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PubMed2004

Survival in patients with peripheral vascular disease after percutaneous coronary intervention and coronary artery bypass graft surgery.

BACKGROUND: Patients with peripheral vascular disease (PVD) undergoing coronary revascularization have high rates of adverse outcomes. Whether there are important differences in outcomes for surgical versus percutaneous coronary revascularization is unknown. The objective of this study was to compare survival in patients with PVD who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) surgery for multivessel coronary artery disease. METHODS: In-hospital data were collected on 1,305 consecutive patients undergoing coronary revascularization (PCI, n = 341; CABG, n = 964) in northern New England from 1994 to 1996. Patient records were linked to the National Death Index to assess survival out to 3 years (mean 1.2 years). Logistic and Cox proportional hazards regression were used to calculate risk-adjusted odds ratios and hazard ratios. RESULTS: Compared with CABG patients, those undergoing PCI were more often women, had more renal failure, more prior coronary revascularizations, were more likely to have two-vessel coronary artery disease and were more likely to undergo the procedure emergently. They were less likely to have a history of heart failure. After adjusting for differences in baseline characteristics, patients undergoing CABG had better intermediate survival than did PCI patients (hazard ratio 0.68; 95% confidence interval, 0.46 to 1.00; p = 0.05). CONCLUSIONS: Patients with multivessel coronary artery disease and PVD undergoing CABG surgery have better intermediate survival out to 3 years than similar patients undergoing PCI. This information may be useful in counseling patients with PVD requiring coronary revascularization.

Aged↗
PubMed1999

Peripheral vascular disease in Behcet's syndrome.

We describe a patient with Behcet's syndrome who had peripheral vascular disease involving the left subclavian artery for which angioplasty with stent placement was performed and reangioplasty done for in-stent restenosis. She presented with recurrence one year after stent placement; angiography revealed diffuse disease of the axillary and radial arteries with mild to moderate restenosis at the site of stent placement.

Adult↗
PubMed2004

Effects of R-102444, an orally active 5-HT2A receptor antagonist, in rat models of peripheral vascular disease.

R-102444 is a prodrug that is metabolized into R-96544, a potent and selective 5-hydroxytryptamine2A (5-HT2A) receptor antagonist. The effects of R-102444 on peripheral vascular disease were examined using two different rat models: one induced by lauric acid and the other by ergotamine plus epinephrine. R-96544 (0.3-30 nM) relaxed the 5-HT (3 microM)-precontracted rat caudal artery in a concentration-dependent manner. The intravenous administration of R-96544 (0.3-3 microg/kg) to anesthetized rats inhibited the pressor response to 5-HT (50 microg/kg i.v.) dose dependently. The oral administration of R-102444 (1 mg/kg) to rats resulted in a marked inhibition of platelet aggregation induced by 5-HT plus ADP, and statistically significant inhibition was still evident 8 h after the dosing. In contrast, sarpogrelate, at a dose of 100 mg/kg p.o., produced only a moderate antiplatelet effect. Oral administration of R-102444 (1 mg/kg/day, o.d.) significantly prevented the progression of peripheral vascular lesion induced by the injection of lauric acid into a rat femoral artery, whereas sarpogrelate (100 mg/kg/day) showed only a minimal effect. Both 5-day treatments with R-102444 (1-30 mg/kg/day p.o., o.d.), one commenced 1 h before the injection of epinephrine plus ergotamine and one just after injection, resulted in the prevention of rat tail gangrene in a dose-dependent manner, whereas sarpogrelate (100 mg/kg) produced a minimal protection in this model. Based on these results, we conclude that 5-HT2A receptor activation is involved in peripheral vascular disease in the rat and that R-102444 is a useful oral agent for the investigation of diseases involving 5-HT2A receptor activation.

Administration, Oral↗
PubMed1995

Peripheral vascular disease in non-insulin-dependent diabetes mellitus in south India.

The prevalence of peripheral vascular disease (PVD) was assessed in terms of ankle/brachial index by doppler studies in a large cohort of non-insulin-dependent diabetes mellitus (NIDDM) patients in South India. One hundred and ninety-two out of 4941 patients (3.9%) had evidence of PVD. There was a slight female excess in PVD patients. There was a linear increase in prevalence of PVD with increasing duration of diabetes. Multiple logistic regression analyses showed that serum cholesterol, serum creatinine, systolic BP, duration of diabetes and ishaemic heart disease are strong predictive factors for PVD. The prevalence of PVD in South Indians is lower than that reported in European populations.

Adult↗
PubMedDate not supplied

Peripheral vascular disease and type 2 diabetes mellitus.

Patients with Type 2 diabetes mellitus frequently have peripheral vascular disease, with a predilection for the lower legs. In this review potential mechanisms for this high prevalence and altered distribution are explored. It is hypothesised that the metabolic abnormalities in the prediabetic phase predispose to a more distal and aggressive atherosclerosis. Once diabetes has developed this process is accelerated due to chronic hyperglycaemia. Furthermore, endothelial damage, non-enzymatic glycosylation and polyneuropathy could lead to impaired vascular remodelling and collateral formation.

Diabetes Mellitus, Type 2↗
PubMed1990

Patient perspectives on smoking and peripheral vascular disease. A veteran population survey.

In keeping with the recent emphasis on smoking and health, we conducted a survey of patients with peripheral vascular disease in our institution. The objective of the survey was to examine the patient's perspective on a) the relative contribution of smoking to his disease, b) the value of alternative measures to encourage smoking cessation, and c) the smoker's role and responsibility in payment for future health care. One hundred sixty patients at the VAMC in Palo Alto, California, participated in the study. The participants were men who had visited the clinic with complaints related to vascular insufficiency. The "typical" smoker from our survey a) had smoked for more than 30 years, b) acknowledges the association between smoking and disease, and c) will not stop smoking until serious health problems intervene. The majority of respondents expected the same health care regardless of smoking history and did not endorse paying more for health services. Most patients identified serious heart and lung disease as potential sequelae of cigarette smoking, however only 44 per cent of active smokers attributed their peripheral vascular disease to smoking. Although the survey was conducted on patients with complaints related to vascular insufficiency, few respondents identified an association in smoking with gangrene of the lower extremity or leg amputations. It is unclear whether this represents a failure on the part of health professionals to stress this relationship or denial on the part of the smoker. Physicians should continue to advise against cigarette smoking. A strong relationship between continued smoking and lower extremity ischemia or amputation needs to be emphasized in the clinical setting and through public health information campaigns.

Adult↗
PubMedDate not supplied

Living with peripheral vascular disease: patients and their carers.

AIM: This study explores the life experiences of those with peripheral vascular disease (PVD) and their carers. SAMPLE: A sample of seven couples. METHOD: An ethnographic approach using taped interviews in participants' own homes. RESULTS: Acceptance and adaptation were the core concepts to emerge from the data. Pain was identified as being central to the experience of PVD, with impaired mobility, loss of independence, disease progress and professional support being closely interrelated. CONCLUSION: The themes highlighted the devastating nature of the experience of living with PVD. Those with PVD need to feel that the complexity of their experience is understood while carers need to feel their role is acknowledged. Health care professionals should develop their understanding of the experience of PVD for patients and their carers, and apply this knowledge to their practice.

Activities of Daily Living↗
PubMed1990

Effect of fructose 1,6-diphosphate on exercise capacity in patients with peripheral vascular disease.

Exogenous fructose 1,6-diphosphate (FDP), a glycolytic intermediate, increases blood ATP and 2,3 diphosphoglycerate levels, facilitates the dissociation of oxygen from hemoglobin, and increases red blood cell flexibility. These mechanisms explain why it has been effective in enhancing energy production in a variety of ischemic conditions. The present study was undertaken to determine whether FDP could enhance oxygen supply and thus improve exercise performance in patients with peripheral vascular disease. Ten male patients (mean age 63 +/- 5 years) with peripheral vascular disease performed symptom-limited exercise testing after randomized, double blind infusion of either 200 mg/kg body weight FDP or placebo. Data were evaluated at rest, at a matched submaximal workload (2-3 MPH/0% grade), and at peak exercise, defined as the occurrence of moderately severe claudication. No differences were observed in heart rate, blood pressure, gas exchange data, time to the onset of claudication or peak exercise, or lactate and 2,3 diphosphoglycerate levels. In contrast to previous studies performed among patients with peripheral vascular disease and other studies using more severe hypoxic conditions, FDP did not affect the respiratory gas exchange or exercise capacity of patients with exertional claudication.

Aged↗
PubMed1978

The excretion of free cortisol, cortisone, cortisol sulfate and cortisone sulfate in peripheral vascular disease, diabetes mellitus and hyperthyroidism.

In four groups of persons, 1/healthy individuals, 2/ patients with diabetes mellitus, 3/ patients with peripheral vascular disease, and 4/ patients with hyperthyroidism, the urinary excretion of free cortisol, cortisone, cortisol sulfate and cortisone sulfate was estimated. In groups 2 and 3 the excretion of all four substances was elevated. In hyperthyroidism a preponderance of free cortisone over cortisol was registered. The ratios of the followed substances suggest in patients with peripheral vascular disease a detoriation in the normal excretion of the followed corticoids, based on a preponderance of 11-OH-corticosteroids over their 11-oxo-derivatives. This observation could be implicated in the mild hyperglycemia or decreased glucose tolerance, that is often found in atherosclerotic disease.

Adult↗
PubMed1984

Assessment of peripheral vascular disease by postocclusive transcutaneous oxygen recovery time.

A method for assessing peripheral vascular disease (PVD) was developed from the pattern of transcutaneous oxygen (PtcO2) changes after temporary limb ischemia induced by pneumatic blood pressure cuff occlusion. The transcutaneous oxygen recovery half-time (TORT) was defined as the time required to recover half of the decrease in the limb/chest PtcO2 ratio produced by temporary limb ischemia. TORT was examined in subjects with and without significant PVD. Patients who underwent operative therapy for symptomatic PVD were studied before and after operation. Comparison was also made of the values of patients in whom therapy was successful in resolving symptoms vs. those in whom it was not. TORT was found to improve the diagnostic accuracy of PtcO2 measurements to differentiate normal vs. PVD limbs and successful vs. unsuccessful results of therapy. Normal subjects uniformly had TORT values less than or equal to 1.5 minutes at both calf and foot positions; limbs with symptomatic PVD consistently had TORT values that were significantly longer in duration (p less than 0.001). Limbs with PVD that received successful therapy had a significant improvement in calf and foot TORT values after surgery (p less than 0.01); postoperative values were usually slightly longer than those of normal subjects, probably reflecting some residual disease. Postoperatively, limbs with PVD that had received unsuccessful therapy either had only slight improvement or worsening of their TORT values, which were significantly greater than the TORT values of limbs that received successful therapy (p less than 0.001). We conclude that measurement of postocclusive TORT is a reliable method for diagnosing PVD and for quantitatively evaluating residual disease after operative therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1976

Pattern of occlusive peripheral vascular disease in India. (clinicopathological study of 79 cases).

The pattern of peripheral vascular disease in India was studied in 89 patients undergoing amputation for vascular insufficiency. A control group of 26 limbs was studied for aging changes. Clinically, cases were classified into TAO (25), ASO (54) and thrombo-embolic disease (10). Angiographic, macroscopic and microscopic study of dissected vascular tree was done in view of clinical diagnosis. No significant difference was noted in the frequency and extent of involvement of limb arteries in TAO and ASO. Histologically angiitis was noted in 4 cases of TAO and one of ASO but these did not form a distinct clinical group. Primary thrombotic occlusion was seen in 21 cases of TAO and 23 cases of ASO. Atheroma with and without thrombosis was found in 26 cases. In 4 cases the arterial tree was normal. Atheromatous lesions were not seen in control group. In the groups under study they were thought to represent old thrombi rather than degenerative lesions predisposing to thrombosis. In view of these findings it was felt that Buerger's disease was primarily a thrombotic disorder. Angiitis was rare and was probably secondary. The two clinical groups TAO and ASO are not pathologically distinct as very high percentage of the latter showed primary thrombosis. The genesis of thrombosis in two groups however may be different.

Acute Disease↗
PubMed1985

The effectiveness of glycosaminoglycans in peripheral vascular disease therapy: a clinical and experimental trial.

Thirty patients suffering from peripheral vascular disease (stage-II according to Fontaine) were included in a double-blind study aimed at assessing the efficacy of a high-dose glycosaminoglycan (GAG) (Sulodexide) both in terms of laboratory parameters, such as lipid metabolism and blood coagulation components, and instrumental procedures (strain-gauge plethysmography). Compared with the fifteen control patients (treated with placebo), the fifteen patients treated with Sulodexide showed a significant decrease in blood triglycerides and fibrinogen as well as a significantly increased HDL-cholesterol, and positive instrumental changes: at the end of treatment Peak and Rest Flow values--and consequently also Winsor's index--were significantly increased only in patients treated with Sulodexide.

Aged↗
PubMedDate not supplied

Incidence and prevalence of clinical peripheral vascular disease in a population-based cohort of diabetic patients.

Clinical peripheral vascular disease (PVD) was studied in an incidence cohort of 1073 residents of Rochester, Minnesota, who were found to have diabetes mellitus in the period 1945-69. About 8% of patients already had clinical evidence of PVD at the time of diagnosis of diabetes. The proportion increased with the age at which diabetes was discovered. Among those unaffected initially, the incidence of subsequent PVD was slightly greater for men, 21.3 per 1000 person-years, than for women, 17.6 per 1000, and it increased both with age and duration of diabetes. The cumulative incidence of subsequent PVD was estimated to be 15% at 10 yr and 45% at 20 yr after the diagnosis of diabetes. The age-adjusted prevalence of residents with diabetes and a history of PVD was 3.3 per 1000 population 30 yr of age or over on 1 January 1970.

Adult↗
PubMed1991

Wound healing and peripheral vascular disease.

Patients who are hospitalized in the intensive care unit with peripheral vascular disease are at a higher risk for developing complications. The impaired wound healing of this patient population compounds the initial presenting pathology. It is the prudent critical care nurse that realizes this and incorporates this into a plan of care for the patient. Postoperative interventions should be aimed at preserving blood flow and tissue oxygen perfusion and maintaining nutritional requirements to achieve adequate collagen synthesis, angiogenesis, and the prevention of infection.

Critical Care↗
PubMed1988

Angioplasty for peripheral vascular disease.

Surgery is no longer the sole option for patients whose peripheral vascular disease requires treatment beyond conservative management; advances in angioplasty have allowed the physician to offer revascularization procedures even to patients who previously would not have been candidates for surgical reconstruction. Several issues, including the location, severity, and number of lesions and the feasibility of surgery, need to be considered in each case. A team approach, utilizing the skills and expertise of the vascular surgeon, the vascular radiologist (or other physician skilled in angioplasty), and the patient's physician, should ensure that the best choice is made for each patient.

Angioplasty, Balloon↗
PubMedDate not supplied

Blood lipid abnormalities in patients suffering from peripheral vascular disease.

Blood lipid profile was investigated in 40 patients suffering from peripheral vascular disease (PVD). The most frequent abnormality was the increase of cholesterol and triglycerides. HDL-cholesterol and the subfractions HDL2 and HDL3 were decreased but not significantly. Cholesterol/HDL-cholesterol ratio was significantly increased suggesting an abnormal cholesterol distribution on lipoprotein fractions. Apolipoproteins AI and AII were within normal range while apolipoproteins B, CII, CIII, and E were significantly increased. This study provide further findings on the blood lipid abnormalities in patients affected by PVD.

Aged↗
PubMed1976

Management of the patient requiring leg amputation for peripheral vascular disease.

Most leg amputations are performed because of the effects of peripheral vascular disease. Only 50% of such amputations were performed below the knee in Ontario in 1972, although the knee joint should be preserved in most patients. Careful preoperative evaluation is essential. Postoperative problems include gas gangrene for which prophylactic measures are recommended; failure of the stump to heal, which necessitates early revision of the stump; and defects in stump contour, which necessitate late revision. An enthusiastic team approach to rehabilitation is necessary to overcome the physical and mental problems that result from amputation of a leg.

Amputation, Surgical↗