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PubMed1978

Serum high-density lipoproteins in peripheral vascular disease.

High-density lipoprotein (H.D.L.) cholesterol has been measured by the 'Autoanalyzer', and apolipoproteins A-I, A-II, and B by an immunochemical method, in 100 patients with peripheral vascular disease (P.V.D.) and in 93 age and sex matched controls with an approximately similar prevalence of hyperlipidaemia. The patients with P.V.D. had significantly lower levels of the H.D.L. apolipoproteins (especially of apo A-I) than the controls. Further analysis of the data showed low H.D.L. levels to be related to the presence (but not to the severity) of the arterial disease and to be independent of concurrent hyperlipidaemia and smoking habits. The changes in H.D.L. apoproteins were not so clearly reflected by H.D.L.-cholesterol measurements in the same patients, possibly because of methodological reasons. It is therefore suggested that studies relating serum-H.D.L. to arterial disease may be more informative if both the lipid and protein portions of these lipoproteins are measured.

Apolipoproteins↗
PubMed1989

Lower extremity peripheral vascular disease. Part 1: Scanning electron microscopy.

The surgical loss of the foot or leg is vigorously resisted by podiatrists who are committed to the conservation of limbs at risk because of peripheral vascular disease. Pathologic changes in blood vessels may, however, progress to a point where no other option is available to the patient. This study assesses amputation of the extremities and investigates tissue alterations that can be identified in diseased blood vessels implicated in these circumstances. Gross pathology and scanning electron microscopy are examined in this, the first of a two-part study.

Amputation, Surgical↗
PubMed2004

Peripheral vascular disease is associated with reduced glycosuria in newly diagnosed type 2 diabetic patients.

OBJECTIVES: We examined whether the finding of glycosuria and its level in themselves give information of clinical relevance, apart from being an unreliable indicator of glycemic control. METHODS: Subjects were a population-based sample of 1,284 newly diagnosed type 2 diabetic patients. Median age was 65.2 years. Urinary glucose concentration (UGC) was determined quantitatively in a freshly voided morning urine specimen. RESULTS: The over-all prevalence of peripheral vascular disease (PVD) was 16.5%. Bivariately, high values of UGC were associated with low prevalence of PVD (p<0.001, chi2-test). The predictive value of PVD--together with HbA1c, glomerular filtration rate (GFR) and 10 other possible predictors--was confirmed in a logistic regression analysis with glycosuria (Y/N) as outcome variable (p=0.0004). CONCLUSION: Surprisingly, type 2 diabetic patients with PVD tend not to have glycosuria as compared to patients without PVD. PVD may be indicative of generalized atherosclerotic lesions in the major vessels, including the renal arteries. This could lead to a lowering of GFR and thereby of the amount of glucose filtered. Assuming no, or only a minor direct effect of PVD on tubular function, this would lead to an increased renal threshold for glucose in patients with PVD.

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PubMed1999

Increased incidence of periprocedural complications among patients with peripheral vascular disease undergoing myocardial revascularization in the bypass angioplasty revascularization investigation.

BACKGROUND: Risks of coronary artery bypass graft surgery (CABG) or percutaneous transluminal coronary angioplasty (PTCA) may be different in the presence of peripheral vascular disease (PVD). METHODS AND RESULTS: We analyzed outcomes of 550 patients with PVD enrolled in the Bypass Angioplasty Revascularization Investigation randomized trial and registry. Compared with 1770 patients without PVD, those with PVD were older and had a greater prevalence of medical comorbid conditions. No significant differences in coronary anatomy or PTCA success rates were found. The risk of any major complication (death, myocardial infarction, stroke, coma, or emergency revascularization) after PTCA was significantly higher among patients with PVD (11.7% versus 7.8%, P=0.027). In multivariate analysis, this represented a 50% increase in the odds of having any major complication (multivariate odds ratio, 1.5; P=0. 032). Among patients undergoing CABG, the risk of major complications was found to be markedly higher for patients with PVD (12%) than those without (6.1%, P=0.003) even after controlling for baseline differences (multivariate odds ratio, 1.8; P=0.018). Major differences between the PTCA and CABG groups were related primarily to a higher risk of neurological complications in PVD patients who had CABG (multivariate odds ratio, 2.8; P<0.001). CONCLUSIONS: We conclude that patients with PVD are at high risk for periprocedural complications after myocardial revascularization, in particular neurological events.

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PubMed1986

Platelet half-life, plasma thromboxane B2 and circulating endothelial-cells in peripheral vascular disease.

We studied platelet half-life (T/2), plasma thromboxane B2-levels (TXB2) and circulating endothelial cells in 107 patients with a mean age of 63 +/- 6.8 years and angiographically proven peripheral vascular disease (PVD). Patients were divided into 4 groups according to Fontaine but also according to additional clinical manifestations of atherosclerosis like coronary heart disease (CHD) and cerebrovascular disease (CVD). Furthermore, the influence of sex and smoking was investigated. Compared to patients without atherosclerotic manifestations we could detect an enhanced platelet consumption measured as shortened platelet half-life time (79.2 +/- 9.1 vs 100.9 +/- 5.6 hours, p less than 0.001 and an increased platelet activity measured as increased TXB2-plasma levels (51.6 +/- 20.9 vs 23.2 +/- 11.2 ng/ml, p less than 0.001). Correspondingly, the amount of circulating endothelial cells was increased 45.2 +/- 25.7 vs 20.3 +/- 23.4, p less than 0.001). Patients with PVD who smoked had the shortest actual platelet half-life, the highest TXB2 plasma levels and the greatest amount of circulating endothelial cells compared to non-smoking patients and controls. Patients with clinical stage IV according to Fontaine had the shortest platelet half-life, the highest TXB2 plasma levels and the greatest amount of circulating endothelial cells compared to the other clinical stages. Analyzing the influence of additional clinical manifestations of atherosclerosis we could detect only in patients with PVD and CHD significant differences compared to the other groups.

Adult↗
PubMed1997

Dose-related effect of intravenous L-arginine on muscular blood flow of the calf in patients with peripheral vascular disease: a H215O positron emission tomography study.

1. Endothelium-derived nitric oxide (NO) contributes to the regulation of vascular tone and blood pressure. Infusion of L-arginine produces systemic vasodilatation via stimulation of endogenous NO formation. Vasodilatation is accompanied by an increase in peripheral arterial blood flow. However, it is not known whether capillary nutritive blood flow increases as well. The time course and dose-response pattern of this effect remain to be elucidated. 2. Two groups of ten patients with peripheral vascular disease (PVD) received an intravenous infusion of 8 g or 30 g of L-arginine over a period of 40 min. Blood pressure and heart rate were monitored non-invasively. Muscular blood flow (MBF) of the calf was determined at 0, 20, 40, 60, 80 min by positron emission tomography with H215O as flow tracer. Plasma L-arginine and cyclic GMP (cGMP) levels were determined at the same time points. 3. L-arginine induced a dose-related decrease in blood pressure during the infusion period. MBF and plasma cGMP levels during and after the infusion of 8 g of L-arginine did not change significantly. In the patients receiving 30 g of L-arginine, MBF was enhanced significantly from 1.56 +/- 0.14 to 2.09 +/- 0.21 ml min-1 100 ml-1 at 40 min and 2.23 +/- 0.15 ml min-1 100 ml-1 after 80 min (+43.0%). The increase in MBF was paralleled by an increase in plasma cGMP from 4789.8 +/- 392.2 nmol/l at baseline to 9223.2 +/- 1233.6 nmol/l at 40 min. 4. We conclude that intravenous L-arginine enhances nutritive capillary MBF in patients with PVD via the NO-cGMP pathway in a dose-related manner. This effect might be therapeutically beneficial in patients with PVD.

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PubMed1995

[Ultrasonic angiography in diagnosis of peripheral vascular disease].

The ability of Quickscan (QS) was studied to assess haemodynamically significant lesions in the iliac and femoro-popliteal arteries. Quickscan was prospectively and independently compared to digital subtraction angiography (DSA) of the iliac and femoro-poplited arteries. In 155 patients, 631 arterial segments were evaluated. A QS frequency ratio of greater than 1:3 had a sensitivity of 93% and a specificity of 85% in detecting stenosis > 50% diameter (75% area) reduction in the iliac artery as shown on DSA. The sensitivity and specificity for stenosis in the femoral and popliteal arteries were 85%, 96%, 82%, 98% respectively. In the detection of occlusion, QS had a sensitivity of 84% and a specifity of 98% in the iliac artery; 94%, 97%, in the femoral; and 94%, 85% in the popliteal arteries respectively. There was a significant correlation between the area reduction found by QS and the calf/brachial pressure index (CBI) (r = -0.77 P < 0.01). 35 patients underwent successfully angioplasty based on QS findings. We conclude that quickscan can provide an inexpensive, quick and noninvasive screening technique for the routine initial assessment of peripheral vascular disease.

Aged↗
PubMed1987

Transcutaneous oxygen tension behavior in the different stages of peripheral vascular disease and its correlation with ankle/arm pressure ratio and calf blood flow.

The practical utility of transcutaneous oxygen tension (TcPO2) has been evaluated in 22 normal subjects and in 54 patients suffering from peripheral vascular disease (PVD) at various stages (II, III, IV), to define its clinical use in the diagnosis of PVD. Basal TcPO2 values can distinguish normal subjects only from stages III and IV PVD patients. In the case of stage II PVD patients the evaluation of the half-recovery time of TcPO2 basal values after an induced ischemia of the limb is mandatory. The study also showed that there are no significant statistical correlations among the TcPO2 values, Doppler, and plethysmographic parameters.

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PubMed1991

[Changes in high density lipoproteins in peripheral vascular disease].

BACKGROUND: It is well known that lipid and lipoprotein disturbances play an important role in the development of atherosclerosis. However, the changes in the high density lipoprotein (HDL) composition in patients with peripheral vascular disease (PVD) and its relation to the severity of ischemia of the lower limbs need to be clarified. METHODS: HDL abnormalities have been studied in 102 men with PVD and in 100 age-sex-matched controls. History of smoking was recorded in 88 patients, but only 58 were smokers at the time of the study; 35 of controls were smokers. RESULTS: Serum triglycerides were 1.66 +/- 0.85 mmol/L (mean +/- SD) in patients and 1.29 +/- 0.61 mmol/L in controls (p less than 0.001). HDL-cholesterol was 0.97 +/- 0.27 mmol/L and 1.08 +/- 0.28 mmol/L (p less than 0.01) respectively; HDL-proteins were 1.16 +/- 0.21 g/L and 1.25 +/- 0.17 g/L (p less than 0.005) respectively. No significant differences were observed when serum apoprotein (apo) A-I and HDL-triglycerides levels were compared between patients and controls. Smoker patients showed a significant increase in serum triglycerides (p less than 0.005) and a lower HDL-cholesterol concentrations (p less than 0.005) compared with non smoker patients. Patients with more severe distal involvement according to the arm-ankle pressure index showed a significantly greater reduction in HDL-cholesterol (p less than 0.05). CONCLUSIONS: HDL-cholesterol is the best marker of PVD, and the degree of severity of ischemia was associated with greater decrease in HDL-cholesterol. Apo A-I has not been revealed as a risk marker for PVD.

Adult↗
PubMed2003

Cartilaginous metaplasia in calcified diabetic peripheral vascular disease: morphologic evidence of enchondral ossification.

The mechanism of arterial calcification is not clear. We examined histological sections of major arteries from lower extremities of two patients with longstanding type II (or non-insulin-dependent) diabetes mellitus, and found morphological evidence of cartilaginous metaplasia and ectopic ossification with associated severe medial arterial calcification and atherosclerosis. Hematoxylin and eosin, alcian blue, and toluidine blue stains were applied for the demonstration of cartilage cells and their specific matrix proteins, and immunohistochemical studies for type II collagen. To our knowledge, cartilaginous metaplasia has not previously been described in medium-sized human muscular arteries. This observation supports the hypothesis that active enchondral ossification may be a pathway leading to arterial calcification in diabetic obstructive peripheral vascular disease.

Arteries↗
PubMedDate not supplied

Percutaneous rotational atherectomy in peripheral vascular disease for lesions unsuitable for balloon angioplasty.

Percutaneous rotational atherectomy (Rotablator), a high speed (> 140,000 RPM) rotational burr was used to relieve 90-99 percent obstruction in 3 superficial femoral and 2 axillary arteries. These patients had severe claudication in respective extremities. In 4 patients, the lesion was considered to be unsuitable for balloon angioplasty and one patient underwent rotational atherectomy after failure to cross the lesion with balloon catheter. The burr size used ranged from 1.5 to 2.5 mm. After rotablation, the stenosis was reduced from 94.6 +/- 4.5 percent to 42 +/- 8.4 percent. The residual narrowing was further reduced by adjunctive balloon angioplasty to 14 +/- 5.5 percent (p < 0.001). Except for hemoglobinuria in one patient, there were no complications. All patients had good distal pulsations and were relieved of their claudication. On follow-up of 5-18 months, there has been no restenosis. Thus, our preliminary experience suggests that rotational atherectomy is safe and produces gratifying results in patients with peripheral vascular disease having lesions unsuitable for primary balloon angioplasty.

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PubMed1999

Net mass transfer of plasma cholesteryl esters and lipid transfer proteins in normolipidemic patients with peripheral vascular disease.

The role of plasma cholesteryl ester transfer and lipid transfer proteins in atherosclerosis is unclear. Recent data suggest both antiatherogenic and atherogenic properties for cholesteryl ester transfer protein (CETP). The overall effect of CETP on atherosclerosis may thus vary depending on individual lipid metabolism. To test whether lipid transfer parameters are of importance even in patients without major lipid risk factors for atherosclerosis, CETP mass and activity, net mass transfer of cholesteryl esters between endogenous lipoproteins (CET), and phospholipid transfer protein (PLTP) activity were determined in plasma from 18 normolipidemic male patients with peripheral vascular disease and 21 controls. Furthermore, lecithin: cholesterol acyltransferase (LCAT) activity was tested. The results show that CETP mass, CETP activity, and LCAT activity are not different between patients and controls. However, specific CETP activity (CETP activity/CETP mass) is lower in the patients (P < .02). On the contrary, higher CET is observed in patients' plasma (P < .001). Increased plasma PLTP activity (P = .052) is demonstrable in the patients. If the data of all subjects are combined, CET correlates positively with triglycerides ([TG], r = .45, P < .001) and with PLTP activity (r = .32, P < .05) but negatively with specific CETP activity (r = -.37 P < .05). CET and specific CETP activity remain significantly different in TG-matched patients and controls and are more strongly interrelated (r = -.71, P < .001), suggesting a higher and selective influence of lipid transfer inhibitor(s) on CET and CETP activity in the patients. CET allows the best discrimination between patients and controls in univariate and multivariate analysis. Eighty-eight percent of the subjects are correctly classified by CET as a single parameter. The results suggest that increased CET in the patients may reflect atherogenic alterations in TG metabolism and/or in lipid transfer protein activities despite normal fasting lipoprotein levels.

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PubMed1987

Effect of nafazatrom on platelet function and release: relationship to symptomatic episodes in patients with peripheral vascular disease.

We studied the effect of nafazatrom on plasma prostacyclin (PGI2) levels, platelet function, and thromboxane B2 (TxB2), and 12-hydroxy-eicosatetraenoic acid (12-HETE) production and clinical improvement in 12 patients with peripheral vascular disease (PVD) by means of a double-blind crossover trial of placebo, 800 or 1600 mg of nafazatrom four times daily for 1 week, with intervening 2-week washout periods. Plasma PGI2 levels were measured as 6-keto-PGF1 alpha by radioimmunoassay. Platelet function ex vivo was measured as collagen and adenosine diphosphate (ADP)-induced platelet aggregation, release of 12-HETE and thromboxane A2 (measured as TxB2), and was determined by high-pressure liquid chromatography (HPLC) and radioimmunoassay, respectively. The plasma 6-keto-PGF1 alpha levels were unaffected by nafazatrom treatment (p greater than 0.25). Nafazatrom treatment had no effect on TxB2 production, but significantly altered the production of the platelet 12-HETE (p less than 0.05). There was a significant association between the changes in 12-HETE production and clinical improvement. These results suggest that the mechanism of action of nafazatrom is in part related to the inhibition of platelet function via the lipoxygenase pathway, independent of PGI2 stimulation.

12-Hydroxy-5,8,10,14-eicosatetraenoic Acid↗
PubMed1989

Enhanced net mass transfer of HDL cholesteryl esters to Apo B-containing lipoproteins in patients with peripheral vascular disease.

In vitro net mass transfer of HDL cholesteryl ester to apolipoprotein (Apo) B-containing lipoproteins (HDL-CET) was found to be nearly twofold higher in plasma from 35 male patients with peripheral vascular disease compared to the values of 27 age- and sex-matched healthy controls (P less than 0.001). Differences in HDL-CET were predominantly observed between normolipidemic patients and controls, and were also demonstrable in pairs of patients and controls with similar HDL cholesterol, VLDL + LDL cholesterol, and triglyceride concentrations. Within the control group, higher HDL-CET was found in individuals with enhanced triglyceride or VLDL + LDL cholesterol levels. This dependence was not observed in the patient group. Consequently, enhanced HDL-CET in the patients seems to be independent of plasma lipid levels.

Aged↗
PubMedDate not supplied

A prospective study of painful symptoms, small-fibre function and peripheral vascular disease in chronic painful diabetic neuropathy.

Fifty diabetic patients with chronic painful sensorimotor neuropathy were studied prospectively to clarify the natural history of this condition and the roles of small-fibre damage and concomitant peripheral vascular disease (PVD). Initially, 30 patients had no significant PVD (ankle:brachial Doppler ratio > 1.0). Pain was assessed using a visual analogue scale (0-10 cm), and small-fibre function by thermal limen (TL), heat-pain threshold (HPT), and weighted pinprick threshold (PPT). At follow-up, on average 3.6 years later (range 3.0-4.1), 11 patients had died (6 with PVD) and contact had been lost with 6. Pain scores fell in subjects without PVD (n = 24; median (range), from 4.8 (0.5-10.0) to 2.0 (0.0-9.2) cm, p < 0.001) and also in those with PVD (n = 9; from 5.1 (2.0-8.2) to 2.1 (0.0-8.0) cm, p < 0.05). Seven patients (5 without PVD) became painfree; at presentation, these 7 patients had experienced pain for a shorter period of time. Despite this symptomatic improvement, small-fibre function generally deteriorated in both groups, with significant worsening (p < 0.05) of HPT and PPT in patients without PVD, and in HPT and TL in patients with PVD. Neuropathic pain therefore tends to improve with time and can resolve completely. By contrast, small-fibre function continues to deteriorate, indicating that these peripheral measures do not predict the evolution of painful symptoms. The presence or absence of PVD does not appear to affect the natural history of neuropathic pain or its symptomatology.

Adult↗
PubMed1993

Lipoprotein (a): a risk factor for peripheral vascular disease.

Lipoprotein (a) [Lp(a)] is a serum protein that has been reported to be predictive of complications from coronary and cerebrovascular atherosclerotic disease. This study was designed to compare plasma levels of Lp(a) in 100 white male patients with and without peripheral vascular disease (PVD) and to determine the role of Lp(a) as a risk factor for PVD independent of known risk factors such as cigarette smoking (CIG), diabetes mellitus (DM), and coronary artery disease (CAD). Patients with PVD (mean age = 67.6 years, n = 50) had a statistically significant (p = 0.04) elevation of Lp(a) (29.8 +/- 3.9 mg/dl) as compared to patients without PVD (20.0 +/- 2.9 mg/dl (mean age = 68.3 years, n = 50). Further analysis revealed that patients with PVD had a significantly higher incidence of CIG (86% vs. 68%, p = 0.03), DM (34% vs. 14%, p = 0.02), and CAD (52% vs. 30%, p = 0.02) than those without PVD. However, there was no statistically significant difference in Lp(a) levels in patients with CIG or CAD compared to those without. Patients with DM had significantly (p = 0.04) lower levels of Lp(a) (17.8 +/- 3.5 mg/dl) than those without DM (27.1 +/- 3.0 mg/dl). Stepwise regression analysis of these various risk factors for PVD revealed that Lp(a) was the strongest significant individual predictor for the presence of PVD (R2 = 0.07) as compared to DM (R2 = 0.05) and CIG (R2 = 0.04). We conclude that there is a significant correlation of Lp(a) levels and the incidence of PVD, which is independent of other major risk factors for PVD.

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