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Arterial Disease (arterial + disease)
Kinds of Arterial Disease Selected AbstractsAssociations Between Lower Extremity Ischemia, Upper and Lower Extremity Strength, and Functional Impairment with Peripheral Arterial DiseaseJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2008Mary M. McDermott MD OBJECTIVES: 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. DESIGN: Cross-sectional. SETTING: Academic medical centers. PARTICIPANTS: Four hundred twenty-four persons with PAD and 271 without PAD. MEASUREMENTS: 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. RESULTS: Lower ABI values were associated with lower plantarflexion strength (P trend=.04) and lower knee extension power (P trend <.001). There were no significant associations between ABI and handgrip or knee extension isometric strength. Significant associations between ABI and measures of lower extremity performance were attenuated after additional adjustment for measures of strength. CONCLUSION: 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. [source] Homocysteine Level and Cognitive Function in Patients with Arterial Disease: The Second Manifestations of ARTerial Disease StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2006Fleur van A. Raamt MD OBJECTIVES: To assess the relationship between total plasma homocysteine (tHcy) level and cognitive function in patients with manifest arterial disease. DESIGN: Cross-sectional. SETTING: Patients with symptomatic cerebrovascular disease, cardiovascular disease, peripheral arterial disease, or abdominal aortic aneurysm included in the Second Manifestations of ARTerial disease study, a single-center, longitudinal study with an extensive screening program at baseline. PARTICIPANTS: Three hundred forty-five consecutively included patients, mean age 59. MEASUREMENTS: The patients underwent an extensive neuropsychological test. The cognitive domains assessed were memory, executive function, attention, and visuoperception and construction. Each raw score was transformed into standardized z-scores, and a sum score for global cognitive function was determined. Risk factors and vascular damage were measured in detail. RESULTS: Linear regression showed that elevated levels of tHcy were related to lower global cognitive function (,=,0.065, 95% confidence interval (CI)=,0.116 to ,0.013) and, more specifically, lower performance on memory (,=,0.078, 95% CI=,0.155 to ,0.002), attention (,=,0.079, 95% CI=,0.163 to ,0.005), and visuoperception and construction (,=,0.125, 95% CI=,0.236 to ,0.014) per standard deviation increase in tHcy (SD=6.4 mol/L), after adjustment for age, sex, educational level, extent of atherosclerosis, and location of vascular disease. Silent cerebral infarcts did not influence this relationship. CONCLUSION: A relationship was found between tHcy levels and cognitive function that was independent of extent and location of arterial disease. The results suggest that vascular mechanisms are not responsible for the relationship between tHcy and cognitive function. [source] Concomitant Coronary and Peripheral Arterial Disease: Single-Stage RevascularizationJOURNAL OF CARDIAC SURGERY, Issue 3 2008Onur S. Goksel M.D. Coexistence of two entities is usually managed with a staged approach; however, decision to treat which entity first may be difficult clinically. We present a 49-year-old man with acute infrarenal aortic occlusion and cardiac ischemia who was treated with single-stage ascending aorta-bifemoral bypass following saphenous vein grafting to left anterior descending artery. Concomitant coronary and peripheral vascular revascularization is a practical method with a high flow inflow source as ascending aorta. We believe that a single-stage approach may be performed in the unstable patient as presented in this report. [source] Diagnostic Coronary Angiography in Patients with Peripheral Arterial Disease: A Sub-study of the Coronary Artery Revascularization Prophylaxis TrialJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2008SANTIAGO GARCIA M.D. Background: Although patients in need of elective vascular surgery are often considered candidates for diagnostic coronary angiography, the safety of this invasive study has not been systematically studied in a large cohort of patients scheduled for an elective vascular operation. The goal of this sub-study of the Coronary Artery Revascularization Prophylaxis (CARP) trial was to assess the safety of coronary angiography in patients with peripheral vascular disease. Methods: The CARP trial tested the long-term benefit of coronary artery revascularization prior to elective vascular operations. Among those patients who underwent diagnostic coronary angiography during screening for the trial, the associated complications were determined at 24 hours following the diagnostic procedure. Results: Over 5,000 patients were screened during a 4-year recruitment period at 18 major VA medical centers and the present cohort consists of 1,298 patients who underwent preoperative coronary angiography. Surgical indications for vascular surgery included an expanding aortic aneurysm (AAA) (n = 446; 34.4%) or arterial occlusive disease with either claudication (n = 457; 35.2%) or rest pain (n = 395; 30.4%). A total of 39 patients had a confirmed complication with a major complication identified in 17 patients (1.3%). Complication rates were higher in patients with arterial occlusive symptoms compared with expanding aneurysms (1.8% vs. 0.5%; P = 0.07) and were not dissimilar with femoral (2.8%) versus nonfemoral (4.7%) access sites (P = 0.42). Conclusions: Coronary angiography is safe in patients with peripheral arterial disease undergoing preoperative coronary angiography. The complication rate is higher in patients with symptoms of arterial occlusive disease. [source] Arterial structural and functional alterations in uraemiaEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 2005A. P. Guérin Abstract Epidemiological and clinical studies have shown that cardiovascular disease in patients with end-stage renal disease (ESRD) is frequently related to damage of large conduit arteries. Arterial disease is responsible for the high incidence of ischaemic heart disease, peripheral artery diseases, left ventricular hypertrophy and congestive heart failure. The vascular complications in ESRD are ascribed to two different but associated mechanisms, namely atherosclerosis and arteriosclerosis. Whereas the former principally affects the conduit function with ischaemic lesions being the most characteristic consequence, the latter primarily disturbs the dampening function of large arteries. Arteriosclerosis in ESRD patients is characterized by diffuse dilation and wall hypertrophy of large conduit arteries and stiffening of arterial walls. These changes represent a clinical form of an accelerated ageing process. The main clinical characteristics due to arterial stiffening are isolated increase in systolic blood pressure with normal or lower diastolic pressure resulting in an increased pulse pressure. The consequences of these alterations are: (i) an increased left ventricular afterload with development of left ventricular hypertrophy and increased myocardial oxygen demand; and (ii) altered coronary perfusion and subendocardial blood flow distribution. Epidemiological studies have identified arterial remodelling and stiffening as independent predictors of overall and cardiac mortality in ESRD patients. [source] CMR2009: 11.06: Reporter gene imaging of novel multimodality-visible encapsulated stem cells for enhanced cell viability in peripheral arterial diseaseCONTRAST MEDIA & MOLECULAR IMAGING, Issue 6 2009D. L. Kraitchman No abstract is available for this article. [source] Flow cytometric measurement of circulating endothelial cells: The effect of age and peripheral arterial disease on baseline levels of mature and progenitor populationsCYTOMETRY, Issue 2 2006Rebecca Gusic Shaffer Abstract Background: Age and cardiovascular disease status appear to alter numbers and function of circulating endothelial progenitor cells (EPCs). Despite no universal phenotypic definition, numerous studies have implicated progenitors with apparent endothelial potential in local responses to vascular injury and with cardiovascular disease in general. To further define the role of this lineage in peripheral artery disease (PAD), we developed a multiparameter flow cytometry assay to analyze multiple phenotypic definitions of progenitor cells (PCs), EPCs, and mature endothelial cells (ECs) and evaluate effects of age and PAD on baseline levels of each subset. Methods: Blood was collected from young healthy subjects (N = 9, mean age 33 ± 8 years), older healthy subjects (N = 13, mean age 66 ± 8 years), and older subjects with PAD (N = 15, mean age 69 ± 8 years). After ammonium chloride lysis, cells were stained and analyzed on a Becton-Dickinson LSR II with a 5-color antibody panel: FITC-anti-CD31, PE-anti-CD146, PE-anti-CD133, PerCP-Cy5.5-anti-CD3,-CD19,-CD33 (lineage panel), PE-Cy7-anti-CD34, and APC-anti-VEGF-R2. Viability was assessed by propidium iodide exclusion, and only viable, low to medium side scatter lineage-negative singlets were analyzed. In some studies, cells were sorted for morphological studies. Subsets were defined as indicated later. Results: Our results, using a comprehensive flow cytometric panel, indicate that CD133+, CD34+, and CD133+/CD34+ PCs are elevated in younger healthy individuals compared to older individuals, both healthy and with PAD. However, the number of EPCs and mature ECs did not significantly differ among the three groups. Assessment of endothelial colony forming units and dual acLDL-lectin staining supported the flow cytometric findings. Conclusions: We describe a comprehensive flow cytometric method to detect circulating mature and progenitor endothelial populations confirmed by conventional morphological and functional assays. Our findings suggest that aging may influence circulating levels of PCs, but not EPCs or ECs; PAD had no effect on baseline levels of any populations investigated. This study provides the basis for evaluating the potential effects of acute stress and therapeutic intervention on circulating progenitor and endothelial populations as a biomarker for cardiovascular status. © 2005 International Society for Analytical Cytology [source] Metabolic, endocrine and haemodynamic risk factors in the patient with peripheral arterial diseaseDIABETES OBESITY & METABOLISM, Issue 2002Jill J. F. Belch The morbidity and mortality associated with peripheral arterial disease (PAD) creates a huge burden in terms of costs both to the patient and to the health service. PAD is a deleterious and progressive condition that causes a marked increase in the risk of cardiovascular and cerebrovascular events. Further, PAD has a major negative impact on quality of life and mortality, and is associated with an increased risk of limb amputation. The clinical profile of patients at risk of PAD overlaps considerably with the known cardiovascular risk factors. These include, increasing age, smoking habit, diabetes, hypertension, dyslipidaemia, male sex and hyperhomocysteinaemia. For women, hormone replacement therapy appears to be associated with a reduced risk of PAD. Published PAD guidelines recommend aggressive management of risk factors, stressing the importance of lifestyle modification, antiplatelet agents, treating dyslipidaemia and diabetes. However, a large number of patients with PAD go undetected, either because they do not report their symptoms or because they are asymptomatic. It is therefore important to improve detection rates so that these patients can receive appropriate risk factor management. [source] Therapeutic targets in the management of Type 1 diabetesDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue S1 2002P. D. Home Abstract For historical reasons, diabetes has long been linked with blood and urine glucose control, partly because these were clearly linked to acute symptoms, and partly because glucose became measurable around 200 years ago. Today it is recognized that there is far more to diabetes than simply monitoring symptoms and blood glucose. Intensive management has an impact on the quality of life. Late complications have their own risk factors and markers. Monitoring and early detection of these risk factors and markers can lead to changes in treatment before tissue damage is too severe. Accordingly, professionals now find themselves monitoring a range of adverse outcomes, markers for adverse outcomes, risk factors and risk markers for microvascular and arterial disease, acute complications of therapy, and the care structures needed to deliver this. Adverse outcomes lend themselves to targets for complication control in populations, and markers of adverse outcomes (such as retinopathy and raised albumin excretion rate) in treatment cohorts. Surveillance systems will have targets for yearly recall and review of early complications. Metabolic (surrogate) outcomes can be monitored in individual patients, but monitoring is only of value in so far as it guides interventions, and this requires comparison to some intervention level or absolute target. Even for blood glucose control this is not easy, for conventional measures such as glycated haemoglobin have their own problems, and more modern approaches such as post-prandial glucose levels are controversial and less convenient to measure. In many people with type 1 diabetes targets for blood pressure, LDL cholesterol, and serum triglycerides will also be appropriate, and need to be part of any protocol of management. Copyright © 2002 John Wiley & Sons, Ltd. [source] Peripheral arterial disease in diabetes,a reviewDIABETIC MEDICINE, Issue 1 2010E. B. Jude Diabet. Med. 27, 4,14 (2010) Abstract Diabetic patients are at high risk for peripheral arterial disease (PAD) characterized by symptoms of intermittent claudication or critical limb ischaemia. Given the inconsistencies of clinical findings in the diagnosis of PAD in the diabetic patient, measurement of ankle-brachial pressure index (ABI) has emerged as the relatively simple, non-invasive and inexpensive diagnostic tool of choice. An ABI < 0.9 is not only diagnostic of PAD even in the asymptomatic patient, but is also an independent marker of increased morbidity and mortality from cardiovascular diseases. With better understanding of the process of atherosclerosis, avenues for treatment have increased. Modification of lifestyle and effective management of the established risk factors such as smoking, dyslipidaemia, hyperglycaemia and hypertension retard the progression of the disease and reduce cardiovascular events in these patients. Newer risk factors such as insulin resistance, hyperfibrinogenaemia, hyperhomocysteinaemia and low-grade inflammation have been identified, but the advantages of modifying them in patients with PAD are yet to be proven. Therapeutic angiogenesis, on the other hand, represents a promising therapeutic adjunct in the management of PAD in these patients. Outcomes after revascularization procedures, such as percutaneous transluminal angioplasty and surgical bypasses in diabetic patients, are poorer, with increased perioperative morbidity and mortality compared with that in non-diabetic patients. Amputation rates are higher due to the distal nature of the disease. Efforts towards increasing awareness and intensive treatment of the risk factors will help to reduce morbidity and mortality in diabetic patients with PAD. [source] Incidence and characteristics of lower limb amputations in people with diabetesDIABETIC MEDICINE, Issue 4 2009S. Fosse Abstract Aims To estimate the incidence, characteristics and potential causes of lower limb amputations in France. Methods Admissions with lower limb amputations were extracted from the 2003 French national hospital discharge database, which includes major diagnoses and procedures performed during hospital admissions. For each patient, diabetes was defined by its record in at least one admission with or without lower limb amputation in the 2002,2003 databases. Results In 2003, 17 551 admissions with lower limb amputation were recorded, involving 15 353 persons, which included 7955 people with diabetes. The crude incidence of lower limb amputation in people with diabetes was 378/100 000 (349/100 000 when excluding traumatic lower limb amputation). The sex and age standardized incidence was 12 times higher in people with than without diabetes (158 vs. 13/100 000). Renal complications and peripheral arterial disease and/or neuropathy were reported in, respectively, 30% and 95% of people with diabetes with lower limb amputation. Traumatic causes (excluding foot contusion) and bone diseases (excluding foot osteomyelitis) were reported in, respectively, 3% and 6% of people with diabetes and lower limb amputation, and were 5 and 13 times more frequent than in people without diabetes. Conclusions We provide a first national estimate of lower limb amputation in France. We highlight its major impact on people with diabetes and its close relationship with peripheral arterial disease/neuropathy and renal complications in the national hospital discharge database. We do not suggest the exclusion of traumatic causes when studying the epidemiology of lower limb amputation related to diabetes, as diabetes may contribute to amputation even when the first cause appears to be traumatic. [source] The influence of exercise on foot perfusion in diabetesDIABETIC MEDICINE, Issue 10 2007D. T. Williams Abstract Aims, Diabetic foot disease is associated with both macro- and microvascular disease. Exercise has both positive and negative effects on the perfusion of lower limbs with peripheral arterial occlusive disease (PAOD). We aimed to measure changes in foot perfusion following a brief period of lower-limb exercise in individuals with and without Type 2 diabetes and non-critical PAOD. Methods, Subjects were allocated to groups according to the presence or absence of diabetes, PAOD on colour duplex imaging and clinically detectable peripheral neuropaÍthy. Transcutaneous oxygen tension (TcPO2), transcutaneous carbon dioxide tension (TcPCO2), ankle-brachial pressure indices, toe pressures and toe-brachial pressure indices (TBI) were measured. Results, One hundred and sixteen limbs were studied in 61 subjects. Post-exercise, toe pressure and TBI increased in the non-diabetic group with arterial disease, but not in the groups with diabetes. Foot TcPO2 values increased in groups with diabetes and TcPCO2 decreased in all groups with arterial disease. Increased chest TcPO2 and decreased TcPCO2 were demonstrated in the groups with diabetes. Conclusions, Elevations in foot TcPO2 and reductions in TcPCO2 indicate improved cutaneous perfusion response to local heating post-exercise. Elevated toe pressures in the non-diabetes group suggest that improved perfusion may be associated with enhanced lower limb macrovascular haemodynamics. However, improvements in TcPO2 and TcPCO2 at foot and chest sites in diabetes imply a global change in cutaneous perfusion. The results suggest that brief exercise results in an improvement in cutaneous perfusion in non-critical PAOD, particularly in individuals with diabetes. [source] Heel ulcers don't heal in diabetes.DIABETIC MEDICINE, Issue 9 2005Or do they? Abstract Aim To obtain information on outcome of heel ulcers in diabetes. Methods Data were recorded prospectively on all patients with heel ulcers who were referred to a specialist multidisciplinary clinic between 1 January 2000 and 30 November 2003. Outcomes were assessed on 31 March 2004. Results There were 157 heel ulcers in the patients referred in the period. Three ulcers were excluded from analysis because of associated osteomyelitis. Of 154 remaining ulcers (121 limbs; 97 patients, 55 male; mean age 68.5 ± 12.8 sd years), 101 (65.6%) healed after a median (range) 200 (24,1225) days. Of 53 non-healed ulcers, 11 (7.1% of 154) were resolved by major amputation, 30 (19.5% of 154) were unhealed at time of patient's death, and 12 (7.8% of 154) remained unhealed. Ulcers healed in 59 of 97 affected patients (60.8%). Twenty-six patients (26.8% of 97) died during the period, of whom 20 died with ulcers unhealed. Worse outcomes were observed in larger ulcers (P = 0.001, Mann,Whitney U -test = 1883.5) and limbs with clinical evidence of peripheral arterial disease (P = 0.001, Mann,Whitney U -test = 1163.00). Backward step-wise logistic regression analysis showed 70.1% of healing could be predicted from these two baseline characteristics. Conclusions The common perception that ,heel ulcers don't heal' is not reflected in clinical practice. Outcome is generally favourable even in a population often affected by serious comorbidity and with limited life expectancy. These data can be used to help define management plans, as well as a basis for counselling of the individual patient. [source] Evaluation of the one-minute exercise test to detect peripheral arterial diseaseEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 5 2008E. K. Hoogeveen ABSTRACT Background,, Asymptomatic peripheral arterial disease (PAD) is common amongst the elderly and is a risk factor for cardiovascular morbidity and mortality. PAD can be assessed by non-invasive tests such as the ankle/brachial pressure index (ABPI) at rest and Doppler flow velocity (DFV) scanning, but these tests may underestimate the prevalence of PAD. The aim of this study was to estimate the added value, for the detection of PAD, of the one-minute exercise test, defined as positive if the drop of the ankle systolic pressure was more than 30 mmHg. We also investigated whether the combination of the ABPI at rest and the one-minute exercise test could replace DFV scanning. Materials and methods,, We studied this in a random sample (n = 631) of a 50- to 75-year-old population. Results,, Of these subjects 11% (66/631) had an abnormal ABPI (< 0·9) and 16% (102/631) had an abnormal DFV curve. Of this sample 72% of the subjects performed a one-minute exercise test. Of all subjects 6% (27/451) had an abnormal ABPI (< 0·9) and 12% (54/451) had an abnormal DFV curve. The one-minute exercise test revealed seven cases of PAD (beyond the 67 already identified) which were not detected by an abnormal ABPI at rest and/or DFV scanning. As a result the prevalence of PAD increased by 2%. All patients with an aortoiliac or femoropopliteal obstruction had an ABPI at rest < 0·9. The sensitivity of the combination of the ABPI at rest and the one-minute exercise test to detect abnormal DFV curves was low for crural obstructions. Conclusion,, The one-minute exercise test slightly improves the detection of peripheral arterial disease in the general population. [source] Cellular microparticles: new players in the field of vascular disease?EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 6 2004M. Diamant Abstract Microparticles are small membrane vesicles that are released from cells upon activation or during apoptosis. Cellular microparticles in body fluids constitute a heterogeneous population, differing in cellular origin, numbers, size, antigenic composition and functional properties. Microparticles support coagulation by exposure of negatively charged phospholipids and sometimes tissue factor, the initiator of coagulation in vivo. Microparticles may transfer bioactive molecules to other cells or microparticles, thereby stimulating cells to produce cytokines, cell-adhesion molecules, growth factors and tissue factor, and modulate endothelial functions. Microparticles derived from various cells, most notably platelets but also leucocytes, lymphocytes, erythrocytes and endothelial cells, are present in the circulation of healthy subjects. Rare hereditary syndromes with disturbances in membrane vesiculation leading to a decreased numbers of microparticles clinically present with a bleeding tendency. In contrast, elevated numbers of microparticles are encountered in patients with a great variety of diseases with vascular involvement and hypercoagulability, including disseminated intravascular coagulation, acute coronary syndromes, peripheral arterial disease, diabetes mellitus and systemic inflammatory disease. Finally, microparticles are a major component of human atherosclerotic plaques. In view of their functional properties, cell-derived microparticles may be an important intermediate in the cascade of cellular and plasmatic dysfunctions underlying the process of atherogenesis. [source] Prevalence and outcome of asymptomatic carotid stenosis: a population-based ultrasonographic studyEUROPEAN JOURNAL OF NEUROLOGY, Issue 4 2002P. P. Mineva The aims of this epidemiological population-based cohort study were to examine the prevalence and outcomes of asymptomatic carotid stenosis (ACS) detected by duplex scanning and its relations to other vascular risk factors. A total of 500 volunteers, 200 men and 300 women, without signs and symptoms of cerebrovascular disease, aged 50,79 years, were enrolled in the study. The prevalence of ACS of 50% or greater was 6.4%. Only severe carotid stenosis was detected in 0.4% of the subjects examined. Significant relationships between ACS and coronary heart disease (CHD) [odds ratio (OR)=8.00], peripheral arterial disease (PAD) (OR=3.66), cigarette smoking in men (OR=4.39) and obesity in women (OR=0.31) were found. The biennial incidence rate of cerebral ischaemic events was 9.4%. A progression of ACS was revealed in 14% and a regression in 6.25% of the subjects. The patients with progressing ACS to more than 70% diameter reduction reached the end-points. Follow-up with repeated duplex scans in patients with advancing ACS of 50% or greater, especially smokers with CHD and PAD, is recommended. [source] Peripheral arterial disease in HIV-infected and uninfected womenHIV MEDICINE, Issue 8 2007A Sharma Objective Although HIV infection has been associated with increased risk of subclinical atherosclerosis and cardiovascular events, peripheral arterial disease (PAD) has not been assessed in HIV-infected patients. The objective of this study was to determine the prevalence of, and risk factors for, PAD using ankle-brachial index (ABI) measurement in HIV-infected and uninfected women. Methods ABI was determined for 335 participants in the Women's Interagency HIV Study (WIHS). A cross-sectional analysis was conducted to determine factors associated with high (,1.40) ABI. Results The prevalence of low ABI (,0.9) was 0.9% (n=3) and the prevalence of high ABI (,1.40) was 6.9% (n=23). The prevalence of low ABI was too low to allow risk factor analysis. On multivariate analysis, factors associated with high ABI were current cigarette smoking [adjusted odds ratio (ORadj) 2.53, 95% confidence interval (CI) 0.99,6.43], being underweight (ORadj 11.0, 95% CI 1.61,75.63) and being overweight (ORadj 5.40, 95% CI 1.13,25.89). Conclusions Although the prevalence of ABI ,0.9 was low in this cohort of HIV-infected and uninfected women, the prevalence of ABI ,1.40 was unexpectedly high. Further studies are indicated to determine the clinical significance of high ABI and its relation to the risk of cardiovascular events in HIV-infected women. [source] Diagnosis of peripheral arterial disease in general practice: can the ankle,brachial index be measured either by pulse palpation or an automatic blood pressure device?,INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 7 2008V. Aboyans Summary Background:, Despite its validity as a screening test for peripheral arterial disease (PAD), and its prognostic value, the ankle,brachial index (ABI) is infrequently used in primary care, probably because a Doppler device is required, along with the requisite skill for its use. We hypothesized that ABI could be accurately measured either by pulse palpation (pABI) or automatic blood pressure devices (autoABI) instead of Doppler method (dABI). Design and methods:, In 54 subjects, we compared the results and the intra-observer reproducibility of pABI to dABI, as well as the inter-observer reproducibility of both pABI and autoABI to dABI. Arm and ankle systolic pressures were measured by the three methods by two observers. The first observer repeated pABI and dABI measurements. The results were compared by the Student paired t -test. Reproducibility was assessed by the intra-class correlation coefficient of agreement (R) and the Bland and Altman method. Results:, The mean dABI obtained by the first observers was 1.03 ± 0.26 vs. a pABI of 0.85 ± 0.44 (p < 0.0001) and an autoABI of 1.09 ± 0.31 (p < 0.05). The intra-observer R -coefficient was at 0.89 for dABI vs. 0.60 for pABI (p < 0.05). The inter-observer R -coefficients were 0.79 for dABI vs. 0.40 for pABI (p < 0.05) and 0.44 for autoABI (p < 0.05). Conclusion:, Neither pulse palpation nor automatic oscillometric devices can be recommended as reliable methods for ABI measurement. [source] Fibromuscular dysplasia of cervical and intracranial arteriesINTERNATIONAL JOURNAL OF STROKE, Issue 4 2010Emmanuel Touzé Fibromuscular dysplasia is an uncommon, segmental, nonatherosclerotic arterial disease of unknown aetiology. The disease primarily affects women and involves intermediate-sized arteries in many areas of the body, including cervical and intracranial arteries. Although often asymptomatic, fibromuscular dysplasia can also be associated with spontaneous dissection, severe stenosis that compromises the distal circulation, or intracranial aneurysm, and is therefore responsible for cerebral ischaemia or subarachnoid haemorrhage. Fibromuscular dysplasia affects middle and distal portions of the internal carotid and vertebral arteries, and occasionally, intracranial arteries. Several pathological and angiographic patterns exist. The most frequent pathological type is medial fibromuscular dysplasia, which is associated with the ,string of beads' angiographic pattern. Unifocal lesions are less common and can be associated with several pathological subtypes. The pathophysiology of the disease is widely unknown. Fibromuscular dysplasia may in fact result from various causes and reflect a non-specific response to different insults. The poor knowledge of the natural history and the lack of randomised trials that compared the different treatment options do not allow any satisfactory judgement to be made regarding the need for or the efficacy of any treatment. [source] Associations Between Lower Extremity Ischemia, Upper and Lower Extremity Strength, and Functional Impairment with Peripheral Arterial DiseaseJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2008Mary M. McDermott MD OBJECTIVES: 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. DESIGN: Cross-sectional. SETTING: Academic medical centers. PARTICIPANTS: Four hundred twenty-four persons with PAD and 271 without PAD. MEASUREMENTS: 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. RESULTS: Lower ABI values were associated with lower plantarflexion strength (P trend=.04) and lower knee extension power (P trend <.001). There were no significant associations between ABI and handgrip or knee extension isometric strength. Significant associations between ABI and measures of lower extremity performance were attenuated after additional adjustment for measures of strength. CONCLUSION: 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. [source] Homocysteine Level and Cognitive Function in Patients with Arterial Disease: The Second Manifestations of ARTerial Disease StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2006Fleur van A. Raamt MD OBJECTIVES: To assess the relationship between total plasma homocysteine (tHcy) level and cognitive function in patients with manifest arterial disease. DESIGN: Cross-sectional. SETTING: Patients with symptomatic cerebrovascular disease, cardiovascular disease, peripheral arterial disease, or abdominal aortic aneurysm included in the Second Manifestations of ARTerial disease study, a single-center, longitudinal study with an extensive screening program at baseline. PARTICIPANTS: Three hundred forty-five consecutively included patients, mean age 59. MEASUREMENTS: The patients underwent an extensive neuropsychological test. The cognitive domains assessed were memory, executive function, attention, and visuoperception and construction. Each raw score was transformed into standardized z-scores, and a sum score for global cognitive function was determined. Risk factors and vascular damage were measured in detail. RESULTS: Linear regression showed that elevated levels of tHcy were related to lower global cognitive function (,=,0.065, 95% confidence interval (CI)=,0.116 to ,0.013) and, more specifically, lower performance on memory (,=,0.078, 95% CI=,0.155 to ,0.002), attention (,=,0.079, 95% CI=,0.163 to ,0.005), and visuoperception and construction (,=,0.125, 95% CI=,0.236 to ,0.014) per standard deviation increase in tHcy (SD=6.4 mol/L), after adjustment for age, sex, educational level, extent of atherosclerosis, and location of vascular disease. Silent cerebral infarcts did not influence this relationship. CONCLUSION: A relationship was found between tHcy levels and cognitive function that was independent of extent and location of arterial disease. The results suggest that vascular mechanisms are not responsible for the relationship between tHcy and cognitive function. [source] Dementia and Alzheimer's Disease Incidence in Relationship to Cardiovascular Disease in the Cardiovascular Health Study CohortJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2005Anne B. Newman MD Objectives: To determine whether coronary artery disease, peripheral arterial disease (PAD), or noninvasive markers of cardiovascular disease (CVD) predict the onset of dementia and Alzheimer's disease (AD). Design: Longitudinal cohort study. Setting: Four U.S. communities. Participants: Men and women (N=3,602) with a brain magnetic resonance imaging (MRI) scan but no dementia were followed for 5.4 years. Participants with stroke were excluded. Measurements: Neurologists and psychiatrists classified incident cases of dementia and subtype using neuropsychological tests, examination, medical records and informant interviews. CVD was defined at the time of the MRI scan. Noninvasive tests of CVD were assessed within 1 year of the MRI. Apolipoprotein E allele status, age, race, sex, education, Mini-Mental State Examination score, and income were assessed as potential confounders. Results: The incidence of dementia was higher in those with prevalent CVD, particularly in the subgroup with PAD. The rate of AD was 34.4 per 1,000 person-years for those with a history of CVD, versus 22.2 per 1,000 person-years without a history of CVD (adjusted hazard ratio (HR)=1.3, 95% confidence interval (CI)=1.0,1.7). Rates of AD were highest in those with PAD (57.4 vs 23.7 per 100 person-years, adjusted HR=2.4, 95% CI=1.4,4.2). Results were similar with further exclusion of those with vascular dementia from the AD group. A gradient of increasing risk was noted with the extent of vascular disease. Conclusion: Older adults with CVD other than stroke had a higher risk of dementia and AD than did those without CVD. The risk was highest in people with PAD, suggesting that extensive peripheral atherosclerosis is a risk factor for AD. [source] Agreement Between Self-Report of Disease Diagnoses and Medical Record Validation in Disabled Older Women: Factors That Modify AgreementJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2004Crystal F. Simpson MD Objectives: To determine the agreement between self-report of chronic disease and validated evidence of disease using multiple ascertainment methods and to assess effects of cognition, education, age, and comorbidity. Design: Cross-sectional analysis. Setting: Community Baltimore, Maryland. Participants: One thousand two community-dwelling disabled women aged 65 and older. Measurements: Kappa statistics were calculated to determine the relationship between self-report of 14 diseases and standardized algorithms. Analyses were stratified using Mini-Mental State Examination score, education, number of chronic diseases, and age. Results: Kappa was excellent for hip fracture (HF), Parkinson's disease (PD), diabetes mellitus (DM), cancer, stroke, and disc disease (DD); fair to good for angina pectoris, congestive heart failure, and myocardial infarction; and poor for peripheral arterial disease, spinal stenosis, osteoporosis, arthritis, and lung disease. Overall, kappa decreased with decreasing cognition and education, increasing age, and four or more diseases. Conclusion: In disabled older women, self-report of physician diagnosis of HF, PD, DM, cancer, stroke, and DD appears valid. In general, increasing comorbidity and age and decreasing cognition and education do not reduce validity for diseases where agreement was excellent overall. [source] Regular or "Super-Aspirins"?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2001A Review of Thienopyridines or Aspirin to Prevent Stroke PURPOSE: To review the evidence for the effectiveness and safety of the thienopyridines (ticlopidine and clopidogrel) compared with aspirin for the prevention of vascular events among patients at high risk of vascular disease. BACKGROUND: Atherosclerosis and resultant cardiovascular disease are important causes of morbidity and mortality in older people. In particular, atherosclerosis of the cerebral arteries can lead to transient ischemic attacks (TIAs) and stroke. Stroke ranks as the third-leading cause of death in the United States and in 1997 was responsible for over 150,000 fatalities.1 In addition to the mortality associated with this disease, stroke is also a leading source of long-term disability in survivors. Nearly 4.5 million stroke survivors are alive today,1 highlighting the fact that primary, but also secondary, prevention are extremely important for minimizing the complications of this illness. DATA SOURCES: Specialized trial registers of the Cochrane Stroke Group and the Antithrombotic Trialist's Collaboration, MEDLINE, and Embase were searched. Additional unpublished information and data were sought from Sanofi, the pharmaceutical company that developed and manufactures ticlopidine and clopidogrel, as well as the principal investigators of the Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events (CAPRIE) trial,7 the largest of the trials identified. STUDY SELECTION CRITERIA: All unconfounded randomized trials comparing either ticlopidine or clopidogrel with aspirin among patients at high risk of vascular disease (those with symptoms of ischemia of the cerebral, coronary, or peripheral circulations) who were followed for at least 1 month for the recurrence of vascular events were included. DATA EXTRACTION: Data were extracted from four completed randomized trials completed in the past 20 years, which included 22,656 patients.7,10 Two authors independently extracted the data from these trials for the following information: the types of patients enrolled; the entry and exclusion criteria; the randomization method; the number of patients originally allocated to the treatment and control groups; the method and duration of follow-up; the number of patients in each group lost to follow-up; information on compliance with the treatment allocated; the definitions of outcome events; the number of outcome events in each treatment group; and any method used for blinding patients, treating clinicians, and outcome assessors to treatment allocation. MAIN RESULTS: Four completed trials involving a total of 22,656 patients were identified. Aspirin was compared with ticlopidine in three trials (3,471 patients)8,10 and with clopidogrel in one trial (19,185 patients).7 A recent TIA or ischemic stroke was the qualifying event in 9,840 patients, a recent myocardial infarction in 6,302 patients, and symptomatic peripheral arterial disease in 6,514 patients. The average age of the patients was approximately 63, with approximately two-thirds of the patients being male and white. The duration of follow-up ranged from 12 to 40 months. CONCLUSIONS: This systematic review demonstrates that, compared with aspirin, thienopyridines are only modestly more effective in preventing serious vascular events in high-risk patients. For patients who are intolerant of, or allergic to aspirin, the available safety and efficacy data suggest that clopidogrel is an appropriate, but more-expensive, alternative antiplatelet drug. It appears safer than ticlopidine and as safe as aspirin but it should not replace aspirin as the first-choice antiplatelet agent for all patients. Further studies are necessary to determine which, if any, particular types of patients would benefit most and least from clopidogrel instead of aspirin. [source] Regenerative medicine in the treatment of peripheral arterial diseaseJOURNAL OF CELLULAR BIOCHEMISTRY, Issue 4 2009Erica B. Sneider Abstract The last decade has witnessed a dramatic increase in the mechanistic understanding of angiogenesis and arteriogenesis, the two processes by which the body responds to obstruction of large conduit arteries. This knowledge has been translated into novel therapeutic approaches to the treatment of peripheral arterial disease, a condition characterized by progressive narrowing of lower extremity arteries and heretofore solely amenable to surgical revascularization. Clinical trials of molecular, genetic, and cell-based treatments for peripheral artery obstruction have generally provided encouraging results. J. Cell. Biochem. 108: 753,761, 2009. © 2009 Wiley-Liss, Inc. [source] Evolving Treatment Options for Prevention of Cardiovascular Events in High-Risk Hypertensive PatientsJOURNAL OF CLINICAL HYPERTENSION, Issue 11 2007Prakash Deedwania MD The identification and treatment of high-risk patients for cardiovascular disease reduces the risk of morbidity and mortality. Significant risk factors for cardiovascular events in hypertensive patients over and above dyslipidemia, smoking, and obesity include coronary heart disease, peripheral arterial disease, cerebrovascular/carotid artery disease, and diabetes. Treatment options for the reduction of cardiovascular events in hypertensive patients include diuretics, ,-blockers, ,-blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and aldosterone antagonists. All of these agents, in various combinations, have been found to reduce the risk of cardiovascular events, even in high-risk patients. The use of ACE inhibitors or ARBs (usually in combination with a diuretic) has proven especially effective in reducing cardiovascular events in diabetes and, although both classes of drugs target the renin-angiotensin-aldosterone system, each has a different mechanism of action. Some investigators believe that combination therapy with an ACE inhibitor and ARB, usually given with other medications, may be more effective than either agent alone with other drugs. The Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET) is evaluating the cardioprotective effect of an ACE inhibitor (ramipril) plus an ARB (telmisartan) in high-risk patients. [source] Peripheral arterial disease and the hospitalist: The rationale for early detection and optimal therapyJOURNAL OF HOSPITAL MEDICINE, Issue S2 2008Steven B. Deitelzweig MD [source] Peripheral Atherectomy: A Critical ReviewJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 6 2007TROY A. BUNTING M.D. Atherectomy is experiencing increased interest from endovascular specialists as a therapeutic treatment in the peripheral arteries. Long studied in the coronary vasculature, atherectomy has several theoretical advantages that make it uniquely suited for the peripheral circulation. In particular, infra-inguinal peripheral arterial disease experiences physiologic stresses and forces that have made traditional percutaneous coronary treatments such as angioplasty and stenting not as successful. Restenosis has been a major problem for angioplasty and stenting alone. The SilverHawk atherectomy device has favorable short-term data but important longer-term data are limited and need further study. Laser atherectomy also has favorable applications in niche patients but the number of studies is limited. Unfortunately, athero-ablative technologies for peripheral arterial disease require more definitive objective data regarding 12-month and longer-term outcomes in order to obtain widespread scientific acceptance. [source] Initial feasibility of a multi-station high resolution three-dimensional dark blood angiography protocol for the assessment of peripheral arterial diseaseJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 4 2009Georgeta Mihai PhD Abstract Purpose To evaluate the feasibility of a multi-station three dimensional (3D) T1-weighted turbo spin echo (TSE) dark-blood Sampling Perfection with Application optimized Contrasts using different flip angle Evolution sequence (T1w-SPACE), to assess aorta, iliac, and superficial femoral (SFA) arteries (inflow vessels) by comparing it with a multi-station contrast enhanced MR angiography (CE-MRA) with identical resolution. Materials and Methods A total of 6 volunteers and 14 peripheral arterial disease (PAD) patients were included in the study. Abdominal and thigh T1w-SPACE and lower leg time-resolved MRA (TR-MRA) with low dose contrast were followed by 3-station CE-MRA. Quantitative measurements of lumen area at 17 locations from T1w-SPACE and CE-MRA were obtained. Additionally, vessel wall areas at the same locations were obtained from the T1w-SPACE images. Results Quantitative comparison of lumen areas with T1w-SPACE and CE-MRA revealed strong correlation between the two techniques and strong inter-observer agreement for each of the two imaging methods (r > 0.9; P < 0.001). Localized vessel wall area measurements obtained in PAD patients were significantly greater compared with those obtained in normal volunteers (mean difference 43.75 ± 12.46 mm2; P < 0.001). Stenosis severity obtained from T1w-SPACE localized measurements showed significant arterial area stenosis in PAD patients. Conclusion T1w-SPACE imaging of inflow vessels is feasible, and in addition to CE-MRA has the ability to assess atherosclerotic plaque and vascular remodeling. J. Magn. Reson. Imaging 2009;30:785,793. © 2009 Wiley-Liss, Inc. [source] Gadopentetate dimeglumine-enhanced three-dimensional MR-angiography: Dosing, safety, and efficacyJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 3 2004Mathias Goyen MD Abstract Noninvasiveness, inherent three-dimensionality allowing reformations in any desired plane, and safe contrast agents, coupled with high diagnostic accuracy have driven the rise in popularity of contrast-enhanced MR angiography (CE-MRA) within the medical community. Reflecting its dominant market share as a paramagnetic contrast agent, gadopentetate dimeglumine (Gd-DTPA) has been used for the majority of clinically-performed MRA exams. Over the period January 1994 to February 2002, a total of 172 original studies describing the use of gadolinium-enhanced MRA in more than three human subjects were identified. Of these, 117 described the use of Gd-DTPA as the contrast agent for MRA. A total of 4046 subjects who received Gd-DTPA for MRA are described in these studies. Analysis of these data demonstrate Gd-DTPA to be a safe contrast agent for MRA when applied in a dose ranging from 0.1 to 0.3 mmol/kg of bodyweight. The documented clinical results show Gd-DTPA to be efficacious in the assessment of the arterial system. The effectiveness of Gd-DTPA-enhanced MRA extends beyond the detection, localization, and characterization of arterial disease, and encompasses choice and planning of appropriate therapy, as well as evaluation of therapeutic effectiveness. J. Magn. Reson. Imaging 2004;19:261,273. © 2004 Wiley-Liss, Inc. [source] | ||||||||||||||||||||||||||||||||||||||||