Coronary artery revascularization before peripheral vascular surgery in patients with peripheral arterial disease

Background: Peripheral arterial disease (PAD) is under diagnosed in primary care practices, yet the extent of unrecognized PAD in patients with coronary artery disease (CAD) is unknown.Objective: To assess the prevalence of previously unrecognized PAD in patients undergoing coronary angiogram and to determine the relationship between presence of PAD and severity of CAD. Material &Methods: This five years retrospective study was conducted at invasive lab of the department of Cardiology, Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh from January 2010 to December 2014. Total 77 patients were included in this study. Study variables were age, sex, risk factors like hypertension, diabetes mellitus, dyslipidaemia, smoking habit and positive family history for ischemic heart disease, severity of coronary artery and peripheral artery disease.Results: Mean age was 56.83±13.64 years, Male mean age was 53.98±15.08 years and female mean age was 54.5±1.73years. Hypertension were detected in 55.8%, diabetes in 87%, dyslipidaemia in 81.8%, smoking habits in 88.3% and 58.4% had positive family history. After catheterization 88.3% had peripheral arterial disease and 71.4% had coronary artery disease. Out of 77 patients 52 had both coronary and peripheral arterial disease which was statistically significant (p<.014). Coronary angiogram revealed 28.6% (22) patients had triple vessel disease, 23.3% (18) had single vessel disease, 19.5% (15) had double vessel disease and 28.6% (22) were normal coronary arteries. Peripheral angiogram revealed 51.9% had superficial femoral artery disease, 24.7% had anterior tibial artery disease, 26% had posterior tibial artery disease, 15.6% had common iliac artery and common femoral artery disease and 2.6% had renal artery disease.Conclusion: There is a strong and definite correlation between coronary and peripheral arterial disease. We found that cardiovascular risk factors were in fact risk factors for both PAD and CAD.University Heart Journal Vol. 11, No. 2, July 2015; 79-84

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

International Surgery Journal ◽

10.18203/2349-2902.isj20195108 ◽

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.

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Long-term outcomes of peripheral arterial disease patients with significant coronary artery disease undergoing percutaneous coronary intervention

PLoS ONE ◽

10.1371/journal.pone.0251542 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251542

Author(s):

Byoung Geol Choi ◽

Ji-Yeon Hong ◽

Seung-Woon Rha ◽

Cheol Ung Choi ◽

Michael S. Lee

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Peripheral Arterial Disease ◽

Significant Coronary Artery Disease ◽

Arterial Disease ◽

Term Survival ◽

Artery Disease ◽

Peripheral Arterial

Background Patients with peripheral arterial disease (PAD) have known to a high risk of cardiac mortality. However, the effectiveness of the routine evaluation of coronary arteries such as routine coronary angiography (CAG) in PAD patients receiving percutaneous transluminal angioplasty (PTA) is unclear. Methods A total of 765 consecutive PAD patients underwent successful PTA and 674 patients (88.1%) underwent routine CAG. Coronary artery disease (CAD) was defined as angiographic stenosis ≥70%. Patients were divided into three groups; 1) routine CAG and a presence of CAD (n = 413 patients), 2) routine CAG and no CAD group (n = 261 patients), and 3) no CAG group (n = 91 patients). To adjust for any potential confounders that could cause bias, multivariable Cox-proportional hazards regression and propensity score matching (PSM) analysis was performed. Clinical outcomes were evaluated by Kaplan-Meier curved analysis at 5-year follow-up. Results In this study, the 5-year survival rate of patients with PAD who underwent PTA was 88.5%. Survival rates were similar among the CAD group, the no CAD group, and the no CAG group, respectively (87.7% vs. 90.4% vs. 86.8% P = 0.241). After PSM analysis between the CAD group and the no CAD group, during the 5-year clinical follow-up, there were no differences in the incidence of death, myocardial infarction, strokes, peripheral revascularization, or target extremity surgeries between the two groups except for repeat PCI, which was higher in the CAD group than the non-CAD group (9.3% vs. 0.8%, P<0.001). Conclusion PAD patients with CAD were expected to have very poor long-term survival, but they are shown no different long-term prognosis such as mortality compared to PAD patients without CAD. These PAD patients with CAD had received PCI and/or optimal medication treatment after the CAG. Therefore a strategy of routine CAG and subsequent PCI, if required, appears to be a reasonable strategy for mortality risk reduction of PAD patients. Our results highlight the importance for evaluation for CAD in patients with PAD.

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Review of 20 years of vascular surgery research in Australasia: Defining future directions

SAGE Open Medicine ◽

10.1177/2050312119871062 ◽

2019 ◽

Vol 7 ◽

pp. 205031211987106

Author(s):

Judy Wang ◽

Jasamine Coles-Black ◽

Matija Radojcic ◽

Jason Chuen ◽

Philip Smart

Keyword(s):

New Zealand ◽

Peripheral Arterial Disease ◽

Vascular Surgery ◽

Case Series ◽

Arterial Disease ◽

Future Research ◽

Hybrid Surgery ◽

Peripheral Arterial ◽

High Level ◽

Over Time

Objectives: High-quality research is fundamental to the advancement of surgical practice. Currently, there is no quantitative assessment of the research output of vascular surgeons in Australia and New Zealand. By conducting this bibliometric analysis, we aim to provide an objective representation of the trends in vascular surgery and guide future research. Methods: A list of all current vascular surgeons in Australia and New Zealand was compiled from the Royal Australasian College of Surgeons ‘Find a Surgeon’ website tool and correlated with the Australia and New Zealand Society for Vascular Surgery database. A Scopus search of each surgeon’s author profile over the last 20 years was conducted. Results: In total, 2120 articles were published by 208 Australasian vascular surgeons between 1998 and July 2018, with an overall increase in publications over time. Audits or case series were the most published type of study and only 8% of the publications were of high-level evidence. The most popular topics were thoracoabdominal aortic pathologies (24%), followed by peripheral arterial disease (15%). Chronological analysis illustrates an increasing volume of peripheral arterial disease research over time and there is a clear trend towards more endovascular and hybrid surgery publications. The top 10 (5%) highest publishing authors by h-index account for 41% of all publications and 49% of all citations and are also responsible for producing significantly more high-level evidence research. Conclusion: Australasian vascular surgeons have made a significant contribution to medical research. However, the majority of these articles are of low-level evidence. In this time, there has been an increasing number of publications on endovascular and hybrid surgery in keeping with the trend in clinical practice. These areas, as well as research regarding peripheral arterial disease, show potential for high-evidence research in the future.

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