SEARCH · PubMed Health

Results for “VASCULAR DISEASES PERIPHERAL”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 397 records · Page 22Linked to original sources

PubMed2006

Risk factors for premature peripheral vascular disease: results for the National Health and Nutritional Survey, 1999-2002.

PURPOSE: Premature peripheral vascular disease (PVD), occurring <60 years of age, is associated with significant cardiovascular morbidity, limb loss, and death. We hypothesized that different risk factors predict the development of PVD in patients <60 years than in patients > or =60 years. METHODS: To address this question, we conducted a population-based observational study using the National Health and Nutritional Survey (NHANES) data set, which represents the noninstitutionalized civilian population in the United States. From 1999 to 2002, 5083 participants were analyzed as part of the NHANES survey. PVD status was defined by an ankle-brachial index (ABI) of <0.9. Putative risk factors for the development of PVD were collected by physical examination, interview, and laboratory testing. Univariate and multivariate logistic regression analyses were used to evaluate interactions between age strata and the development of PVD. RESULTS: Premature PVD was found in 2.1% +/- 0.2% of the population <60 years, and PVD was found in 12.0% +/- 0.8% of the population > or =60 years. This corresponds to approximately 1.44 million people with premature PVD. Multivariate analysis determined coronary artery disease (odds ratio [OR] 2.90 vs 1.26, P = .083) and elevated serum fibrinogen (OR 1.07 vs 1.03, P = .034) were stronger predictors of PVD in subjects <60 years than in older subjects. Chronic renal insufficiency (OR 1.02 vs 1.16, P = .006) was more highly predictive of PVD in subjects >60 years. Other significant predictors, irrespective of age, in the multivariate model included hypertension (OR 1.99, P < .001), smoking (OR 2.22, P < .001), and serum homocysteine (OR 1.27, P = .067). CONCLUSIONS: Clinicians should be aware of the high risk of developing premature PVD in patients <60 years with coexisting coronary artery disease or elevated plasma fibrinogen. Routine screening by ABI measurements in high-risk patients would enhance the detection of subclinical premature PVD and allow for secondary intervention.

Age of Onset↗

PubMed1999

Asymptomatic carotid artery stenosis associated with peripheral vascular disease: a prospective study.

This study aimed to determine the prevalence of symptomless internal carotid artery stenosis in consecutive patients presenting with peripheral vascular disease. Duplex ultrasound screening of the carotid arteries was used to determine the degree of stenosis. Co-morbidities were recorded together with age, sex and tobacco use. Internal carotid artery stenosis of > 50% was found in 35% of patients. Among these there was > or = 70% stenosis in 18% of patients and of this group 5% had an occluded carotid vessel at first presentation. Males presented with peripheral vascular disease and associated carotid stenoses at a younger age than females. Male smokers had a higher prevalence of stenosis (P = 0.036) but all smokers had developed stenoses 3-5 years before non-smokers. Females with abdominal aortic aneurysms had a greater prevalence of carotid stenosis (P = 0.037), and male aneurysmal disease diminished stenosis prevalence (P = 0.023). Men with an elevated serum creatinine were more likely to have a stenosis (P = 0.019), but not women. The other co-morbidities were not specifically associated with carotid artery stenosis.

Adult↗

PubMedDate not supplied

Comparison of risk factors of macrovascular complications. Peripheral vascular disease, cerebral vascular disease, and coronary heart disease in Japanese type 2 diabetes mellitus patients.

Although macroangiopathies such as peripheral vascular disease (PVD), cerebral vascular disease (CVD), and coronary heart disease (CHD) can often be observed in patients with diabetes mellitus, they are not specific for diabetes mellitus. Moreover, it is unclear whether their progressive mechanism is different. In the present study, we compared the risk factors among the diabetic macrovascular complications. Univariate analyses showed that in all patients, age at examination, duration of diabetes, thrombin-antithrombin III complex (TAT) level, fibrinogen level, lipoprotein (a) (Lp(a)) level, total cholesterol (T-Chol) level, and existence of microagiopathy were risk factors for PVD. Age, duration of diabetes, insulin level, TAT level, fibrinogen level, HDL cholesterol (HDL-Chol) level, hypertension, and nephropathy were risk factors for CVD. Only fibrinogen level was a risk factor for CHD. Moreover, Lp(a) level was a risk factor for PVD and CVD in male patients, but not in females. On the other hand, insulin level was a risk factor for CVD in female patients, but not in males. Multivariate analyses showed that TAT level, T-Chol level, and neuropathy were independent variables for PVD and that age, TAT level, and HDL-Chol level were independent variables for CVD. On the other hand, only fibrinogen level was the independent variable for CHD in males. Our results suggest that the progressive mechanism of PVD and CVD might be different from that of CHD and might differ according to gender in Japanese diabetic patients.

Blood Glucose↗

PubMed2000

Correlation between plasma total homocysteine and copper in patients with peripheral vascular disease.

BACKGROUND: Increased concentrations of both plasma total homocysteine and copper are separately associated with cardiovascular disease. Correlations between plasma total homocysteine, trace elements, and vitamins in patients with peripheral vascular disease have not been investigated. METHODS: The concentrations of trace elements in plasma were determined by the multielement analytical technique of total-reflection x-ray fluorescence spectrometry. Plasma total homocysteine was determined by HPLC. RESULTS: In the univariate and multivariate regression analyses, copper was positively correlated with plasma total homocysteine in all subjects (coefficient +/- SE, 0.347 +/- 0.113; P = 0.0026 and coefficient +/- SE, 0.422 +/- 0.108; P = 0.0002, respectively), and in patients with peripheral vascular disease (coefficient +/- SE, 0.370 +/- 0.150; P = 0.016; and coefficient +/- SE, 0.490 +/- 0.151; P = 0.0025, respectively). Correlation between copper and plasma total homocysteine was not detected in healthy control subjects. The concentration of calcium in plasma (67.5 vs 80. 8 microg/g) was significantly lower in the patients than in the control subjects (P = 0.02). When the patients were divided into groups, the patients with suprainguinal lesions had significantly higher copper concentrations (P = 0.04) and significantly lower selenium and calcium concentrations (P = 0.01 and 0.008, respectively) than the healthy subjects. Patients had higher concentrations of autoantibodies against oxidized LDL and concentrations of thiobarbituric acid-reactive substance than the healthy subjects (P <0.0001 and P = 0.001, respectively). The concentrations of plasma total homocysteine and alpha-tocopherol were significantly higher, and the concentrations of vitamin B(6) and beta-carotene were lower in the patients than the healthy subjects. CONCLUSION: Our findings suggest that the atherogenicity of homocysteine may be related to copper-dependent interactions.

Antioxidants↗

PubMedDate not supplied

Resting plasma fibrinolytic activity and fibrinolytic potential in peripheral vascular disease.

Reduced plasma fibrinolytic activity may be a risk factor in venous and arterial thrombotic disease. Resting plasma fibrinolytic activity and fibrinolytic potential after ten minutes of venous occlusion were compared in 100 patients with peripheral vascular disease of varying severity and 20 age-sex matched controls. The fibrinolytic assay used was the euglobulin lysis time. Resting plasma fibrinolytic activity was significantly reduced in patients with a recent arterial thrombosis (p = 0.02) and ischaemic rest pain (p = 0.008) compared with controls. Fibrinolytic potential after venous occlusion was significantly reduced also in patients with a recent arterial thrombosis (p = 0.02) and ischaemic rest pain (p = 0.05) compared with controls. There were no significant differences between patients with claudication and controls. A reduced plasma fibrinolytic activity has been confirmed in patients with peripheral vascular disease and fibrinolytic potential may be a superior method of assessment as the euglobulin lysis time after venous occlusion is independent of the fibrinogen concentration. It remains uncertain whether the finding of reduced plasma fibrinolytic activity in patients with peripheral vascular disease is cause or effect and whether the finding has prognostic significance.

Aged↗

PubMed1991

Preoperative evaluation of patients with peripheral vascular disease.

Coronary artery disease is the leading cause of death after revascularization procedures for abdominal aortic aneurysms and peripheral vascular disease. Late survival after vascular procedures is substantially reduced, largely by the high incidence of subsequent cardiac events. At the Lahey Clinic, it is not our practice to perform routine coronary angiography before elective revascularization. Thallium myocardial perfusion imaging should be performed in all patients before operation. Abnormal results on thallium exercise scanning showing multiple perfusion abnormalities or lung uptake at peak exercise identify patients who are candidates for preoperative cardiac catheterization. When severe correctable coronary artery disease is identified, these patients should be considered for coronary artery bypass surgery before vascular operation.

Coronary Artery Bypass↗

PubMed2004

The role of endothelial cell reactive antibodies in peripheral vascular disease.

The mechanism by which a small but significant proportion of patients with peripheral vascular disease (PVD) rapidly progress to critical ischaemia is unclear. Both experimental and clinical data suggest a role for autoantibodies in the pathogenesis of atherosclerotic disease, particularly in the accelerated atherosclerosis seen in patients with systemic lupus erythematosus and the anti-phospholipid syndrome. This review examines the evidence for a role for endothelial cell reactive autoantibodies in PVD and the potential mechanisms by which these autoantibodies could contribute to the acceleration of atherosclerosis in a proportion of patients. The identification of such markers could lead to the identification of patients with PVD who are at risk of developing critical ischaemia and may warrant early and aggressive intervention.

Animals↗

PubMed1996

Peripheral vascular disease in spinal cord injury patients: a difficult diagnosis.

The timely detection of peripheral vascular disease (PVD) in spinal cord injury (SCI) patients is difficult because the usual symptoms of claudication and rest pain are absent. In fact, the initial manifestation of PVD in SCI patients is often advanced gangrene, so that healing, primarily or following major amputation, is either difficult and prolonged or impossible. In addition, sacral and ischial pressure sores common among SCI patients may be exacerbated and reconstruction made more difficult by PVD. Five SCI patients presented with lower extremity gangrene as the initial recognized manifestation of PVD at our institution between January 1992 and January 1994. All 5 patients had risk factors for PVD. Four out of ten limbs in these patients required amputation, either above the knee or below the knee. Three patients required concurrent vascular reconstruction of the aortoiliac segments, including an aortobiprofunda femoral bypass, an iliac embolectomy with femoral-femoral bypass, and iliac angioplasty. Three patients had ischial and/or sacral pressure sores that had recurred following multiple musculocutaneous flap reconstructions before vascular disease was recognized. The timely diagnosis of PVD involving the iliac segment in the SCI patient is sometimes overlooked and is often necessary to optimize the treatment of both lower extremity ulcers and sacral/ ischial pressure sores common among these patients.

Adult↗

PubMed1991

Antihypertensive treatment in concomitant peripheral vascular disease: current experience and the potential of carvedilol.

The relative importance of hypertension as a risk factor for peripheral vascular disease is of the same order as coronary artery disease. The design of drug studies in occlusive vascular disease presents several problems. First, investigations must be placebo-controlled and crossover in design. Second, since these patients are very much at risk from other vascular occlusions, length of treatment phase is critical. Third, drug doses are also critical--probably best chosen by titration to similar antihypertensive effect. Fourth, patients must be trained in treadmill procedure. Fifth, measurements of limb blood flow must be accompanied where possible by "functional" assessment, e.g., claudication distance. With respect to the specific problem of low perfusion pressure distal to the blockage of peripheral vasculature, resting blood flow may remain normal, implying compensatory reduction in tone of arteriolar resistance vessels. Thus, regional circulation distal to blockage is sensitive to changes in perfusion pressure. There is the risk of "steal" with vasodilator agents; however, conflict exists in the literature over effects of beta-blockers in this situation. In view of its peripheral hemodynamic profile, the theoretical possibilities with the beta-blocker/vasodilator carvedilol in patients with hypertension and peripheral vascular disease seem extremely rewarding, but remain to be borne out in practice.

Adrenergic beta-Antagonists↗

PubMed1993

Apolipoprotein(a) genetic polymorphism and serum lipoprotein(a) concentration in patients with peripheral vascular disease.

Serum lipoprotein(a) (Lp(a)) levels were measured in 89 men with peripheral vascular disease (PVD) and 129 (100 male and 29 woman) healthy controls. Apolipoprotein(a) genetic polymorphism was determined by immunoblotting in all subjects. Patients with PVD had significantly higher serum Lp(a) levels than controls. Apolipoprotein(a) phenotype frequencies in patients with PVD did not differ from those of the control group. Both patients and controls with phenotype S2 had higher serum Lp(a) levels than those with phenotype S4. It should be emphasized that serum Lp(a) levels were significantly higher in PVD patients than controls for those with phenotype S2, S3/S4 and S4. Raised serum Lp(a) levels together with other lipoprotein abnormalities in patients with PVD imply a high cardiovascular risk. Genetic polymorphism clearly influences serum Lp(a) levels both in patients and controls. In patients with PVD, environmental and/or other genetic factors must play a role in raising Lp(a) levels.

Adult↗

PubMedDate not supplied

Plasma high density lipoproteins in coronary, cerebral and peripheral vascular disease. The influence of various risk factors.

High density lipoprotein (HDL) cholesterol and the HDL/total cholesterol ratio have been measured in 440 patients with coronary, cerebral or peripheral vascular disease and in 440 matched controls. The patients were subdivided into sex- and age-groups and according to physical activity, smoking, hypertension and non-insulin-dependent and insulin-dependent diabetes mellitus. The average HDL cholesterol level was significantly decreased in all the three groups of localization of ischaemic vascular disease (IVD). Plasma HDL concentration in men was lower than in women in every age-group. Lowest values were measured in patients with cerebral vascular diseases. From among the risk factors supposed to be related to IVD, lack of physical exercise resulted in a decrease of HDL cholesterol and HDL/total cholesterol values. In all the three localizations of IVD cigarette smokers had lower HDL levels than non-smokers. The influence of hypertension on serum HDL concentration was not unidirectional. The coexistence of non-insulin-dependent diabetes and IVD resulted in decreased lipid parameters. The sera of insulin-dependent diabetics had higher HDL contents and higher HDL/total cholesterol ratios than those of non-diabetics in all the three localizations of the vascular disease in men and in women suffering from peripheral vascular disease.

Adult↗

PubMed2001

Incidental renal artery stenosis in peripheral vascular disease: a case for treatment?

BACKGROUND: Renal artery stenosis (RAS) is frequently encountered as an incidental finding in peripheral vascular disease. We assessed whether revascularization is indicated to prevent the practical consequences of end-stage renal failure, that is, the need for renal replacement therapy. METHODS: In a retrospective study, a cohort of consecutive patients was followed who had undergone angiography 8 to 10 years previously for peripheral artery disease. Patients with untreated incidental RAS of > or =50% diameter stenosis (68.8 +/- 9.8 years, mean +/- SD) were compared with regard to the prevalence of renal replacement therapy to controls without RAS who were matched for age and gender. RESULTS: RAS was present in 126 of 386 evaluable patients (33%). None of these patients required renal replacement therapy during the 10-year follow-up. Serum creatinine values remained stable during follow-up. CONCLUSIONS: Incidental RAS is frequently seen in patients with peripheral vascular disease. If left untreated, incidental RAS seems not to result in end-stage renal failure or in a need for renal replacement therapy. Revascularization with the aim to prevent end-stage renal failure seems less indicated, and further prospective studies are indicated to elucidate this issue.

Aged↗

PubMed1999

The effects of peripheral vascular disease with osteomyelitis in the diabetic foot.

BACKGROUND: Osteomyelitis in the diabetic foot is a difficult problem with multiple etiologies. The effects of peripheral vascular disease, neuropathy, and repetitive trauma all interact to produce complex lesions with exposed bone, surrounding cellulitis, and gangrenous changes. METHODS: We performed a retrospective study over a 14-year period at a community hospital looking at osteomyelitis in the diabetic foot. We looked at the contributing factors, organisms involved, most common locations, physical findings, and surgical procedures necessary to treat this condition. The purpose of the study was to determine the incidence and effect of peripheral vascular disease in diabetic patients with foot ulcers. RESULTS: There were a total of 150 patients requiring 278 hospitalizations over the 14-year period who represented 14% of all diabetic admissions. A total of 438 surgical procedures were necessary in these patients, with the most common being debridement (39%) and toe amputation (19%). There were 6 deaths (4%) in this series, and leg amputation was necessary in 21 patients (14%). A vascular bypass was necessary for healing and limb salvage in 36 patients (24%). Most of the bypasses (85%) were with autogenous tissue to the distal leg in order to limit the extent of amputation and to preserve a functional limb. CONCLUSION: Ischemia is often a contributing factor in the diabetic foot ulcer that must be recognized and treated to avoid prolonged hospitalization, spreading infection, and unnecessary amputation.

Adult↗

PubMed2002

Contrast-enhanced magnetic resonance angiography MoBI-trak in the study of peripheral vascular disease.

PURPOSE: To evaluate the diagnostic accuracy of contrast-enhanced magnetic resonance angiography (CE-MRA) MoBI-trak of peripheral vessels in patients with peripheral vascular disease who were candidates for digital subtraction angiography (DSA). METHODS: Eleven patients underwent CE-MRA with automated table movement (MoBI-trak) using a 1.5 T superconducting magnet (Philips Gyroscan ACS NT) equipped with a Power Trak 6000 gradient. Contrast medium (Gd-DTPA) was administered in two sequential boluses-20 cm(3) at 0.6 cm(3)/sec (starting phase) and 20 cm(3) at 0.3 cm(3)/sec (maintenance phase)-using a MedRad Spectris automatic injector. DSA was the gold standard and was performed using a Philips Integris 3000, with a brilliance intensifier of 38 seconds. DSA and MRA were evaluated on printed films. RESULTS: DSA provided 213 diagnostic assessments: 144 negative, 30 stenosis <50%, 5 stenoses in the 51-70% range, 12 stenoses in the 71-99% range and 22 occlusions. CE-MRA MoBI-trak sensitivity, specificity, positive and negative predictive value and diagnostic accuracy were 94.1%, 99.2%, 98.4%, 80.0% and 97.5%, respectively. CONCLUSIONS: Our work is in accordance with the literature. Using this technique MoBI-trak has been shown to be a reliable technique for the detection of peripheral vascular disease up to the trifurcation, although it underlines the necessity for more diagnostic investigation and improvements in the technique.

Angiography, Digital Subtraction↗

PubMed1995

Abnormal membrane concentrations of 20 and 22-carbon essential fatty acids: a common link between risk factors and coronary and peripheral vascular disease?

Although elevated levels of cholesterol are associated with increased risks of coronary and peripheral vascular disease, the association frequently fails to provide a causative explanation at the individual level. New hypotheses are required which, whether or not they are correct, will provide new lines of research. It is proposed here that the causes of vascular disease are abnormal membrane phospholipid concentrations of the 20-carbon and 22-carbon essential fatty acids (EFAs) of the n-6 and n-3 series. These levels become abnormal with ageing, with stress and in response to smoking, high cholesterol levels and high saturated fat intakes. They are also abnormal in patients with diabetes and hypertension. The effects of these EFAs and their metabolites include lowering of triglycerides, elevation of high-density lipoprotein (HDL)-cholesterol, reduction of blood pressure, vasodilatation, reduction of fibrinogen levels and inhibition of platelet aggregation and of cardiac arrhythmias. Prospective studies have shown that abnormal levels of these fatty acids are predictive of future coronary death. Controlled trials of treatment have demonstrated that provision of the fatty acids reduces both coronary and total mortality. Further experimental and clinical investigations of the roles of appropriate membrane concentrations of these fatty acids are justified.

Animals↗

PubMed2002

Risk of myocardial infarction and angina in patients with severe peripheral vascular disease: predictive role of C-reactive protein.

BACKGROUND: Patients undergoing revascularization procedures for peripheral vascular disease (PVD) have a greatly increased risk for coronary artery disease (CAD) that is predicted only partly by clinical data and cardiovascular risk factors. We investigated whether the prognostic assessment in PVD patients could be improved by preoperative measurements of C-reactive protein (CRP). METHODS AND RESULTS: We assessed clinical and risk factors profiles, Eagle clinical scores, and preoperative CRP serum levels in 51 patients with PVD at Fontaine-Leriche stages II to IV without severe rest ventricular dysfunction or ischemia. During 24 months of follow-up, 17 patients (34%) had fatal (11) or nonfatal (6) myocardial infarction (MI). With univariate logistic regression analysis, only previous history of CAD, Eagle score, and CRP were independently related to MI. At multivariate logistic regression analysis, only CRP values in the upper tertile (<9 mg/L) were significantly associated with MI (P<0.05) and identified 65% of cases. CONCLUSIONS: The high incidence of MI in patients with PVD severe enough to require revascularization is strongly predicted by preprocedural measurements of serum CRP, independent of previous CAD, Eagle score index, and traditional cardiovascular risk factors. These patients may benefit from therapy modulating the inflammatory response.

Aged↗

PubMed2001

Depression in older people with mild stroke, carotid stenosis and peripheral vascular disease: a comparison with healthy controls.

BACKGROUND: Although depression has a recognised association with stroke, the role of "silent" cerebrovascular pathology associated with carotid stenosis and peripheral vascular disease remains unexplored. METHODS: Four groups of 25 community residents aged 65 and over were recruited, comprising first anterior circulation stroke, carotid stenosis accompanied by transient ischaemic attack, peripheral vascular disease and a non-vascular control group. All participants were interviewed using the Hamilton Rating Scale for Depression [HRSD] (including a modified version) and Geriatric Depression Scale. DSM IV criteria for major depression and measures of handicap, social support and physical illness were also administered. Head computerised tomography (CT) scans were performed on stroke patients to examine the relationship between lesion location and depression. RESULTS: One hundred patients were interviewed. Stroke patients were more likely to live in a nursing home and had less social support than other groups. Mean scores on the modified Hamilton and Geriatric Depression Scales were higher in stroke and carotid stenosis groups than controls. Patients with stroke did not show a higher prevalence of DSM IV major depressive disorder than those with carotid stenosis. There was no relationship between the presence of lesions affecting the frontal/subcortical system and prevalence/severity of depression. LIMITATIONS: Small numbers, mortality of stroke patients in hospital, possible selection bias in the control group and use of a previously unvalidated depression rating scale all limit the study. CONCLUSIONS: A possible role for carotid stenosis in the pathogenesis of depressive disorder is suggested. Larger studies incorporating brain imaging may be required to examine the mechanism of this association more closely. The use of a shorter version of the HRSD in older people with cerebrovascular disease may warrant further exploration.

Aged↗

PubMed1999

Beta3 integrin--a promiscuous integrin involved in vascular pathology.

OBJECTIVE: To determine whether beta3 integrin is present in blood vessels involved by atherosclerosis, Mönckeberg's medial calcinosis, vein graft atherosclerosis, transplant graft vascular disease and arterial restenosis. DESIGN: Retrospective histological and immunohistochemistry examination of tissues obtained from autopsy and surgery. SETTING: Tertiary care hospital. PATIENTS: The patients had surgical excisions of limbs, grafts, veins and arteries for the treatment of ischemic heart disease and peripheral vascular disease. Other tissues were derived from autopsies of the same patient populations. MAIN RESULTS: Beta3 integrin was found in the blood vessels involved in all of the vascular diseases examined. The location of the integrin varied among the diseases. Osteopontin, a bone sialoprotein involved in atherosclerosis and vascular repair, was also commonly detected. CONCLUSIONS: Beta3 integrin expression noted in the present study confirms the presence of this integrin in arteries with restenosis and atherosclerosis, which expands its involvement to the processes of transplant graft vascular disease, peripheral vascular disease and vein graft disease. The integrin may influence cell migration and adhesion by its interaction with noncollagenous matrix proteins, including osteopontin.

Arteriosclerosis↗