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PubMed1979

[Epidemiology of peripheral vascular disease in diabetics (author's transl)].

623 non-selected diabetic outpatients were screened by the Doppler-ultrasonic-method for peripheral vascular disease. Additional angiologic work up was performed to define the location of stenosis and obliteration. 15.9% of the diabetics were shown to have peripheral vascular disease and 57% of those denied claudication. 9% of the patients had signs of mediasclerosis. The predilection of peripheral vascular disease in diabetics for the arteries below the knee (peripheral type) was confirmed in our study. Patients with a pelvic or femoropopliteal type of peripheral vascular disease showed a high frequency of cardiovascular risk factors. An influence of the duration of diabetes on peripheral vascular disease was not evident. In contrast to this, a significant correlation (p less than 0.001) of the peripheral type of peripheral vascular disease-as well as of mediasclerosis--could be demonstrated with the diabetes of long duration. In patients with the peripheral type of peripheral vascular disease significantly more often higher blood sugar volues were found. Thus the quality of metabolic control seems to be of some importance for this form of diabetic macroangiopathy.

Adolescent↗
PubMed2000

Update on endovascular treatment of peripheral vascular disease: new tools, techniques, and indications.

The treatment of peripheral vascular disease is one of the most rapidly expanding fields of medicine today At one time, patients who had peripheral vascular disease had few medical or surgical options. Now, however, options abound. The number of peripheral interventions increased from 90,000 in 1994 to more than 200,000 in 1997 and endovascular techniques may soon replace up to 50% of traditional vascular operations. Cardiologists, interventional radiologists, and vascular surgeons bring various types of expertise to endovascular intervention; nonetheless, they seem to share similar levels of enthusiasm about this treatment option. The many advantages to the patient that such intervention offers over traditional surgery, such as the avoidance of anesthesia and other surgical risks, the rapid recovery time, and the relatively low treatment costs, provide encouragement to these specialists. Endovascular intervention requires dedication on the part of practitioners, because it demands such complete knowledge of vascular disease and of the anatomic changes experienced by the patient. The challenge is intensified by the continual introduction of new products and methods. We hope, herein, to offer pertinent information about recent advances in interventional techniques and devices, and to provide a framework for future education.

Angioplasty, Balloon↗
PubMed2003

Peripheral vascular disease. Diagnosing and treating the 3 most common peripheral vasculopathies.

A common sign of generalized atherosclerosis, peripheral vascular disease (PVD) occurs as a result of arterial narrowing or obstruction that restricts blood flow to distal tissues. Prevalence of PVD ranges from 3% in patients age > 55, to 11% in patients age > 65, to 20% in those age 75 and older. Cerebrovascular/carotid disease, abdominal aortic aneurysms, and peripheral arterial occlusive disease are the most common peripheral vasculopathies seen by primary care physicians. All require aggressive medical management to prevent potentially serious complications and may require referral to vascular surgeons for evaluation. Prevention remains the best therapy.

Age Distribution↗
PubMed2004

Clinical utility of rapid prescreening magnetic resonance angiography of peripheral vascular disease prior to cardiac catheterization.

PURPOSE: The presence of peripheral vascular disease, in particular iliofemoral disease, is responsible in part for vascular complications from femoral artery cannulation. We investigated whether prescreening for vascular obstructions with magnetic resonance angiography (MRA) in high-risk patients with peripheral vascular disease (PVD) would provide useful information to angiographers seeking to improve the safety and efficiency of femoral artery access at cardiac catheterization. METHODS: Twelve consecutive patients with known or suspected PVD underwent contrast-enhanced, aorto-iliofemoral MRA using a real-time BolusTrak technique. Contrast-to-noise ratios for each patient were calculated. The cardiac angiographer reviewed the MRA prior to catheterization and selected an access site. The patients' subsequent clinical course was evaluated, and a postprocedure questionnaire was completed by the angiographer to define the value of the prescreening MRA. RESULTS: No significant vascular complications occurred in these patients as defined by failure of initially chosen access site, arterial dissection, limb ischemia, pseudoaneurysm formation, hemorrhage (including retroperitoneal hematoma), or need for blood transfusion or emergency vascular surgical repair. Statistical frequency analysis of the responses in the postprocedure questionnaire demonstrated that the MR data were clinically valuable in (1) influencing the initial choice of access site; (2) influencing technical alterations to the standard access; and, (3) enhancing confidence in the selection of access site. CONCLUSIONS: MRA prescreening in patients with PVD is an effective, novel adjunct to cardiac catheterization in selected patients that improves physician confidence and influences technical choices during coronary angiography from the femoral artery approach.

Adult↗
PubMed2003

Percutaneous arterial closure in peripheral vascular disease: a prospective randomized evaluation of the Perclose device.

BACKGROUND: Patients with peripheral vascular disease have been excluded from initial studies of percutaneous suture-mediated closure devices (SMCD) despite representing a significant proportion of those requiring endovascular intervention. We sought to determine whether these devices could be safely used in patients with peripheral vascular disease. METHODS: Patients were stratified into two groups and five subgroups on the basis of indication for arteriography, and they were prospectively randomized at the end of the procedure to receive either the SMCD or manual compression. Ankle-brachial index was determined and duplex ultrasound scanning of the accessed femoral artery was performed, before and after the procedure. Ultrasound data included peak systolic velocity, minimum intraluminal vessel diameter, and presence or absence of calcified plaque. Time to hemostasis, ambulation, and discharge were recorded, and major or minor complications were noted. RESULTS: Of 102 patients included in the study, 52 patients were randomized to receive the SMCD. There was no difference in ankle-brachial index, minimum intraluminal vessel diameter, or peak systolic velocity in the accessed vessel after closure with SMCD or manual compression. Time to hemostasis, ambulation, and discharge was significantly less in the SMCD group (P =.001). Presence of calcified plaque was not associated with complications (P =.146). In the SMCD group, hemostasis was achieved with 49 of 52 devices (94.2%). There were six complications (5.9%), two of which were major and required operative intervention. All complications were hemorrhagic and not occlusive. There was no difference in overall complication rate between SMCD (7.7%) and manual compression (4.0%) groups (P =.678). No infection was noted in any of the 102 patients. CONCLUSIONS: Suture-mediated percutaneous arterial closure can be safely performed in patients with peripheral vascular disease, even in the presence of calcified plaque. This closure technique enables shorter time to hemostasis, ambulation, and hospital discharge. There are observed differences in minor, but not major, complication rates for MC versus percutaneous arterial closure in patients with peripheral vascular disease, but these differences did not achieve statistical significance in this small series.

Aged↗
PubMed2000

[True and presumed contraindications of beta blockers. Peripheral vascular disease, diabetes mellitus, chronic bronchopneumopathy].

Traditional contraindications to beta-blockers are peripheral vascular diseases, diabetes mellitus, chronic obstructive pulmonary disease (COPD) and asthma. Recent data seem to show that rigorous application of these rules are not completely justified and indicate that many patients would be inappropriately excluded from the beneficial effects of this therapy. Appraisal of clear guidelines for a safe use of beta-blockers is thus mandatory for the clinician. A brief review of the effects of beta-adrenergic receptor blockade is offered. The therapy is aimed at blocking beta 1-receptors. On the other hand, the block of beta 2-receptors causes the well known side effects, i.e. vasoconstriction, delayed response to hypoglycemia in diabetic patients, bronchoconstriction. From the first compound, propranolol, with uniform action on beta 1 and beta 2-receptors, further generation of beta-blockers were subsequently developed: beta 1-selective, with intrinsic sympathomimetic activity, and with associated vasodilating "ancillary" property. Some favorable reduction in collateral effects has thus been obtained with new compounds, without reaching complete safety. Examination of exclusion criteria applied in clinical trials offers no useful indications because of their imprecise definition. Examination of the literature and a more accurate understanding of the diseases, traditionally considered contraindications, may help setting up a uniform and clear path: peripheral vascular disease: beta-blockers should be avoided only in those patients with vasospastic disorders, rest pain with severe peripheral vascular disease or nonhealing lesions. In patients with mild to moderate disease, beta-blockers can be prescribed, but careful surveillance for any changes in symptoms related to intermittent claudicatio should be achieved; diabetes mellitus: previous apprehension for the lessening reaction to hypoglycemia in patients treated with insulin has been retracted. Beta-blockers are not contraindicated in these patients. Some caution should be addressed when signs of autonomic disease are present or in patients with difficult glycemic control. Patients on oral long-acting antidiabetic drugs should not be neglected. The risk of prolonged and paucisymptomatic hypoglycemia while taking beta-blocker agents is somewhat more relevant than in patients treated regularly with insulin; COPD and asthma: confusion may arise if rigorous definition of these diseases and their severity is not applied following the guidelines of the American Thoracic Society. Because bronchial hyperreactivity seems the crucial factor in determining collateral effects to beta-blocker agents, agreement can be reached on the following statements. Beta-blockers are contraindicated a) when history of asthma is present, b) when COPD is moderate to severe, i.e. with FEV1 reduction < 50% of the predicted value, c) in patients on chronic bronchodilator treatment, d) in chronic airflow limitation with evidence of > or = 20% reversibility in airway obstruction in response to inhaled salbutamol. When FEV1 is > 50% of the predicted value, beta-blockers can be given, providing adequate control of stability of ventilatory conditions.

Adrenergic beta-Antagonists↗
PubMed1977

Factors in the rehabilitation of patients with peripheral vascular disease.

At some point in the progression of peripheral vascular disease, a hospitalized patient may require the services of a rehabilitation unit. All patients, however, can benefit from basic rehabilitative care that should begin at the time of initial diagnosis of their disease and be considered throughout their treatment course. The nurse in the clinic , in the intensive care unit, and on the medical and surgical units should be aware of potential factors that may prevent the person with peripheral vascular disease from realizing his full potential. Physical, psychologic, social, economic, vocational, and spiritual needs are all important factors in the rehabilitation process.

Activities of Daily Living↗
PubMed2001

Long-term outcomes of revascularization for peripheral vascular disease in end-stage renal disease patients.

The occurrence of peripheral vascular disease (PVD) and atraumatic lower-extremity amputations is significantly greater in patients with end-stage renal disease (ESRD) than those with normal renal function. Moreover, the mortality for dialysis patients undergoing atraumatic lower-extremity amputations is far greater. Because PVD requiring amputation is an extreme form of PVD, we tested the hypothesis that mortality and intermediate outcomes for patients with ESRD undergoing lower-extremity revascularization, a less extreme form of PVD, would be equivalent to that for patients without ESRD. This is a retrospective case-control analysis of lower-extremity revascularization in patients with ESRD. Procedures in patients with ESRD were matched with procedures in non-ESRD controls for patient age, sex, race, diabetes mellitus, and hospital setting. Patient survival, graft survival, and limb salvage rates were determined using Kaplan-Meier analysis. Subjective interpretation of functional and symptomatic improvement was determined by telephone interviews with patients or relatives. Thirty-one procedures were performed on 20 patients with ESRD and 64 matched procedures were performed on 57 patients without ESRD. In the ESRD group, median patient survival was 1.72 years compared with 5.17 years for the control group (P < 0.001). Time to 50% limb loss was 1.24 years in the ESRD group and longer than 5.65 years in the control group (P < 0.001). Time to 50% graft patency loss was 0.70 years in the ESRD group and longer than 5.5 years in the control group (P < 0.05). Subjective improvement was less in patients with ESRD. Outcomes of lower-extremity revascularization in patients with ESRD are inferior to those in non-ESRD controls. The mortality rate for patients with ESRD who undergo revascularization is extremely high. Patient-related variables (eg, increased prevalence of hypertension and cardiovascular disease) and/or provider-specific factors (eg, timing of surgery in the course of PVD) may be responsible for poorer outcomes.

Adult↗
PubMed1994

Renal artery stenosis: a common and important problem in patients with peripheral vascular disease.

OBJECTIVE: To study the prevalence, severity, vascular risk factors, and clinical implications of renal artery stenosis in patients with peripheral vascular disease. DESIGN: Cross-sectional study of consecutive patients who were electively referred from the department of vascular surgery for lower limb digital subtraction angiography. SETTING: St. George's Hospital, London, United Kingdom. SUBJECTS: One hundred twenty-seven patients presenting with intermittent claudication or lower limb ischemic ulceration. MAIN OUTCOME MEASURES: Prevalence and clinical importance of renal artery stenosis in patients with peripheral vascular disease adjusted for the confounding effects of age and hypertension. RESULTS: Of the 127 patients, 57 (44.9%) had renal artery disease, of whom 22 (17.3%) had mild disease, 20 (15.7%) had severe disease, and 15 (11.8%) had bilateral renal artery stenosis. There was a significant positive relationship between the presence of renal artery stenosis and the severity of peripheral vascular disease (p = 0.00015). The risk of having renal artery stenosis was nearly four times greater in those with three to four vessels affected and nearly seven times greater in those with five or more vessels affected as compared with those with a milder degree of peripheral vascular disease (one or two vessels affected). This association persisted when the confounding effect of age and hypertension was accounted for. Six patients (31.6%) with renal artery stenosis who underwent revascularization for peripheral vascular disease died during the early postoperative period of cardiac or renal complications. None of the patients with normal renal arteries who had similar surgery developed postoperative complications (p = 0.005). CONCLUSIONS: Renal artery stenosis is a common independent feature in patients with peripheral vascular disease, and its prevalence increases with the increasing severity of the peripheral vascular disease. The postoperative risk following revascularization for peripheral vascular disease appears to be greater in those patients with renal artery stenosis. All patients studied with digital subtraction angiography for peripheral vascular disease should have an aortic flush performed to image the renal arteries. This information may be used to identify those patients likely to develop postoperative complications during peripheral revascularization.

Aged↗
PubMed1992

Detection of reversible platelet aggregates in the blood of smokers and ex-smokers with peripheral vascular disease.

OBJECTIVE: To demonstrate that smoking increases platelet aggregation in vivo, that smoking cessation reverses platelet aggregation and that this explains, in part, why smoking perpetuates the development of peripheral vascular disease. DESIGN: Prospective case-control study involving three groups of patients: smokers with peripheral vascular disease, ex-smokers with peripheral vascular disease and smokers with peripheral vascular disease who quit smoking during the study. SETTING/PARTICIPANTS: Fourteen smokers and seven ex-smokers, new patients with confirmed peripheral vascular disease, attending the vascular clinic at Fremantle Hospital between February and November, 1988. INTERVENTIONS: Blood samples taken weekly from all subjects for five weeks. Week 1 was taken as the baseline before smoking cessation in the six smokers who were assigned to stop smoking during the study. MAIN OUTCOME CRITERIA: Platelet aggregate ratio, an indicator of in-vivo platelet aggregability where an increase in platelet aggregate ratio suggests a decrease in platelet function. RESULTS: Only three of six smokers stopped smoking for the duration of the study. Median platelet aggregate ratios were: smokers = 0.85 (range, 0.79-0.92) v. non-smokers = 0.93 (range, 0.91-1.00). The difference was statistically significant P less than 0.0002. The difference in platelet aggregate ratios between smokers and quitters was not statistically significant. CONCLUSIONS: This study demonstrated an increase in platelet aggregability in smokers compared to ex-smokers but there was no clear evidence that platelet function was fully reversed after only four weeks cessation of smoking. The data suggested that platelet function of the ex-smokers had fully reversed to normal over a longer period. This could explain the decreased incidence of complications of peripheral vascular disease in ex-smokers. The small number of patients able to quit smoking impeded this study.

Adult↗
PubMed1986

Arterio-venous shunting complicating occlusive atherosclerotic peripheral vascular disease.

Three cases of severe occlusive peripheral vascular disease are described in which spontaneous arterio-venous fistulae at the site of atheromatous occlusion have been demonstrated by angiography during the arterial phase. Although none of these patients exhibited specific clinical signs of an arterio-venous fistula, this phenomenon is considered to have been a clinically significant factor in the patients' peripheral ischaemia. In one case both the superficial femoral artery stenosis and the spontaneous shunts were effectively treated by percutaneous angioplasty.

Aged↗
PubMed1985

Transluminal angioplasty: results in high-risk patients with advanced peripheral vascular disease.

The role of percutaneous transluminal angioplasty in treating advanced peripheral vascular disease is unknown. The authors therefore reviewed the experience of Sunnybrook Medical Centre in Toronto with 85 consecutive patients who had rest pain, ulceration, pregangrene or gangrene as a result of peripheral vascular disease and who underwent percutaneous transluminal angioplasty. Seventy-four percent were smokers and 91% were at increased risk due to one or more of the following: coronary or cerebral ischemic disease, diabetes mellitus, obesity and hypertension. Thirty-six patients underwent dilatation of iliac lesions, 46 of superficial femoral or popliteal and 3 of more distal lesions. In nine patients angioplasty was repeated on the same lesion. In 16 patients, the procedure was technically unsatisfactory. The morbidity and 30-day mortality were 5% and 2%, respectively. When the procedure was technically satisfactory, surgery was avoided and the limb was salvaged at 1, 2 and 5 years in 69%, 62% and 54% of cases, respectively (life-table analysis). The authors conclude that percutaneous transluminal angioplasty is acceptable treatment for patients with advanced peripheral vascular disease, because the morbidity and mortality are low and the long-term results are good.

Adult↗
PubMed1988

Percutaneous laser angioplasty in the treatment of peripheral vascular disease.

For a long time the treatment of peripheral vascular diseases mainly was a surgical one. Improvements in drug therapy and success of PTCA have increased the interest in a more conservative therapy. So laser promised to be another tool in the percutaneous treatment of peripheral vascular diseases. First successful experiments were followed by the experience of technical problems and side effects of this new method. First clinical studies in occluded human femoral arteries were started at Stanford University in 1983. The results, published in 1985, showed that occlusive lesions in this vascular region could be successfully reopened by a percutaneous approach. But in cases of severe calcification the danger of perforation or dissection was significantly increased. Moreover the newly created channel proved to be too small for a sufficient revascularization, so that this method had to be combined with balloon angioplasty. By the development of the metalcapped "hot tip", laser energy was totally changed into thermal energy. By this new system greater channels of 2 up to 2.5 mm could be created and by the special design of the metalcap thermal injury to the arterial wall could be decreased. Nevertheless perforation occurred also with this system. Moreover, additional balloon angioplasty was still necessary in proximal segments of the femoral artery. Futural developments of greater metal heads may lead to the exclusive use of the "hot tip" especially in more distal parts. Longterm results will show, if laser angioplasty is comparable to other conventional methods like balloon angioplasty or surgery. There is still a long way to go, until the ideal of reopening atherosclerotic stenoses only by laser energy can be reached.

Angioplasty, Balloon↗
PubMed2001

Non-surgical treatment of patients with peripheral vascular disease.

Dotter first described percutaneous revascularization of peripheral vascular disease (PVD) in 1964. In 1974, Gruentzig developed a balloon catheter for dilation of vascular lesions. Currently, percutaneous transluminal angioplasty (PTA) employs a variety of devices ranging from implantable stents to endovascular radiation devices for re-stenosis and is recognized as a safe and effective alternative to surgery for selected patients. In addition to the general efficacy of peripheral angioplasty, which is comparable to that of bypass surgery for selected lesions, angioplasty offers several distinct advantages over surgery. It is performed under local anaesthesia, making it feasible to treat patients who are at high risk for general anaesthesia. When compared to surgical revascularization, the morbidity from angioplasty is low, generally related to problems at the vascular access site, and mortality is extremely rare. Unlike vascular surgery, there is no recovery period after angioplasty, and most patients can return to normal activity within 24-48 h of an uncomplicated procedure. Finally, angioplasty can be repeated if necessary usually without increased difficulty or increased patient risk compared to the first procedure, and does not preclude surgery as adjunctive or definitive therapy.

Angina, Unstable↗
PubMed1990

[Epidemiologic study on peripheral vascular diseases in Shanghai].

Epidemiologic investigation and study were made on peripheral vascular diseases in Shanghai area during 1988 and 1989. The total number of examined subjects was 30,712, including peasants and workers from heavy and light industries. The number of the subjects suffered from peripheral vascular diseases was 2,679, with an incidence of 8.72%. Among them, varicosity of the superficial veins in the lower extremities was found in 2,577, and other peripheral vascular diseases were found in 102. Risk factors for varicose veins include hard labour, body mass, standing, pregnancy and sitting. New concepts about the varicose veins were advanced by the authors.

Adolescent↗
PubMed1980

Transverse section imaging of soft tissue tumors and peripheral vascular disease.

The development of soft tissue tumors and peripheral vascular disease is accompanied by changes in physiologic parameters such as blood flow and metabolism. Positron tomography can provide regional values of parameters such as blood flow, blood volume, oxygen utilization, and glucose metabolism in normal and diseased tissue. Such information may be of value in determining appropriate therapy and in assessing the effects of therapy. Equilibrium imaging during continuous inhalation of C15O2 provides a means of measuring blood flow on a regional basis. Equilibrium C15O2 imaging has been applied on a preliminary basis in patients with soft tissue tumors. In general, tumor tissue exhibits markedly higher rate of blood flow than normal tissue. In some patients, necrotic areas exhibit a greatly diminished blood flow. In the case of peripheral vascular disease, equilibrium C15O2 imaging shows decreased blood flow in affected regions. A significant increase in blood flow is seen following transluminal dilation.

Aged↗
PubMed1993

The Bard Rotary Atherectomy System (BRAS): initial experience in patients with peripheral vascular disease.

Sixteen patients with a mean age of 65.4 +/- 9.8 years and suffering from peripheral vascular disease underwent peripheral atherectomy using a new mechanical device--the BARD Rotary Atherectomy System (BRAS). The BRAS is an "over the wire" system that consists of a spiral guidewire and a handheld motor drive unit, which rotates at 1,500 rpm. Prior to the procedure angiography demonstrated the presence of 18 obstructions (1 tibial, 2 popliteal, 15 superficial femoral arteries) with a mean stenosis of 95.7 +/- 8%. Successful atherectomy was achieved in 16 of 18 lesions and resulted in an 89% immediate success rate and a significant (P less than 0.01) reduction of stenosis to 37.8 +/- 12.5%. There were no significant complications. The excised and removed material embedded over the spiral guidewire demonstrated the presence of fibrotic tissue, fatty lesions, and calcium deposits. Medial or adventitial layers were not present in the removed atherosclerotic material. Mean ABI was significantly (P less than 0.01) increased from 0.38 +/- 0.17 to 0.55 +/- 0.21 following atherectomy. Angiographic follow-up obtained in ten patients 8.8 +/- 5.2 months following the procedure demonstrated restenosis in six of those ten patients. The ABI at this time remained unchanged. These results demonstrated that the new BRAS mechanical atherectomy system is feasible and safe for recanalization of severely stenosed arteries in patients with peripheral vascular disease.

Aged↗