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PubMed1992

Superiority of L-propionylcarnitine vs L-carnitine in improving walking capacity in patients with peripheral vascular disease: an acute, intravenous, double-blind, cross-over study.

The effects of L-propionylcarnitine on walking capacity were assessed in a group of patients with peripheral vascular disease. In 12 patients, 300 mg of L-propionylcarnitine, given intravenously as a single bolus did not affect walking capacity, while 600 mg increased both initial claudication distance from the placebo value of 179 +/- 114 to 245 +/- 129 m (P less than 0.05), and maximal walking distance from 245 +/- 124 to 349 +/- 155 m (P less than 0.05). Once the efficacious dose of L-propionylcarnitine was assessed, its effect was compared to that of an equimolar dose of L-carnitine (500 mg i.v.) according to a double-blind, double-dummy, cross-over design. In 14 patients, both treatments improved walking capacity; however, the analysis of variance showed that the increase in maximal walking distance with L-propionylcarnitine was greater than that with L-carnitine (P less than 0.05). Finally, in seven additional patients, the effects of L-propionylcarnitine and L-carnitine on the haemodynamics of the affected limb were assessed by an ultrasonic duplex system. Results indicated that both drugs did not affect the blood velocity and the blood flow rate in the ischaemic leg, thus suggesting that the beneficial effect on walking capacity was dependent on a metabolic effect. In conclusion, L-propionylcarnitine improves walking capacity in patients with peripheral vascular disease, probably acting through a metabolic mechanism. On a molar basis, this beneficial effect is greater than that observed with L-carnitine and, thus, the findings of the present study may have clinical relevance in terms of treatment cost and patient compliance.

Arterial Occlusive Diseases↗
PubMedDate not supplied

Percutaneous transluminal rotational atherectomy in the treatment of peripheral vascular disease using a transluminal endatherectomy catheter (TEC): initial results and angiographic follow-Up.

PURPOSE: To evaluate the clinical results of percutaneous transluminal rotational atherectomy in the treatment of peripheral vascular disease. METHODS: Rotational atherectomy was performed in 39 patients aged 39-87 years (mean 66.6 years). A total of 71 lesions (43 stenoses and 28 occlusions) were treated in 40 limbs. Additional balloon angioplasty was required in 54% of lesions. Fifteen patients (37.5%) presented in Fontaine stage II, 10 patients (25%) in Fontaine stage III and 15 patients (37.5%) in Fontaine stage IV. Rotational atherectomy at 750 rpm was carried out over a 0.014-inch guidewire with continuous aspiration into a vacuum bottle. Follow-up angiography and color flow Doppler examinations were performed in 22 patients (23 limbs) after a mean period of 6 months (range 2-14 months). RESULTS: There was one primary technical failure. In 36 of 40 lesions there was a good angiographic result with residual stenoses in less than 30%. In 70 lesions treated by rotational atherectomy, however, 54% showed residual stenoses of 30%-50% and these cases required additional balloon angioplasty. The mean ankle-brachial index improved significantly (p << 0.001) from 0.49 before the procedure to 1.01 after the procedure. A single distal embolus, related to primary recanalization, occurred and there were two large inguinal hematomas. Cumulative clinical patency after 6 months was 83.8% and cumulative angiographic patency after 6 months was 79.1%. CONCLUSION: Percutaneous rotational atherectomy is a promising approach for the treatment of chronic peripheral vascular disease. Further prospective, randomized studies are necessary to compare percutaneous transluminal angioplasty with this new technical approach.

Adult↗
PubMed1976

The measurement of skin blood flow in peripheral vascular disease by epicutaneous application of Xenon133.

Radioactive xenon133 applied epicutaneously was used to study the skin blood flow below the knee in sixteen normal subjects, in eight patients with peripheral vascular disease not requiring amputation, and in a blind study of twenty-nine patients requiring amputation. Following these twenty-nine amputations, the flow rates were made known and correlated with the rates of healing. When the flow rates were above 1.5 milliliters per minute per 100 grams of tissue (skin), the wounds generally healed. In thirteen other patients, Syme or below-the-knee amputations were performed on the basis of the flow rates, and all of the wounds healed. The test, therefore, is now used routinely prior to amputation for peripheral vascular disease as an adjunct to clinical judgment in the determination of the level of amputation.

Adult↗
PubMed2004

Implementation of an iron reduction protocol in patients with peripheral vascular disease: VA cooperative study no. 410: the Iron (Fe) and Atherosclerosis Study (FeAST).

BACKGROUND: Iron accumulates imperceptibly over time in adults because intake exceeds loss and because no physiologic mechanism exists for excreting levels that may be toxic. Levels of stored iron represented by the serum ferritin concentration have been implicated in the pathogenesis of vascular (and other) diseases, but the role of such stored iron remains controversial. Our hypothesis was that reduction in body iron stores to levels typical of children and premenopausal women (corresponding to ferritin levels of approximately 25 ng/mL) would alter morbidity and mortality rates in patients with advanced peripheral vascular disease. METHODS AND RESULTS: A randomized, single-blinded, clinical trial of graded reduction of iron stores by controlled phlebotomy was undertaken in patients with advanced peripheral vascular disease. Details of implementation of the protocol for testing this unusual experimental intervention are reported. CONCLUSIONS: A methodology is described for testing the concept that reduction of body iron stores (while avoiding iron deficiency) may alter disease outcomes. This methodology appears to be suitable for further testing to determine whether levels of iron stores presumed to be pathologic contribute to disease initiation or progression.

Aged↗
PubMed1997

Lipoprotein (a) and its relationship to risk factors and severity of atherosclerotic peripheral vascular disease.

OBJECTIVES: To determine the significance of Lipoprotein (a) (Lp(a)) as a risk factor for atherosclerotic lower limb peripheral vascular disease (PVD), and its relationship to other demographic and biochemical variables and disease pattern and severity. DESIGN: Prospective case-control study. MATERIAL AND METHODS: Demographic and biochemical risk factors, lipoprotein fractions and Lp(a) were measured in 200 patients with PVD and 200 age- and sex-matched control subjects. Lp(a) levels were correlated with traditional risk factors and clinical and vascular laboratory disease parameters. RESULTS: Patients with PVD have a higher incidence of smoking, hypertension, and diabetes mellitus; and had significantly higher levels of serum cholesterol, triglycerides, LDL, VLDL, apolipoprotein B, fasting glucose, fibrinogen, plasminogen, haematocrit, white cell and platelet counts; but lower levels of HDL and apolipoprotein A1. Fasting Lp (a) concentration is an independent risk factor for PVD and is significantly higher in the patients (median = 26.1 mg/dl [4.8-195], mean = 36.5 +/- 32.6 mg/dl) than in controls (median = 18.2 mg/dl [5.4-216], mean = 27.2 +/- 28.1 mg/dl; p < 0.0001). In patients with PVD, Lp(a) correlated positively with plasma LDL, cholesterol, fibrinogen, renal disease, and apolipoprotein B. Fasting levels of > 24 mg/dl incurred a two-fold increase in risk of PVD. Patients with a higher Lp(a) have a significantly higher incidence of resting pain and ulcerations, and regression analysis confirmed smoking and Lp(a) level to be associated with the SVS category of disease severity. CONCLUSIONS: Lipoprotein (a) is a significant independent risk factor for PVD. Lp(a) levels correlated with LDL, cholesterol, fibrinogen, apolipoprotein B and disease severity. An elevated Lp(a) level may be associated with more severe forms of PVD.

Aged↗
PubMed1995

The effect of peripheral vascular disease on in-hospital mortality rates with coronary artery bypass surgery. Northern New England Cardiovascular Disease Study Group.

PURPOSE: The purpose of this study was to examine the effect of peripheral vascular disease (PVD) on in-hospital mortality rates after coronary artery bypass grafting (CABG). METHODS: We performed a regional cohort study of 3003 patients undergoing CABG between 1987 and 1989 at five tertiary care centers in Maine, New Hampshire, and Vermont. Data reflecting patient characteristics, severity of heart disease, comorbidity, and in-hospital mortality rates were collected prospectively; the presence of clinical and subclinical indicators of PVD was determined retrospectively. RESULTS: Observed in-hospital mortality rates with CABG were 2.4-fold higher in the 796 patients with indicators of PVD (7.7%) than in the 2207 patients without PVD (3.2%) (crude odds ratio [OR] 2.42 [95% confidence interval (CI) 1.73-3.37]). After adjusting for their higher comorbidity scores, more advanced heart disease, and age, patients with PVD remained 73% more likely to die in hospital after CABG (adjusted OR 1.73 [CI 1.19-2.51]). The excess risk of in-hospital death associated with PVD was attributable largely to lower extremity occlusive disease (adjusted OR 2.03 [CI 1.34-3.07]). Subclinical lower extremity occlusive disease (asymptomatic absence of pedal pulses) had the same effect as clinically overt disease. Cerebrovascular disease had a small and statistically nonsignificant effect on CABG-related deaths (adjusted OR 1.13 [CI 0.73-1.74]). Excess mortality rates in patients with PVD were primarily due to increased risk of death from heart failure and dysrhythmias, but not to cerebrovascular accidents or peripheral arterial complications. CONCLUSIONS: The presence of lower extremity arterial occlusive disease is an important, independent predictor of in-hospital mortality rates for patients undergoing CABG. Controlled studies of the long-term effects of CABG in patients with PVD are needed to determine the optimal role of myocardial revascularization in this population.

Aged↗
PubMed1994

General practitioner referral of patients with symptoms of peripheral vascular disease.

A questionnaire survey has been carried out to assess the circumstances under which general practitioners refer patients with peripheral vascular disease to a district general hospital. A single-page questionnaire was sent to 100 general practitioners seeking information about their referral of patients with claudication, ischaemic rest pain or abdominal aortic aneurysms. Of the 77% who responded, over half would not refer a 70-year-old with claudication at half a mile or an 80-year-old with claudication at 100 m, and 44% would not refer an 80-year-old with a palpable abdominal aortic aneurysm. The results suggest that many elderly patients with symptomatic claudication or asymptomatic aneurysms are not currently referred. Changing referral patterns due to a heightened awareness of minimally invasive methods of treatment or the benefits of aneurysm surgery have the potential for profound effects upon vascular surgical work-load.

Age Factors↗
PubMed1999

Deep venous thrombosis in peripheral vascular disease.

BACKGROUND: This prospective study aimed to determine the prevalence of lower limb deep venous thrombosis in patients with peripheral vascular disease (PVD). METHODS: Some 136 patients admitted for arteriography, angioplasty or arterial reconstruction with limiting claudication (n = 72), ischaemic rest pain (n = 26) or gangrene (n = 38) and 40 control subjects admitted for general surgical procedures but without evidence of PVD were screened with colour duplex ultrasonography for the presence of venous thrombosis in the lower limb deep veins before any surgical or radiological procedures were undertaken. Patient age, the ankle : brachial pressure index (ABPI) and the presence of other risk factors for venous thromboembolism were also recorded. RESULTS: Venous thrombosis was found in 27 of 136 patients with PVD and two of 40 control patients (P = 0.03). Logistic regression analysis demonstrated that decreasing ABPI independently contributed to an increased risk of deep venous thrombosis. CONCLUSION: There was a high prevalence of venous thrombosis among patients with PVD which was related to the severity of the ischaemia. Presented to the South West Vascular Surgeons Meeting in Newport, UK, March 1998

Adult↗
PubMed1992

Peripheral vascular disease in heart transplant recipients.

The improved longevity of heart transplant recipients demands heightened awareness of the long-term complications of the procedure. Between 1979 and 1990, 232 patients received 241 heart transplants at our institution. Accelerated coronary atherosclerosis occurred in 45 (19%) of the 232 patients, typically appearing within 2 years of transplantation, whereas peripheral vascular disease (PVD) appeared in 23 (10%) of the 232 patients, usually within 3 years of transplantation. In the patients with PVD, 13 had occlusive disease, nine had aneurysms, and one patient suffered a vertebral artery dissection. Accelerated coronary atherosclerosis afflicted 12 (52%) of the 23 patients affected by PVD (p < 0.05) and preceded the development of PVD in all 12. Logistic regression analysis revealed risk factors predictive of the development of PVD after transplantation to be a pretransplant history of ischemic cardiomyopathy and posttransplant hypertension and hypertriglyceridemia (p < 0.05), with the presence of more than one risk factor increasing the probability of development of PVD. Those patients thus identified as at risk should be closely monitored for the development of PVD. Aggressive medical management of hypertension and hyperlipidemia in this subpopulation may forestall or prevent the development of peripheral vascular disease after heart transplantation.

Adult↗
PubMed1985

Level of plasma fibronectin in patients with peripheral vascular disease.

Plasma concentration of fibronectin, a recently characterized high molecular mass glycoprotein, was determined in patients with peripheral vascular disease. The plasma fibronectin concentration was lower in patients with peripheral obstructive arterial disease as well as in patients with venous disease, than in corresponding healthy controls. Patients with venous disease had significantly lower levels of plasma fibronectin than patients with peripheral obstructive arterial disease. The patients with peripheral arterial disease were divided into two groups, one having diabetes and another not having diabetes respectively. Between these two groups there was no significant difference in plasma fibronectin concentration.

Aged↗
PubMed1989

Effect of L-carnitine on the reactive hyperemia in patients affected by peripheral vascular disease: a double-blind, crossover study.

A double-blind, crossover study was designed to evaluate the effect of L-carnitine on the reactive hyperemia in patients with peripheral vascular disease. After drug washout, 18 patients were randomly assigned to receive placebo or L-carnitine, 3 g IV as a bolus, followed by continuous intravenous infusion of 2 mg/kg/min for thirty minutes. Blood flow in the affected limb was measured by impedance plethysmography, under resting conditions and every two minutes for ten minutes after a five-minute ischemia induced in the affected limb. As compared with placebo, L-carnitine did not modify blood flow at rest. On the contrary, the hyperemic response with carnitine was higher than that observed with placebo. A significant increase in blood flow was found two, four, and six minutes after the release of ischemia with placebo, whereas the blood perfusion to the affected limb rose significantly at all times of recording after carnitine administration. Moreover, the values of the blood flow at two and ten minutes with carnitine were significantly higher than those recorded after placebo at the same times of recording. After the release of ischemia, the mean maximum value of blood flow observed after carnitine was 3.1 +/- 1.4 mL/min/100 mL, a value significantly higher than that recorded after placebo, which was 2.7 +/- 1.3 mL/min/100 mL (p less than 0.05). In conclusion, this study demonstrates that L-carnitine, although not affecting blood flow and ankle/arm systolic blood pressure ratio under resting conditions, improves the functional circulatory reserve in patients with peripheral vascular disease.

Carnitine↗
PubMed2006

[Prevalence of peripheral vascular disease in diabetics and impaired glucose regulation subjects: a community-based study].

OBJECTIVE: To investigate the prevalence of peripheral vascular disease (PVD) in patients with diabetes mellitus (DM) and impaired glucose regulation (IGR). METHODS: Follow-up 5 years after the previous epidemiologic study of metabolic syndrome in Chaoyang community, Shanghai, 2000 - 2001 was conducted among 717 patients with DM or IGR. Questionnaire survey about general status and DM-related history and behaviors, including smoking, was carried out. Physical examination was made. Ankle/brachial index (A/BI) was measured. Intermittent claudication was surveyed by Edinburgh claudication questionnaire (ECQ). Blood sugar and blood lipid were detected. 427 patients, 210 males and 217 females, aged 67.3 +/- 14.0 (21 - 104), with intact data were enrolled into the analysis. RESULTS: The overall prevalence of PVD was 12.2% in the hyperglycemic population. The prevalence of PVD in the diabetics was 15.1%, significantly higher than that of the IGP subjects (7.7%, P = 0.022). The rate of intermittent claudication in those with the A/BI <or= 0.9 was 13.5%. Logistic regression revealed that age, sex, diabetic duration, and total cholesterol were independent risk factors of diabetic PVD. CONCLUSION: The PVD prevalence is rather high in both diabetics and IGR subjects. Most PVD patients are asymptomatic. AB/I measurement helps early diagnosis of PVD.

Adult↗
PubMedDate not supplied

Peripheral vascular disease in newly diagnosed non-insulin-dependent diabetic.

The aim of this study was to assess the prevalence of peripheral vascular disease (PVD) in newly diagnosed diabetic patients and the possible relationship to various risk factors. One hundred and twenty non-insulin-dependent diabetics (NIDDs) aged 50-70 years and 93 non-diabetic subjects, matched for age and sex, were studied using Doppler ultrasound. None had a history of alcoholic abuse, while 12 diabetic and 8 non-diabetic subjects were smokers. There were 6 male subjects with PVD (5 NIDDs, 1 control subject) and 2 female diabetic subjects with PVD (p: No SD). In group of male diabetics with PVD, HDL-C levels were found to be lower and triglyceride levels higher, than in those without diabetes, but the difference was not significant. Hypertension, body mass index and smoking were not associated with the presence of PVD in either female or male diabetic subjects. It is concluded that, although PVD tended to be more common in men with newly diagnosed diabetes, the overall findings support the view that macrovascular disease is related to duration of diabetes.

Age Factors↗
PubMed1986

Peripheral vascular disease: prospective study of intraarterial digital subtraction angiography using a 9-inch intensifier.

A prospective randomized study was undertaken to evaluate the role of intraarterial digital subtraction angiography (IADSA) in the study of peripheral vascular disease. Patients underwent either conventional film-based angiography alone, digital subtraction angiography (DSA) alone, or a combined study. With a 9-inch image intensifier, DSA alone resulted in cost savings of film and contrast material but required a significantly longer examination period than the other groups and an increased iodine dose per examination. When the images were analyzed by a radiologist and a vascular surgeon, the DSA studies provided less detail in the aortoiliac region than the other techniques but had advantages in demonstrating the runoff vessels. IADSA examination should not replace conventional arteriography in patients with peripheral vascular disease but has a useful complementary role.

Aged↗