scholarly journals Long-term incidence and outcomes of obesity-related peripheral vascular disease after bariatric surgery

2021 ◽  
Author(s):  
Osama Moussa ◽  
Maddalena Ardissino ◽  
Silvia Muttoni ◽  
Ara Faraj ◽  
Alice Tang ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Primary Endpoint ◽  
Arterial Disease ◽  
Venous Disease ◽  
Peripheral Vascular ◽  
Event Rates

Abstract Background and aims Patients with obesity are at high risk of suffering from arterial and venous peripheral vascular disease (PVD). Bariatric surgery is an effective strategy to achieve weight reduction for patients with obesity. The long-term impact of bariatric surgery on obesity-related morbidity is subject to increasing research interest. This study aimed to ascertain the impact of bariatric surgery on the long-term occurrence of PVD in patients with obesity. Methods The study population was extracted from the Clinical Practice Research Datalink, a nation-wide database containing primary and secondary care records of consenting patients. The intervention cohort was 2959 patients who had undergone bariatric surgery during follow-up; their controls were 2959 propensity-score-matched counterparts. The primary endpoint was development of any PVD: arterial or venous. Secondary endpoints were incident peripheral arterial disease alone, incident peripheral venous disease alone. Results Three hundred forty-six patients suffered a primary endpoint during follow-up. Bariatric surgery did not improve peripheral vascular disease rates as a whole, but it was associated with significantly lower event rates of arterial disease (HR = 0.560, 95%CI 0.327–0.959, p = 0.035) but higher event rates of venous disease (HR = 1.685, 95%CI 1.256–2.262, p < 0.001). Conclusions Bariatric surgery was associated with significantly reduced long-term occurrence of arterial disease but increased occurrence of venous disease in patients with obesity.

Long-Term Follow-up of Syme Amputations for Peripheral Vascular Disease Associated with Diabetes Mellitus

Foot & Ankle ◽  
1988 ◽  
Vol 9 (3) ◽  
pp. 107-110 ◽  
Author(s):  
Richard S. Jany ◽  
J. Kenneth Burkus
Keyword(s):  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Peripheral Vascular ◽  
Surgical Wounds ◽  
Surgical Incisions ◽  
Long Term Follow Up ◽  
Successful Clinical Outcome ◽  
Clinical Records

Ten patients underwent Syme amputation for diabetic peripheral vascular disease between 1980 and 1986 and were observed postoperatively for an average of 5 years. Surgical wounds healed in only five of the 10 patients; they were then fitted for a permanent Syme's prosthesis. All failures resulted from the inability to heal the surgical incisions primarily. The clinical records of these patients were retrospectively analyzed for predictors of successful clinical outcome. The ischemic index, grade of the lesion, initial wound treatment, and presence of the infection at the time of amputation were not found to be reliable predictors of a successful level of amputation. Clinical assessment of both the vascular and nutritional status of the patient was necessary to predict a successful result at this level of amputation.

scholarly journals Patient characteristics predict patency of early-cannulation arteriovenous grafts

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
David B. Kingsmore ◽  
Karen S. Stevenson ◽  
S. Richarz ◽  
Andrej Isaak ◽  
Andrew Jackson ◽  
...  
Keyword(s):  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Vascular Access ◽  
Demographic Data ◽  
Univariate Analysis ◽  
Patient Characteristics ◽  
Peripheral Vascular ◽  
Arteriovenous Grafts ◽  
One Year

AbstractThere is a new emphasis on tailoring appropriate vascular access for hemodialysis to patients and their life-plans, but there is little known about the optimal use of newer devices such as early-cannulation arteriovenous grafts (ecAVG), with studies utilising them in a wide variety of situations. The aim of this study was to determine if the outcome of ecAVG can be predicted by patient characteristics known pre-operatively. This retrospective analysis of 278 consecutive ecAVG with minimum one-year follow-up correlated functional patency with demographic data, renal history, renal replacement and vascular access history. On univariate analysis, aetiology of renal disease, indication for an ecAVG, the number of previous tunnelled central venous catheters (TCVC) prior to insertion of an ecAVG, peripheral vascular disease, and BMI were significant associates with functional patency. On multivariate analysis the number of previous TCVC, the presence of peripheral vascular disease and indication were independently associated with outcome after allowing for age, sex and BMI. When selecting for vascular access, understanding the clinical circumstances such as indication and previous vascular access can identify patients with differing outcomes. Importantly, strategies that result in TCVC exposure have an independent and cumulative association with decreasing long-term patency for subsequent ecAVG. As such, TCVC exposure is best avoided or minimised particularly when ecAVG can be considered.

scholarly journals Serum homocysteine as a predictor of severity of peripheral arterial disease in association with Doppler ultrasonography

2019 ◽  
Vol 6 (11) ◽  
pp. 3977
Author(s):  
Preethi S. P. ◽  
Tejaswi Hemachandran
Keyword(s):  
Peripheral Arterial Disease ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Prognostic Marker ◽  
Doppler Ultrasonography ◽  
Binary Logistic Regression ◽  
Arterial Disease ◽  
Peripheral Vascular ◽  
Serum Homocysteine ◽  
Peripheral Arterial

Background: To evaluate association between raised serum homocysteine levels and severity of peripheral vascular disease (PVD) and to assess the role of homocysteine as a prognostic marker in PVD and thereby aid in early referrals to prevent cerebral and coronary events in those patients and introduce homocysteine lowering with vitamin therapy as part of medical management in patients diagnosed with PVD.Methods: The serum homocysteine levels was measured in all patients admitted for peripheral vascular disease of upper and/or lower limb and to correlate the above values with Doppler ultrasonography (USG) in the duration between 2016-2018 (18 months).Results: The comparison of homocysteine levels with Doppler shows corresponding significant increase in Serum Hcy levels only in cases of moderate PVD. Statistical analysis with binary logistic regression does show a significant association with moderate severity of PVD and serum homocysteine levels with 66.7% predictability.Conclusions: There was significant association of homocysteinemia only in Moderate PVD with no statistically significant correlation with mild, severe cases of peripheral arterial disease (PAD) and radiological normal cases, further large randomised trials are required to elucidate its clinical relevance in PAD as a prognostic marker of severity. 

Acute pain in peripheral vascular disease

2011 ◽  
Author(s):  
Arif H. Ghazi ◽  
Obi Agu
Keyword(s):  
Pain Relief ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Acute Pain ◽  
Peripheral Vascular ◽  
Surgical Revascularization ◽  
End Stage

Pain in vascular disease is often severe. Atherosclerosis is the commonest cause of ischaemic pain. Angioplasty, stents, and surgical revascularization should be attempted to treat the underlying cause. Pain relief is also aimed at neuropathic and sympathetic components of pain. In end stage ischaemic disease, amputation may be necessary often leading to long-term pain.

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