Robotic Peripheral Vascular Intervention With Drug-Coated Balloons Is Feasible and Reduces Operator Radiation Exposure: Results of the Robotic-Assisted Peripheral Intervention for Peripheral Artery Disease (RAPID) Study II

Purpose: Patients with diabetes mellitus (DM) are known to be at higher risk for peripheral artery disease (PAD), amputations, and major adverse cardiovascular events, though it is unclear whether they are at any higher risk for repeat intervention. LIBERTY 360 offered an opportunity to study a real-world cohort of patients who underwent distal superficial femoral artery endovascular revascularizations. We aimed to describe patients with DM, their outcomes following peripheral vascular intervention, and the effect of DM on outcomes in the LIBERTY 360 cohort. Methods: LIBERTY 360 is a prospective, multi-center, non-randomized, mono-industry funded observational study of patients undergoing endovascular revascularization. Outcomes included 30-day and 1-year all-cause mortality, major amputation, target vessel/lesion revascularization, and a composite of those events. A multivariable regression model including DM was constructed to examine the effect of DM on outcomes. Multivariable survival estimates were made using Cox proportional hazards models. Results: A total of 1,204 patients were enrolled, of whom 727 had DM (60.4%). Patients with DM had significantly more comorbidities and a third required insulin for DM management. Patients with DM had more severe disease based on Rutherford classification at baseline. After adjusting for comorbidities and disease severity, DM patients had more frequent major amputations at 1 year (5.2% versus 1.2%; HR 2.71, 95%CI 1.05-6.98, p = 0.040). The 1-year rates of all-cause mortality and target vessel/lesion revascularization were not significantly higher for patients with DM. Conclusions: Diabetes mellitus was associated with increased major amputations at 1 year following endovascular revascularization after accounting for demographics, comorbidities, and PAD-related characteristics. Further research is needed to determine which aspects of PAD and DM are most strongly associated with poor outcomes following lower extremity revascularization.

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Serum Metabolic Signatures of Chronic Limb-Threatening Ischemia in Patients with Peripheral Artery Disease

Journal of Clinical Medicine ◽

10.3390/jcm9061877 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1877 ◽

Cited By ~ 3

Author(s):

Sandi M. Azab ◽

Abdelrahman Zamzam ◽

Muzammil H. Syed ◽

Rawand Abdin ◽

Mohammad Qadura ◽

...

Keyword(s):

Peripheral Artery Disease ◽

Ankle Brachial Index ◽

Premature Death ◽

Serum Concentrations ◽

Peripheral Artery ◽

Vascular Intervention ◽

Diagnosis And Prognosis ◽

Risk Patients ◽

Peripheral Vascular Intervention ◽

Artery Disease

Peripheral artery disease (PAD) is characterized by the atherosclerotic narrowing of lower limb vessels, leading to ischemic muscle pain in older persons. Some patients experience progression to advanced chronic limb-threatening ischemia (CLTI) with poor long-term survivorship. Herein, we performed serum metabolomics to reveal the mechanisms of PAD pathophysiology that may improve its diagnosis and prognosis to CLTI complementary to the ankle–brachial index (ABI) and clinical presentations. Non-targeted metabolite profiling of serum was performed by multisegment injection–capillary electrophoresis–mass spectrometry (MSI–CE–MS) from age and sex-matched, non-diabetic, PAD participants who were recruited and clinically stratified based on the Rutherford classification into CLTI (n = 18) and intermittent claudication (IC, n = 20). Compared to the non-PAD controls (n = 20), PAD patients had lower serum concentrations of creatine, histidine, lysine, oxoproline, monomethylarginine, as well as higher circulating phenylacetylglutamine (p < 0.05). Importantly, CLTI cases exhibited higher serum concentrations of carnitine, creatinine, cystine and trimethylamine-N-oxide along with lower circulating fatty acids relative to well matched IC patients. Most serum metabolites associated with PAD progression were also correlated with ABI (r = ±0.24−0.59, p < 0.05), whereas the ratio of stearic acid to carnitine, and arginine to propionylcarnitine differentiated CLTI from IC with good accuracy (AUC = 0.87, p = 4.0 × 10−5). This work provides new biochemical insights into PAD progression for the early detection and surveillance of high-risk patients who may require peripheral vascular intervention to prevent amputation and premature death.

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The association of race with quality of health in peripheral artery disease following peripheral vascular intervention: The Q-PAD Study

Vascular Medicine ◽

10.1177/1358863x17733065 ◽

2017 ◽

Vol 22 (6) ◽

pp. 498-504 ◽

Cited By ~ 3

Author(s):

Anwar Zaitoun ◽

Saif Al-Najafi ◽

Thaer Musa ◽

Susan Szpunar ◽

Dawn Light ◽

...

Keyword(s):

Peripheral Vascular ◽

Peripheral Artery ◽

Vascular Intervention ◽

Black Patients ◽

Significant Difference ◽

Peripheral Vascular Intervention ◽

Artery Disease ◽

White Patients

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).

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Discharge Prescription Patterns for Antiplatelet Therapy Following Lower Extremity Peripheral Vascular Intervention

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.119.008791 ◽

2020 ◽

Vol 13 (8) ◽

Cited By ~ 2

Author(s):

Nikhil Singh ◽

Li Ding ◽

Gregory A. Magee ◽

David M. Shavelle ◽

Vikram S. Kashyap ◽

...

Keyword(s):

Lower Extremity ◽

Antiplatelet Therapy ◽

Single Agent ◽

Final Analysis ◽

Prescribing Patterns ◽

Peripheral Vascular ◽

Vascular Intervention ◽

Therapy Regimen ◽

Peripheral Vascular Intervention ◽

Artery Disease

Background: Despite current guidelines suggesting a benefit for dual antiplatelet therapy (DAPT) following peripheral vascular intervention (PVI), there are limited data on antiplatelet prescribing patterns post-procedure. We attempted to determine variables associated with DAPT prescription following lower extremity PVI. Methods: Retrospective analysis of patients undergoing lower extremity PVI in the Vascular Quality Initiative (2017–2018) was performed. Participants not on anticoagulation or DAPT before the procedure were considered for the final analysis. Postdischarge antiplatelet therapy regimen rates were determined (none, aspirin only, P2Y12 inhibitor only, and DAPT). Multivariate logistic regression was performed to determine variables associated with DAPT initiation compared with those discharged on single-agent or no antiplatelet therapy. Results: A total of 16 597 procedures were included for analysis, with 49% initiated on DAPT post-PVI. Male sex (odds ratio [OR], 1.12 [95% CI, 1.05–1.20]), smoking (OR, 1.20 [95% CI, 1.09–1.32]), and coronary artery disease (OR, 1.19 [95% CI, 1.11–1.27]) were associated with an increased likelihood of post-PVI DAPT prescription. Procedures requiring multiple types of interventions (OR, 1.28 [95% CI, 1.15–1.42]), stent placement (OR, 1.16 [95% CI, 1.06–1.27]), and with complications (OR, 1.31 [95% CI, 1.14–1.52]) were also positively associated with DAPT prescription. Conclusions: In patients not already receiving anticoagulation or on DAPT at the time of lower extremity PVI, prescription of DAPT following intervention is ≈50%. Multiple factors were associated with the decision for DAPT versus single antiplatelet therapy, and further study is required to understand how this affects postintervention adverse limb and cardiovascular events.

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Association Between Prevalence of Peripheral Artery Disease and Radiation Exposure in the Atomic Bomb Survivors

Journal of the American Heart Association ◽

10.1161/jaha.118.008921 ◽

2018 ◽

Vol 7 (23) ◽

Cited By ~ 1

Author(s):

Ikuno Takahashi ◽

John Cologne ◽

Daisuke Haruta ◽

Michiko Yamada ◽

Tetsuya Takahashi ◽

...

Keyword(s):

Radiation Exposure ◽

Peripheral Artery Disease ◽

Atomic Bomb ◽

Peripheral Artery ◽

Atomic Bomb Survivors ◽

Artery Disease

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Prevalence of peripheral artery disease in diabetes mellitus: research article

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20174938 ◽

2017 ◽

Vol 5 (11) ◽

pp. 4881

Author(s):

Vinod Tyagi ◽

Abhishek Gupta ◽

Naman Bansal ◽

S. K. Virmani

Keyword(s):

Diabetes Mellitus ◽

Vascular Disease ◽

Peripheral Vascular Disease ◽

Peripheral Artery Disease ◽

Ankle Brachial Index ◽

Ankle Brachial Pressure Index ◽

Peripheral Vascular ◽

Peripheral Artery ◽

Pressure Index ◽

Artery Disease

Background: Peripheral artery disease is a major macrovascular complication of diabetes mellitus. Patients with diabetes mellitus have an increased prevalence of PAD. The ankle brachial pressure index is an easy, non invasive and often under utilised tool for diagnosis of PAD.Methods: In the present study, 100 patients from Western Uttar Pradesh with diabetes mellitus were enrolled to find out prevalence of peripheral vascular disease using ankle brachial pressure index and study the associated risk factors.Results: 59 percent of the subjects were female and 41 percent were male. Ankle-brachial index (ABI) examination of patients indicated Abnormal (ABI= <0.9), in 40 cases.Conclusions: it can be concluded that peripheral vascular disease in Diabetes Mellitus is more commonly associated than is generally believed.

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