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PubMed1993

Prognostic value of noninvasive cardiac tests in the assessment of patients with peripheral vascular disease.

Two hundred thirty-six patients with peripheral vascular disease were prospectively studied to assess whether noninvasive cardiac investigations could predict prognosis better than simple clinical assessment. Clinical history, examination and resting electrocardiography were considered in all patients; exercise electrocardiography, Holter monitoring, radionuclide ventriculography and dipyridamole thallium imaging were performed in a subgroup of 168 patients. Follow-up for 6 to 30 months revealed major cardiac events in 21 patients. Cox survival analysis showed that clinical evidence of prior coronary artery disease was the best variable from clinical assessment that predicted cardiac events, with no other clinical variable adding to the statistical model. When variables from noninvasive cardiac assessment were added to the model, which included clinical evidence of coronary artery disease, dipyridamole thallium heart:lung ratio and left ventricular ejection fraction added significantly and incrementally to the prediction of cardiac events. Results of exercise electrocardiography or Holter monitoring did not add significantly. It is concluded that high lung uptake of thallium during dipyridamole stress, and impaired left ventricular ejection fraction help to identify patients with peripheral vascular disease who are at high cardiac risk, and should therefore be used for selecting subsequent cardiovascular medical, surgical and anesthetic management.

Aged↗
PubMed1975

Hypercoagulability in patients with peripheral vascular disease.

Twenty-seven patients with peripheral vascular disease had studies of thrombin generation, antithrombin III -alues, factor VIII values, platelet adhesitivity, and activated partial thromboplastin time. Of the studies performed, the thrombin generation index, antithrombin III values, and, to a lesser extent, activated partial thromboplastin time were reliable in confirming clinically suspected hypercoagulability. When patients were placed into groups with and without operative complications, it was noted that the group with operative complications had higher average values of thrombin generation index and lower average values of antithrombin III and activated partial thromboplastin time than did the group without operative complications. It is thought that these tests may be useful in selecting those patients with a high risk of thrombotic complications from vascular surgery and who may benefit from anticoagulant management while undergoing necessary vascular reconstructive procedures.

Adult↗
PubMed1991

Effect of sulodexide on blood viscosity in patients with peripheral vascular disease.

Thirty patients with Stage II peripheral vascular disease were treated with sulodexide, a new, medium molecular weight glycosaminoglycan, and placebo using a double-blind, crossover study design. After a 1-month wash-out period, patients were treated for 1 month with one or other trial medication and then crossed over to the alternative preparation for a further month. Measurements were made at baseline and at the end of each treatment period of serum, plasma and whole blood viscosities (at various shear rates), fibrinogen levels and red cell filterability. Tolerance parameters were also assessed at the same times. The results showed that there were statistically significant reductions in plasma and whole blood viscosity and in fibrinogen levels after sulodexide, but not after placebo. Neither treatment had any marked effect on red blood cell filterability. Local and systemic tolerance of the treatment was excellent, and some patients reported an improvement in symptoms whilst they were taking sulodexide; this, however, could not be quantified in this study. It is suggested that the viscosity and fibrinogen reducing effect of sulodexide make it a useful form of treatment in patients with atheromatous vascular diseases of the lower limbs.

Adult↗
PubMedDate not supplied

The value of segmental pressure measurement in the assessment of peripheral vascular disease.

In 60 patients with symptomatic peripheral vascular disease a study was performed to evaluate the reliability of segmental pressure measurement in detecting and localizing vascular lesions. Five groups of limbs with different pressure patterns were identified: normals, distals disease (diabetics), aorto-iliac disease, aorto-iliac and superficial femoral disease, superficial femoral and distal disease. The comparison with angiography showed the high efficacy of this method (when combined with Doppler study of the arteries) to localize and quantify the lesions. The combination with femoral intraarterial pressure measurement allows to predict exactly the segmental pressure after segmental vascular reconstructions. It is concluded that segmental pressure measurement (with the described technique) selects patients for angiography and surgery and can predict the outcome of vascular reconstruction.

Adult↗
PubMed1982

Ultrastructural and capillary adaptation of gastrocnemius muscle to occlusive peripheral vascular disease.

The effect of chronic occlusive peripheral vascular disease (PVD) on the histochemistry and capillarity of the gastrocnemius muscle was studied in 129 biopsies taken from 93 subjects. Sixty-three patients underwent biopsy during surgical procedures, and data related to walking distance and ankle systolic pressure. Thirty biopsies taken from normal subjects post mortem served as a control group, and data were analyzed for fiber type distribution, fiber area, fiber type grouping, and fiber capillarity. Fiber type distribution did not alter significantly between the patients with PVD and the control group, but the mean fiber area of the type 1 fiber in male patients with intermittent claudication (IC) was reduced when compared to that in age-matched controls (4608 +/- 1181 mu 2, IC +/- 1 SD; 5795 +/- 1771 mu 2, controls +/- 1 SD) (P less than 0.05). When bilateral biopsies were taken from the gastrocnemii of patients with unilateral occlusions, the type 2 fibers in the diseased leg were significantly smaller than fibers of the control group (2821 +/- 953 mu 2, IC +/- 1 SD; 4318 +/- 1504 mu 2, controls +/- 1 SD) (P less than 0.02). Fiber type grouping, evidence of denervation and reinnervation of muscle, appeared to be more common in patients with more severe limb ischemia. Overall capillary numbers did not appear to alter with degree of ischemia, but fiber shrinkage appeared to compensate for any loss of capillaries in the more ischemic muscle. These data suggest that the limb of the untrained patient with IC does not adapt to ischemia by adjusting its exercise capacity but merely shows evidence of disuse. These adaptations suggest that there may be much to be gained by nonsurgical methods of treating IC.

Adaptation, Physiological↗
PubMedDate not supplied

Evaluation of indirect blood pressure measurement as a method of assessment of peripheral vascular disease.

In over 200 patients with peripheral vascular disease, pressure index (formula: see text) was compared with radiological grade; although calf P.I. had a better correlation, there was wide overlap between the groups. In 28 patients, resting calf P.I. was compared with functional impairment measured on a treadmill. At two rates of exercise, calf P.I. correlated poorly with functional impairment. In 35 patients, reproducibility of indirect pressure measurement was assessed; coefficients of variation ranged 0-10%; coefficient of variation of calf P.I. ranged 0-8%; coefficient of variation of calf P.I. ranged 0-8%. In 12 patients, indirect thigh systolic pressure was compared with and nearly always exceeded direct common femoral artery pressure; this was due to an effect of the cuff which reduced blood flow and reduced the pressure gradient. This methodological error has not previously been described and reduces the clinical value of the measurement.

Arteries↗
PubMed1991

Morphological abnormalities in the sural nerve from patients with peripheral vascular disease.

The present paper has been written in order to determine the morphological alterations in the sural nerve from patients with chronic arteriosclerotic occlusive disease. Eight patients with Peripheral Vascular Disease (PVD) and six age-matched control subjects were studied. Morphometric data revealed two groups of patients, one of them with mild disease (n = 5), and the other one with severe damage (n = 3), consisting in loss of myelinated fibres and increase in the number of small fibres (p less than 0.05). Teased nerve fibres and electron microscopic studies also showed two types of patients, with respect to the myelin or the axonal alterations. The unmyelinated fibre population was affected equally in both groups. In conclusion, this study supports the idea that ischemia is able to cause structural alterations in the peripheral nerve, and that it can play a role in the development of neuropathy.

Aged↗
PubMed1981

Decreased sensitivity of human platelets to PGI2 during long-term intraarterial prostacyclin infusion in patients with peripheral vascular disease--a rebound phenomenon?

During successful treatment of peripheral vascular disease with synthetic prostacyclin no alteration in platelet function was reported (1). In 8 patients infused with synthetic prostacyclin continuously for 7 days intraarterially, the platelet function was monitored. Special attention was drawn to the platelet sensitivity in vitro for PGI2, which is discussed as an important factor maintaining the hemostatic balance. In all the patients with peripheral vascular disease between 24 and 48 hours after the beginning of the infusion a sudden decrease in platelet sensitivity accompanied by an increase in platelet count could be seen. These dramatic alterations representing probably a rebound phenomenon occurring during long-term PGI2-treatment might be an explanation for a non-beneficial effect of the treatment and in some cases a limiting factor for the continuation of the infusion itself. It is not clear, if this rebound phenomenon is due to a stimulation of an endogenous inhibitor, lowering the synthesis of a naturally occurring substance acting against this inhibitor or tachyphylaxia.

Aged↗
PubMed1998

In vitro cytotoxicity of IgG antibodies on vascular endothelial cells from patients with endemic peripheral vascular disease in Taiwan.

A unique peripheral vascular disorder called 'blackfoot disease' is endemic in a limited area on the south-west coast of Taiwan. Clinically, the signs and symptoms of blackfoot disease (BFD) are similar to those of arteriosclerosis and Buerger's disease. A destruction of vascular endothelial cells (ECs) takes place at an early stage in the affected limbs. Currently, the cause of BFD is believed to be artesian drinking water containing a high concentration of arsenic and/or humic substances, although the mechanism of EC destruction is not entirely understood. The purpose of the present study was to examine the factors related to EC damage in BFD. Thus, we investigated the effects of purified IgG collected from patients with BFD (BFD-IgG) and from normal controls (N-IgG) on cultured EC. We found that: (1) EC binding activity of BFD-IgG was significantly higher than that of N-IgG; (2) BFD-IgG, at a concentration higher than 100 microg/ml but not N-IgG, induced concentration-dependent EC cytotoxicity; (3) BFD-IgG at a concentration of 100 microg/ml stimulated neither the release of von Willebrand factor nor the expression of intercellular adhesion molecule-1 by EC. Fluorescent video microscopic examination revealed an increase in transcapillary and interstitial diffusion of nailfold capillary loops in clinically normal fingers of BFD patients. These findings strongly suggested that immunological mechanisms played a significant role in the pathogenesis of BFD. We propose that only persons who produce the IgG anti-endothelial cell antibody are potential victims of BFD.

Antibodies, Anti-Idiotypic↗
PubMed2002

Endothelial function in patients with peripheral vascular disease: influence of prostaglandin E1.

Peripheral arterial occlusive disease (PAOD) is characterized by atherosclerotic lesions in large vessels and disturbances on the microcirculatory level. In the local regulation of vascular tone and microvascular perfusion, vascular endothelium plays a key role. For many years prostaglandin E1 (PGE1) has been used for the treatment of PAOD. Because PGE1 has only moderate effects on blood flow other mechanisms may be relevant for the therapeutical efficacy. The aim of our pilot study was to evaluate endothelial function in patients with PAOD and to investigate the impact of PGE1 on endothelial-dependent vasodilation in peripheral vesselsIn 8 controls and in 8 patients with PAOD stage II, endothelial-dependent vascular responses of the femoral vessels to increasing doses of acetylcholine (30,60,90 microg/min) were determined by Doppler flow velocity measurements in the common femoral artery. Furthermore, vascular reactivity was evaluated before and immediately after intravenous infusion of 30 microg PGE1/30 min in patients. Endothelial-dependent vasodilation was significantly reduced in patients with PAOD compared to control subjects. Infusion of PGE1 neither increased blood flow in the common femoral artery nor endothelium-dependent vasodilation of peripheral resistance vessels as indicated by unchanged reaction to acetylcholine. In conclusion, endothelial function is impaired in patients with PAOD. Administration of PGE1 did not increase femoral artery blood flow or improve endothelial-dependent reactivity of peripheral resistance vessels in patients with PAOD. Therefore, beneficial effects of PGE1 in peripheral vascular disease cannot be attributed to an increase in blood supply or an improvement of endothelial-dependent vasodilation.

Aged↗
PubMed2004

Coronary surgery in patients with peripheral vascular disease: effect of avoiding cardiopulmonary bypass.

BACKGROUND: An increasing number of patients with peripheral vascular disease are undergoing coronary artery bypass grafting. Such patients have an increased risk of adverse outcomes. Our aim was to quantify the effect of avoiding cardiopulmonary bypass in this group of patients. METHODS: Between April 1997 and March 2002, 3,771 consecutive patients underwent coronary artery bypass grafting performed by five surgeons. Four hundred and twenty-two (11.2%) had peripheral vascular disease and of these, 211 (50%) received off-pump surgery. We used multivariate logistic regression analysis to assess the effect of off-pump surgery on in-hospital mortality and morbidity, while adjusting for treatment selection bias. Treatment selection bias was controlled for by constructing a propensity score, which was the probability of receiving off-pump surgery and included core patient characteristics. The C statistic for this model was 0.8. RESULTS: Off-pump patients were more likely to have preoperative renal dysfunction, previous gastrointestinal surgery, and less extensive disease. The left internal mammary artery was used more in off-pump compared to on-pump cases (90.1% vs 82.9%; p = 0.033). In the univariate analyses, off-pump patients were less likely to have a postoperative stroke (p = 0.007), and had shorter postoperative hospital stays (p < 0.001). However, the incidence of new atrial arrhythmia was higher (p = 0.028). After adjustment for differences in case-mix (propensity score), avoidance of cardiopulmonary bypass was still associated with a significant reduction in postoperative stroke (adjusted odds ratio 0.09 [95% confidence interval 0.02 to 0.50]; p = 0.005), and shorter postoperative hospital stay (p = 0.001). CONCLUSIONS: Off-pump coronary surgery is safe in patients with peripheral vascular disease, with acceptable results. The incidence of postoperative stroke is substantially reduced when avoiding cardiopulmonary bypass in patients with peripheral vascular disease.

Aged↗
PubMed1992

Not so rapid progression of peripheral vascular disease after diagnostic angiography.

It was recently reported that peripheral vascular disease may progress so rapidly after diagnostic angiography that most likely the diagnostic procedure is in some way responsible. Because flow-limiting arterial stenoses often become complete occlusions within hours or days of the diagnostic procedure, it was recommended that angioplasty be performed immediately after diagnostic angiography to avoid this complication. The authors attempted to confirm these findings before implementing this recommendation. In fact, they did not confirm the findings. Among 96 flow-limiting stenoses considered for angioplasty, the procedure was performed in 31 on the same day. Among the remaining 65 cases, in 64 the stenosis did not occlude and angioplasty was successfully performed. Only one stenosis was discovered to have thrombosed, and this occurred 3 weeks after diagnostic angiography. These results indicate that there is not such rapid progression of peripheral vascular disease after diagnostic angiography. It is not necessary to perform angioplasty of stenotic lesions emergently, and treatment is not impaired by electively scheduling the patient for the next available day.

Angiography↗
PubMed1980

[Extracranial arterial occlusive disease in arteriopathies with peripheral vascular disease (author's transl)].

Aortography and angiography of the aortic arch were carried out in 176 patients with peripheral arterial occlusive disease. In 63,6% there were haemodynamically relevant stenoses or occlusions of the supraaortic vessels, the carotid arteries with 39,2% and the vertebral arteries with 35,2%, being the most commonly involved. Peripheral arterial disease included haemodynamically relevant changes in the femoro-popliteal arteries in 83%, in the aorto-iliac region in 67,1% and in the calf vessels in 58,5%. There was a statistically significant correlation between the clinical severity of the cerebrovascular insufficiency and of the Frontaine stages with the angiographically demonstrable extent of the arteriosclerosis. In addition there was an increasing statistical risk of extracranial arterial occlusion if the disease affected more than one arterial level.

Aorta, Abdominal↗
PubMed1996

Dose-response relationship between peripheral vascular disease and ingested inorganic arsenic among residents in blackfoot disease endemic villages in Taiwan.

The purpose of this study was to examine the correlation between previous arsenic exposure and peripheral vascular disease after stopping consumption of high-arsenic artesian well water for more than two decades in blackfoot disease endemic villages in Taiwan. A total of 582 adults (263 men and 319 women, aged 52.6 +/- 10.6 years) living in these villages underwent Doppler ultrasound measurement of systolic pressures on bilateral ankle (posterior tibial and dorsal pedal) and brachial arteries and estimation for long-term arsenic exposure. The diagnosis of peripheral vascular disease was based on an ankle-brachial index (the ratio between ankle and brachial systolic pressures) <0.90 on either side. Three indices of arsenic exposure were estimated: (1) duration of living in blackfoot disease endemic villages; (2) duration of artesian well water consumption; and (3) cumulative arsenic exposure in mg/l-years based on the detailed history of residential addresses and artesian well water consumption and the arsenic concentration in artesian well water. Multiple logistic regression analysis was used to assess the association between peripheral vascular disease and arsenic exposure. A dose-response relation was observed between the prevalence of peripheral vascular disease and the long-term arsenic exposure. The odds ratios (95% confidence intervals) after adjustment for age, sex, body mass index, cigarette smoking, serum cholesterol and triglyceride levels, diabetes mellitus and hypertension were 2.77 (0.84-9.14), and 4.28 (1.26-14.54) for those who had cumulative arsenic exposure of 0.1-19.9 and > or = 20.0 mg/l-years, respectively, compared with those who were not exposed. This study suggests a close relation between long-term arsenic exposure and peripheral vascular disease in blackfoot disease endemic villages in Taiwan after stopping consumption of artesian well water.

Adult↗
PubMed1978

Platelet aggregation in patients with peripheral vascular disease.

Platelet aggregation has been studied in 28 control subjects and 46 patients with peripheral vascular disease. The platelets from the patients with peripheral vascular disease were significantly more sensitive to the aggregating effects of adenosine diphosphate and adrenaline than those from the control group (P less than 0.001). In addition, spontaneous platelet aggregation was observed in vitro in several of the vascular patients; this response was not apparent in the control group. Increased platelet aggregation could add to the vascular impairment in the unoperated subject and might also play a part in premature graft failure. Platelet function studies should perhaps be included as a routine in the assessment of patients with peripheral vascular disease.

Adenosine Diphosphate↗
PubMed1971

Insulin response to glucose in patients with peripheral vascular disease, arteritis, and Raynaud's phenomenon.

Twenty-three patients with peripheral vascular disease due to atheromatous blocks in large vessels, four patients with arteritis, and twenty patients with Raynaud's phenomenon were tested for insulin response to glucose. (In an earlier investigation patients with small-vessel peripheral vascular disease did not secrete insulin in response to a glucose load--a previously unreported finding.) Insulin output after glucose in patients with atheromatous blocks in large peripheral arteries fell into three categories: (1) normal glucose tolerance and insulin output, the insulin rise (peak/basal ratio) comparing well with the rise in controls; (2) carbohydrate intolerance with a prediabetic pattern of glucose-tolerance test, and raised circulating insulin levels both fasting insulin and after glucose, so that the insulin rise was lower than normal; or (3) the flat insulin responses after glucose that had been noted in small-vessel disease with normal glucose tolerance. Thus in these twenty-three patients with large-vessel blocks presenting with peripheral vascular disease the high and late insulin secretion after glucose reported by other workers for patients with atheroma could not be confirmed. High but not delayed insulin peaks were seen after a glucose stimulus in some patients with arteritis and with Raynaud's phenomenon.

Adolescent↗
PubMed1998

Premature peripheral vascular disease: clinical profile and abnormal lipid peroxidation.

The aim of this study was to determine any biochemical differences between early-onset peripheral vascular disease and typical onset atherosclerosis, and age-matched controls. A subset of patients present at a young age ( < 50 years) with peripheral vascular disease which pursues an aggressive course. As lipid oxidation seems important in atherosclerosis, total lipid peroxides, oxidized subfractions, and Trolox equivalent antioxidant capacity (TEAC) were studied in patients with premature peripheral vascular disease. Charts were reviewed of patients operated on for vascular occlusive disease over a 5-year period. Patients with early-onset peripheral vascular disease (group I) were evaluated for biochemical abnormalities and compared with typical onset atherosclerotics (group II) and age-matched controls (group III). Sixteen patients with early-onset peripheral vascular disease underwent biochemical evaluation. Conventional lipid profiles did not differ statistically from those of age-matched controls, except for mild elevations in LDL and VLDL in patients with vascular occlusive disease (207 and 195 mg/dl in groups I and 11 versus 157 mg/dl in group III). Total oxidative potential was significantly elevated (P = 0.006) 3.04, 2.15 and 2.04 nmol/ml in groups I, II and III, respectively. Levels of oxidized LDL and VLDL were even more significantly elevated (P = 0.0009) for premature peripheral vascular disease, (1.2, 0.58 and 0.47 nmol/ml in groups I-II). TEAC values did not differ significantly between groups (0.83, 0.82, 0.82 nmol/ml) and did not correlate with total lipid peroxide values for individual patients. In conclusion, lipid peroxides were significantly elevated in patients with premature peripheral vascular disease, the most marked changes being seen in oxidized LDL and VLDL subfractions. Lipid peroxides were elevated when standard lipid profiles were only mildly abnormal. The poor long-term prognosis in these patients suggests the need for aggressive evaluation and treatment of lipid abnormalities.

Adult↗