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PubMed1993

Coronary arterial ectasia: increased prevalence in patients with abdominal aortic aneurysm as compared to occlusive atherosclerotic peripheral vascular disease.

Coronary artery ectasia (CAE) is the saccular or fusiform dilatation of a coronary artery. CAE is found in 1.2% to 4.9% of patients at autopsy or during angiographic studies, with a similar prevalence of CAE found in patients with atherosclerotic peripheral vascular disease (PVD). Abdominal aortic aneurysm (AAA) and CAE are similar in pathogenesis and histology. To determine whether CAE occurs more frequently in patients with AAA than in occlusive forms of atherosclerotic PVD, a review of coronary angiograms was performed in patients who underwent cardiac catheterization and vascular reconstruction for AAA or occlusive atherosclerotic PVD of the lower extremities. Of 72 patients with AAA, 15 had CAE (20.8%) compared with only 2 of 69 patients with atherosclerotic PVD (2.9%) (p < 0.003). CAE was predominantly discrete, located in the left coronary system, and associated with significant coronary atherosclerosis. CAE may be more prevalent in patients with AAA resulting from a similar pathogenetic process.

Aged↗
PubMed1995

Calf muscle mitochondrial and glycogenolytic ATP synthesis in patients with claudication due to peripheral vascular disease analysed using 31P magnetic resonance spectroscopy.

1. We set out to define abnormalities of oxidative ATP synthesis, cellular proton efflux and the efficiency of ATP usage in gastrocnemius muscle of patients with claudication due to peripheral vascular disease, using data obtained by 31P magnetic resonance spectroscopy during aerobic exercise and recovery. 2. Eleven patients with moderate claudication were studied and results were compared with 25 age-matched control subjects. Changes in pH and phosphocreatine concentration during recovery were used to calculate the maximum rate of oxidative ATP synthesis (Qmax.) and the capacity of net proton efflux. Changes in pH and phosphocreatine concentration were used to estimate rates of non-oxidative and (indirectly) oxidative ATP synthesis throughout exercise, taking account of abnormalities in proton efflux during exercise. 3. In patients with claudication, slow post-exercise phosphocreatine recovery showed a 42 +/- 9% decrease in Qmax., and the slow ADP recovery was consistent with this. pH recovery was slow, showing a 77 +/- 9% decrease in the capacity for proton efflux. Both abnormalities are compatible with a substantial reduction in muscle blood flow. 4. During exercise, increased phosphocreatine depletion and intracellular acidification were a consequence of impaired oxidative ATP synthesis and the consequent increase in non-oxidative ATP synthesis, compounded by reduced proton efflux. The acidification prevented an increase in ADP concentration which could otherwise partially compensate for the oxidative defect. All these abnormalities are compatible with a reduced muscle blood flow. 5. In addition, initial-exercise changes in pH and phosphocreatine concentration implied a 44 +/- 5% reduction in 'effective muscle mass', necessitating an ATP turnover (per litre of muscle water) twice as high for given power output as in control muscle. Some of this is probably due to a localized loss of muscle fibres, but the rest appears to reflect reduced metabolic efficiency of the muscle. This is not a direct consequence of reduced blood flow, and may be related to change in muscle fibre type.

Adenosine Triphosphate↗
PubMed1995

A model for the study of wounds in normal elderly adults and patients with peripheral vascular disease or diabetes mellitus.

The purpose of the study was to test the hypothesis that significant delays in cutaneous wound healing could be demonstrated using standard wounds and high quality histological methods in patients with severe peripheral vascular disease (PVD) and/or diabetes mellitus (DM) compared to healthy elderly controls. Additionally, we proposed that standard wounds on the arms of elderly controls would heal more rapidly than comparable wounds on the legs. In order to test these hypotheses we developed and characterized a partial thickness wound model which could be used safely in human subjects. The study population consisted of 25 elderly normal volunteers, 17 patients with PVD, and 24 patients with DM. Standard wounds were created using a Simplate II bleeding-time device. A total of 309 wounds ranging in age from 1 to 25 days were determined to be suitable for analysis. A global index of wound maturity was developed based on selected epidermal and dermal events of repair which could be scored histologically. The superficial component (within 0.1 mm of the epidermis) and deep components of dermal wounds were analyzed separately. Simultaneously created arm and leg wounds were studied in 15 of the elderly controls. Transcutaneous partial pressure of oxygen (TcPO2) measurements were used to estimate the severity of cutaneous ischemia. Data analysis revealed that the most striking differences observed were in dermal events of repair. Control wounds were more mature than dermal wounds from patients with PVD (P < 0.05). A significant reduction in the number of neutrophils and macrophages (P < 0.05) was demonstrated in 7-day-old wounds of patients with PVD compared to controls. Patients with DM showed a similar trend of reduced wound maturity but it did not reach statistical significance. Wounds created in skin with TcPO2 > 20 were more mature than wounds with TcPO2 < or = 20 (P < 0.05) and arm wounds were more mature than leg wounds (P < 0.01). The most significant difference noted in this wound model was that the superficial compartment of dermal wounds was significantly more mature than the deep compartment (P < 0.001). Good agreement was observed between two independent scorers of wound histology and no complications were noted in either patients or controls when using this human wound model. We conclude that the model described allows evaluation of both epidermal and dermal events of repair with relative safety even in patients with PVD and DM.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed2005

Daily supplementation with (n-3) PUFAs, oleic acid, folic acid, and vitamins B-6 and E increases pain-free walking distance and improves risk factors in men with peripheral vascular disease.

A number of nutrients are known to be effective in preventing cardiovascular disease (CVD). We investigated the possible effects of a daily intake of low amounts of these nutrients on risk factors and clinical parameters in patients with peripheral vascular disease and intermittent claudication (PVD-IC). Male PVD-IC patients (n = 60) were randomly allocated into 2 groups. The supplement (S) group consumed 500 mL/d of a fortified dairy product containing eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), oleic acid, folic acid, and vitamins A, B-6, D, and E. The control (C) group consumed 500 mL/d of semiskimmed milk with added vitamins A and D. The patients received lifestyle and dietary recommendations, and they were instructed to consume the products in addition to their regular diet. Blood extractions and clinical explorations were performed after 0, 3, 6, 9, and 12 mo. Plasma concentrations of EPA, DHA, oleic acid, folic acid, and vitamins B-6 and E increased after treatment with supplements (P < 0.05). Plasma total cholesterol and ApoB concentrations decreased in the S group, and total homocysteine decreased in those patients with high initial concentrations. Walking distance before the onset of claudication increased in the S group (P < 0.001), and ankle-brachial pressure index values increased (P < 0.05). The inclusion in the everyday diet of certain nutrients known to promote cardiovascular health improved clinical outcomes while reducing a variety of risk factors in men with PVD-IC, providing new evidence of the potential role of nutrition in the reduction of PVD-IC symptoms.

Aged↗
PubMed1992

Double blind comparison of Iomeprol 350 and Iopamidol 340 in intravenous digital subtraction angiography for peripheral vascular disease.

A randomized double blind study was undertaken to compare the diagnostic efficacy and side effects of a new non-ionic contrast medium Iomeprol with a commonly used one--Iopamidol. Visual and densitometric comparison was made of intravenous digital subtraction angiograms performed for peripheral vascular disease. The results show the two media to be similar both in imaging quality and in the incidence of associated side effects. Ninety-eight per cent of the intravenous digital subtraction angiograms were assessed as adequate for clinical management by the vascular surgeon.

Adult↗
PubMed2006

Spinal cord stimulation for refractory angina pectoris and peripheral vascular disease.

Spinal cord stimulation has been used in clinical practice for more than three decades. The primary use of this therapy has been in spine-related disorders. In recent years, the therapy has been used more extensively in diseases of the vascular system. Increasingly, interest has piqued in using this mode of treatment for refractory angina and ischemic pain secondary to peripheral vascular disease. In this publication, we review the current literature on these two indications and present case examples of both therapies.

Angina Pectoris↗
PubMed1995

Lipid peroxidation of circulating low density lipoproteins with age, smoking and in peripheral vascular disease.

In this study, lipid peroxides in plasma and the low density lipoprotein (LDL) fraction and plasma concentrations of vitamin E, lipids and lipoproteins were measured in 22 smokers (mean age 35 years), 26 non-smoking patients with peripheral vascular disease (PVD), mean age 66 years), and 23 younger (ages < or = 55 years) and 26 older (ages > 55 years) healthy subjects. Plasma lipid peroxide concentrations in the PVD patients (105.9 +/- 20.6 vs. 91.8 +/- 15.8 ng malondialdehyde (MDA)/ml plasma, mean +/- S.D.) and the smokers (94.1 +/- vs. 74.0 +/- 13.9 ng MDA/ml plasma) were significantly elevated compared with levels in the appropriate control subjects and levels were significantly higher in older compared with younger control subjects. Plasma LDL lipid peroxides were also significantly raised in patients with PVD and smokers compared with control values (PVD): 37.1 +/- 7.7 vs. 26.3 +/- 4.1 ng MDA/ml plasma; smokers: 30.4 +/- 6.9 vs 24.9 +/- 7.5 ng MDA/ml plasma). The ratio of LDL lipid peroxides: LDL-cholesterol was significantly higher in the smokers, and plasma cholesterol and LDL-cholesterol were significantly higher in patients with PVD compared with other groups of subjects. The ratio of vitamin E: total lipid was not significantly different between the study groups. These data show that lipid peroxide levels in the plasma LDL fraction are elevated along with raised circulating levels in patients with PVD and smokers but that LDL lipid peroxide concentrations were independent of age in the healthy subjects. Elevated LDL lipid peroxide concentrations may may be mainly due to abnormally high LDL levels in PVD patients, whereas in smokers, the concentration of lipid peroxides in the LDL particles is raised and might render the lipoprotein more atherogenic.

Adult↗
PubMed2001

Assessing the impact of a nurse-led health education intervention for people with peripheral vascular disease who smoke: the use of physiological markers, nicotine dependence and withdrawal.

This study evaluated the impact of a nurse-led health education programme on the behaviour, nicotine dependence and nicotine withdrawal in patients who smoke and suffer from peripheral vascular disease, based in a large teaching hospital in the north of England. Smoking behaviour was measured by self report, end-expired carbon monoxide and urinary cotinine. Nicotine dependence and withdrawal were measured using a nicotine dependence scale and a nicotine withdrawal scale. The findings demonstrated that the programme did have some impact on behaviour. The study raised issues concerning the measurement of physiological markers for smoking as nursing outcomes. Issues about the measurement of nicotine dependence and withdrawal are highlighted.

Aged↗
PubMed1986

Noninvasive evaluation of peripheral vascular disease: recent advances and future implications.

Noninvasive diagnostic techniques have become a recognized adjunct in screening and follow-up of patients with peripheral arterial, venous, and cerebrovascular diseases. These techniques provide physiologic information at little or no risk to patients. Although primarily of diagnostic intent, these studies are also expanding our knowledge base about the natural history of peripheral vascular diseases and the efficacy of various interventions. Advances in radiology have complemented but not replaced the need for the noninvasive peripheral vascular laboratory. It is incumbent upon all physicians to appreciate the diagnostic value and recognize the limitations of these noninvasive techniques. Intelligent use of these modalities may enhance patient care without significantly increasing health care costs. Further prospective studies of the cost benefit or effectiveness of these techniques are indicated.

Arterial Occlusive Diseases↗
PubMed1999

Circulating immune complexes and complement C4 null alleles in patients in patients operated on for premature atherosclerotic peripheral vascular disease.

Circulating immune complexes can lead to vascular inflammation and premature atherosclerosis and the fourth component of complement, C4, plays an important role in the removal of immune complexes. The objective of this study was to analyze the relation between circulating immune complexes and C4 null alleles in patients operated on for peripheral vascular disease before the age of 50. The prevalence of circulating immune complexes and null alleles of C4 (C4Q0) was determined in 62 patients with peripheral atherosclerosis requiring surgery before 50 years of age and in a matched control group. C4A and C4B null alleles (C4A*Q0, C4B*Q0) were determined by electrophoresis of plasma, followed by immunofixation. C4A and C4B concentrations were measured by ELISA. Circulating immune complexes were determined by sucrose density gradient centrifugation and gel filtration. There was no difference in the distribution of C4Q0 between patients and controls. The patients had higher prevalences and levels of circulating immune complexes. This was correlated with the presence of C4Q0, especially C4A*Q0. There was an inverse correlation of concentration of circulating immune complexes with C4A levels and with ratio of C4A/B levels. Thus, a significant proportion of patients with premature peripheral atherosclerosis had circulating immune complexes and C4A*Q0 enhanced the propensity to immune complex formation. This might represent one mechanism for vascular damage in this patient group.

Adult↗
PubMed2005

Usefulness of the presence of peripheral vascular disease in predicting mortality in acute myocardial infarction patients treated with primary angioplasty (from the Primary Angioplasty in Myocardial Infarction Database).

Patients with acute myocardial infarction (AMI) often have multiple co-morbidities that influence outcome. We sought to evaluate the impact of peripheral vascular disease (PVD) on the outcome of patients with AMI treated with primary angioplasty. We evaluated 3,716 patients with AMI who underwent emergency catheterization with planned primary angioplasty in the Primary Angioplasty in Myocardial Infarction trials. Patients with a history of PVD (claudication, stroke, or transient ischemic attack) were compared with patients without PVD. Of the 3,716 patients, 394 (10.6%) had PVD and were older, more often women, and more frequently had a history of diabetes mellitus, hypertension, smoking, congestive heart failure, angina, myocardial infarction, and coronary revascularization. They presented more often with a heart rate >100 beats/min, Killip class >1, lower ejection fraction, and multivessel disease. No difference was found in stent use, final percentage of stenosis, or Thrombolysis In Myocardial Infarction 3 flow. Patients with PVD had a twofold increased in-hospital mortality (5.3% vs 2.6%, p = 0.0021). The difference remained significant at 1 month, 6 months, and 1 year (12.6% vs 6%, p < 0.0001). In multivariate logistic regression analysis, a history of PVD was an independent predictor of in-hospital mortality and death at 1 year (odds ratio 1.64, 95% confidence interval 1.04 to 2.57, p = 0.032). In conclusion, patients with AMI with PVD have increased co-morbidities and higher mortality despite treatment with primary angioplasty. The presence of PVD is an independent predictor of in-hospital mortality and death at 1 year.

Aged↗
PubMed1987

Platelet function and prostaglandins in patients with peripheral vascular disease treated with calcium dobesilate.

In a double-blind placebo controlled study, 25 male patients (age range: 48-67 years) suffering from peripheral vascular disease were treated daily for 4 weeks with either 2 g of calcium dobesilate (n = 13) or placebo (n = 12). Different platelet and prostaglandin parameters were examined before and at the end of therapy. The number of circulating endothelial cells decreased significantly (4.9 +/- 2.9 to 2.0 +/- 1.9; p less than 0.0004). In addition, a decrease in serum TXB2 was noted (p less than 0.0001), but no significant change in plasma TXB2. The fibrinogen half-life was shortened (p less than 0.0001) and the platelet half-life was prolonged (p less than 0.04). The level of beta TG was decreased (p less than 0.006), but PF4 was unchanged. No alteration in the conversion of exogenous 14C-arachidonic acid by platelets to eicosanoids was observed. These observations indicate that calcium dobesilate is able to exert a favourable effect on some parameters of platelet function and prostaglandin synthesis which are important in the regulation of the hemostatic process. It is suggested that these pharmacological actions might explain, at least in part, the beneficial clinical effect of the drug.

Aged↗
PubMed1978

A study on tissue concentrations of cephradine achieved in patients with peripheral vascular disease.

The levels of cephradine were measured in serum, voluntary muscle and subcutaneous fat samples collected from 30 patients during surgical operations for peripheral vascular disease. Cephradine 2 g was administered in two equal doses by intramuscular and intravenous routes before each operation. The mean levels found in the serum and muscle were well above the minimum inhibitory concentrations required for most important Gram-positive and Gram-negative pathogens, in contrast to the relatively low mean level found in subcutaneous fat.

Adipose Tissue↗
PubMed1991

Percutaneous radiofrequency thermolesion of the sympathetic chain in the treatment of peripheral vascular disease.

Percutaneous radiofrequency thermal lesion of the lumbar sympathetic chain (PRFS) was performed in 30 patients with diabetes mellitus suffering from unreconstractable endstage peripheral vascular disease. All of the patients had the feeling of warmth after PRFS, 45% were free of further complaints and 63% changed to stage II according fontaine. The reported data demonstrate a good comparability concerning amputation after a period of two years to the results obtained by surgical sympathectomy. As there is no need of general anesthesia PRFS turned out to be a good alternative to the surgical sympathectomy.

Adult↗