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PubMed1998

Cerebrovascular CO2 reactivity during anesthesia in patients with diabetes mellitus and peripheral vascular disease.

BACKGROUND: Diabetes mellitus (DM) and systemic atherosclerosis are risk factors for stroke. Although the origins of increased risk are complex, one possibility is that cerebrovascular reactivity is impaired and does not allow the brain to compensate for aberrations in physiology. The current study tested this issue by evaluating mean blood flow velocity of the middle cerebral artery (Vmca) and carbon dioxide reactivity during anesthesia in patients with DM and peripheral vascular disease (PVD). METHODS: Fifty-two patients were observed: 20 patients with DM (the DM group), 12 patients with PVD (the PVD group), and 20 patients classified as American Society of Anesthesiologists physical status 1 or 2 (the control group). The Vmca was measured using transcranial Doppler ultrasonography during isoflurane-nitrous oxide anesthesia. After measuring baseline Vmca at a partial pressure of carbon dioxide in arterial blood (PaCO2) of 37.7 +/- 4.5 mmHg (mean +/- SD), measurements were repeated at a PaCO of 44.2 +/- 3.8 mmHg, and the carbon dioxide reactivity (absolute value: cm x s(-1) x mmHg(-1); relative value: percentage of baseline Vmca/mmHg) was calculated. RESULTS: The baseline Vmca of the DM group (51 +/- 12 cm/s) was significantly greater than those of the control group (42 +/- 6 cm/s) and the PVD group (42 +/- 13 cm/s). The absolute and relative values of carbon dioxide reactivity in the DM group (3.1 +/- 1.3 cm x s(-1) x mmHg(-1); 6.3 +/- 2.4%/mmHg) were significantly greater than or equivalent to those of the control group (2.3 +/- 0.8 cm x s(-1) x mmHg(-1); 5.3 +/- 1.7%/mmHg), respectively. In the PVD group, the baseline Vmca was equivalent to the control group, but the carbon dioxide reactivity (1.1 +/- 0.5 cm x s(-1) x mmHg(-1) 2.8 +/- 1.2%/mmHg) was significantly less. CONCLUSIONS: The patients with DM have increased baseline cerebral blood flow velocity and normal carbon dioxide reactivity during anesthesia. The patients with PVD have decreased carbon dioxide reactivity, but baseline flow velocity is maintained.

Adult↗

PubMed1988

High prevalence of abdominal aortic aneurysm in men with peripheral vascular disease: screening by ultrasonography.

A study was carried out to see if an ultrasonic examination of the abdominal aorta was indicated in every patient who attended an outpatient clinic with peripheral vascular disease (PVD). One hundred consecutive patients were studied and compared with a control group. The incidence of abdominal aortic aneurysm (AAA) in the control group was 2 per cent. In the study group, the male patients had an incidence of 20 per cent of aneurysm and ectasia, while the female patients had an incidence of 12 per cent. Of all the abnormal aortas found by ultrasound, only 31 per cent were palpable clinically. Two aneurysms that required operation were found, while the remainder are to be followed by regular ultrasound assessment. Further studies are necessary to conclude if screening of a high risk group, such as patients with PVD, is worthwhile.

Adult↗

PubMed1985

Concentration and chemical composition of plasma lipoprotein subfractions in patients with peripheral vascular disease. Evidence for normal apolipoprotein B but low cholesteryl ester content in small VLDL.

Subfractionation of the 3 major plasma lipoprotein classes was performed in 20 male patients with symptomatic peripheral vascular disease (PVD) and 18 male healthy controls of similar age and serum lipid levels as the patients in order to investigate if, at comparable levels of total serum lipids, any difference in the distribution or the chemical composition of the lipoprotein subfractions existed between patients and controls. Concentrations of free and esterified cholesterol, triglycerides, phospholipids, apolipoprotein B (apo B) and soluble apolipoproteins did not differ significantly in any lipoprotein subfraction of PVD patients compared to controls. Calculated molecular weights and numbers of lipoprotein particles/ml plasma were also similar in the 2 groups except that there were more heavy LDL particles in the patient group. Plotting concentrations of apo B against cholesteryl ester in the VLDL-D subfraction (Sf 20-100) yielded a linear regression in both groups. The PVD regression line was significantly steeper than that of controls. Calculation of the molecular mass of the various constituents of the VLDL-D fraction in the subjects with the highest content of esterified cholesterol in VLDL-D, where this difference was most pronounced, suggests that this difference was due entirely to a decreased number of cholesteryl ester molecules per lipoprotein particle in PVD. The findings suggest that a disordered metabolism of plasma cholesteryl esters may be present in certain PVD patients.

Aged↗

PubMed1997

Ventilatory and gas exchange response during walking in severe peripheral vascular disease.

It has long been recognized that at the onset of a dynamic muscular exercise the ventilatory and the circulatory (blood flow) responses appear to be matched, thereby maintaining arterial blood gas homeostasis. Such a coupling has recently been suggested to rely upon ventilatory reflex triggered by mechanoreceptors encoding changes in muscle blood flow or, more likely, blood volume. The aim of this study was to investigate whether patients with severe peripheral blood flow limitation to the lower extremities have a normal ventilatory response during a light intensity exercise. The ventilatory and gas exchange temporal response characteristics were studied during a 6 min walking test in seven patients with severe ischemic peripheral vascular disease and in six normal age-matched subjects. The magnitude of the overall ventilatory and Vo2 increment at the end of the tests was similar in both groups. However, in contrast to the control subjects, who presented an almost rectangular response, the patients had a considerably slowed response dynamics (t50 = 33 +/- 4 vs. 9 +/- 3 sec for Vo2 and 37 +/- 5 vs. 10 +/- 8 sec for VE) with a dramatic reduction in the magnitude of the initial 20 sec of the responses. Although the slow Vo2 dynamics in patients presumably reflected the impeded perfusion of the working muscles. the accompanying sluggishness of the V1 course implies that either muscular ischemia actually inhibits ventilatory response to exercise or, more likely, that this response is strongly linked to the magnitude of the hyperemia in the exercising muscles.

Heart Rate↗

PubMed2001

Parameters of postocclusive reactive hyperemia measured by near infrared spectroscopy in patients with peripheral vascular disease and in healthy volunteers.

The main purpose of our study was to determine the parameters of the postocclusive reactive hyperemia test that could help and provide the clinician with information about the tissue oxygenation, the severity of the disease, and the results of the applied therapies. Near infrared spectroscopy (NIRS) proved to be a valid noninvasive trend monitor useful for investigating the physiology of oxygen transport to tissue. Important advantages of NIRS over transcutaneous oximetry (TcpO2) are: (a) a more dynamic nature of the NIRS signals which reflects more closely the actual response of the peripheral vasculature to the occlusive provocation; (b) larger sampling volume; and (c) the ability of assessing tissue oxygenation at deeper tissue levels. We demonstrated that the time parameters of reactive hyperemia, the rate of reactive hyperemia, and the maximal change during reactive hyperemia, all calculated from the oxyhemoglobin (HbO2) signal of the NIRS, clearly distinguish between healthy volunteers and patients with vascular disorder. The time parameters of reactive hyperemia were significantly longer (p<0.01), and the rate of reactive hyperemia (p=0.01) as well as the maximal change during reactive hyperemia (p=0.02) were significantly lower in patient group compared to healthy volunteers. These parameters were also in good correlation with the values of ankle brachial index (ABI) and the resting values of oxygen partial pressure (TcpO2). Values of the chosen parameters obtained from the HbO2 signal were further compared between groups of diabetic and nondiabetic patients with peripheral vascular disease. Although longer time parameters of reactive hyperemia and lower rates of hyperemic response were detected, the difference between both groups was not statistically significant.

Aged↗

PubMed1986

Prostaglandin E1 incorporated in lipid microspheres in the treatment of peripheral vascular diseases and diabetic neuropathy.

Lipo-PGE1 is a drug preparation of prostaglandin E1 (PGE1) incorporated in lipid microspheres similar in properties to liposomes. A randomized, single-blind, cross-over study comparing free PGE1 (PGE1 cyclodextrine, PGE1CD) with lipo-PGE1 was performed. Twenty patients with peripheral vascular diseases and diabetic neuropathy entered the trial. The first seven days' treatment was either 5 micrograms/day of lipo-PGE1 or 40 micrograms/day of PGE1CD, followed by a seven-day wash-out period; then cross-over was performed for another week's administration. Improvements were achieved by both PGE1 preparations. The comparison between lipo-PGE1 and PGE1CD showed that the former was significantly superior, both in final global improvement (p less than 0.01) and in terms of patients' preference (p less than 0.01); lipo-PGE1 also produced fewer side-effects. This study suggests that lipo-PGE1 is a very valuable agent for the treatment of peripheral vascular disorders and diabetic neuropathy.

Alprostadil↗

PubMed1954