scholarly journals History of Peripheral Vascular Disease

2020 ◽  
Author(s):  
Keyword(s):  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Peripheral Vascular ◽  
History Of

Abstract 101: Gender Has Differential Effects on Non-Hemorrhagic Stroke Outcomes

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Justin Pieper ◽  
Michael Ashamalla ◽  
Daniel Sedhom ◽  
Neil Yager ◽  
Ketan Ghate ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Renal Insufficiency ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Hemorrhagic Stroke ◽  
Peripheral Vascular ◽  
Stroke Outcomes ◽  
History Of ◽  
Artery Disease

Background: We sought to examine the relationship between gender, age, co-morbidities, and outcomes in patients with non-hemorrhagic stroke. Materials and methods: Retrospective chart review was performed on 517 consecutive non-hemorrhagic stroke patients (48% women, 20% with diabetes, 26.8% with CAD, 38% with dyslipidemia, 62.2% with HTN, 4.2% with peripheral vascular disease, 4.7% with renal insufficiency) treated at a single academic medical center. Results: Younger patients were more likely to be men (age<50 55%, 51-60 58.3%, 61-70 59.6%; p<0.05) while older patients were likely to be women (age 71-80 54.9%, >80 56.6; p<0.05). Accordingly, the subsequent analysis stratified the cohort into two groups, <70 and >70 years old. Regardless of age, men had a higher prevalence of CAD (age <70, 25.2% vs 18.8% in women, and age >70, 43.7% vs. 23.1% in women; p<0.05) and dyslipidemia (age <70, 43.4% vs 32.5% in women and age >70, 44.8% vs. 30.6% in women; p=.05). There were no significant gender based differences in BMI, prevalence of diabetes, hypertension, peripheral vascular disease, or chronic renal insufficiency. The mean follow up duration was 47.3+/-0.9 months. Gender did not affect mortality in patients younger than 70 years old (15.5% men vs. 15.6% women.) However in patients of age >70 mortality was significantly increased in men (50.5% in men vs. 41.7% in women; chi-squared p<0.001, log-rank p<0.0001, Figure). In logistic regression analysis, when compared to women younger than 70 years old, men of the same age had similar mortality (HR 1.0; 95%CI 0.5-1.9, p=0.980); while age greater than 70 conferred 4-5 fold increased risk of mortality (HR 3.9; 95%CI 2.1-7.0, p<0.0001 in women, and HR 5.5; 95%CI 3.0-10.3, p<0.0001 in men). When gender and age were accounted for, history of coronary artery disease and/or dyslipidemia did not affect the outcomes. Conclusion: Men with non-hemorrhagic stroke were more likely to have dyslipidemia and history of coronary artery disease. This, however, did not translate into increased mortality in younger men. Gender appears to have a differential effect on non-hemorrhagic stroke outcomes which warrants future investigation.

scholarly journals Intestinal thromboangiitis obliterans: Consequence of a delay in diagnosis

2020 ◽  
Author(s):  
Swastik Sourav Mishra ◽  
Tushar Subhadarshan Mishra ◽  
Suvradeep Mitra ◽  
Pankaj Kumar
Keyword(s):  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Elevated Serum ◽  
Thromboangiitis Obliterans ◽  
Prior History ◽  
Peripheral Vascular ◽  
Buerger’S Disease ◽  
Buerger's Disease ◽  
Diffuse Abdominal Pain ◽  
History Of

Abstract Background: Thromboangiitis obliterans (TAO) or Buerger’s disease is a form of peripheral vascular disease in young male smokers. The involvement of the intestine occurs only about 2% of the cases. Symptoms of peripheral vascular disease usually precede intestinal manifestations, although the latter can sometimes be the index presentation. The cessation of smoking usually, though not necessarily, prevents the progression of the disease and visceral involvement.Case presentation: Our patient presented with diffuse abdominal pain along with bouts of vomiting and loose motions. He was a known smoker with a prior history of amputation of the right foot, four years before. Physical examination revealed abdominal distension and diffuse tenderness and guarding. An omental band attached to the tip of the appendix was discovered at the initial exploration along with dilated proximal bowel loops, for which a release of the omental band along with appendectomy was done. He developed an enterocutaneous fistula on the sixth postoperative day for which the abdomen was re-explored which revealed multiple segmental perforation in the jejunum and two subcentimetric perforation adjacent to each other in the distal ileum. Resection of the affected jejunal segment was performed followed by Roux-en-Y gastrojejunosotomy and distal ileostomy. A feeding jejunostomy was also performed. The bleeding from the cut ends was unsatisfactory. The patient however had persistent feculent discharge from the wound for which a third exploration was done which revealed a leak from the gastrojejunostomy and feeding jejunosotomy sites, both of which were repaired primarily. However, the patient developed septicemia with persistently elevated serum lactate levels which progressed to refractory septic shock and ultimately succumbed to the illness on 23rd postoperative day of the index surgery.Conclusion: Acute abdomen in a young man, who is a chronic smoker and having an antecedent history of amputation of some part of an extremity for a nontraumatic cause should raise the suspicion of Buerger’s disease of the intestine. Although it is a progressive disease and things are already late by the time intestinal symptoms manifest, early detection may give some scope of salvage and decreasing morbidity and mortality.

P907Respective pronostic value of the valvular aortic calcifications and the thoracic aorta calcifications in patients with and without low gradient aortic stenosis after TAVI

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
B Harbaoui ◽  
G Souteyrand ◽  
T Lefevre ◽  
H Liebgott ◽  
P Y Courand ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Aortic Stenosis ◽  
Renal Insufficiency ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Cardiovascular Mortality ◽  
Chronic Respiratory Disease ◽  
Peripheral Vascular ◽  
History Of

Abstract Background Both the valvular aortic calcifications (VAC) and the thoracic aorta calcifications (TAC) have a prognostic impact in patients with aortic stenosis. Their respective prognostic values in patients with and without low gradient aortic stenosis (LGAS) remain unknown after TAVI. Objectives To assess the prognostic significance of VAC and TAC in patients with and without LGAS regarding cardiovascular mortality after 3 years follow-up. Methods The CAPRI-LGAS is an ancillary study of the C4CAPRI trial (NCT02935491) including 1282 consecutive TAVI patients. Calcifications were measured on pre-TAVI CT. The primary outcome was defined as cardiovascular mortality 3 years after TAVI. Results Among the 1282 patients, 397 (31%) had a LGAS. Compared to the other patients, LGAS patients were more prone to be men, younger, with atrial fibrillation, and lower left ventricular ejection fraction (LVEF), p<0.05 for all. No statistically significant difference was noticed for pulmonary systolic pressures, history of diabetes, chronic respiratory disease, renal insufficiency or peripheral vascular disease. VAC was lower in LGAS compared to non-LGAS patients (1.05 cm3±0.7 vs 0.75 cm3±0.5), p<0.001, the contrary was noticed for TAC, (3.1 cm3±3 vs 3.7 cm3±3.7), p=0.011. After 3 years follow-up, 227 (17.7%) patients died from cardiovascular causes; respectively 85 (21.4%) and 142 (16.1%) patients with and without LGAS, p=0.02. In univariate analysis, in LGAS patients each increase of 1cm3 TAC was associated with cardiovascular mortality while VAC was not, respectively Hazard Ratio (HR) 1.07 and confidence interval (CI) (1.023–1.119) p=0.003, and HR 0.822 CI (0.523–1.292), p=0.39. In patients without LGAS both TAC and VAC were associated with mortality, respectively HR 1.054 CI (1.006–1.104), p=0.028 and HR 1.363 CI (1.092–1.701), p=0.006. Multivariate analysis was adjusted for TAC, VAC, age, gender, atrial fibrillation, and LVEF. In LGAS patients TAC but not VAC was still a predictor of cardiovascular mortality, respectively HR 1.092 CI (1.031–1.158), p=0.003, and HR 0.743 CI (0.464–1.191), p=0.21. In patients without LGAS TAC was no more associated with cardiovascular mortality while VAC was, respectively HR 1.306 CI (1.024–1.666), p=0.031, and HR 1.038 CI (0.985–1.094), p=0.161. When further adjusting on pulmonary systolic pressures, history of diabetes, chronic respiratory disease, renal insufficiency and peripheral vascular disease, the results remained similar ie in LGAS patients, TAC HR 1.090 CI (1.022–1.162), p=0.009 while in patients without LGAS VAC HR 1.377 CI (1.049–1.809), p=0.021. Conclusions The present study shows that VAC and TAC involve different prognostic information in patients with and without LGAS after TAVI. While VAC may be a marker of early and periprocedural mortality and aortic regurgitation in non-LGAS patients, TAC may continue to be harmful and increase afterload in patients with LGAS whom LVEF is often impaired.

Abstract 067: Predictors of High-sensitivity C-reactive Protein Elevation Among Patients With Myocardial Infarction: Insights From VIRGO and TRIUMPH

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Mohammed Qintar ◽  
Puza P Sharma ◽  
Yuanyuan Tang ◽  
Philip Jones ◽  
Yashashwi Pokharel ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
High Sensitivity ◽  
Peripheral Vascular ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
History Of ◽  
Multivariable Regression ◽  
Hs Crp

Background: Elevated hs-CRP is associated with worse cardiovascular outcomes in patients with acute myocardial infarction (AMI), but little is known about predictors of elevated hs-CRP after AMI. Methods: TRIUMPH and VIRGO are prospective AMI registries that assessed hs-CRP levels 30 days after AMI. TRIUMPH assessed hs-CRP levels at 6 months. Multivariable regression analysis was conducted to examine predictors of elevated hs-CRP [≥2.0 mg/L] at 30 days and at 6 months after an AMI (TRIUMPH only). Results: Of 3410 patients in both registries, 58.6% had elevated hs-CRP 30 days post AMI. Patients with elevated hs-CRP were more likely to be female, black, obese, smokers, to have had higher LDL-C at the time of their AMI, with more peripheral vascular disease and history of heart failure, and were less likely to have had a prior PCI (Table). In TRIUMPH, baseline hs-CRP ≥2 mg/L (n=1301) was significantly associated with elevated hs-CRP at 6 months (p<0.001). Patients with elevated hs-CRP at 6 months (n=407) were more likely to be black, obese, smokers, have peripheral vascular disease and have higher baseline hs-CRP. Conclusions: hs-CRP remains elevated in a large proportion of patients following AMI. We identified several predictors of elevated hs-CRP at 1 and 6 months post AMI. Further studies are needed to validate the findings and understand the utility of routine screening of hs-CRP in post AMI patients.

scholarly journals Analysis of drug prescription appropriateness according to the STOPP/START criteria of the elderly patients with type 2 diabetes mellitus in the endocrinology department of a multi-speciality hospital

2020 ◽  
pp. 47-56
Author(s):  
A. I. Kochetkov ◽  
V. A. De ◽  
N. Yu. Voevodina ◽  
M. V. Chachiashvili ◽  
A. V. Grishina ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Elderly Patients ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Peripheral Vascular ◽  
Start Criteria ◽  
History Of

To assess the appropriateness of prescribed drugs according to the STOPP/START criteria of elderly patients with type 2 diabetes mellitus (T2DM) in the endocrinology department of a multi-speciality hospital.Medical records of 136 patients ≥65 years old with T2DM hospitalized in the endocrinology department of  the multi-speciality hospital (Moscow, Russia) were analyzed according to  the «STOPP/START» criteria.The analysis of  prescription leaflets has identified 30 potentially not recommended drugs (46 patients [33,8%]), the use of which should be avoided in certain clinical situations. Also the analysis has identified 175 medications that should be considered for elderly patients with certain conditions (89 patients [65,4%]). The most frequent identified STOPP criteria were: «Glibenclamide or chlorpropamide or glimepiride with T2DM» (23,3%); «Non-steroidal anti-inflammatory drug (NSAID) with history of peptic ulcer disease or gastro-intestinal bleeding, unless with concurrent histamine H2 receptor antagonist, proton pump inhibitors or misoprostol» (13,3%) and «NSAID with estimated glomerular filtration rate 20–50 ml/min/1.73m2» (3%). The most frequent START criteria were: «Statin therapy with a documented history of coronary, cerebral or peripheral vascular disease, where the patient’s functional status remains independent for activities of daily living and life expectancy is >5 years» (25,1%); «Сlopidogrel with a documented history of cerebral or peripheral vascular disease» (18,9%); «Aspirin with a documented history of atherosclerotic coronary disease in patients with sinus rhythm» (18,3%).In  patients ≥ 65 years old with T2DM potentially not recommended drugs are often administrated and there are no prescriptions for some appropriate drugs required in certain clinical settings. The findings give evidence of the need to optimization of pharmacotherapy in elderly and senile patients with T2DM. This adaptation will improve the patients’ quality of  life and avoid wasteful spending.

scholarly journals A Retrospective Review of Risk Factors and Conversion Rate of Transmetatarsal Amputations to Below or Above Knee Amputation

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Jefferson Sabatini ◽  
Susan Odum ◽  
J. Kent Ellington ◽  
Carroll P. Jones ◽  
W. Hodges Davis
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
High Rate ◽  
Peripheral Vascular ◽  
Knee Amputation ◽  
Tobacco Abuse ◽  
History Of ◽  
Transmetatarsal Amputation

Category: Diabetes Introduction/Purpose: Despite the presence of several studies examining the conversion from transmetatarsal amputation (TMA) to a more proximal amputation, few studies identified the possible predictors of failure. The objective of this study is to examine the rate of conversion of transmetatarsal amputation to below or above knee amputation, and to identify the risk factors for conversion. Methods: A retrospective cohort study was performed examining 71 transmetatarsal amputations performed by a single group of foot and ankle subspecialists within a single specialty group between October 1 2005 and August 25 2015. Demographic information and comorbidities were recorded, as were complications, readmission rate, and rate of conversion to a more proximal amputation. Results: Of the 71 patients who underwent transmetatarsal amputation during the study period, 74.7% progressed to a revision amputation or more proximal amputation at a mean of 9.7 months, but a median of only 3.2 months. 87.3% progressed to below knee amputation, 9.9% underwent revision transmetatarsal amputation, and 2.8% received an above knee amputation. Of the patients who progressed to more proximal amputation, 88.2% had diabetes mellitus, 72.4% had a pre-operative ulceration, and 81.7% had peripheral neuropathy. Only 52.7% had diagnosed peripheral vascular disease, 38.1% had a history of renal disease, and 35% were smokers. Conclusion: Transmetatarsal amputation has an extremely high short-term reamputation rate with the vast progressing to a below knee amputation. Comorbidities such as diabetes mellitus, neuropathy, and history of ulceration are often found in these patients, while renal and peripheral vascular disease as well as tobacco abuse are not necessarily present. This high rate of reamputation may bring into question the efficacy of performing transmetatarsal amputation as opposed to a more proximal amputation as a definitive procedure when lower extremity amputation is required.

Dyslipoproteinemia and Migraine

PEDIATRICS ◽  
1986 ◽  
Vol 78 (5) ◽  
pp. 956-957
Author(s):  
CHARLES J. GLUECK
Keyword(s):  
Myocardial Infarction ◽  
Essential Hypertension ◽  
Family History ◽  
High Risk ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Cerebrovascular Accident ◽  
Peripheral Vascular ◽  
Parental History ◽  
History Of

In Reply.— Because the anatomic, biochemical, epidemiologic, nutritional, genetic, and clinical genesis of atherosclerosis is in childhood,1,2 it is important to consider models for sampling in childhood for the dyslipoproteinemias. At a minimum, I would recommend a family history-triggered high-risk strategy with sampling of all children whose parents had sustained premature (≤age 60 years) myocardial infarction, angina, cerebrovascular accident, or peripheral vascular disease.1,2 Second, all children with known parental dyslipoproteinemia should be sampled, as should all children with parental history of essential hypertension gout/hyperuricemia, and/or diabetes.

scholarly journals Can vascular pathology in cerebral and coronary fields predict peripheral artery disease in a cohort of diabetic patients?

2016 ◽  
Vol 10 (4) ◽  
Author(s):  
Kamran K Chima ◽  
Ambreen Butt ◽  
Faisal Masud ◽  
Bilal Saulat
Keyword(s):  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Peripheral Artery Disease ◽  
Lower Limbs ◽  
Vascular Pathology ◽  
Diabetic Patients ◽  
Peripheral Vascular ◽  
Peripheral Artery ◽  
History Of ◽  
Artery Disease

Objective: To find out whether peripheral artery disease followed the same pattern, set of risk factors and indicators as macro vascular disease in the coronary arteries and cerebral arteries disease. Study design: This was a randomized cross sectional retrospective analysis. Place and duration: Study was carried out at The Diabetes Management Center at The Services Hospital Lahore, during June 1999 to June 2001. Patients and methods: A total of 580 patients were selected from the diabetic data base that had absent pulsations in the any of the four arteries of the lower limbs. Another set of 580 diabetics with presence of pulsations in all the arteries of the lower and upper limbs was randomly selected to match the cases. Results: Diabetics with peripheral vascular disease had a significant positive history of past CVA and past MI. Conclusion: Presence of peripheral vascular disease is significantly associated with presence of history of past CVA and past MI, raised systolic BP, diastolic BP, and mean BP and increased proteinurea.

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