart rate to calculate the stroke flow. A significantly increased D of Sub was found in the racket arm of able-bodied tennis players compared with the opposite arm (19%). Fem of able-bodied road cyclist athletes and of the intact limb in below-knee amputated athletes showed similar increases. D of Fem was lower in athletes with paraplegia (37%) and in below-knee amputated athletes proximal to the lesion (21%) compared with able-bodied, untrained subjects; CS-indexes were reduced 57 and 31%, respectively. Athletes with paraplegia demonstrated a larger D (19%) and a larger CS-index in Sub (54%) than able-bodied, untrained subjects. No significant differences in D and CS-indexes of the thoracic and abdominal aorta were found between any of the groups. The changes measured in Sub and Fem were associated with corresponding alterations in blood flow and stroke flow in all groups. The study suggests that the size and blood flow volume of the proximal limb arteries are adjusted to the metabolic needs of the corresponding extremity musculature and underscore the impact of exercise training or disuse on the structure and the function of the arterial system.

  12. The significance of gender in patients administered coronary angiography with respect to smoking, peripheral arterial disease, diabetes mellitus and the procedure used.

    Science.gov (United States)

    Atik, Derya; Atik, Cem; Paker, Salih; Işlek, Mesut

    2014-12-01

    This descriptive study was planned and conducted to determine whether or not gender is significant in patients administered coronary angiography with respect to smoking, peripheral arterial disease, diabetes mellitus and the procedure used. Based on the hospital records that were scanned retrospectively, the study included patients aged 18 and over who were diagnosed with coronary arterial disease and were administered for the first time a coronary angiography procedure in the Cardiology Clinic of Osmaniye Private New Life Hospital between 1 September 2012 and 31 December 2013. The data was evaluated on the SPSS 21.0 software. Percentages, averages, analysis of variance, Pearson's correlation analysis, chi-square independence test were used as our analysis method. 40.2% of the patients who took part in the study were female and 59.8% male; the mean age was 58.18 ± 11.73. It was observed that approximately 41% of the patients smoked, 5% of them had peripheral arterial disease, 23.9% were administered percutaneous transluminal coronary angioplasty + stent and a surgical treatment was planned for 16.1% of them. Gender was considered statistically significant in terms of smoking, peripheral arterial disease, diabetes mellitus and the procedure used (P patient group consisting of patients with coronary arterial disease. We think that the information herein will provide a guideline for evaluating treatment strategies and prognoses as well as for the training and consultancy to be provided to patient groups. © 2014 John Wiley & Sons, Ltd.

  13. A serving of blueberry (V. corymbosum) acutely improves peripheral arterial dysfunction in young smokers and non-smokers: two randomized, controlled, crossover pilot studies.

    Science.gov (United States)

    Del Bo', Cristian; Deon, Valeria; Campolo, Jonica; Lanti, Claudia; Parolini, Marina; Porrini, Marisa; Klimis-Zacas, Dorothy; Riso, Patrizia

    2017-11-15

    Several studies have documented the important role of polyphenol-rich foods in the modulation of vascular remodelling and function. This study aimed to evaluate the capacity of a single portion of blueberry (V. corymbosum) to acutely improve peripheral arterial dysfunction in a group of young volunteers. Twenty-four healthy males (12 non-smokers and 12 smokers) were recruited for two different randomized, controlled, crossover pilot acute studies. In the first study, non-smokers were exposed to a control treatment (C; 300 mL of water with sugar) and a blueberry treatment (BB; 300 g of blueberry). In the second study, smokers underwent 3 different protocols: (1) - smoking treatment (S); (2) - control treatment (CS; 300 mL of water with sugar + smoking); (3) - blueberry treatment (BS; 300 g of blueberry + smoking). Each treatment (1 day long) was separated by a one week washout period. Blood pressure, peripheral arterial function (reactive hyperemia index, RHI, a marker of endothelial function) and arterial stiffness (digital augmentation index, dAix and dAix normalized by considering a heart rate of 75 bpm, dAix@75) were measured before and after each treatment. In the first study, the consumption of blueberry and control treatment acutely increased peripheral arterial function in the group of non-smokers. The improvement in RHI was higher and significantly different after blueberry treatment compared to the control treatment (54.8 ± 8.4% BB vs. 28.2 ± 8.3% C; p = 0.01). No effects were observed for markers of arterial stiffness, blood pressure and heart rate. Acute cigarette smoke significantly increased blood pressure and heart rate, while no significant effect was registered in peripheral arterial function and stiffness. The intake of blueberry and control treatment before a cigarette did not counteract the increase in blood pressure and heart rate, while it significantly improved peripheral arterial function. In particular, a significant increase was observed

  14. Association of Serum Uric Acid Levels with Leg Ischemia in Patients with Peripheral Arterial Disease after Treatment.

    Science.gov (United States)

    Sotoda, Yoko; Hirooka, Shigeki; Orita, Hiroyuki; Wakabayashi, Ichiro

    2017-07-01

    We investigated the relationships of serum uric acid levels with the progression of atherosclerosis in patients with peripheral arterial disease (PAD) after treatment. Subjects were male patients diagnosed with PAD. Atherosclerosis at the common carotid artery was evaluated based on its intima-media thickness (IMT). Leg arterial flow was evaluated by measuring ankle-brachial index (ABI) and exercise-induced decrease in ABI. Among various risk factors including age, blood pressure, adiposity, estimated glomerular filtration rate, and blood lipid, blood glucose, uric acid, fibrinogen and C-reactive protein levels, only uric acid levels showed significant correlations with ABI [Pearson's correlation coefficient, -0.292 (p<0.01)] and leg exercise-induced decrease in ABI [Pearson's correlation coefficient, 0.236 (p< 0.05)]. However, there was no significant correlation between uric acid levels and maximum or mean IMT. Odds ratios of subjects with the 3rd tertile versus subjects with the 1st tertile for uric acid levels were significantly higher than the reference level of 1.00 for low ABI [4.44 (95% confidence interval, 1.45-13.65, p<0.01)] and for high % decrease in ABI after exercise [4.31 (95% confidence interval, 1.34-13.82, p<0.05)]. The associations of uric acid levels with the indicators of leg ischemia were also found after adjustment for age, history of revascularization therapy, diabetes, smoking, alcohol consumption, body mass index, triglyceride levels, and renal function. Uric acid levels are associated with the degree of leg ischemia in patients with PAD. Further interventional studies are needed to determine whether the correction of uric acid levels is effective in preventing the progression of PAD.

  15. Concentrations of C-reactive protein, serum amyloid A, and haptoglobin in uterine arterial and peripheral blood in bitches with pyometra.

    Science.gov (United States)

    Dąbrowski, Roman; Kostro, Krzysztof; Szczubiał, Marek

    2013-09-15

    Pyometra is a life-threatening reproductive disorder that affects the uterus of female dogs. This study was designed to identify the possible indicators of uterine inflammation by comparing C-reactive protein (CRP), serum amyloid A (SAA), and haptoglobin (Hp) concentrations in uterine arterial and peripheral venous blood in bitches with open- and closed-cervix pyometra. CRP, SAA, and Hp concentrations were higher in bitches with closed-cervix pyometra irrespective of the site of blood collection. Higher acute-phase protein concentrations were observed in peripheral compared with uterine arterial blood in bitches with closed-cervix pyometra, whereas the levels were comparable in dogs with open-cervix pyometra. Our results indicate that mean acute-phase protein concentrations differ according to pyometra type/severity and blood source and suggest the possible use of peripheral blood levels of CRP, SAA, and Hp to monitor inflammation during the course of pyometra. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. How Admission to a Vascular Surgery Department Improves Medical Treatment in Patients with Lower Extremity Peripheral Arterial Disease.

    Science.gov (United States)

    Thiney, Martina; Della Schiava, Nellie; Feugier, Patrick; Lermusiaux, Patrick; Ninet, Jacques; Millon, Antoine; Long, Anne

    2017-04-01

    All patients with lower extremity peripheral arterial disease (LE-PAD) should benefit from recommended pharmacologic therapies including antiplatelet agents, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin receptor blockers (ARBs), and hydroxy-methyl-glutaryl-coenzyme A reductase inhibitors (statins). In the present study, this triple therapy was defined as the best medical treatment. This study was designed to determine the number of patients who received best medical treatment at admission and at discharge from a vascular surgery department. We also examined the number of patients who received adapted medical treatment and every pharmacologic class separately. Finally, we investigated whether there were differences in prescribing rates according to patient characteristics and cardiovascular history, clinical grade of LE-PAD, and the type of surgery practiced. This study is a retrospective chart analysis of 140 consecutive patients admitted to the vascular surgery department of our university hospital, between January 1, 2013, and June 30, 2013. To be included, patients required a vascular surgery for peripheral arterial disease with atherosclerosis. Data from guideline-recommended classes of medications (antiplatelet agents, ACE, ARBs, and statins) at the time of admission and discharge were collected and compared. Best medical treatment was prescribed in 44% patients before hospital admission and in 50% at discharge (P = 0.10). Before hospital admission, 84% of patients had antiplatelet therapy compared with 96% at discharge (P = 0.0004); 73% had a statin, compared with 83% at discharge (P = 0.001); 64% had an ACE inhibitor or ARB, compared with 63% at the time of discharge (P = 1).The proportion of patients receiving best medical treatment at admission and discharge increased in case of coronary artery disease (P = 0.004). There was no difference in prescriptions of best medical treatment and best or adapted treatments at admission and

  17. Prevalência da doença arterial obstrutiva periférica em doentes com insuficiência renal crônica Prevalence of peripheral occlusive arterial disease in patients with chronic renal failure

    Directory of Open Access Journals (Sweden)

    José Aderval Aragão

    2009-12-01

    Full Text Available Contexto: A doença arterial obstrutiva periférica tem sido reconhecida como um sensível marcador de aterosclerose sistêmica e preditora de eventos cardiovasculares. Apesar da alta prevalência da doença cardiovascular, há poucos estudos sobre a doença arterial obstrutiva periférica em pacientes com insuficiência renal crônica em tratamento hemodialítico. Objetivo: Determinar a prevalência de doença arterial obstrutiva periférica em pacientes com insuficiência renal crônica em uma clínica de referência para tratamento hemodialítico no estado de Sergipe. Métodos: Trata-se de um estudo transversal, realizado no período de junho a novembro de 2008, em uma clínica de referência para tratamento de pacientes com insuficiência renal crônica. Foram caracterizados como portadores de doença arterial obstrutiva periférica os pacientes que apresentavam índice tornozelo-braquial (ITB ≤ 0,9. Resultados: De uma população de 239 pacientes com insuficiência renal crônica, foram avaliados 201. Destes, 28 (14% apresentavam insuficiência arterial periférica com ITB ≤ 0,9. A idade variou de 24 a 82 anos, com média de 52 anos. A hipertensão e a dislipidemia foram os fatores de risco mais frequentes. Dos pacientes com doença arterial obstrutiva periférica, 89% eram dislipidêmicos, 71% hipertensos e 29% tinham coronariopatias. Conclusão: A prevalência de doença arterial obstrutiva periférica em doentes com insuficiência renal crônica foi de 14%.Background: Peripheral occlusive arterial disease has been found to be a sensitive marker of systemic atherosclerosis and a predictor of other cardiovascular diseases. In spite of the high prevalence of the cardiovascular diseases, there are few studies about peripheral occlusive arterial disease in patients with chronic renal failure under hemodialysis treatment. Objective: To determine the prevalence of peripheral occlusive arterial disease in patients with chronic renal failure

  18. Immune function of peripheral T cells in patients with venous thromboembolism or coronary artery atherosclerosis.

    Science.gov (United States)

    Zhou, Lin; Song, Haoming; Xu, Wenjun; Xu, Jiahong; Jiang, Jinfa; Gong, Zhu; Liu, Yang; Yan, Wenwen; Wang, Lemin

    2014-06-01

    Recent studies have shown that the major risk factors for arterial thrombotic diseases are closely associated with venous thromboembolism (VTE). This study aimed to investigate the expression of CD3, CD4 and CD8 in T lymphocytes, the CD4/CD8 ratio and high-sensitivity C-reactive protein (hs-CRP) levels in patients with VTE, coronary artery atherosclerosis (CAA) and healthy subjects. A total of 82 healthy subjects, 51 VTE patients and 114 CAA patients were recruited, and the expression of CD3, CD4 and CD8 in T lymphocytes and the CD4/CD8 ratio were determined. Serum hs-CRP was also measured. Compared to healthy subjects, VTE patients had significantly reduced CD3 expression (p=0.019), comparable CD4 expression (p=0.868), significantly reduced CD8 expression (p<0.001) and increased CD4/CD8 ratio (p=0.044). However, VTE patients had comparable expression of CD3, CD4 and CD8 and CD4/CD8 ratio to CAA patients. In addition, among patients with VTE or CAA, the proportion of patients with reduced CD3+ and CD8+ T lymphocytes or increased CD4/CD8 ratio was significantly higher than in healthy subjects. In addition, hs-CRP in both VTE and CAA groups was significantly higher than in healthy subjects. The antigen recognition and signal transduction activation of T cells is significantly reduced in patients with VTE or CAA, and the killing effect of T cells on pathogens, including viruses, is also significantly compromised. In addition, inflammatory and immune mechanisms are involved in the occurrence and development of venous and arterial thrombosis. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  19. [Measurement of Rho-kinase in peripheral blood monocytes in patients with pulmonary arterial hypertension related to chronic obstructive pulmonary diseases].

    Science.gov (United States)

    Cai, Qian; Wu, Shangjie; Zhao, Xuefeng

    2012-05-01

    To determine effects of the RhoA/Rho kinase signaling pathway on patients with pulmonary arterial hypertension related to chronic obstructive pulmonary diseases by testing levels of Rho-associated coiled-coil containing protein kinase 1(ROCK1) in peripheral blood monocytes in healthy subjects, patients with chronic obstructive pulmonary diseases (COPD), and patients with pulmonary arterial hypertension related to COPD. Ten healthy subjects (Group A), 10 patients with COPD (Group B), and 10 patients with pulmonary arterial hypertension related to COPD (Group C) were enrolled, all of whom were hospitalized in the Third Hospital of Changsha between Dec. 2010 and Apr. 2011. Twenty milliliters of blood was collected from each subject. The peripheral blood mononuclear cells (PBMC) were separated by Percoll and, monocytes were incubated. Levels of ROCK1 in the three groups were measured by ELISA. The pulmonary function was measured by spirometric tests, and the pulmonary arterial systolic pressure (PASP) was detected by color Doppler echocardiogram. 1)The PASP in Group C was significantly higher than that of Groups A and B(P0.05). Rho kinase plays a key role in the pathogenesis of pulmonary arterial hypertension. The ROCK1 may be a marker of the severity of pulmonary arterial hypertension related to COPD.

  20. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary

    Science.gov (United States)

    Gerhard-Herman, Marie D.; Gornik, Heather L.; Barrett, Coletta; Barshes, Neal R.; Corriere, Matthew A.; Drachman, Douglas E.; Fleisher, Lee A.; Fowkes, Francis Gerry R.; Hamburg, Naomi M.; Kinlay, Scott; Lookstein, Robert; Misra, Sanjay; Mureebe, Leila; Olin, Jeffrey W.; Patel, Rajan A.G.; Regensteiner, Judith G.; Schanzer, Andres; Shishehbor, Mehdi H.; Stewart, Kerry J.; Treat-Jacobson, Diane; Walsh, M. Eileen; Halperin, Jonathan L.

    2017-01-01

    ). Members are restricted with regard to writing or voting on sections to which their RWI apply. For transparency, members' comprehensive disclosure information is available online. Comprehensive disclosure information for the Task Force is also available online. The Task Force strives to avoid bias by selecting experts from a broad array of backgrounds representing different geographic regions, sexes, ethnicities, intellectual perspectives/biases, and scopes of clinical practice, and by inviting organizations and professional societies with related interests and expertise to participate as partners or collaborators. Individualizing Care in Patients With Associated Conditions and Comorbidities Managing patients with multiple conditions can be complex, especially when recommendations applicable to coexisting illnesses are discordant or interacting.8 The guidelines are intended to define practices meeting the needs of patients in most, but not all, circumstances. The recommendations should not replace clinical judgment. Clinical Implementation Management in accordance with guideline recommendations is effective only when followed. Adherence to recommendations can be enhanced by shared decision making between clinicians and patients, with patient engagement in selecting interventions on the basis of individual values, preferences, and associated conditions and comorbidities. Consequently, circumstances may arise in which deviations from these guidelines are appropriate. The reader is encouraged to consult the full-text guideline9 for additional guidance and details with regard to lower extremity peripheral artery disease (PAD) because the executive summary contains limited information. PMID:27840332

  1. Reproducibility of rest and exercise stress contrast-enhanced calf perfusion magnetic resonance imaging in peripheral arterial disease

    Directory of Open Access Journals (Sweden)

    Jiji Ronny S

    2013-01-01

    Full Text Available Abstract Background The purpose was to determine the reproducibility and utility of rest, exercise, and perfusion reserve (PR measures by contrast-enhanced (CE calf perfusion magnetic resonance imaging (MRI of the calf in normal subjects (NL and patients with peripheral arterial disease (PAD. Methods Eleven PAD patients with claudication (ankle-brachial index 0.67 ±0.14 and 16 age-matched NL underwent symptom-limited CE-MRI using a pedal ergometer. Tissue perfusion and arterial input were measured at rest and peak exercise after injection of 0.1 mM/kg of gadolinium-diethylnetriamine pentaacetic acid (Gd-DTPA. Tissue function (TF and arterial input function (AIF measurements were made from the slope of time-intensity curves in muscle and artery, respectively, and normalized to proton density signal to correct for coil inhomogeneity. Perfusion index (PI = TF/AIF. Perfusion reserve (PR = exercise TF/ rest TF. Intraclass correlation coefficient (ICC was calculated from 11 NL and 10 PAD with repeated MRI on a different day. Results Resting TF was low in NL and PAD (mean ± SD 0.25 ± 0.18 vs 0.35 ± 0.71, p = 0.59 but reproducible (ICC 0.76. Exercise TF was higher in NL than PAD (5.5 ± 3.2 vs. 3.4 ± 1.6, p = 0.04. Perfusion reserve was similar between groups and highly variable (28.6 ± 19.8 vs. 42.6 ± 41.0, p = 0.26. Exercise TF and PI were reproducible measures (ICC 0.63 and 0.60, respectively. Conclusion Although rest measures are reproducible, they are quite low, do not distinguish NL from PAD, and lead to variability in perfusion reserve measures. Exercise TF and PI are the most reproducible MRI perfusion measures in PAD for use in clinical trials.

  2. Effectiveness of a New Exercise Program after Lower Limb Arterial Blood Flow Surgery in Patients with Peripheral Arterial Disease: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Edita Jakubsevičienė

    2014-08-01

    Full Text Available Objective: The aim of this study was to evaluate the effectiveness of a supervised exercise program (SEP plus at home nonsupervised exercise therapy (non-SET on functional status, quality of life (QoL and hemodynamic response in post-lower-limb bypass surgery patients. Results: One hundred and seventeen patients were randomized to an intervention (n = 57 or a control group (n = 60. A new individual SEP was designed for patients with peripheral arterial disease (PAD and applied to the studied subjects of the intervention group who also continued non-SET at home, whereas those assigned to the control group received just usual SEP according to a common cardiovascular program. The participants of the study were assessed by a 6-min walking test (6 MWT, an ankle-brachial index (ABI, and the Medical Outcomes Study Short Form-36 (SF-36 of QoL at baseline, at 1 and 6 months after surgery. A significant improvement was observed in the walked distance in the intervention group after 6 months compared with the control group (p < 0.001. The intervention group had significantly higher QoL score in the physical and mental component of SF-36 (p < 0.05. Conclusions: A 6-month application of the new SEP and non-SET at home has yielded significantly better results in walking distance and QoL in the intervention group than in the controls.

  3. [Ankle-brachial index screening for peripheral artery disease in high cardiovascular risk patients. Prospective observational study of 370 asymptomatic patients at high cardiovascular risk].

    Science.gov (United States)

    Rada, C; Oummou, S; Merzouk, F; Amarir, B; Boussabnia, G; Bougrini, H; Benzaroual, D; Elkarimi, S; Elhattaoui, M

    2016-12-01

    Peripheral arterial disease is a marker of systemic atherosclerosis; it is associated with a high risk of cardiovascular disease. The aim of our study was to assess the prevalence of peripheral arterial disease by measuring the ankle-brachial pressure index in patients at high cardiovascular risk and to study the risk factors associated with this disease. This was a descriptive and analytic cross-sectional study which focused on 370 patients seen at the medical consultation for atherosclerosis prevention. The ankle-brachial index was measured with a portable Doppler (BIDOP 3) using 4 and 8Hz dual frequency probes. The standards were: normal ankle-brachial index 0.9 to 1.3; peripheral artery obstructive disease ankle-brachial index less than 0.9; poorly compressible artery (medial arterial calcification) ankle-brachial index greater than 1.3. Cardiovascular risk factors were also studied. Three hundred and seventy subjects (mean age 65.5±8.7years) were screened Cardiovascular risk factors were: sedentary lifestyle (91.5 %), hypertension (68.1 %), elevated LDL-cholesterolemia (36.3 %), diabetes (48.3 %) and tobacco smoking (33.8 %). The prevalence of peripheral artery disease was 32.4 % of which 77.5 % were asymptomatic. We found a significant correlation with smoking, diabetes, dyslipidemia and the presence of coronary artery disease or vascular cerebral disease. Screening for peripheral arterial disease (PAD) with the ankle-brachial index has increased the percentage of polyvascular patients from 6.2 to 29 %. Factors independently associated with PAD were advanced age, presence of cardiovascular disease, smoking and glycated hemoglobin. PAD is a common condition in people at high cardiovascular risk, the frequency of asymptomatic forms justifies the screening with pocket Doppler which is a simple, inexpensive and effective test to assess the overall cardiovascular risk. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  4. [Recanalization of the peripheral arteries by laser thermal balloon angioplasty. 2 years of clinical experience].

    Science.gov (United States)

    Riambau Alonso, V; Masotti Centol, M; Latorre Vilallonga, J; Viver Manresa, E; Crexells Figueres, C; Oriol Palou, A

    1991-01-01

    Laser angioplasty represents an attractive alternative to overcome the limitations of balloon angioplasty. We describe our results with laser thermal balloon angioplasty (LTBA) in the treatment of atherosclerosis obliterans in the lower limbs after two years clinical follow up. We also analyse the influence of lesion characteristics on immediate results. Thirty seven patients (34 men), whose mean age was 58 +/- 9 years, were included in this study. Occlusive arterial disease (Fontaine stage II-IV), with 39 significant haemodynamic arterial lesions were present in all of them. Ankle/brachial Doppler index was O,51 +/- 0,17. Eighteen lesions were located in the iliac area (13 stenoses 2,3 +/- 1 cm of length and 5 occlusions 4,2 +/- 3 cm) and 21 lesions in femoro-popliteal area (5 stenoses 2,6 +/- 2 cm and 16 occlusions 5,7 +/- 3 cm). A percutaneous procedure was used in 38 cases and only in one case a femoral dissection was necessary. The laser source was argon in 26 cases and Nd-YAG in 13. The overall immediate angiographic and clinical success was 85% (89% in iliac lesions and 81% in femoropopliteal lesions; 100% in stenoses and 70% in occlusions). The presence of occlusion (p less than 0,01) and/or calcium (p less than O,05) influenced negatively the immediate results. No major complications were observed. Seven (17%) minor complications occurred, but no emergency surgery was necessary. The ankle/brachial Doppler index after treatment was 0,82 +/- 0,21. Cumulative clinical patency was 91% for successfully treated patients after two years follow up. We conclude that LTBA represents an effective and less aggressive way to treat atherosclerosis obliterans.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Day-case peripheral angioplasty using nurse-led admission, discharge, and follow-up procedures: arterial closure devices are not necessary

    Energy Technology Data Exchange (ETDEWEB)

    Kasthuri, R.; Karunaratne, D.; Andrew, H.; Sumner, J. [Department of Radiology, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL (United Kingdom); Chalmers, N. [Department of Radiology, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL (United Kingdom)], E-mail: nicholas.chalmers@cmmc.nhs.uk

    2007-12-15

    Aim: To audit the safety of day-case peripheral arterial intervention without the use of arterial-closure devices using nurse-led admission, discharge, and follow-up procedures. Materials and methods: Patients referred for elective, peripheral vascular intervention were selected for day-case care according to pre-determined criteria using telephone triage. Post-procedure haemostasis was achieved using manual compression. After 3 h bed-rest, patients were mobilized and discharged at 5 h. Patients were contacted by telephone next working day to audit complications. Results: One hundred and eighty-three elective day-case peripheral interventions were performed over 2 years, predominantly using 6 F sheaths. No closure devices were used. Five patients (2%) returned to the department because of persistent groin symptoms the next day. One of these had a false aneurysm. Four required no further treatment. A single patient returned at day 6 with a delayed false aneurysm. Conclusion: Day-case peripheral vascular intervention can be safely performed in appropriately selected patients without the use of arterial closure devices. Specialist radiology nurses have a major role in the counselling, care, and follow-up of these patients.

  6. Diverging effects of diabetes mellitus in patients with peripheral artery disease and abdominal aortic aneurysm and the role of advanced glycation end-products: ARTERY study - protocol for a multicentre cross-sectional study.

    Science.gov (United States)

    de Vos, L C; Boersema, J; Hillebrands, J L; Schalkwijk, C G; Meerwaldt, R; Breek, J C; Smit, A J; Zeebregts, C J; Lefrandt, J D

    2017-04-11

    Diabetes mellitus is a well-defined risk factor for peripheral artery disease (PAD), but protects against the development and growth of abdominal aortic aneurysm (AAA). Diabetes mellitus is associated with arterial stiffening and peripheral arterial media sclerosis. Advanced glycation end-products (AGEs) are increased in diabetes mellitus and cardiovascular disease. AGEs are known to form cross-links between proteins and are associated with arterial stiffness. Whether AGEs contribute to the protective effects of diabetes mellitus in AAA is unknown. Therefore, the ARTERY ( A dvanced glycation end-p R oducts in patients with peripheral ar T ery dis E ase and abdominal ao R tic aneur Y sm) study is designed to evaluate the role of AGEs in the diverging effects of diabetes mellitus on AAA and PAD. This cross-sectional multicentre study will compare the amount, type and location of AGEs in the arterial wall in a total of 120 patients with AAA or PAD with and without diabetes mellitus (n=30 per subgroup). Also, local and systemic vascular parameters, including pulse wave velocity, will be measured to evaluate the association between arterial stiffness and AGEs. Finally, AGEs will be measured in serum, urine, and assessed in skin with skin autofluorescence using the AGE Reader. This study is approved by the Medical Ethics committees of University Medical Center Groningen, Martini Hospital and Medisch Spectrum Twente, the Netherlands. Study results will be disseminated through peer-reviewed journals and scientific events. trialregister.nl NTR 5363. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  7. Racial disparities in outcomes of endovascular procedures for peripheral arterial disease: an evaluation of California hospitals, 2005-2009.

    Science.gov (United States)

    Loja, Melissa N; Brunson, Ann; Li, Chin-Shang; Carson, John G; White, Richard H; Romano, Patrick S; Hedayati, Nasim

    2015-07-01

    Racial/ethnic disparities in treatment outcomes of peripheral arterial disease (PAD) are well documented. Compared with non-Hispanic (NH) whites, blacks and Hispanics are more likely to undergo amputation and less likely to undergo bypass surgery for limb salvage. Endovascular procedures are being increasingly performed as first line of therapy for PAD. In this study, we examined the outcomes of endovascular PAD treatments based on race/ethnicity in a contemporary large population-based study. We used Patient Discharge Data from California's Office of Statewide Health Planning and Development to identify all patients over the age of 35 who underwent a lower extremity arterial intervention from 2005 to 2009. A look-back period of 5 years was used to exclude all patients with prior lower extremity arterial revascularization procedures or major amputation. Cox proportional hazards regression was used to compare amputation-free survival and time to death within 365 days. Logistic regression was used for comparison of 1-month myocardial infarction, 1-month major amputation, 1-month all-cause mortality, 12-month major amputation, 12-month reintervention, and 12-month all-cause mortality rates among NH white, black, and Hispanic patients. These analyses were adjusted for age, gender, insurance status, severity of PAD, comorbidities, history of coronary artery angioplasty or bypass surgery, or history of carotid endarterectomy. Between 2005 and 2009, a total of 41,507 individuals underwent PAD interventions, 25,635 (61.7%) of whom underwent endovascular procedures. There were 17,433 (68%) NH whites, 4,417 (17.2%) Hispanics, 1,979 (7.7%) blacks, 1,163 (4.5%) Asian/Native Hawaiians, and 643 (2.5%) others in this group. There was a statistically significant difference in the amputation-free survival within 365 days among the NH white, Hispanic, and black groups (P amputation within 365 days was 1.69 in Hispanics (95% confidence interval [CI] 1.51-1.90, P procedures after

  8. Interaction of central and peripheral factors during repeated sprints at different levels of arterial O2 saturation.

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    François Billaut

    Full Text Available PURPOSE: To investigate the interaction between the development of peripheral locomotor muscle fatigue, muscle recruitment and performance during repeated-sprint exercise (RSE. METHOD: In a single-blind, randomised and cross-over design, ten male team-sport athletes performed two RSE (fifteen 5-s cycling sprints interspersed with 25 s of rest; power self-selected in normoxia and in acute moderate hypoxia (FIO2 0.138. Mechanical work, total electromyographic intensity (summed quadriceps electromyograms, RMSsum and muscle (vastus lateralis and pre-fontal cortex near-infrared spectroscopy (NIRS parameters were calculated for every sprint. Blood lactate concentration ([Lac(-] was measured throughout the protocol. Peripheral quadriceps fatigue was assessed via changes in potentiated quadriceps twitch force (ΔQtw,pot pre- versus post-exercise in response to supra-maximal magnetic femoral nerve stimulation. The central activation ratio (QCAR was used to quantify completeness of quadriceps activation. RESULTS: Compared with normoxia, hypoxia reduced arterial oxygen saturation (-13.7%, P=0.001, quadriceps RMSsum (-13.7%, P=0.022, QCAR (-3.3%, P=0.041 and total mechanical work (-8.3%, P=0.019. However, the magnitude of quadriceps fatigue induced by RSE was similar in the two conditions (ΔQtw,pot: -53.5% and -55.1%, P=0.71. The lower cycling performance in hypoxia occurred despite similar metabolic (muscle NIRS parameters and blood [Lac(-] and functional (twitch and M-wave muscle states. CONCLUSION: Results suggest that the central nervous system regulates quadriceps muscle recruitment and, thereby, performance to limit the development of muscle fatigue during intermittent, short sprints. This finding highlights the complex interaction between muscular perturbations and neural adjustments during sprint exercise, and further supports the presence of pacing during intermittent sprint exercise.

  9. CT Angiography of Peripheral Arterial Disease by 256-Slice Scanner: Accuracy, Advantages and Disadvantages Compared to Digital Subtraction Angiography.

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    Mishra, Atul; Jain, Narendra; Bhagwat, Anand

    2017-07-01

    Peripheral arterial occlusive disease (PAOD) may cause disabling claudication or critical limb ischemia. Multidetector computed tomography (CT) technology has evolved to the level of 256-slice CT scanners which has significantly improved the spatial and temporal resolution of the images. This has provided the capability of chasing the contrast bolus at a fast speed enabling angiographic imaging of long segments of the body. These images can be reconstructed in various planes and various modes for detailed analysis of the peripheral vascular diseases which helps in making treatment decision. The aim of this retrospective study was to compare the CT angiograms (CTAs) of all cases of PAOD done by 256-slice CT scanner at a tertiary care vascular center and comparing these images with the digital subtraction angiograms (DSAs) of these patients. The retrospective study included 53 patients who underwent both CTA and DSA at our center over a period of 3 years from March 2013 to March 2016. The CTA showed high sensitivity (93%) and specificity (92.7%) for overall assessment of degree of stenosis in a vascular segment in cases of aortic and lower limb occlusive disease. The assessment of lesions of infrapopliteal segment was comparatively inferior (sensitivity 91.6%, accuracy 73.3%, and positive predictive value 78.5%), more so in the presence of significant calcification. The advantages of CTA were its noninvasive nature, ability to image large area of body, almost no adverse effects to the patients, and better assessment of vessel wall disease. However, the CTA assessment of collaterals was inferior with a sensitivity of only 62.7% as compared to DSA. Overall, 256-slice CTA provides fast and accurate imaging of vascular tree which can restrict DSA only in few selected cases as a problem-solving tool where clinico-radiological mismatch is present.

  10. A Meta-Analysis of Randomized Controlled Trials on Antiplatelet Agents Versus Placebo/Control for Treating Peripheral Artery Disease

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    Qian, Jun; Yang, Xiao Hong

    2015-01-01

    Abstract Effect of aspirin (antiplatelet agents) in patients with peripheral artery disease (PAD) was still controversial. Varying studies reported varying results. Therefore, we did this meta-analysis to investigate if aspirin could reduce cardiovascular events in patients with PAD. A comprehensive literature search (PubMed, CCTR, Embase, Web of Science, CNKI, CBM-disc, and relevant websites) was conducted from 1990 to September 2014. The key search terms (“aspirin,” “PAD,” “peripheral arterial occlusive diseases,” and “claudication”) produced 9 high-quality randomized controlled trials (RCTs) of aspirin versus placebo/control. Mantel–Haenszel random-effects model was used to analysis of the 9 RCTs. The primary outcome was the cardiovascular events. Nine RCTs, composed of 9526 patients (4786 aspirin-treated and 4740 placebo or control-treated patients), were meta-analyzed. The results indicated that compared to placebo/control, aspirin could not significantly reduce the cardiovascular events (OR = 0.81, 95% CI = 0.56–1.15). Moreover, aspirin could not produce better effect on prevention of nonfatal myocardial infarction (OR = 0.98, 95% CI = 0.52–1.84), nonfatal stroke (OR = 0.89, 95% CI = 0.69–1.14), cardiovascular death (OR = 0.97, 95% CI = 0.68–1.38), any death (OR = 1.05, 95% CI = 0.85–1.30), and major bleeding (OR = 1.16, 95% CI = 0.82–1.65) than placebo/control. But aspirin, as monotherapy therapy, did significantly reduce the risk of nonfatal stroke (OR = 0.42, 95% CI = 0.21–0.84). Aspirin, as monotherapy or combination therapy, did not result in a significant decrease in the cardiovascular events. But aspirin, as monotherapy therapy, did significantly reduce the risk of nonfatal stroke. Our conclusion might help clinicians in clinical treating PAD. Future studies are needed to draw firm conclusions about the clinical benefit and risks of aspirin and other antiplatelet

  11. Dynamic contrast-enhanced MRI assessment of hyperemic fractional microvascular blood plasma volume in peripheral arterial disease: initial findings.

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    Bas Versluis

    Full Text Available OBJECTIVES: The aim of the current study was to describe a method that assesses the hyperemic microvascular blood plasma volume of the calf musculature. The reversibly albumin binding contrast agent gadofosveset was used in dynamic contrast-enhanced magnetic resonance imaging (DCE MRI to assess the microvascular status in patients with peripheral arterial disease (PAD and healthy controls. In addition, the reproducibility of this method in healthy controls was determined. MATERIALS AND METHODS: Ten PAD patients with intermittent claudication and 10 healthy control subjects were included. Patients underwent contrast-enhanced MR angiography of the peripheral arteries, followed by one DCE MRI examination of the musculature of the calf. Healthy control subjects were examined twice on different days to determine normative values and the interreader and interscan reproducibility of the technique. The MRI protocol comprised dynamic imaging of contrast agent wash-in under reactive hyperemia conditions of the calf musculature. Using pharmacokinetic modeling the hyperemic fractional microvascular blood plasma volume (V(p, unit: % of the anterior tibial, gastrocnemius and soleus muscles was calculated. RESULTS: V(p was significantly lower for all muscle groups in PAD patients (4.3±1.6%, 5.0±3.3% and 6.1±3.6% for anterior tibial, gastrocnemius and soleus muscles, respectively compared to healthy control subjects (9.1±2.0%, 8.9±1.9% and 9.3±2.1%. Differences in V(p between muscle groups were not significant. The coefficient of variation of V(p varied from 10-14% and 11-16% at interscan and interreader level, respectively. CONCLUSIONS: Using DCE MRI after contrast-enhanced MR angiography with gadofosveset enables reproducible assessment of hyperemic fractional microvascular blood plasma volume of the calf musculature. V(p was lower in PAD patients than in healthy controls, which reflects a promising functional (hemodynamic biomarker for the

  12. Multicenter, double-blind, randomized, intraindividual crossover comparison of gadobenate dimeglumine and gadopentetate dimeglumine for MR angiography of peripheral arteries.

    Science.gov (United States)

    Gerretsen, Suzanne C; le Maire, Thierry F; Miller, Stephan; Thurnher, Siegfried A; Herborn, Christoph U; Michaely, Henrik J; Kramer, Harald; Vanzulli, Angelo; Vymazal, Josef; Wasser, Martin N; Ballarati, Claudio E M; Kirchin, Miles A; Pirovano, Gianpaolo; Leiner, Tim

    2010-06-01

    To prospectively compare the image quality and diagnostic performance achieved with doses of gadobenate dimeglumine and gadopentetate dimeglumine of 0.1 mmol per kilogram of body weight in patients undergoing contrast material-enhanced magnetic resonance (MR) angiography of the pelvis, thigh, and lower-leg (excluding foot) for suspected or known peripheral arterial occlusive disease. Institutional review board approval was granted from each center and informed written consent was obtained from all patients. Between November 2006 and January 2008, 96 patients (62 men, 34 women; mean age, 63.7 years +/- 10.4 [standard deviation]; range, 39-86 years) underwent two identical examinations at 1.5 T by using three-dimensional spoiled gradient-echo sequences and randomized 0.1-mmol/kg doses of each agent. Images were evaluated on-site for technical adequacy and quality of vessel visualization and offsite by three independent blinded readers for anatomic delineation and detection/exclusion of pathologic features. Comparative diagnostic performance was determined in 31 patients who underwent digital subtraction angiography. Data were analyzed by using the Wilcoxon signed-rank, McNemar, and Wald tests. Interreader agreement was determined by using generalized kappa statistics. Differences in quantitative contrast enhancement were assessed and a safety evaluation was performed. Ninety-two patients received both agents. Significantly better performance (P dimeglumine was noted on-site for technical adequacy and vessel visualization quality and offsite for anatomic delineation and detection/exclusion of pathologic features. Contrast enhancement (P dimeglumine. Interreader agreement for stenosis detection and grading was good to excellent (kappa = 0.749 and 0.805, respectively). Mild adverse events were reported for four (six events) and five (eight events) patients after gadobenate dimeglumine and gadopentetate dimeglumine, respectively. Higher-quality vessel visualization

  13. Beta-blockers and health-related quality of life in patients with peripheral arterial disease and COPD

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    Yvette RBM van Gestel

    2009-05-01

    Full Text Available Yvette RBM van Gestel1, Sanne E Hoeks1, Don D Sin2, Henk Stam3, Frans W Mertens3, Jeroen J Bax4, Ron T van Domburg5, Don Poldermans61Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands; 2Department of Medicine, University of British Columbia and The James Hogg iCAPTURe Center, St. Paul’s Hospital, Vancouver, Canada; 3Department of Pulmonology, Erasmus Medical Center, Rotterdam, The Netherlands; 4Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; 5Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands; 6Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The NetherlandsBackground: Beta-blockers are frequently withheld in patients with cardiovascular disease who also have chronic obstructive pulmonary disease (COPD because of concerns that they might provoke bronchospasm and cause deterioration in health status. Although beta1-selective beta-blockers are associated with reduced mortality in COPD patients, their effects on health status are unknown. The aim of this study was to investigate the relationship between beta-blockers and health-related quality of life (HRQOL in patients with peripheral arterial disease and COPD.Methods: Of the original cohort of 3371 vascular surgery patients, 1310 had COPD of whom 469 survived during long-term follow-up. These COPD patients were sent the Short Form-36 (SF-36 health-related quality of life questionnaire, which was completed and returned by 326 (70% patients.Results: No significant differences in any of the SF-36 domains were observed between COPD patients who did and did not use beta-blockers (p > 0.05 for all. Furthermore, beta-blockers were not associated with any impairment in HRQOL among patients with COPD.Conclusion: Beta-blockers had no material impact on the HRQOL of patients with peripheral arterial disease who also had COPD. This suggests that beta-blockers can, in most circumstances, be