scholarly journals Is There a Risk Factor More Responsible for Disaster?

2015 ◽  
Vol 61 (3) ◽  
pp. 245-247
Author(s):  
Carasca Cosmin ◽  
Muresan Vasile Adrian ◽  
Tilea Ioan ◽  
Magdas Annamaria ◽  
Carasca Emilian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Peripheral Arterial Disease ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Risk Level ◽  
Critical Ischemia ◽  
Medium Risk ◽  
Peripheral Arterial

Abstract Background: Risk factors for peripheral arterial disease are generally the same as those responsible for the ischemic heart disease and in both cases are overlapping risk factors involved in the etiology of atherosclerosis, such as smoking, dyslipidemia, diabetes and hypertension. Case report: We present a case of a 61 years old male, whose ischemic peripheral symptoms began in 2003, at the age of 49, presenting as a Leriche syndrome. The patient was subjected to first revascularization procedure consisting in aortic-bifemoral grafting in the same year. General examination revealed no risk factors except smoking. Only a year after, he returns with critical right lower limb ischemia due to bypass thrombosis, therefore two thrombectomies were performed followed by a right side femoro-popliteal bypassing with Dacron prosthesis. The patient’s condition was good until 2008 when a femoro-popliteal bypass using inverted autologus saphenous vein was imposed due to occlusion of the previous graft. In 2013 the patient was readmitted to hospital with left lower limb critical ischemia. A femoro-popliteal bypass was performed, followed by two thrombectomies and the amputation of the left thigh. Up to this date, the patient kept smoking. Discussions: Although our patient has a low/medium risk level of atherosclerosis by Framingham score and a minimum Prevent III score, all the surgical revascularization procedures were not able to avoid the amputation. Conclusions: There are enough reasons to believe that smoking as a single risk factor can strongly influence the unfavorable progression to amputation in patients with peripheral arterial disease.

Abstract P250: Incidence of Hospitalized Peripheral Arterial Disease and Critical Limb Ischemia: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Corey A Kalbaugh ◽  
Anna Kucharska-Newton ◽  
Laura Loehr ◽  
Elizabeth Selvin ◽  
Aaron R Folsom ◽  
...  
Keyword(s):  
Risk Factors ◽  
African Americans ◽  
Peripheral Arterial Disease ◽  
Lower Extremity ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk ◽  
Baseline Characteristics ◽  
Peripheral Arterial

Introduction: Lower extremity peripheral arterial disease (PAD) affects between 12% and 20% of Americans over the age of 65. PAD compromises quality of life, contributes a high burden of disability and its related health care costs exceed $4 billion/year, yet this preventable CVD outcome remains understudied. Aims: Assess the incidence of hospitalized PAD, and of the most severe form of PAD, critical limb ischemia (CLI), in middle-aged men and women, and evaluate their risk factors in a bi-ethnic, population-based cohort. We hypothesized that incidence of hospitalized PAD and CLI are higher in African Americans, and that modifiable atherosclerosis risk factors in middle age predict these sequelae of PAD. Methods: We analyzed data from 13,865 participants from the Atherosclerosis Risk in Communities Study aged 45–64 without PAD at baseline (1987–89). Incident PAD and CLI events were identified using ICD-9 codes from active surveillance of all hospitalizations among cohort participants from 1987 through 2008. All estimates are incidence rates per 10,000 person-years; nominal statistical significance was achieved for all baseline characteristic comparisons reported. Results: There were 707 incident hospitalized PAD during a median of 18 years of follow-up (249,570 person-years). The overall age-adjusted incidence of PAD and limb-threatening CLI were 26.0 and 9.6 per 10,000 person-years, respectively. Incidence of hospitalized PAD was higher in African Americans than whites (34.7 vs. 23.2) and in men compared to women (32.4 vs. 26.7). Baseline characteristics associated with age-adjusted incident PAD (per 10,000 person-years) compared to their referent groups were diabetes (91.2 vs. 19.0), history of smoking (33.6 vs. 16.2), hypertension (42.6 vs. 18.6), coronary heart disease (81.4 vs. 24.1), and obesity (41.5 vs. 20.2). Incidence of CLI also was higher among African Americans (21.0 vs. 5.9) and in men (10.5 vs. 8.9 per 10,000 person-years). Baseline characteristics associated with incident CLI were similar to those for PAD. Conclusions: The absolute risk of hospitalized lower extremity PAD in this community-based cohort is of a magnitude similar to that of heart failure and of stroke. As modifiable factors are strongly predictive of the long-term risk of hospitalized PAD and CLI, particularly among African Americans, our results highlight the need for effective risk factor prevention and control.

scholarly journals Hyperfibrinogenemia in Peripheral Arterial Disease: Coexistent and Independent Risk Factor (A Report of Two Cases and Review of Literature)

PRILOZI ◽  
2018 ◽  
Vol 39 (2-3) ◽  
pp. 93-96
Author(s):  
Marijan Bosevski ◽  
Gorjan Krstevski ◽  
Irena Mitevska ◽  
Emilija Antova ◽  
Golubinka Bosevska
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factor ◽  
Lower Limb ◽  
Case Reports ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Lower Limb Ischemia ◽  
Left Limb ◽  
Peripheral Arterial

Abstract These case reports aim to show that hyperfibrinogenemia is a risk factor for the progression and prognosis of peripheral arterial disease (PAD), in patients with and without diabetes mellitus type 2. We present a patient with PAD who has type 2 diabetes mellitus, who has previously been repeatedly treated for lower limb ischemia with multiple vascular surgeries performed. A few weeks before admission the patient developed critical lower limb ischemia, which was treated with an iliaco-popliteal and femorofemoral bypass. The patient had elevated serum fibrinogen values. In the current admission, renewed left limb ischemia was diagnosed, and surgically evaluated with a recommendation for amputation of the left limb as a surgical recommendation. Our second patient had a stable intermittent claudication, dyslipidemia and hyperfibrinogenemia. He was successfully treated for those risk factors. Regular monitoring of the patient showed improved claudication distance and quality of life Our case reports, supported by a literature review, demonstrate that hyperfibrinogenemia is a possible risk factor for progression and the prognosis of PAD.

scholarly journals COVID Toes: Concurrent Lower Limb Arterial and Venous Thromboembolism in a Patient with COVID-19 Pneumonitis Presenting with Foot Ischaemia

2021 ◽  
pp. 153857442110456
Author(s):  
Kathryn A. Lee ◽  
Richard S. McBride ◽  
Ranjeet Narlawar ◽  
Rebecca Myers ◽  
George A. Antoniou
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Venous Thromboembolism ◽  
Peripheral Arterial Disease ◽  
Lower Limb ◽  
Respiratory Symptoms ◽  
Arterial Disease ◽  
High Index ◽  
Peripheral Arterial ◽  
High Index Of Suspicion

We present a 74-year-old gentleman, who presented with foot ischaemia requiring bilateral amputation in the absence of radiological signs of occlusive peripheral arterial disease. He was found to have COVID-19 pneumonitis and concurrent arterial and venous thromboemboli despite no initial respiratory symptoms or signs, nor pre-existing risk factors for cardiovascular disease. Patients who present with foot ischaemia with or without respiratory symptoms or signs warrant a high index of suspicion for COVID-19 infection, particularly in those with no predisposing risk factors.

scholarly journals PROTECTIVE FACTORS AGAINST DEPRESSION IN PATIENTS WITH PERIPHERAL ARTERIAL DISEASE WITH CRITICAL LIMB ISCHEMIA

2017 ◽  
Vol 64 (4) ◽  
pp. 296-299
Author(s):  
Liliana Veronica Diaconescu ◽  
◽  
Ion Diaconescu ◽  
Keyword(s):  
Social Support ◽  
Peripheral Arterial Disease ◽  
Coping Strategies ◽  
Depression Scale ◽  
Limb Ischemia ◽  
Psychosocial Interventions ◽  
Arterial Disease ◽  
Active Coping ◽  
Critical Ischemia ◽  
Peripheral Arterial

Introduction. The aim of the study was to assess the extent to which psychosocial factors (social support and coping strategies) may have a protective role against depression in patients with peripheral arterial disease (PAD). Methods. The design of the study was transversal and included 37 patients with PAD with critical ischemia (32 men, 5 women, mean age = 62.41). They were administered Center for Epidemiologic Studies Depression Scale, Duke-UNC Functional Social Support Questionnaire and COPE inventory. Results. Depressive symptoms were found at 28.6% of the patients. There were low scores of perceived social support at 32.4% of the patients. Depression correlated (p<.001) positively with mental disengagement (r=.791), denial (r=.672), behavioral disengagement (r=.760), restraint (r=.075) and negatively with social support (r= -.879) and positive reinterpretation (r=-.844), active coping (r=-.776), use of emotional support (r=-.624). Discussion. PAD patients experience depression. Is highlighted the buffer role of social support and of active coping strategies in facing a chronic disease. Conclusions. Recognition and evaluation for depression in patients with PAD followed by identifying psychosocial interventions may be useful in improving outcomes of these patients.

scholarly journals Angiotensin-Converting Enzyme Genotype and Peripheral Arterial Disease in Diabetic Patients

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Chin-Hsiao Tseng ◽  
Farn-Hsuan Tseng ◽  
Choon-Khim Chong ◽  
Ching-Ping Tseng ◽  
Ju-Chien Cheng
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Peripheral Arterial Disease ◽  
Angiotensin Converting Enzyme ◽  
Arterial Disease ◽  
Diabetic Patients ◽  
Converting Enzyme ◽  
Odds Ratios ◽  
Traditional Risk Factors ◽  
Peripheral Arterial

We investigated the effect of traditional risk factors (hypertension, dyslipidemia and smoking) on the association between angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and peripheral arterial disease (PAD) in 945 (454 men and 491 women) Taiwanese type 2 diabetic patients with a mean age of 63.5 (SD: 11.4) years. Among them, 81 (31 men and 50 women) had PAD (ankle-brachial index <0.9). The adjusted odds ratios (95% confidence intervals) were 2.48 (1.18–5.21), 1.69 (1.00–2.85) and 1.64 (1.12–2.39), respectively, for recessive (DD versus II + ID), dominant (DD + ID versus II) and additive (II = 0, ID = 1 and DD = 2) models. While analyzing the interaction between DD and the individual risk factor of hypertension, smoking and dyslipidemia, patients with the risk factor and with DD had the highest risk compared to referent patients without the risk factor and with II/ID. The respective adjusted odds ratios were 5.41 (2.05–14.31), 7.38 (1.87–29.06) and 4.64 (1.70–12.64). We did not find a significant interaction between DD and any of the risk factors under multiplicative or additive scale. In conclusion, traditional risk factors (hypertension, smoking and dyslipidemia) play an important role in the association between ACE genotypes and PAD. Patients with DD genotype and traditional risk factors are at the highest risk.

scholarly journals Genetics of Vascular Inflammation in Lower Limb Ischemia: The TNF-α Hypothesis in Peripheral Arterial Disease

2021 ◽  
Author(s):  
Diego Caicedo ◽  
Clara V. Álvarez ◽  
Sihara Pérez ◽  
Jesús Devesa
Keyword(s):  
Peripheral Arterial Disease ◽  
Mrna Expression ◽  
Lower Limb ◽  
Vascular Inflammation ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Diabetic Patients ◽  
Lower Limb Ischemia ◽  
Hs Crp ◽  
Peripheral Arterial

Background: Vascular inflammation plays a crucial role in peripheral arterial disease (PAD), although the role of the mediators involved has not yet been properly defined. The aim of this work is to investigate gene expression and plasma biomarkers in chronic limb-threating ischemia (CLTI). Methods: Using patients from the GHAS trial, both blood and ischemic muscle samples were obtained to analyze plasma markers and mRNA expression, respectively. Statistical analy-sis was performed by using univariate (Spearman, t-Student, X2) and multivariate (multiple lo-gistic regression) tests. Results: 35 patients were available at baseline (29 for mRNA expression). Baseline characteristics (mean): Age:71.4&plusmn;12.4 (79.4% male); TNF-&alpha;:10.7&plusmn;4.9; hs-CRP:1.6&plusmn;2.2; Neutrophil-to-lymphocyte ratio (NLR):3.5&plusmn;2.8. Plasma TNF-&alpha; was found elevated (&ge;8.1) in 68.6% of patients, while high hs-CRP (&ge;0.5) in 60.5%. Diabetic patients with high level of inflammation showed significantly higher levels of NOX4 expression at baseline (p=0.0346). Plasma TNF-&alpha; had a negative correlation with eNOS expression (-0.5, p=0.015) and hs-CRP with VEGF-A (-0.63, p=0.005). The expression of NOX4 was parallel to that of plasma TNF-&alpha; (0.305, p=0.037), especial-ly in DM. Cumulative mortality at 12-month was related to NLR &ge;3 (p=0.019) and TNF-&alpha; &ge;8.1 (p=0.048). The best cut-off point for NLR to predict mortality was 3.4. Conclusions: NOX4 and TNF-&alpha; are crucial for the development and complications of lower limb ischemia, especially in DM. hs-CRP could have a negative influence on angiogenesis too. NLR and TNF-&alpha; represent suita-ble markers of mortality in CLTI. These results are novel because they connect muscle gene expres-sion and plasma information in patients with advanced PAD, deepening the search of new and ac-curate targets for this condition.

scholarly journals Comparison of Color Doppler and computed tomography angiography (CTA) in arterial disease in patients with lower limb ischemia.

2021 ◽  
Vol 28 (10) ◽  
pp. 1381-1391
Author(s):  
Muhammad Zakir ◽  
Anjum Tazeen ◽  
Faisal Nadeem Khan ◽  
Mehreen Fatima ◽  
Javed Tauqir ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Peripheral Arterial Disease ◽  
Computed Tomography Angiography ◽  
Lower Limb ◽  
Color Doppler ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Cross Sectional ◽  
Lower Limb Ischemia ◽  
Peripheral Arterial

Objective: To compare the diagnostic accuracy of color Doppler ultrasound with computed tomography angiography in patients with lower limb ischemia and to assess the severity of stenosis. Study Design: Cross Sectional Analytical study. Setting: Shalamar Hospital, Lahore. Period: May 2020 to October 2020. Material & Methods: Data were collected according to the Age, Height, Weight, BMI, Duration of diabetes, Total Cholesterol, LDL, HDL, Triglyceride, Gender, Socioeconomic status, Diabetes, Hypertension, Stenosis, Collateral, calcification. Sample size of46 patients were included in this research comprising 32 males (69.6%) and 14 females (30.4%).Data entry and analysis will be done by using SPSS version-23. Results: Total numbers of 46 patients were included in this research comprising 32 males (69.6%) and 14 females (30.4%). According to the result analysis 34 patients had shown peripheral arterial disease at color Doppler and 12 patients had not shown peripheral arterial disease at color doppler. 38 patients had shown peripheral arterial disease at CTA and 8 patients had not shown peripheral arterial disease at CTA. Conclusion: This study concludes that computed tomography angiography for detection of peripheral arterial disease as the gold standard, MDCT angiography shows higher sensitivity (82.6%) than color-coded Doppler ultrasonography (73.9%) in the assessment of peripheral arterial disease.

scholarly journals Epidemiological Analysis of Lower Limb Revascularization for Peripheral Arterial Disease over 12 years in the Public Health System in Brazil

2021 ◽  
Author(s):  
Nelson Wolosker ◽  
Marcelo Fiorelli Alexandrino da Silva ◽  
Maria Fernanda Portugal ◽  
Nickolas Stabellini ◽  
Antonio Eduardo Zerati ◽  
...  
Keyword(s):  
Public Health ◽  
Peripheral Arterial Disease ◽  
Health System ◽  
Lower Limb ◽  
Endovascular Procedures ◽  
Public Health System ◽  
Arterial Disease ◽  
High Morbidity ◽  
Critical Ischemia ◽  
Peripheral Arterial

Objectives: Worldwide, peripheral arterial disease (PAD) is a disorder with high morbidity, affecting more than 200 million people. Our objective was to analyse the surgical treatment for PAD performed in the Unified Health System of Brazil over 12 years based on publicly available data. Methods: The study was conducted with data analysis available on the DATASUS platform of the Brazilian Health Ministry, assessing procedure technique distribution throughout the years, mortality and cost. Results: A total of 129,424 procedures were analysed (either for claudicants or critical ischemia, proportion unknown). The vast majority of procedures were Endovascular (65.49%), with a tendency for increase in this disproportion (p<0.001). There were 3,306 in-hospital deaths (mortality of 2.55%), with lower mortality in the Endovascular group (1.2% vs. 5.0%, p=0.008). The overall governmental investment for these procedures was U$ 238,010,096.51, and Endovascular Procedures were on average significantly more expensive than Open Surgery (U$ 1,932.27 v. U$ 1,517.32; p=0.016). Conclusions: In the Brazilian Public Health System, lower limb revascularizations occurred with gradual growing frequency between 2008 and 2019. Endovascular procedures were vastly more common, and related to lower in-hospital mortality rates, but higher procedural costs.

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