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PubMed1999

The effects of peripheral vascular disease on gait.

This study was designed to determine whether patients with peripheral vascular disease (PVD) have gait abnormalities. A previous study on humans with PVD found no abnormalities whereas significant gait changes were seen with a rat model of PVD. The study population was comprised of 10 controls and 9 subjects with PVD (all male). The PVD group had documented pain in one or both legs while walking. Subjects ranged in age from 55-92 years of age, with a mean age of 69 in the PVD group and 70 in the control group. The GaitMat II system was used to measure both spatial and temporal variables of gait. Subjects walked across the mat, four to six times, at their comfortable walking speed. The PVD group then walked on a treadmill until they experienced moderate claudication pain and felt they had to stop (pain levels between 6 and 8, with maximal pain at level 10). Control group walked on a treadmill for 10 minutes without pain. All subjects repeated the gait tests on the GaitMat H system immediately after treadmill walking. Claudication pain persisted in the PVD group during the second gait test. The PVD group was not different than control group in any of the measured variables on the first test (p values from .35 to .99). Difference scores (post- minus pre-treadmill walking)for PVD group were significantly different than those for control group on 8 of 11 variables (p values <.005). The primary response in PVD subjects was reduced walking speed (1.02+/-0.16 to 0.94+/-0.16 m/s) and reduced step length (0.60+/-0.08 to 0.57+/-0.09 m/s), whereas control subjects increased their speed (1.09+/-0.17 to 1.19+/-0.19 m/s) and step length (0.63+/-0.10 to 0.67+/-0.10 m/s). No asymmetries in gait were measured in either group, either before or after treadmill walking. In conclusion, PVD subjects were not different in gait while rested, but responded to claudication pain by reducing preferred walking speed and step size.

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PubMed1999

Arachidonic acid-induced hind limb gangrene: a new experimental rat model of peripheral vascular disease.

The purpose of this study was to investigate the characteristics of arachidonic acid-induced peripheral vascular disease in rats. Injecting arachidonic acid (2 mg/leg) into the femoral artery caused hind limb gangrene. Histopathological examination revealed occlusive thrombi and marked vascular injury, including denudation of the endothelium and degeneration of the media in the paw arteries. Arachidonic acid injection markedly enhanced the platelet response to both U-46619 and collagen. Although the number of circulating platelets did not differ between sham-operation rats and arachidonic acid-injected rats, the numbers of circulating white blood cells and red blood cells were raised 10 d after arachidonic acid injection. Thrombocytopenia, induced before arachidonic acid injection, markedly suppressed arachidonic acid-induced hind limb gangrene in rats. In addition, the combined administration of aspirin (100 mg/kg/d, p.o.) and ticlopidine (300 mg/kg/d, p.o.) prevented the progression of arachidonic acid-induced hind limb gangrene. These results suggest that platelets are involved in the progression of arachidonic acid-induced hind limb gangrene. This experimental rat model may be suitable for developing novel drugs for the treatment of peripheral vascular disease.

Animals↗
PubMed2003

Pulse pressure as a risk factor for peripheral vascular disease in type 2 diabetic patients.

This study examined whether pulse pressure (PP) could be an independent predictor and associated with severity of peripheral vascular disease (PVD) in 396 type 2 diabetic patients (143 men and 253 women, aged 64.1 +/- 11.2 years). Peripheral vascular disease was diagnosed by an ankle-brachial index (ABI) < 0.90 and as severe PVD if ABI < 0.80. Association was evaluated before and after adjustment for age, sex, diabetes duration, hypertension, smoking, fasting plasma glucose (FPG), total cholesterol (TC), usage of insulin, and usage of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB); and for systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), respectively. Results showed that PP increased from no (n = 348) to mild (n = 25) and severe (n = 23) PVD (one-way ANOVA, p < 0.001; multiple comparisons, p < 0.05 for any two groups). The PP increase from no to mild PVD was due to SBP increase; while further increase to severe PVD was due to both DBP drop and an even higher SBP. Adjusted odds ratio (AOR) for PVD for every 1-mmHg PP increment was 1.035 (1.012-1.058). When PP was categorized as tertiles (< 50, 50-59 and > or = 60 mmHg), respective AOR for PVD for second and third vs. first tertile was 2.605 (1.008-6.729) and 2.835 (1.123-7.156). Pulse pressure was also predictive for ABI independent of the effects of the confounders and the other parameters of blood pressure. In conclusion, PP was an independent predictor and correlated with severity of PVD in type 2 diabetic patients.

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PubMed1983

Use of transcutaneous O2 monitoring in the intraoperative management of severe peripheral vascular disease.

Transcutaneous O2 (PtcO2) and CO2 (PtcCO2) monitoring has been used in infants, in critically ill adults, and more recently, in peripheral vascular disease. The present report compares values of centrally placed chest (PtcO2 and PtcCO2) sensors with values of peripherally placed calf (Ptc'O2 and Ptc'CO2) sensors in a patient with severe peripheral vascular disease during performance of an axillofemoral bypass graft. The calf Ptc'O2 values may be expressed as a ratio of their corresponding PaO2 values or as a percentage of the chest PtcO2, i.e., calf Ptc'O2/chest PtcO2 X 100. The ratio reflects local tissue perfusion in the face of fluctuating PaO2 and central PtcO2 values. The data demonstrate that PtcO2 sensors reflect tissue blood flow and oxygenation and, therefore, are useful measures of tissue perfusion, especially during limb revascularization.

Arterial Occlusive Diseases↗
PubMed1995

The distribution of peripheral vascular disease in a Dutch Caucasian population: comparison of type II diabetic and non-diabetic subjects.

OBJECTIVES: To study the distribution of peripheral vascular disease and the relationship to diabetes. DESIGN: Prospective population based study of Dutch caucasian inhabitants. METHODS: From a total of 10,500 subjects aged between 50 and 75 years, 2484 Caucasian inhabitants were screened with respect to their glucose tolerance. Subjects using oral antidiabetic agents or insulin were classified directly as having diabetes mellitus. The other participants were screened using two oral glucose tolerance tests and classified using WHO criteria. A group of 173 people with diabetes and a representative age/sex stratified sample of 288 non-diabetic subjects were seen in the vascular laboratory. Carotid artery disease was investigated with Duplex scanning, arm and leg artery obstructions with real time frequency analysis of continuous wave Doppler signals and indirect blood pressure measurements. RESULTS: Comparing diabetic with non-diabetic subjects, we found significantly more obstructions of the carotid arteries (8.7 vs 2.8%), arm arteries (2.3 vs 0%), as well as leg arteries (31.8 vs. 18.4%). The same holds if only the crural artery obstructions were compared (23.7 vs 16.0%). Two of the four diabetic subjects with arm artery obstructions had retrograde vertebral flow, three of them had carotid artery obstructions as well, and three also had leg artery obstructions. More than half of the subjects with a carotid artery obstruction, also had leg artery obstructions. CONCLUSIONS: Peripheral vascular disease is common in diabetes, but most are asymptomatic.

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PubMed1977

Focal lesions of muscle in peripheral vascular disease.

Lesions in skeletal muscle resulting from ischemia caused by peripheral vascular disease in two patients were essentially identical to the early muscle lesions of Duchenne muscular dystrophy (DMD) patients and carriers of that disease, as well as to the early muscle lesions of experimental animals with aorta ligations plus a small dose of 5-hydroxytryptamine (serotonin). The one similarity is harmonious with, although does not necessarily advance, the ischemia hypothesis of DMD, and the other supports the ischemia mechanism proposed in the animal model.

Adult↗
PubMed1998

Pharmacologic management of peripheral vascular disease.

Although our understanding of the pathophysiology of atherosclerosis and peripheral vascular disease continues to grow, we have yet to discover a medication that can safely and efficaciously be given to most claudicants that will alleviate their symptoms to prevent disease progression. Many patients with intermittent claudication improve or remain stable without therapy if they attempt to alter their risk factors (e.g., control of diabetes, smoking cessation, lowering of cholesterol levels). However, many require concomitant drug therapy to alleviate symptoms of PVD, and some require surgical intervention. Even with the recent advances in therapeutic development and the promise of agents currently in clinical trials, the questions of who to treat, when treatment should begin, and which agent to use remain uncertain.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1990

Plasma lipids as a risk factor in peripheral vascular disease.

Plasma lipids were tested in 59 patients with symptomatic peripheral vascular disease (PVD) (confirmed by angiographic and, in many cases, operative examinations) and compared with the lipid balance in 47 nonarteriopathic subjects constituting the control group. Of all the elements considered, only the hypertriglyceridemia and the fall in the HDL cholesterol/total cholesterol ratio showed a statistically significant difference between the two groups. In particular, there was a significant difference between the two groups. In particular, there was a significant difference in the triglyceridemia present in the arteriopathic patients, as evidenced by the double check afforded by the frequency test (PVD: 25/59; control: 8/47; p less than 0.01) and the averages test (PVD: 201 +/- 131; control: 138 +/- 98; p less than 0.01).

Arteriosclerosis↗
PubMed1986

Comparison of intra-arterial digital subtraction angiography and conventional filming in peripheral vascular disease.

We studied a series of 114 patients with ischemic peripheral vascular disease angiographically by conventional film-screen (CF) and by intra-arterial digital subtraction (DSA) techniques. The quality of films and images was evaluated at four anatomic levels. We reached the following conclusions: a) in most patients a DSA study will suffice for diagnosis; b) an ability to see arteries was related to the film or image quality; c) in the pelvis, although most studies were of excellent quality, more CF than DSA were of excellent quality; d) in the thigh, both CF and DSA studies were mostly of excellent quality; e) in the leg and foot, more DSA than CF studies were of excellent quality; f) patients preferred DSA to CF studies; g) physician acceptance of DSA was mixed; and h) good patient hydration can reduce the potential renal complications of the larger contrast loads used in CF studies.

Angiography↗
PubMed1977

Atherosclerosis: a major cause of peripheral vascular disease.

Atherosclerosis is one of the most common causes of peripheral vascular disease. Complications result from arteries compromised because of focal accumulations of lipids and other materials within and between cells in the vessel walls. Factors including hyperlipidemia, hypertension, diabetes mellitus, obesity, physical inactivity, smoking, social stress, and genetic background have been implicated as promoting a higher risk of atherosclerosis and its consequences.

Animals↗
PubMed1996

The effect of peripheral vascular disease on long-term mortality after coronary artery bypass surgery. Northern New England Cardiovascular Disease Study Group.

OBJECTIVE: To examine the effect of peripheral vascular disease (PVD) on long-term mortality after successful myocardial revascularization. METHODS: We performed a regional cohort study of 2871 consecutive patients discharged alive after coronary artery bypass graft surgery at five tertiary care centers in Maine, New Hampshire, and Vermont between 1987 and 1989. Data reflecting patient characteristics, heart disease severity, and comorbidity were collected prospectively; the presence of clinical and subclinical indicators of PVD was determined by medical record review; and vital status was determined using the National Death Index (mean follow-up, 4.4 years). RESULTS: Five-year mortality following coronary artery bypass graft surgery was substantially higher in the 755 patients with indicators of PVD (20%; 95% confidence interval [CI], 17% to 23%) than in the 2116 patients without PVD (8%, 95% CI, 7 to 9; P<.001). The crude hazard ratio of long-term mortality associated with PVD was 2.77 (95% CI, 2.19 to 3.50; P<.001). After adjusting for their higher comorbidity scores, more advanced cardiac disease, and age, mortality rates in patients with PVD remained twice as high as those in patients without PVD (adjusted hazard ratio, 2.01; 95% CI, 1.57 to 2.58; P<.001). Long-term mortality was increased in patients with any of the indicators of PVD. Patients with multilevel PVD had especially high late mortality rates (adjusted hazard ratio, 2.46; 95% CI, 1.64 to 3.68; P<.001). CONCLUSIONS: Even after successful myocardial revascularization, patients with PVD remain at substantially increased risk for long-term mortality. The presence of clinical or subclinical PVD is important when predicting both short- and long-term outcomes in patients considering coronary artery bypass graft surgery.

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