scholarly journals Different Lower Extremity Arterial Calcification Patterns in Patients with Chronic Limb-Threatening Ischemia Compared with Asymptomatic Controls

2021 ◽  
Vol 11 (6) ◽  
pp. 493
Author(s):  
Louise C. D. Konijn ◽  
Richard A. P. Takx ◽  
Willem P. Th. M. Mali ◽  
Hugo T. C. Veger ◽  
Hendrik van Overhagen
Keyword(s):  
Logistic Regression ◽  
Vessel Wall ◽  
Lower Extremities ◽  
Arterial Disease ◽  
Arterial Calcification ◽  
Multiple Logistic Regression ◽  
Therapeutic Consequences ◽  
Peripheral Arterial ◽  
Crural Arteries ◽  
Severe Type

Objectives: The most severe type of peripheral arterial disease (PAD) is critical limb-threatening ischemia (CLI). In CLI, calcification of the vessel wall plays an important role in symptoms, amputation rate, and mortality. However, calcified arteries are also found in asymptomatic persons (non-PAD patients). We investigated whether the calcification pattern in CLI patients and non- PAD patients are different and could possibly explain the symptoms in CLI patients. Materials and Methods: 130 CLI and 204 non-PAD patients underwent a CT of the lower extremities. This resulted in 118 CLI patients (mean age 72 ± 12, 70.3% male) that were age-matched with 118 non-PAD patients (mean age 71 ± 11, 51.7% male). The characteristics severity, annularity, thickness, and continuity were assessed in the femoral and crural arteries and analyzed by binary multiple logistic regression. Results: Nearly all CLI patients have calcifications and these are equally frequent in the femoropopliteal (98.3%) and crural arteries (97.5%), while the non-PAD patients had in just 67% any calcifications with more calcifications in the femoropopliteal (70.3%) than in the crural arteries (55.9%, p < 0.005). The crural arteries of CLI patients had significantly more complete annular calcifications (OR 2.92, p = 0.001), while in non-PAD patients dot-like calcifications dominated. In CLI patients, the femoropopliteal arteries had more severe, irregular/patchy, and thick calcifications (OR 2.40, 3.27, 1.81, p ≤ 0.05, respectively) while in non-PAD patients, thin continuous calcifications prevailed. Conclusions: Compared with non-PAD patients, arteries of the lower extremities of CLI patients are more frequently and extensively calcified. Annular calcifications were found in the crural arteries of CLI patients while dot-like calcifications were mostly present in non-PAD patients. These different patterns of calcifications in CLI point at different etiology and can have prognostic and eventually therapeutic consequences.

scholarly journals Different Lower Extremity Arterial Calcification Patterns in Patients with Chronic Limb-Threatening Ischemia Compared with Asymptomatic Controls

2021 ◽  
Author(s):  
Louise CD Konijn ◽  
Richard AP Takx ◽  
Willem PThM Mali ◽  
Hugo TC Veger ◽  
Hendrik van Overhagen
Keyword(s):  
Vessel Wall ◽  
Arterial Disease ◽  
Critical Limb Ischaemia ◽  
Arterial Calcification ◽  
Limb Ischaemia ◽  
Multiple Logistic Regression ◽  
Therapeutic Consequences ◽  
Peripheral Arterial ◽  
Crural Arteries ◽  
Severe Type

Objectives The most severe type of peripheral arterial disease (PAD) is critical limb ischaemia (CLI). In CLI, calcification of the vessel wall plays an important role in symptoms, amputation rate and mortality. However, calcified arteries are also found in asymptomatic persons (non-PAD patients). We investigated whether the calcification pattern in CLI patients and non- PAD patients are different and could possibly explain the symptoms in CLI patients. Materials and Methods 130 CLI and 204 non-PAD patients underwent a CT of the lower extremities. This resulted in 118 CLI patients (mean age 72&plusmn;12, 70.3% male) that were age-matched with 118 non-PAD patients (mean age 71&plusmn;11, 51.7% male). The characteristics severity, annularity, thickness and continuity were assessed in the femoral and crural arteries and analysed by binary multiple logistic regression. Results Nearly all CLI patients have calcifications and these are equally frequent in the femoropopliteal (98.3%) and crural arteries (97.5%), while the non-PAD patients had in just 67% any calcifications with more calcifications in the femoropopliteal (70.3%) than in the crural arteries (55.9%, p&lt;0.005). The crural arteries of the CLI patients had significantly more complete annular calcifications (OR 2.92, p=0.001.) while in the non-PAD patients dot-like calcifications dominated. In CLI patients, the femoropopliteal arteries had more severe, irregular / patchy and thick calcifications (OR 2.40, 3.27, 1.81, p&le;0.05, respectively) while in non-PAD patients, thin continuous calcifications prevailed. Conclusions Compared with non-PAD patients CLI patients are more frequently and extensively calcified. Annular calcifications were found in the crural arteries of CLI patients while dot-like calcifications were mostly present in the non-PAD patients. These different patterns of calcifications in CLI point at different etiology and can have prognostic and eventually therapeutic consequences.

scholarly journals The Efficacy of Cone-Beam CT-Based Perfusion Mapping in Evaluation of Tissue Perfusion in Peripheral Arterial Disease

2021 ◽  
Vol 10 (5) ◽  
pp. 947
Author(s):  
Ran Kim ◽  
Sun Young Choi ◽  
Yeo Ju Kim
Keyword(s):  
Logistic Regression ◽  
Peripheral Arterial Disease ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Tissue Perfusion ◽  
Arterial Disease ◽  
Observer Agreement ◽  
Cone Beam ◽  
Multiple Logistic Regression ◽  
Peripheral Arterial

This study investigated the use of cone-beam computed tomography (CBCT)-based perfusion mapping during percutaneous transluminal angioplasty (PTA) to predict clinical outcome in the peripheral arterial disease (PAD). From January 2016 to March 2020, 43 patients (28 male, 15 female; mean age, 69) with 51 limbs, who underwent PTA with CBCT-based foot perfusion mapping for PAD were included. Parenchymal blood volume (PBV) of foot was measured. Clinical response was investigated based on medical records. Predictive value for clinical success was evaluated using multiple logistic regression with C-statistics. Two reviewers visually assessed the improvement on angiography and CBCT-based foot perfusion mapping; inter-observer agreement of clinical success between the two were measured. Technical and clinical success rate of PTA was 90.8% and 68.6%, respectively. In multiple logistic regression, the maximum value of PBV (PBVmax) on perfusion mapping after PTA was significant (p = 0.03) for evaluating clinical success with the highest C-statistic (0.84). Using a cutoff of 235.7 mL/L for PBVmax after PTA, area under curve for prediction of clinical success was 0.664, and sensitivity and specificity were 71.4% and 68.8%, respectively. Consistency in prediction of clinical success between the two reviewers was almost perfect for CBCT-based foot perfusion mapping.

Peripheral arterial disease and Virchow’s triad

2009 ◽  
Vol 101 (06) ◽  
pp. 1032-1040 ◽  
Author(s):  
Philip Bennett ◽  
Stanley Silverman ◽  
Paramjit Gill ◽  
Gregory Lip
Keyword(s):  
Risk Factors ◽  
Peripheral Arterial Disease ◽  
Vessel Wall ◽  
Clinical Utility ◽  
Thrombus Formation ◽  
Arterial Disease ◽  
Blood Constituents ◽  
Global Health Care ◽  
Considerable Morbidity ◽  
Peripheral Arterial

SummaryPeripheral arterial disease (PAD) is an important global health-care problem associated with considerable morbidity and mortality. This disease is an important manifestation of atherosclerosis and the pathophysiological processes involved in its development, progression and complications are atherothrombosis and thromboembolism. Over 150 years ago, Virchow described a triad of abnormalities (abnormal blood flow, abnormal vessel wall and abnormal blood constituents) associated with thrombus formation (thrombogenesis). An improvement in biochemical techniques has allowed quantification of various components of Virchow’s triad, and as a consequence, there has been increasing interest in the measurement of such biomarkers in understanding the development and progression of PAD, as well as its symptomatic complications. This review discusses quantifiable components of Virchow’s triad that have been associated with PAD and their clinical utility as risk factors for PAD.

The Limitations of Ankle Brachial Index when used Alone for the Detection/Screening of Peripheral Arterial Disease in a Population with an Increased Prevalence of Diabetes

2007 ◽  
Vol 31 (3) ◽  
pp. 149-151 ◽  
Author(s):  
Brian P. Hembling ◽  
Kelley C. Hubler ◽  
Peter M. Richard ◽  
William A. O'Keefe ◽  
Chelsey Husfloen ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Waveform Analysis ◽  
Arterial Calcification ◽  
Normal Limits ◽  
High Prevalence ◽  
High Incidence ◽  
Doppler Waveform ◽  
Peripheral Arterial

A retrospective analysis was performed comparing the effectiveness of ankle brachial index (ABI) to Doppler waveform analysis for the detection of peripheral arterial disease (PAD) in a group of patients with an estimated 31% prevalence of diabetes. A total of 21,199 ankle pressures and corresponding Doppler waveforms were correlated; 8,628, or 41%, of the ankle pressures were within normal limits; 8,335, or 40%, of the ankle pressures were below normal limits; and 4,042, or 19%, of the ankle pressures were noncompressible. Using ABI alone for screening in a population with a high incidence of diabetes is significantly limited because of noncompressible ankle pressures caused by arterial calcification. A total of 19% of the segments evaluated in this population yielded noncompressible vessels. The prevalence of PAD, detected by Doppler waveform analysis in the segments with non-compressible ankle pressures, was 69%. Additional modalities such as Doppler waveform analysis would further increase the accuracy of screening for PAD in this population. Alternately, using the ABI alone for the detection of PAD can be improved by interpreting ABIs greater than 1.2 as positive results because of the high prevalence of PAD in this group.

Atherosclerosis: Carotid vessel wall thickness and aortic stiffness compared to stenosis class in peripheral arterial disease

2013 ◽  
Vol 24 ◽  
pp. e38-e39
Author(s):  
Harrie CM van den Bosch ◽  
Jos JM Westenberg ◽  
Wikke Setz-Pels ◽  
Alette Daniels-Gooszen ◽  
Lucien EM Duijm ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Wall Thickness ◽  
Vessel Wall ◽  
Aortic Stiffness ◽  
Arterial Disease ◽  
Vessel Wall Thickness ◽  
Carotid Vessel Wall ◽  
Peripheral Arterial ◽  
Carotid Vessel

scholarly journals 4423 Impact of Gender on High On-Treatment Platelet Reactivity (HPR) and Major Adverse Cardiovascular Events (MACEs) in Caribbean Hispanic patients using Clopidogrel

2020 ◽  
Vol 4 (s1) ◽  
pp. 109-110
Author(s):  
Hector Jose Nunez Medina ◽  
Jorge Duconge ◽  
Luis A. Velez ◽  
Laura I. Fernandez ◽  
Orlando Arce
Keyword(s):  
Logistic Regression ◽  
Puerto Rico ◽  
Cardiovascular Events ◽  
Platelet Reactivity ◽  
Arterial Disease ◽  
Platelet Inhibition ◽  
Major Adverse Cardiovascular Events ◽  
And Gender ◽  
One Year ◽  
Peripheral Arterial

OBJECTIVES/GOALS: The use of P2Y12 receptor inhibitors like Clopidogrel is crucial in the prevention of thrombotic events in patients with coronary artery disease, peripheral arterial disease, and cerebrovascular disease. Variation in the level of platelet inhibition is present in many patients, and it is associated with the occurrence of major adverse cardiovascular events (MACEs). The term High-on treatment platelet reactivity (HTRP) is used to describe impaired antiplatelet inhibition while on Clopidogrel. Multiple factors have been associated with the presence of HTPR in patients with CAD and PAD, including CYP2C19 loss of function polymorphism, drug-drug interactions, and medical comorbidities. Gender differences are another factor that might influence the levels of platelet inhibition while on Clopidogrel and hence, HTPR. Differences by Gender exist in platelet biology, count, and activation. The evidence for the influence of Gender in HTPR is limited, but a possible association has been described. In this study, we described the association of Gender with HTPR and Major Adverse Cardiovascular Events (MACEs) occurrence. The data is from a sample of Hispano-Caribbean patients on Clopidogrel therapy alone or in combination with Aspirin that were retrospectively evaluated from an ongoing trial in Puerto Rico. The result of this study provided evidence of the influence that Gender has on antiplatelet therapy function and MACEs occurrence. METHODS/STUDY POPULATION: The population in the study consisted of Hispano-Caribbean patients using Clopidogrel alone or in combination with Aspirin for coronary artery disease, peripheral arterial disease, or cerebrovascular disease. The sample was obtained from multiple hospital institutions with cardiovascular services in Puerto Rico during the years 2016-2019. Patients were part of the ongoing trial, “Adopting a precision medicine paradigm in Puerto Rico: leveraging ancestral diversity to identify predictors of Clopidogrel response in Caribbean Hispanics.” The sample size consisted of 150 patients. Participants were recruited during routine medical care, pre-admission evaluation for elective cardiac procedures, or during hospitalization in the participating institutions. Platelet reactivity testing was performed with the system Verify Now® to determine PRU values, and High on-treatment platelet reactivity was defined as PRU ≥208. One year after recruitment, the patients were re-evaluated for the occurrence of MACEs. The association of the variables HTPR, occurrence of MACEs, and Gender were assessed using logistic regression in addition to the role of HTPR and Gender for predicting MACE occurrence. The analysis was done using the statistic software Intellectus ©. RESULTS/ANTICIPATED RESULTS: The sample consisted of 67 females and 83 males with and Mean age of 67.87 years and 61.11 years, respectively. The prevalence of HTPR in the sample was 32.67 % (n = 49) with 36% (n = 24) for females, and 30%(n = 25) for males. The mean PRU values were 179.54 for females and 170.81 for males. The percentage of MACEs one year after recruitment was 29.33 % (n = 44) with 43% on females (n = 19), and 57% on males (n = 25). Logistic regression for Gender predicting HTPR was non-significant with a χ2(2) = 0.55, p = .758, and McFadden R2 = 0.00. Also, logistic regression for the effects of Gender and HTPR on the Odds of MACEs occurrence was not significant based on a model with an alpha of 0.05, χ2(2) = 1.99, p = .370, and McFadden R2 = 0.01. DISCUSSION/SIGNIFICANCE OF IMPACT: The sample consisted of 67 females and 83 males with and Mean age of 67.87 years and 61.11 years, respectively. The prevalence of HTPR in the sample was 32.67 % (n = 49) with 36% (n = 24) for females, and 30%(n = 25) for males. The mean PRU values were 179.54 (±70.42) for females and 170.81(±64.89) for males. The percentage of MACEs one year after recruitment was 29.33 % (n = 44) with 43% on females (n = 19), and 57% on males (n = 25). Logistic regression for Gender predicting HTPR was non-significant with a χ2(2) = 0.55, p = .758, and McFadden R2 = 0.00. Also, logistic regression for the effects of Gender and HTPR on the odds of MACEs occurrence was not significant based on a model with an alpha of 0.05, χ2(2) = 1.99, p = .370, and McFadden R2 = 0.01.

scholarly journals Contrast ultrasound perfusion imaging of lower extremities in peripheral arterial disease: a novel diagnostic method

2005 ◽  
Vol 27 (3) ◽  
pp. 310-315 ◽  
Author(s):  
Daniel Duerschmied ◽  
Lisa Olson ◽  
Manfred Olschewski ◽  
Alexandra Rossknecht ◽  
Gabriele Freund ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Perfusion Imaging ◽  
Diagnostic Method ◽  
Lower Extremities ◽  
Arterial Disease ◽  
Peripheral Arterial ◽  
Contrast Ultrasound
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