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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↗
PubMed1995

Genetic models of human vascular disease.

The use of genetic models has greatly assisted investigations of the natural history, mechanisms, and potential therapy for human vascular disease. In the past, genetic models of vascular disease were obtained through serendipity and/or selective breeding to obtain inbred lines that express the phenotype of interest. This approach has yielded several valuable models of atherosclerosis and hypertension. In the past several years, the advent of molecular techniques has enabled investigators to produce additional novel genetic models of disease that have further enhanced the study of vascular biology and medicine. Transgenic techniques and the techniques of homologous recombination have allowed researchers to alter the genotype of an animal in a precise manner and to study the resultant change in phenotype. More recently, techniques of in vivo gene transfer have also accelerated and enhanced the development of novel models. The application of these methodologies has resulted in important breakthroughs in our understanding of the pathogenesis and treatment of vascular diseases. In this review, we compare and contrast these technologies along with examples of their use in the studies of vascular biology and medicine.

Animals↗
PubMedDate not supplied

Plasma high density lipoproteins in coronary, cerebral and peripheral vascular disease. The influence of various risk factors.

High density lipoprotein (HDL) cholesterol and the HDL/total cholesterol ratio have been measured in 440 patients with coronary, cerebral or peripheral vascular disease and in 440 matched controls. The patients were subdivided into sex- and age-groups and according to physical activity, smoking, hypertension and non-insulin-dependent and insulin-dependent diabetes mellitus. The average HDL cholesterol level was significantly decreased in all the three groups of localization of ischaemic vascular disease (IVD). Plasma HDL concentration in men was lower than in women in every age-group. Lowest values were measured in patients with cerebral vascular diseases. From among the risk factors supposed to be related to IVD, lack of physical exercise resulted in a decrease of HDL cholesterol and HDL/total cholesterol values. In all the three localizations of IVD cigarette smokers had lower HDL levels than non-smokers. The influence of hypertension on serum HDL concentration was not unidirectional. The coexistence of non-insulin-dependent diabetes and IVD resulted in decreased lipid parameters. The sera of insulin-dependent diabetics had higher HDL contents and higher HDL/total cholesterol ratios than those of non-diabetics in all the three localizations of the vascular disease in men and in women suffering from peripheral vascular disease.

Adult↗
PubMed2002

Missed opportunities to treat atherosclerosis in patients undergoing peripheral vascular interventions: insights from the University of Michigan Peripheral Vascular Disease Quality Improvement Initiative (PVD-QI2).

BACKGROUND: Peripheral vascular disease is a manifestation of systemic atherosclerosis and is associated with an increased risk of cardiovascular morbidity and mortality. METHODS AND RESULTS: We examined clinical outcomes in 66 consecutive patients undergoing peripheral vascular interventions at our institution between January 2001 and October 2001. At hospital discharge and at 6 months, lifestyle modifications and use of evidence-based therapy was suboptimal. At 6 months, a significant proportion continued to smoke (22.7%) and only half of the patients exercised, controlled their weight, or modified their diet for lipid control. The use of antiplatelet therapy was 77.2%; of angiotensin-converting enzyme, 35.9%; of beta-blockers, 42.5%; and of statins, 50%. Twelve of the 66 patients (18.2%) had a clinical event of death, myocardial infarction, or stroke. An appropriateness algorithm for use of secondary prevention measures was created with the use of evidence-based therapy guidelines, and a composite appropriateness variable was also created. The use of evidence-based therapy was associated with a significant reduction of the composite of death, myocardial infarction, and stroke at 6 months (OR 0.02, 95% CI 0.01 to 0.44, P=0.01). CONCLUSIONS: Atherosclerosis risk factors are very prevalent in patients with peripheral vascular disease, but these patients receive less than optimal treatment after a predominantly technical vascular intervention. Effective secondary prevention with appropriate lifestyle interventions and evidence-based medical therapy needs to be strongly encouraged and implemented in these patients.

Algorithms↗
PubMed1996

Sensitivity and specificity of QTc dispersion for identification of risk of cardiac death in patients with peripheral vascular disease.

OBJECTIVE: To determine whether QTc dispersion, which is easily obtained from a standard electrocardiogram, can predict those patients with peripheral vascular disease who will subsequently suffer a cardiac death, despite having no cardiac symptoms or signs. DESIGN: Patients with peripheral vascular disease were followed up for five years after they had had coronary angiography, radionuclide ventriculography, and their QTc dispersion calculated from their 12 lead electrocardiogram. SUBJECTS: 49 such patients were then divided into three groups: survivors (34), cardiac death (12), and non-cardiac death (3). MAIN OUTCOME MEASURE: Survival. RESULTS: The mean (SD; range) ejection fractions were similar in all three groups: survivors 45.9 (11.0; 27.0-52.0), cardiac death 44.0 (7.90; 28.5-59.0), and non-cardiac death 45.3 (4.55; 39.0-50.0). QTc dispersion was significantly prolonged in the cardiac death group compared with in the survivors (86.3(23.9; 41.0-139) v 56.5 (25.4; 25.0-164); P = 0.002). A QTc dispersion > or = 60 ms had a 92% sensitivity and 81% specificity in predicting cardiac death, QTc dispersion in patients with diffuse coronary artery disease was significantly (P < 0.05) greater than in those with no disease or disease affecting one, two, or three vessels. CONCLUSIONS: There is a strong link between QTc dispersion and cardiac death in patients with peripheral vascular disease. QTc dispersion may therefore be a cheap and non-invasive way of assessing the risk of cardiac death in patients with peripheral vascular disease.

Aged↗
PubMedDate not supplied

Metaischemic (post-Goldblatt) hypertensive vascular disease in rats.

Malignant hypertension was induced in rats by aortic ligation above the left renal artery. After 7- and 28-day periods of hypertension, the characteristics of the vascular disease were studied and the kidney below the aortic ligation was removed. The blood pressure and the vascular disease were reexamined at the end of the first and fourth weeks after nephrectomy. The evolution of the vascular disease was assessed in the contralateral kidney, in the heart, and in the superior mesentery. The results obtained allowed the following conclusions: 1) when the predominant lesions are of fibrinoid necrosis and moderate intimal hyperplasia without fibromucoid changes (initial phase), the hypertension and the hypertensive vascular disease are completely reversible after the nephrectomy; 2) when the predominant lesions are proliferative endarteritis with fibromucoid changes (chronic phase), neither the hypertension nor the vascular disease are reversible after the left nephrectomy and during the period of follow-up. Therefore, the type of vascular lesion seems to be one important determinant of the reversibility of the hypertensive process after nephrectomy.

Acute Disease↗
PubMed1999

Clearance of inhaled technetium-99m-DTPA as a clinical index of pulmonary vascular disease in systemic sclerosis.

This study evaluated the utility of the clearance time of inhaled diethylenetriamine pentaacetate (DTPA) to distinguish pulmonary vascular disease from early fibrosing alveolitis (FA) in patients with systemic sclerosis (SSc). It was hypothesized that this would be preserved in patients with vascular disease compared with FA, despite similar gas-transfer deficits and matching lung volumes, because of the preservation of alveolar epithelial integrity. All patients had SSc and were categorized into a control group (C; n=9), pulmonary vascular group (VAS; n=14) or FA group (n=14) dependent on the appearance on a computed tomography (CT) scan and the transfer factor of the lung for carbon monoxide (T(L,CO)) (VAS and FA < or =70%, C > or =80%). All patients had a forced vital capacity (FVC) of >80%. The T(L,CO) (median) was similar in the VAS (57.5%) and FA (60%) groups. There was a significant difference in median DTPA clearance half-times between FA (21.25 min) and VAS (46.5 min) (p=0.014) and between FA and C (84.5 min) (p=0.0004). No difference was found between VAS and C (p=0.0778). Follow-up data from the VAS group showed no subsequent development of FA on the CT scan and no decrease in FVC (n=13, mean 42 months). These results suggest that clearance of diethylenetriamine pentaacetate is preserved in patients likely to have pulmonary vascular disease and may be useful in distinguishing fibrosing alveolitis from vascular disease in systemic sclerosis.

Adult↗
PubMed2026

The Vascular Genome as a Therapeutic Target: A Systematic Review of CRISPR-based Gene Editing In Vascular Disease.

Despite advances in therapy, arterial, venous, and pulmonary vascular diseases remain leading causes of morbidity and mortality. Persistent endothelial dysfunction, inflammation, oxidative stress, and maladaptive vascular remodeling continue to drive disease progression and residual risk. CRISPR/Cas9 technology offers a unique opportunity to modify the molecular pathways underlying vascular pathophysiology directly. The PRISMA 2020 guidelines guided the systematic review. The databases PubMed/MEDLINE, Embase, Web of Science, Cochrane Library, ClinicalTrials.gov, and Google Scholar were searched from their inception until September 2025 for experimental and/or clinical studies evaluating the application of CRISPR/Cas9 on vascular disease. Included were in vitro studies, animal model studies, and early-phase human studies aimed at targeting the endothelial cell regulatory pathways, inflammatory pathways, metabolic remodeling processes, and hereditary causes of vasculopathy. Seventeen studies met the inclusion criteria. CRISPR technologies targeting PCSK9, NOS3, HIF1A, NLRP3, METTL4, BMPR2, and ACTA2 were identified to enhance repair mechanisms in endothelial cells, regulate inflammation, modulate lipid metabolism, and remodel the vascular system. The human studies demonstrated sustained gene silencing effects following a single dose of CRISPR-induced in vivo editing. The use of CRISPR technology to edit cell genomes offers potential to alter disease progression in vascular medicine, with a growing body of translational evidence supporting the feasibility and durability of the approach.

Humans↗
PubMed2006

[The cerebral function monitoring in severe cerebral vascular disease].

OBJECTIVE: To evaluate the value of combined evoked potential, continuous EEG with transcranial Doppler to monitor the cases of severe cerebral vascular disease. METHODS: 32 cases of severe cerebral vascular disease were admitted to the hospital and divided into severe or moderate groups based on the GCS (< or = or > 8) when the patients were admitted. BAEP and SEP were used to for monitoring of brain and brainstem functions. The BAEP and SEP results were divided into grade I, grade II and grade III according to Cant's classification. Continuous EEG monitored all patients by bedside. The EEG findings were divided into 6 grades based on Young's criteria. TCD monitoring by using bilateral 2 MHz Probes with probe holder were lasted at least 30 minutes per day through temporal windows and eye windows to explore the velocity of cerebral artery. The patients were classified into three groups according to the velocities, i.e. (1) the group with elevated velocity, (2) the group with reduced velocity, and (3) the group with normal velocity. The association among the brain and brain stem function, cortex function and cerebral flow velocity was analyzed with patient outcome in the two groups. RESULTS: (1) The mortality of the patients in the severe group was 42.86%, significantly higher than that in the group of moderate symptom (22.22%). The survivors with good outcome accounted for 33.33% in the moderate group, and those with independent disability accounted for 44.44% in the moderate group, much better than those in the severe group. (2) The numbers of the patients with III grade SEP and BAEP results in the severe group were higher than those in the moderate group. The mortality of the patients with III grade SEP and BAEP results was high and the most of survivors were found with obvious disability in outcome. The patients with grade I SEP and BAEP results showed a better outcome. (3) 32 patients of cerebral vascular disease were monitored with continuous EEG monitoring by bedside. The results revealed that the mortality of the patients with grade II EEG results was much higher than that of the patients with grade I EEG results. (4) The association of the brain blood flow velocity, either increased or decreased or within normal range was uncertain (all P > 0.05). CONCLUSION: The cerebral function of patients of severe cerebral vascular disease may be estimated precisely and objectively by using continuous monitoring of SEP, BAEP and EEG at bedside, which will provide valuable information about patient's prognosis and treatment.

Aged↗
PubMed1998

Age and cystathionine beta-synthase activity in cultured fibroblasts from patients with arterial and venous vascular disease.

In order to determine if cystathionine beta-synthase (CBS) could separate groups of patients with various vascular disease, CBS activity was studied in cultured human skin fibroblasts from 30 subjects being either controls, atherosclerotic patients or patients having suffered a deep venous thrombosis. We found a tendency to a negative correlation between age and CBS activity in the control group only (r = -0.58, P = 0.08), with a tendency to lower CBS activities in the young patients with atherosclerotic (4.9) or venous disease (5.3) compared to the young control group (10.2). This could implicate higher levels of p-homocysteine with increased age as well as in young patients with atherosclerotic or thrombotic disease causing vascular damage. The results are important for the further discussion of the role of homocysteine as a risk factor for developing atherosclerotic and thrombogenic vascular disease and for finding a suitable screening method as prevention is by vitamin supplement only.

Adult↗
PubMed1993

Low-dose aspirin fails to inhibit increased platelet reactivity in patients with peripheral vascular disease.

A study was performed to evaluate the effect of low-dose aspirin (75 mg/day) on platelet reactivity in patients with peripheral vascular disease. Platelet function was measured in 31 patients with advanced peripheral vascular disease requiring surgery. Shear-induced haemostasis and collagen-induced thrombus formation were used as indicators of platelet reactivity. They were measured in non-anticoagulated fresh whole blood samples ex vivo using a haemostatometer. Results were compared with those from 30 age- and sex-matched controls. Shear-induced haemostasis and collagen-induced thrombus formation were also measured in 18 of the 31 patients before the start of aspirin administration (before operation) and 1 week after surgery. Patients with advanced peripheral vascular disease were found to have increased platelet reactivity with a mean(s.e.m.) shear-induced haemostasis index of 1977(180) mmHg s compared with a control value of 3161(234) mmHg s (P < 0.001) and a mean(s.e.m.) collagen-induced thrombus formation index of 3980(460) mmHg s compared with a control value of 5350(420) mmHg s (P = 0.02). Perioperative low-dose aspirin failed to inhibit platelet function in patients with peripheral vascular disease.

Aged↗
PubMed2004

Vascular NAD(P)H oxidase as a novel therapeutic target in vascular disease.

Oxidative stress, involving elevated levels of reactive oxygen species such as superoxide and peroxynitrite, has been implicated in the pathogenesis of several, if not most, forms of cardiovascular disease. Recent studies using viral-mediated gene transfer of genes that redress oxidative stress in animal models of cardiovascular disease have suggested that targeting sources of superoxide would provide a novel therapeutic strategy in cardiovascular disease. Identification of a vascular form of the NAD(P)H oxidase as the major source of superoxide has resulted in a search for effective inhibitors. This review summarizes the developments in the area of vascular NAD(P)H oxidase as a novel therapeutic target in vascular disease.

Animals↗
PubMedDate not supplied

Apolipoprotein E polymorphism in patients with Alzheimer's disease, vascular dementia and ischemic cerebrovascular disease.

Apolipoprotein E sigma4 allele (ApoE sigma4) is associated with Alzheimer's disease (AD) in familial and sporadic cases, but the associations of ApoE sigma4 allele and vascular dementia (VD) and/or ischemic cerebrovascular disease (ICVD) are still controversial. To clarify the associations of ApoE polymorphism with AD, VD and ICVD in Japanese, we examined ApoE polymorphism in samples of 255 patients with AD, 87 patients with VD, and 123 patients with ICVD, as compared with 117 age-matched healthy control subjects (CTL). The frequency of the ApoE sigma4 allele was significantly higher in the VD group (0.21), the ICVD group (0.15) as well as in the AD group (0. 26) than in the CTL subjects (0.08). These findings suggest that the genotype of ApoE sigma4 is associated with not only AD but also VD and ICVD, and that ApoE sigma4 plays an important role in the development of dementia and ICVD.

Aged↗
PubMed1997

Von Willebrand factor and soluble E-selectin in hyperlipidaemia: relationship to lipids and vascular disease.

Our objective was to determine whether endothelial cell products von Willebrand factor and soluble E-selectin are related to serum lipids, lipoprotein (a), and vascular disease in patients with hyperlipidaemia. In order to achieve our aim, blood samples were obtained for four experiments from 1) 160 patients (49 with symptomatic vascular disease) with hypercholesterolaemia and an equal number of age and sex matched controls; 2) 31 patients who were studied serially before and after successful resolution of their hypercholesterolaemia; 3) 15 patients with hypertriglyceridaemia; and 4) 20 controls, half of whom consumed a lipid-rich breakfast. von Willebrand factor and soluble E-selectin were measured by enzyme linked immunosorbent assay (ELISA) using commercial reagents. In experiment (1) von Willebrand factor was increased in the patients with hypercholesterolaemia (P=0.0077) and was higher still in patients with vascular disease (P<0.0001). Soluble E-selectin was not influenced by hypercholesterolaemia or vascular disease. The correlation of von Willebrand factor with total and LDL cholesterol (both P<0.001) remained after both age and blood pressure were controlled. Experiment (2) showed that serial studies in patients over an average of 7 months a reduction in total cholesterol was associated with a reduction in von Willebrand factor (r=0.51, P=0.002). Experiment (3) demonstrated that von Willebrand factor was not increased in patients with hypertriglyceridaemia (median 8.9 mmol/L), and in experiment (4) a lipid-rich breakfast taken by fasted, healthy controls produced an increase in serum triglycerides (P<0.01) but did not influence von Willebrand factor over an 8 hour period. We conclude that von Willebrand factor, but not soluble E-selectin, is raised in hypercholesterolaemia and therefore may be a potential indicator of endothelial cell physiology in subjects with, or at risk of, atherosclerotic vascular disease.

Adult↗
PubMed1987

Limb salvage in the patient with severe peripheral vascular disease: the role of microsurgical free-tissue transfer.

Severe peripheral vascular disease has traditionally precluded the use of free-tissue transfer for lower extremity salvage. In the present series, 10 microvascular transfers performed over a 2-year period are critically evaluated. Vascular surgical consultation was obtained if the preoperative assessment revealed reconstructible vascular disease proximal to the offending wound. Flaps were performed for osteomyelitis in two cases and neurotrophic ulcers in eight cases. Seven of the 10 extremities had prior distal revascularization procedures before the tissue-transfer procedure. There were no anastomotic flap failures; however, one lower extremity underwent below-knee amputation due to sepsis and its cardiovascular sequelae. In properly selected peripheral vascular disease patients, limb salvage can be effected with microsurgical free-tissue transfer. The technique appears invaluable in those patients who have undergone prior contralateral amputation.

Aged↗
PubMed1993

[Gastric emptying in elderly patients with cerebral vascular diseases and the effect of trimebutine].

The authors investigated gastric emptying in 18 elderly patients with cerebral vascular diseases using the acetaminophen method. Subjects were divided into 2 groups according to their levels of daily activity. One group consisted of 10 comatose patients (71-92 years old), the other consisted of 8 patients (74-95 years old) who could walk by themselves. We also investigated gastric emptying in 6 comatose patients (38-83 years old) because of other diseases such as amyotrophic lateral sclerosis and in 11 elder controls (75-95 years old). In elderly controls, the acetaminophen concentration at 45 minutes was 9.08 +/- 1.71 micrograms/ml. In comatose patients due to cerebral vascular diseases, the concentration was 3.89 +/- 1.60 micrograms/ml, which showed significantly delayed gastric emptying (p < 0.05). In patients with cerebral vascular diseases who could walk, the concentration was 6.51 +/- 0.99 micrograms/ml. In comatose patients by another diseases, the concentration was 5.82 +/- 1.13 micrograms/ml. We suspected that delayed gastric emptying is related to the comatose state. Trimebutine significantly (p < 0.01) improved gastric emptying in comatose patients with cerebral vascular diseases.

Adult↗
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↗