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PubMed1997

Activated protein C resistance, factor V Leiden and peripheral vascular disease.

Activated protein C resistance caused by factor V Leiden is an important thrombophilia disorder which predisposes to venous thromboembolism. Some studies also suggest a role in the pathogenesis of arterial thrombosis and atherosclerosis. The authors have investigated the prevalence of activated protein C resistance and factor V Leiden in a series of 45 patients with peripheral vascular disease. Twelve patients were receiving warfarin. The activated protein C resistance ratios were significantly lower in the group of 33 non-warfarinized patients with peripheral vascular disease (median 2.82 (range 1.36-3.83)) compared with 33 age- and sex-matched controls (median 2.97 range 2.24-4.11); P<0.005; Wilcoxon rank sum). Eight patients (24%) had activated protein C resistance (ratio <2.2). The prevalence of factor V Leiden in patients with peripheral vascular disease was 17.8% (8/45). This is significantly increased compared with the local population and UK published frequency of 3.5% for this genotype. The presence of factor V Leiden did not affect the late outcome of arterial reconstructive surgery in terms of graft patency (P=0.5, Fisher's Exact test).

Aged↗
PubMed1991

Infusion of a stable prostacyclin analogue, iloprost, to patients with peripheral vascular disease: lack of antiplatelet effect but risk of thromboembolism.

PURPOSE: Prostacyclin, a potent inhibitor of platelet function and vasodilator, has been used to treat peripheral vascular disease. The aim of this study was to monitor the thrombotic status of patients treated by infusion of a stable prostacyclin analogue, iloprost. PATIENTS AND METHODS: Thirteen patients with peripheral vascular disease underwent iloprost infusion for 3 days (8 hours each day) in a dose ranging from 0.5 to 2 ng/kg/minute. Variable parameters of thrombosis such as platelet reactivity (shear-induced hemostatic plug formation and thrombus formation on a collagen fiber), coagulation, and spontaneous thrombolysis (dislodgment of hemostatic plugs) were measured from non-anticoagulated blood samples by hemostatometry immediately before and 1 hour after the infusion and on the last day, 4 hours after initiation of the infusion. RESULTS: Analysis of data from all patients 1 hour after the infusion showed no changes in platelet reactivity and spontaneous thrombolysis, but coagulation was significantly enhanced. In four patients, significant platelet hyperreactivity was observed after the infusion. Four of the five patients tested while undergoing iloprost infusion showed an enhanced thrombotic reaction and markedly enhanced coagulation. Iloprost employed in vitro in a concentration that corresponds to the therapeutic peak blood level caused no inhibition of platelet function but significantly enhanced coagulation. The threshold in vitro iloprost concentration at which anti-platelet effect and increased spontaneous thrombolysis were observed was twice that of the therapeutic blood level. CONCLUSIONS: These findings challenge the view that antagonism of platelet function is an important factor of iloprost therapy. Furthermore, platelet hyperreactivity in some patients and markedly enhanced coagulation during and after infusion of iloprost in general, represent a risk of thromboembolism, especially as patients are already in a prethrombotic condition.

Adult↗
PubMed2005

Arsenic exposure, urinary arsenic speciation, and peripheral vascular disease in blackfoot disease-hyperendemic villages in Taiwan.

Long-term exposure to ingested inorganic arsenic is associated with peripheral vascular disease (PVD) in the blackfoot disease (BFD)-hyperendemic area in Taiwan. This study further examined the interaction between arsenic exposure and urinary arsenic speciation on the risk of PVD. A total of 479 (220 men and 259 women) adults residing in the BFD-hyperendemic area were studied. Doppler ultrasound was used to diagnose PVD. Arsenic exposure was estimated by an index of cumulative arsenic exposure (CAE). Urinary levels of total arsenic, inorganic arsenite (As(III)) and arsenate (As(V)), monomethylarsonic acid (MMA(V)), and dimethylarsinic acid (DMA(V)) were determined. Primary methylation index [PMI = MMA(V)/(As(III) + As(V))] and secondary methylation index (SMI = DMA(V)/MMA(V)) were calculated. The association between PVD and urinary arsenic parameters was evaluated with consideration of the interaction with CAE and the confounding effects of age, sex, body mass index, total cholesterol, triglycerides, cigarette smoking, and alcohol consumption. Results showed that aging was associated with a diminishing capacity to methylate inorganic arsenic and women possessed a more efficient arsenic methylation capacity than men did. PVD risk increased with a higher CAE and a lower capacity to methylate arsenic to DMA(V). The multivariate-adjusted odds ratios for CAE of 0, 0.1-15.4, and >15.4 mg/L x year were 1.00, 3.41 (0.74-15.78), and 4.62 (0.96-22.21), respectively (P < 0.05, trend test); and for PMI < or = 1.77 and SMI > 6.93, PMI > 1.77 and SMI > 6.93, PMI > 1.77 and SMI < or = 6.93, and PMI < or = 1.77 and SMI < or = 6.93 were 1.00, 2.93 (0.90-9.52), 2.85 (1.05-7.73), and 3.60 (1.12-11.56), respectively (P < 0.05, trend test). It was concluded that individuals with a higher arsenic exposure and a lower capacity to methylate inorganic arsenic to DMA(V) have a higher risk of developing PVD in the BFD-hyperendemic area in Taiwan.

Age Factors↗
PubMed1989

The association of lower extremity peripheral vascular disease in patients undergoing coronary bypass surgery.

The association of lower extremity peripheral vascular disease (PVD) in patients undergoing coronary artery bypass (CAB) has been studied in two groups of patients who have been operated upon between January and May 1987. Group 1 consists of 125 cases in which only resting ankle-arm pressure index (AAPI) were evaluated. Group 2 consists of 50 cases where both resting and after exercise AAPI were recorded. In total, 17 cases of one extremity and in 10 both lower extremity resting AAPI were below 0.9 (15.4%). In Group 2 comparison of resting and after exercise AAPI on both sides showed no statistically significant difference. However in Group 2, 13 cases (26%) had after exercise AAPI below 0.9 and in 26 (52%) cases after exercise AAPI were lower than the resting AAPI. This study showed that, although the coexistence of PVD in patients undergoing CAB is not as high as the coexistence of CAD in patients undergoing peripheral vascular procedures, this percentage can increase when the presence of PVD is evaluated with an exercise test whenever possible.

Adult↗
PubMed2006

Peripheral vascular disease endovascular management in patients scheduled for cardiac surgery: a clinical-angiographic approach.

BACKGROUND: Endovascular management of peripheral vascular disease before cardiac surgery is still debated. We sought to present our preliminary experience of endovascular stent placement in patients scheduled for urgent cardiac surgery. METHODS: Between November 2003 and August 2005, 20 patients scheduled for urgent coronary surgery (13 males, mean age 72.5+/-5.3 years) underwent endovascular repair of PVD on the basis of clinical and angiographic indications. Aspirin (100 mg/day) plus low molecular weight heparin (nadroparin calcium) 100 IU/kg/12 h for urgent coronary surgical revascularization was administered after the procedure. RESULTS: Endovascular stenting has been performed in four clinical settings: renal artery stenting prior to coronary surgery (nine patients) to decrease the impact of extracorporeal circulation on an impaired renal function, iliac artery artery angioplasty and stenting (eight patients) in order to facilitate aortic balloon pump insertion after surgery, subclavian artery angioplasty and stenting propedeutical to arterial conduits bypass surgery (one patient), carotid artery stenting before coronary surgery (two patients). All patients underwent successful endovascular repair followed by cardiac surgery. At a mean follow-up of 12+/-4.6 months all patients are alive and without evident thrombosis or restenosis of the implanted vascular stents. CONCLUSIONS: Endovascular treatment of PVD in patients scheduled for urgent coronary surgery may be effective, relatively safe and lasting in spite of low dose antiplatelet regimen.

Aged↗
PubMed1997

Peripheral vascular disease after kidney-pancreas transplantation in diabetic patients with end-stage renal disease.

OBJECTIVE: To determine the long-term effect of a functioning pancreas transplant on peripheral vasculopathy. DESIGN: We compared the progression of peripheral vascular disease in 39 recipients of successful kidney-pancreas transplants (KPT) with 65 consecutive diabetic patients who received cadaver kidney transplants alone (KTA) during the same period in a nonrandomized, retrospective control study. The mean duration of follow-up was more than 4 years in both groups. SETTING: Academic subspecialty referral practice. PATIENTS: A consecutive sample of all KPT recipients with more than 6 months of pancreas allograft function performed between May 1, 1988, and April 30, 1995. All patients who received cadaver renal transplants for diabetic nephropathy during the same period and who maintained a functioning renal allograft for more than 6 months were included as controls. INTERVENTION: Kidney-pancreas transplantation. MAIN OUTCOME MEASURE: Progression of peripheral vascular complications (PVC) defined as any midfoot or limb amputation (AMP), any ischemic ulceration requiring treatment (ULCER), and lower-extremity bypass surgery or angioplasty (LEBP). Ulcers leading to amputation were considered as single events (AMP only). RESULTS: Thirty-five (90%) of 39 KPT recipients are insulin-free. The KTA recipients had more atherosclerotic risk factors, including a higher incidence of coronary artery disease (P = .008), higher serum cholesterol levels (P = .03), and higher triglyceride levels (P = .04) than KPT recipients. Peripheral vascular complications before transplantation were comparable (P = .94) between groups. After transplantation, there were 35 new PVC (9 AMP, 11 ulcers, and 15 LEBP) in 18 of 39 KPT recipients vs 32 PVC (10 AMP, 8 ulcers, and 14 LEBP) in 20 of 65 KTA recipients (P = .005), indicating that KPT recipients had more PVC than did KTA recipients, despite a functioning pancreas. Seven bypass grafts failed after KPT, resulting in 6 limb amputations. In contrast, only 3 limb amputations were performed in 14 patients undergoing lower-extremity bypass procedures after KTA. CONCLUSIONS: Despite fewer risk factors for peripheral vasculopathy and the presence of insulin independence, KPT recipients had a higher incidence of PVC than a cohort of uremic diabetic patients undergoing KTA during the same period. These data show that a functioning pancreas allograft performed with a renal transplantation not only does not alter the progression of peripheral vascular disease in patients with renal failure secondary to diabetic nephropathy but also may accelerate PVC.

Adult↗
PubMed1987

Failure of pentoxifylline for end-stage peripheral vascular disease.

In this trial of pentoxifylline, 15 patients with end-stage peripheral vascular disease had symptoms severe enough to warrant operation, but surgery was contraindicated because of anatomically noncorrectable disease, serious medical problems, or refusal. Their mean age was sixty-six years. Each patient received oral pentoxifylline, 400 mg tid, for twelve weeks. Pentoxifylline had no measurable clinical benefit in 14 of the patients. In addition, the authors noted an increased incidence of symptomatic coronary artery insufficiency during the trial period that may or may not have been drug related.

Aged↗
PubMed1988

Long-term follow-up of Syme amputations for peripheral vascular disease associated with diabetes mellitus.

Ten patients underwent Syme amputation for diabetic peripheral vascular disease between 1980 and 1986 and were observed postoperatively for an average of 5 years. Surgical wounds healed in only five of the 10 patients; they were then fitted for a permanent Syme's prosthesis. All failures resulted from the inability to heal the surgical incisions primarily. The clinical records of these patients were retrospectively analyzed for predictors of successful clinical outcome. The ischemic index, grade of the lesion, initial wound treatment, and presence of the infection at the time of amputation were not found to be reliable predictors of a successful level of amputation. Clinical assessment of both the vascular and nutritional status of the patient was necessary to predict a successful result at this level of amputation.

Adult↗
PubMed1984

Tailored approach for evaluation of peripheral vascular disease: intravenous digital subtraction angiography.

A tailored approach for evaluating patients with peripheral vascular disease has been developed using intravenous digital subtraction angiography (IV DSA). This approach includes a history, physical examination, and correlation with Doppler pressure measurements to predict the location of the dominant lesion. In 60 patients, two views of the aortoiliac segment plus three or four views of the femoral and runoff circulation in the most symptomatic leg were obtained. Of the 60 patients, 36% had percutaneous transluminal angioplasty as a primary form of therapy, 32% were treated surgically, and 32% were followed clinically. Only 10% of these patients required further evaluation by conventional angiography. By omitting inpatient arteriography, considerable financial savings and increased patient comfort result.

Aortic Diseases↗
PubMedDate not supplied

Glycosylated haemoglobin in non-diabetic peripheral vascular disease.

Glycosylated haemoglobin (Hb A1c) was measured in 20 patients with severe peripheral vascular disease (P.V.D.) and 12 controls. Levels were significantly higher in those with P.V.D. and this may be due to mild carbohydrate intolerance frequently exhibited by this group of patients.

Aged↗
PubMedDate not supplied

Renal artery stenosis in patients with peripheral vascular disease and its correlation to hypertension. A retrospective study.

To estimate the frequency of renal artery stenosis, and to detect the correlation between renal artery stenosis and hypertension, 450 consecutive patients with peripheral vascular disease (PVD) were selected. All subjects had undergone aorto-femoral conventional angiography. For a possible association with renal artery stenosis, risk factors, clinical and angiographical variables were evaluated e.g.: age, sex, diabetes mellitus, smoking habits, use of antihypertensive drugs, serum creatinine, serum cholesterol, ECG pathology, side of the renal artery lesion, bilateral stenoses, post-stenotic dilatation, number of renal arteries, aortic atherosclerosis, size of the kidneys and angiography induced renal dysfunction. Renal artery stenosis (RAS) was found in 49.1%, 117 patients had a moderate and 104 had a severe stenosis. Of the 221 patients with a renal artery lesion, 44 were normotensive, 177 hypertensive. Hypertension was significantly correlated to RAS. An association was also found for age over 70 years, smoking and pathologic ECG. It is concluded that renal artery stenosis is very common in a population with peripheral vascular disease, and the results achieved from this study makes it worthwhile to identify possible functional markers in a prospective study.

Adult↗
PubMedDate not supplied

Effect of naftidrofuryl and aspirin on platelet aggregation in peripheral vascular disease.

Platelet aggregation in whole blood (WB) was assessed in healthy subjects and in patients with peripheral vascular disease (PVD) using a WB-free platelet counting (WB-FPC) method. Aggregation induced by stirring and platelet agonists was significantly enhanced in PVD patients. WB-FPC aggregation induced by 5-HT was diminished significantly by incubation with naftidrofuryl (NAF) in WB of PVD patients. In contrast, aspirin (acetylsalicylic acid; ASA), added in vitro, did not significantly affect 5-HT or stirring-induced WB-PFC aggregation in PVD patients. Furthermore, 5-HT-induced WB-FPC was inhibited by NAF in blood collected from PVD patients that were taking low dose aspirin. These findings suggest that NAF may be of benefit to patients with hyperaggregable platelets and elevated plasma 5-HT concentrations, factors thought to predispose to thrombotic complications.

Adult↗
PubMed1988

Effects of adenosine-induced hypotension on myocardial hemodynamics and metabolism in fentanyl anesthetized patients with peripheral vascular disease.

The effects of adenosine on central and myocardial hemodynamics and metabolism were evaluated during fentanyl anesthesia (100 micrograms.kg-1) in six patients with peripheral vascular disease. Adenosine was intravenously infused, at a rate of 90 +/- 20 (SEM) micrograms.kg-1.min-1, to reduce mean arterial blood pressure by approximately 20% (23 +/- 2% SEM, from 82 +/- 3 to 63 +/- 3 SEM mmHg) during a 20-min period. Systemic and pulmonary vascular resistance indices decreased by 36 +/- 3 and 32 +/- 6% (SEM), and cardiac index increased by 18 +/- 5%. Heart rate, ventricular filling pressures, and whole body oxygen consumption were not affected by adenosine. Despite the reduced mean arterial blood pressure, coronary sinus flow increased by 128 +/- 26% (SEM) in parallel with a 96 +/- 11% (SEM) increase in coronary sinus oxygen content. Left and right ventricular stroke work indices, as well as myocardial oxygen consumption, were maintained. ECG (12-lead) demonstrated signs of ischemia in one subject, while myocardial lactate uptake was unchanged in all subjects. In conclusion, adenosine-induced hypotension in patients with peripheral vascular disease increased cardiac index without affecting myocardial work, whole body, and myocardial oxygen consumptions. The marked increase in coronary sinus blood flow, indicating coronary vasodilation, was not related to increased myocardial work. Further information regarding myocardial effect of adenosine in patients with ischemic heart disease is warranted.

Adenosine↗
PubMed2002

Racial differences in the incidence of limb loss secondary to peripheral vascular disease: a population-based study.

OBJECTIVE: To evaluate racial differences in limb loss caused by peripheral vascular disease in a diverse, statewide population. DESIGN: Retrospective analysis of a cohort of dysvascular amputees. SETTING: Maryland State Hospital Discharge Data from 1986 to 1997. PARTICIPANTS: Persons with a procedure code for lower-limb amputation (ICD9-CM code 84.11-.19) were identified. Patients with limb loss because of trauma, malignancy, or congenital anomalies were excluded. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Incidence rates standardized for age, gender, and race; and time trends. RESULTS: There were 27,149 discharges with dysvascular amputations, yielding an average annual rate of 44.3 per 100,000 persons. Incidence rates for dysvascular amputations increased from 41.4 per 100,000 in 1986 to 47.2 per 100,000 in 1997. For all levels of amputation, annual incidence rates among African Americans were considerably higher than those of other persons. African Americans were 2 to 4 times more likely to lose a lower limb than white persons of similar age and gender. CONCLUSIONS: Rising rates of lower-limb amputations in the general population combined with disproportionately higher rates among African Americans are concerning and warrant further investigation into their underlying causes and consequences.

Adult↗
PubMed2003

Antioxidant enzymes activity in patients with peripheral vascular disease, with and without presence of diabetes mellitus.

The study evaluated antioxidant status in patients with peripheral vascular disease (PVD), with and without concomitant diabetes mellitus (DM). 211 participants were divided into standardized 4 groups: patients with PVD and DM (PVD+DM+), patients with PVD without DM (PVD+DM-), patients without PVD with DM (PVD-DM+) and patients without PVD and DM (PVD-DM-). The diagnosis of PVD was established by Doppler sonography analysis, including determination of the ankle brachial index (ABI), partial pressures along the leg, and CW Doppler sonography at typical locations. Antioxidant status has been evaluated through the colorimetrically assessed serum activity of key antioxidant enzymes: superoxide dismutase (SOD), catalase, and glutathione peroxidase (GLPX) as well as through total antioxidant status (TAS) determination. In PVD+DM- group, as well as PVD-DM+ group, a significantly lower activity of the GLPX, catalase and TAS was found, whereas activity of SOD was significantly higher. There was no statistically significant difference between PVD+DM+ and PVD-DM+ group. Likewise, there was no statistically significant difference between PVD+DM- and PVD-DM-group. This study has shown that there is statistically significant difference in activity of antioxidant enzymes between diabetic and non-diabetic patients, irrespectively of PVD presence. Furthermore, PVD present alone does not alter key antioxidant enzymes activity in comparison with healthy subjects.

Antioxidants↗