scholarly journals Nitric Oxide Manipulation: A Therapeutic Target for Peripheral Arterial Disease?

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Gareth Williams ◽  
Xu Shi-Wen ◽  
David Abraham ◽  
Sadasivam Selvakumar ◽  
Daryll M. Baker ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Peripheral Arterial Disease ◽  
Vascular Dysfunction ◽  
Treatment Options ◽  
Arterial Disease ◽  
Major Amputation ◽  
Western World ◽  
Risk Factor Modification ◽  
Number Of Patients ◽  
Peripheral Arterial

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.

Secondary medical prevention in patients with peripheral arterial disease - Prescriptions of vascular surgeons and medical doctors (angiologists) in a multidisciplinary vascular centre

VASA ◽  
2010 ◽  
Vol 39 (2) ◽  
pp. 145-152 ◽  
Author(s):  
Klein-Weigel ◽  
Gutsche-Petrak ◽  
Wolbergs ◽  
Köning ◽  
Flessenkamper
Keyword(s):  
Peripheral Arterial Disease ◽  
Oral Anticoagulants ◽  
Arterial Disease ◽  
Disease Stage ◽  
Channel Blockers ◽  
Medical Doctors ◽  
Vascular Surgeon ◽  
Medical Prevention ◽  
Number Of Patients ◽  
Peripheral Arterial

Background: We compared medical secondary prevention in patients with peripheral arterial disease stage II (Fontaine) located in the femoro-popliteal artery managed by vascular surgeons and medical doctors / angiologists in our multidisciplinary vascular center. Patients and methods: We retrospectively analyzed demission protocols of in-hospital treatments between 01.01.2007 and 20.06.2008. Results: We surveyed 264 patients (54.2 % women; mean age 67.52 ± 8.98 yrs), 179 (67.8 %) primarily treated by medical doctors / angiologists and 85 (32.2 %) primarily managed by vascular surgeons. Medical doctors / angiologists treated more women (n = 109) than men (n = 34), (p = 0.002) and documented smoking and diabetes mellitus more often (p < 0.001) than vascular surgeons. Besides, patients had similar cardiovascular risk profiles and concomitant diseases, vascular surgeons prescribed 5.47 ± 2.26 drugs, medical doctors / angiologists 6.37 ± 2.67 (p = 0.005). Overall, 239 (90.5 %) patients were on aspirin, 180 (68.2 %) on clopidogrel, and 18 (6.9 %) on oral anticoagulants. Significantly more patients treated by medical doctors / angiologists received clopidogrel (169 versus 11; p < 0.001), significantly more surgical patients received oral anticoagulants (11 versus 7; p = 0.016). The number of patients without prescriptions for any antithrombotic therapy was 6 (6.9 %) in patients treated by vascular surgeons and 0 (0 %) in patients managed by medical doctors / angiologists (p = 0.001). Prescription-rates of β-blockers, ACE-inhibitors, Angiotensin II-antangonists, calcium channel blockers, and diuretics were statistically not different between the two disciplines, but statins were prescribed significantly more often by medical doctors / angiologists (139 versus 49; p < 0001). With the exceptions of Clopidogrel (women > men) and diuretics (men > women) we observed no gender-specific prescriptions. Conclusions: We observed high prescriptions rates of secondary medical prevention in patients primarily treated by medical doctors / angiologists and vascular surgeons. We believe that this result is highly influenced by our multidisciplinary approach. Nevertheless, efforts have to be made to raise vascular surgeon’s awareness of statin use and complete prescription of antithrombotic and antiplatelet drugs.

scholarly journals Association of Carboxyhemoglobin Levels with Peripheral Arterial Disease in Chronic Smokers Managed at Dr George Mukhari Academic Hospital

2020 ◽  
Vol 17 (15) ◽  
pp. 5581
Author(s):  
Mashudu Nemukula ◽  
Motetelo Alfred Mogale ◽  
Honey Bridget Mkhondo ◽  
Lizette Bekker
Keyword(s):  
Nitric Oxide ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Academic Hospital ◽  
Convenience Sample ◽  
Logistic Analysis ◽  
Arterial Dilation ◽  
Peripheral Arterial ◽  
Arterial Damage ◽  
Multivariate Logistic Analysis

Chronic cigarette smokers (CCS) are known to have elevated levels of carboxyhemoglobin (COHb). However, it is not known whether increased levels of COHb are associated with endothelial dysfunction (ED), and therefore the development of peripheral arterial disease (PAD). The aim of the study was to investigate the association of blood COHb and plasma nitric oxide (NO) levels, and whether it is an independent risk factor in the development of PAD among CCS at Dr George Mukhari Academic Hospital (DGMAH). A sample of 120 CCS with PAD and a convenience sample of 100 CCS without PAD were recruited into the study. Blood COHb levels were measured using the ABL 90 FLEX CO-oximeter automated spectroscopy. Plasma nitric oxide (NO) levels were measure using ELISA. Logistic regression analysis was used to investigate the association of blood COHb and plasma NO with PAD. Blood COHb levels of CCS with PAD were significantly higher than those of CCS without PAD, and the NO levels of CCS with PAD were significantly lower than those of CCS without PAD. Although both the blood COHb and plasma NO in CCS were significantly associated with PAD in bivariate logistic analysis, only plasma NO was independently associated with PAD in multivariate logistic analysis. This finding is consistent with the hypothesis that COHb is a cause of arterial damage in PAD, leading to reduced NO, and therefore reduced arterial dilation.

Wound management of chronic diabetic foot ulcers: From the basics to regenerative medicine

2015 ◽  
Vol 39 (1) ◽  
pp. 29-39 ◽  
Author(s):  
Karen L Andrews ◽  
Matthew T Houdek ◽  
Lester J Kiemele
Keyword(s):  
Peripheral Arterial Disease ◽  
Diabetic Foot ◽  
Arterial Disease ◽  
Current Treatment ◽  
Foot Ulcers ◽  
Foot Deformities ◽  
Minor Trauma ◽  
Diabetic Foot Ulcers ◽  
Number Of Patients ◽  
Peripheral Arterial

Background: Hospital-based studies have shown that mortality rates in individuals with diabetic foot ulcers are about twice those observed in individuals with diabetes without foot ulcers. Objective: To assess the etiology and management of chronic diabetic foot ulcers. Study design: Literature review. Methods: Systematic review of the literature discussing management of diabetic foot ulcers. Since there were only a few randomized controlled trials on this topic, articles were selected to attempt to be comprehensive rather than a formal assessment of study quality. Results: Chronic nonhealing foot ulcers occur in approximately 15% of patients with diabetes. Many factors contribute to impaired diabetic wound healing. Risk factors include peripheral neuropathy, peripheral arterial disease, limited joint mobility, foot deformities, abnormal foot pressures, minor trauma, a history of ulceration or amputation, and impaired visual acuity. With the current treatment for nonhealing diabetic foot ulcers, a significant number of patients require amputation. Conclusion: Diabetic foot ulcers are optimally managed by a multidisciplinary integrated team. Offloading and preventative management are important. Dressings play an adjunctive role. There is a critical need to develop novel treatments to improve healing of diabetic foot ulcers. The goal is to have wounds heal and remain healed. Clinical relevance Diabetic neuropathy and peripheral arterial disease are major factors involved in a diabetic foot ulcer. Despite current treatment modalities for nonhealing diabetic foot ulcers, there are a significant number of patients who require amputations. No known therapy will be effective without concomitant management of ischemia, infection, and adequate offloading.

scholarly journals Imbalance between nitric oxide generation and oxidative stress in patients with peripheral arterial disease: Effect of an antioxidant treatment

2006 ◽  
Vol 44 (3) ◽  
pp. 525-530 ◽  
Author(s):  
Lorenzo Loffredo ◽  
Pasquale Pignatelli ◽  
Roberto Cangemi ◽  
Paola Andreozzi ◽  
Maria Antonietta Panico ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Nitric Oxide ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Antioxidant Treatment ◽  
Disease Effect ◽  
Peripheral Arterial ◽  
And Oxidative Stress

scholarly journals Endovascular invasions for femoral-popliteal segment disorders of C andD-type according to TASC-II classification

2018 ◽  
Vol 24 (2) ◽  
pp. 69-76
Author(s):  
O.L. Nikishin ◽  
M.I. Muz ◽  
A.I. Gavretskiy ◽  
I.V. Altman ◽  
S.I. Savoluk
Keyword(s):  
Peripheral Arterial Disease ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Vascular Bed ◽  
Number Of Patients ◽  
Surgical Methods ◽  
Peripheral Arterial ◽  
Surgical Treatments ◽  
Medical Recommendations

Currently, direct re-vascularization for the management of critical limb ischemia (CLI) is effectuated through open and hybrid surgical treatments. At the same time, therapeutic recommendations for one of the methods appear as a subject of lasting discussions. Today TASC II (TransAtlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease) adopted in 2007 is the most popular document that provides justifications for endovascular and surgical treatment of peripheral arterial disease. Clinical practice provides evidence that there is a significant number of patients having critical limb ischemia who suffer from vascular bed disorders and are classified as C or D-type according to TASC classification. Meanwhile, there also are cases when these patients have no other alternative than re-vascularization by means of open surgery, which is why endovascular invasion appears as the only method of re-vascularization for them. The article presents some results of comparative studies within endovascular and surgical tools aimed at revascularization in the area of femoral-popliteal segment, including cases where patients are classified as C and D-type. The results of shunting operations are compared to angioplasty and remote endarterectomy, whereas technical methods for re-entry during subintimal angioplasty are regarded apart. Despite the fact that there are medical recommendations for the use of endovascular and surgical methods depending on TASC II classification, today there is no evidence that these tools can be efficient in revascularization of femoral-popliteal segment. In order to identify the efficiency of distinct methods in revascularization of femoral-popliteal segment there a need in a number of extended randomized studies designed to evaluate the role of such factors, as anatomic location of the vascular bed disorder, the extent of a disease, the location of purolo-necrotic areas as well as other pathologies on the results of the study.

Trends in amputations in people with hospital admissions for peripheral arterial disease in Germany

VASA ◽  
2011 ◽  
Vol 40 (4) ◽  
pp. 289-295 ◽  
Author(s):  
Moysidis ◽  
Nowack ◽  
Eickmeyer ◽  
Waldhausen ◽  
Brunken ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Hospital Admissions ◽  
Arterial Disease ◽  
Major Amputation ◽  
Hospitalized Patients ◽  
Hospitalisation Rate ◽  
Minor Amputation ◽  
Federal Statistical ◽  
Peripheral Arterial ◽  
First Time

Background: Using the information of the federal statistics, a detailed description of the hospitalisation rate for amputation in Germany was possible for the first time, and trends since 2005 can be reported. Patients and methods: Detailed lists of all amputations coded as minor amputations (OPS 5 - 864) and major amputations (OPS 5 - 865) performed in 2005 and 2008, divided into the 4th and 5th number of the OPS-code, were provided by the Federal Statistical Office. Results: Despite an increase in total number of hospitalized patients suffering from peripheral arterial disease and neurovascular disease there is a relevant decrease in age adjusted major amputation rates per 100.000 population in Germany from 27.0 in 2005 to 25.1 in 2008 in males and from 19.7 in 2005 to 17.1 in 2008 in females. Overall minor amputation rates do not show such a decrease but increased in males (from 47.4 in 2005 to 53.7 in 2008) und remained unchanged in females (23.1 in 2005 and 23.1 in 2008). In the 6th and 7th decade of life males have approximately four times higher major and minor amputation rates than females. Conclusions: Hospitalisation rate for major amputation in Germany decreased in the recent years whereas hospitalisation rate for minor amputation did not.

Abstract 288: Role of Cilostazol in Preventing Instent Restenosis Among Patients With Peripheral Arterial Disease: A Meta-analysis

2015 ◽  
Vol 35 (suppl_1) ◽  
Author(s):  
Omer Iftikhar ◽  
Karla Oliveros ◽  
Alfonso Tafur ◽  
Ana Casanegra
Keyword(s):  
Peripheral Arterial Disease ◽  
Odds Ratio ◽  
Random Effect ◽  
Random Effect Model ◽  
Arterial Disease ◽  
Primary Patency ◽  
Stent Restenosis ◽  
Number Of Patients ◽  
Peripheral Arterial ◽  
In Stent Restenosis

Objective: Peripheral arterial disease (PAD) is associated with two to six fold increase in the cardiovascular mortality. Revascularization is indicated to relieve life limiting ischemic symptoms and improve wound healing. Primary patency for balloon angioplasty has been reported to be around 40 to 60% in the first year[8]. Stents have improved rates of primary patency but long-term patency rates are not comparable to bypass surgery, with many patients at high risk of in-stent restenosis. Many adjunctive therapies have been proposed to reduce the high restenosis rate. Our aim is to evaluate the use of cilostazol to prevent in-stent restenosis among patients with lower extremity arterial stenting. Methods: We performed a MEDLINE and EMBASE search, and reviewed the abstracts and manuscripts following the PRISMA guidelines. Patency rate after stenting was the primary efficacy outcome. At least 2 abstractors reviewed the study list and selected manuscripts. We calculated Q statistic and a homogeneity formal test. The odds ratio (OR) estimates were pooled by using the Mantel-Haenszel random-effects method. Data were analyzed using the R META package Results: We identified 524 studies, 20 articles were fully abstracted and 4 included in the metaanalysis. The total number of patients was 2434. The cilostazol and control groups were evenly divided. All studies were of moderate quality. Clinical characteristics including age and BMI were similar in the two groups. Stents were placed to treat de novo lesions. Two of the studies compared cilostazol to ticlopidine. Cilostazol group patients had better primary patency rates after endovascular therapy than patients not taking cilostazol (OR 0.55, 95% CI 0.43 - 0.71). Heterogeneity was moderate with I2 of 38% and of moderate clinical relevance not statistically significant thus random effect model was kept. Omitting a single study did not affect the overall odds ratio of the other studies. Funnel plot suggested no publication bias. Conclusions: In stent stenosis among revascularized patients with PAD was 45% lower for patients who were on cilostazol.

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