Two decades of peripheral arterial disease intervention in a tertiary vascular referral center

Abstract. Background: Multilevel peripheral arterial disease is frequently observed in patients with intermittent claudication or critical limb ischemia. This report evaluates the efficacy of one-stage hybrid revascularization in patients with multilevel arterial peripheral disease. Patients and methods: A retrospective analysis of a prospective database included all consecutive patients treated by a hybrid approach for a multilevel arterial peripheral disease. The primary outcome was the patency rate at 6 months and 1 year. Secondary outcomes were early and midterm complication rate, limb salvage and mortality rate. Statistical analysis, including a Kaplan-Meier estimate and univariate and multivariate Cox regression analyses were carried out with the primary, primary assisted and secondary patency, comparing the impact of various risk factors in pre- and post-operative treatments. Results: 64 patients were included in the study, with a mean follow-up time of 428 days (range: 4 − 1140). The technical success rate was 100 %. The primary, primary assisted and secondary patency rates at 1 year were 39 %, 66 % and 81 %, respectively. The limb-salvage rate was 94 %. The early mortality rate was 3.1 %. Early and midterm complication rates were 15.4 % and 6.4 %, respectively. The early mortality rate was 3.1 %. Conclusions: The hybrid approach is a major alternative in the treatment of peripheral arterial disease in multilevel disease and comorbid patients, with low complication and mortality rates and a high limb-salvage rate.

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Markers of arterial stiffness in peripheral arterial disease

VASA ◽

10.1024/0301-1526/a000452 ◽

2015 ◽

Vol 44 (5) ◽

pp. 341-348 ◽

Cited By ~ 25

Author(s):

Marc Husmann ◽

Vincenzo Jacomella ◽

Christoph Thalhammer ◽

Beatrice R. Amann-Vesti

Keyword(s):

Arterial Stiffness ◽

Peripheral Arterial Disease ◽

Pulse Wave ◽

Augmentation Index ◽

Arterial Disease ◽

Care Physician ◽

Additional Information ◽

Non Invasive ◽

Assessment Techniques ◽

Peripheral Arterial

Abstract. Increased arterial stiffness results from reduced elasticity of the arterial wall and is an independent predictor for cardiovascular risk. The gold standard for assessment of arterial stiffness is the carotid-femoral pulse wave velocity. Other parameters such as central aortic pulse pressure and aortic augmentation index are indirect, surrogate markers of arterial stiffness, but provide additional information on the characteristics of wave reflection. Peripheral arterial disease (PAD) is characterised by its association with systolic hypertension, increased arterial stiffness, disturbed wave reflexion and prognosis depending on ankle-brachial pressure index. This review summarises the physiology of pulse wave propagation and reflection and its changes due to aging and atherosclerosis. We discuss different non-invasive assessment techniques and highlight the importance of the understanding of arterial pulse wave analysis for each vascular specialist and primary care physician alike in the context of PAD.

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

VASA ◽

10.1024/0301-1526/a000020 ◽

2010 ◽

Vol 39 (2) ◽

pp. 145-152 ◽

Cited By ~ 6

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 surgeons awareness of statin use and complete prescription of antithrombotic and antiplatelet drugs.

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Comparison of Generic and Disease-Specific Questionnaires for the Assessment of Quality of Life in Patients With Peripheral Arterial Disease

Yearbook of Vascular Surgery ◽

10.1016/s0749-4041(08)70167-2 ◽

2006 ◽

Vol 2006 ◽

pp. 216-217

Author(s):

G.L. Moneta

Keyword(s):

Quality Of Life ◽

Peripheral Arterial Disease ◽

Arterial Disease ◽

Peripheral Arterial ◽

Disease Specific

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Fifteen Coagulation and Fibrinolysis Parameters in Diabetes Mellitus and in Patients with Vasculopathy

Thrombosis and Haemostasis ◽

10.1055/s-0038-1661158 ◽

1984 ◽

Vol 52 (02) ◽

pp. 138-143 ◽

Cited By ~ 44

Author(s):

M Christe ◽

J Fritschi ◽

B Lämmle ◽

T H Tran ◽

G A Marbet ◽

...

Keyword(s):

Diabetes Mellitus ◽

Peripheral Arterial Disease ◽

Negative Correlation ◽

Fibrinolytic Activity ◽

Antithrombin Iii ◽

Predictor Variable ◽

Arterial Disease ◽

Thrombin Time ◽

Peripheral Arterial ◽

Coagulation And Fibrinolysis

SummaryFifteen haemostasis parameters have been measured in 48 normal persons, 36 diabetics without and 44 with complications and 27 with peripheral arterial disease. Since the patients groups are older than normals, part of the differences are due to age. However, the differences are significant between normals and patients. They become highly significant for the diabetics with complications and nephropathy (Table 7). In diabetics without complications factor VIII functions, fibrinogen and thrombin time are related to age whereas there is a negative correlation for the fibrinolytic activity and antithrombin III. The diabetic complications shade off the correlations, which subsist only for VIIIR: CoF, VIIIR: Ag, ATIII and lysis before stasis. With Hbalc as dependent variable VIIIR:CoF is the only significant predictor variable in diabetics (Table 9).

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