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PubMed1986

Intra-arterial digital subtraction angiography as a method to study peripheral vascular disease.

In many patients with peripheral vascular disease, conventional arteriograms are not adequate to make proper preoperative decisions. In the past, these inadequate studies led to surgical exploration of vessels and intraoperative angiography to determine operability. Such efforts prolonged operating time and potentially had adverse effects on amputation levels. Recently, intra-arterial digital subtraction angiography (IDSA) has provided an excellent means to further evaluate these patients preoperatively. We presently have 30 patients in whom IDSA supplemented routine aortography and runoff studies. When standard angiographic studies were considered inadequate, the catheter was positioned appropriately and IDSA was obtained. Inadequate lower extremity distal runoff in 23 patients and no proximal or distal runoff in seven patients prompted the IDSA. The IDSA study yielded further information on all patients, and 26 of 30 patients underwent successful bypass operation. In all 17 patients having femoropopliteal or femorotibial bypass, the IDSA was confirmed by an intraoperative (after bypass) angiogram. Nine patients had inflow procedures, and operative findings corroborated the IDSA. Two patients refused surgery and two patients were not candidates for revascularization. The IDSA study provided an accurate "road map," eliminated unnecessary vessel exploration, saved vital operative time, and prevented compromise of potential amputation levels.

Aged↗
PubMed1984

Collagen-vascular diseases.

Some of the collagen-vascular diseases and overlap syndromes included are polymyosititis, systemic lupus erythematosus, scleroderma, Sjögren's syndrome, and Raynaud's phenomenon. Because diagnosis and treatment can be complicated, primary care physicians may want to seek experienced consultation.

Adrenal Cortex Hormones↗
PubMed1985

Heparin-induced platelet aggregation in anorexia nervosa and in severe peripheral vascular disease.

We have previously demonstrated that platelets obtained from patients with anorexia nervosa or severe peripheral vascular disease are hyperaggregable. Since conventional heparins are known to activate platelets in vitro and occasionally induce thrombosis and consumptive thrombocytopenia in vivo, we have investigated the direct effect of a conventional heparin on platelets obtained from patients with anorexia nervosa or severe peripheral vascular disease. Heparin at therapeutic concentrations was found to induce platelet aggregation of such platelets in vitro. In contrast, a recently developed low molecular weight heparinoid (Org 10172), at therapeutic concentrations, had no effect on these hyperaggregable platelets. We conclude that: heparin may be potentially harmful to patients with hyperaggregable platelets; thrombocytopenia and thrombosis associated with heparin therapy may be mediated through a direct effect of heparin on platelets; it is unlikely that heparin induced thrombocytopenia is always mediated by classical immunological mechanisms, especially in patients with hyperaggregable platelets; and low molecular weight heparinoids may be safer anticoagulants in patients with platelet hyperaggregability.

Adolescent↗
PubMed2004

Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes.

CONTEXT: Control of blood glucose levels, blood pressure, and cholesterol levels is proven to reduce the risk of vascular disease among individuals with diabetes mellitus; however, the current state of control of these risk factors among individuals in the United States is uncertain. OBJECTIVES: To examine 1999-2000 national data on control of risk factors for vascular disease among adults with previously diagnosed diabetes and to assess trends during the past decade. DESIGN, SETTING, AND PARTICIPANTS: Review of data from the Third National Health and Nutrition Examination Survey (NHANES III, conducted 1988-1994) and NHANES 1999-2000, cross-sectional surveys of a nationally representative sample of the noninstitutionalized civilian US population. Participants were adults aged 20 years and older with previously diagnosed diabetes who participated in both the interview and examination in either NHANES III (n = 1265) or NHANES 1999-2000 (n = 441). MAIN OUTCOME MEASURES: Levels of glycosylated hemoglobin (HbA1c), blood pressure, and total serum cholesterol in reference to target goals. RESULTS: Compared with NHANES III, participants with previously diagnosed diabetes in NHANES 1999-2000 were similar by age and sex, were less likely to be non-Hispanic white, were diagnosed at an earlier age, had a higher body mass index, and were more likely to use insulin in combination with oral agents. In NHANES 1999-2000, only 37.0% of participants achieved the target goal of HbA1c level less than 7.0% and 37.2% of participants were above the recommended "take action" HbA1c level of greater than 8.0%; these percentages did not change significantly from NHANES III (P =.11 and P =.87, respectively). Only 35.8% of participants achieved the target of systolic blood pressure (SBP) less than 130 mm Hg and diastolic blood pressure (DBP) less than 80 mm Hg, and 40.4% had hypertensive blood pressure levels (SBP > or =140 or DBP > or =90 mm Hg). These percentages did not change significantly from NHANES III (P =.10 and P =.56, respectively). Over half (51.8%) of the participants in NHANES 1999-2000 had total cholesterol levels of 200 mg/dL or greater (vs 66.1% in NHANES III; P<.001). In total, only 7.3% (95% confidence interval, 2.8%-11.9%) of adults with diabetes in NHANES 1999-2000 attained recommended goals of HbA1c level less than 7%, blood pressure less than 130/80 mm Hg, and total cholesterol level less than 200 mg/dL (5.18 mmol/L). CONCLUSION: Further public health efforts are needed to control risk factors for vascular disease among individuals with diagnosed diabetes.

Adult↗
PubMed1996

Vascular disease of the lower extremities in diabetes mellitus.

Vascular disease, neuropathy, and infection act synergistically to cause diabetic foot ulceration. Appropriate care is hindered by misconceptions about microvascular disease. Recent advances and success with extreme distal revascularization combined with surgical management of infection have greatly improved salvage of the diabetic foot. Success is enhanced by a multidisciplinary team approach.

Diabetes Complications↗
PubMed1992

Aerobic capacity with two leg work versus one leg plus both arms work in men with peripheral vascular disease.

The purpose of this pilot study was to examine the correlation between ergometry in men with peripheral vascular disease exercising with both legs and with one leg and both arms. Fifteen men with peripheral vascular disease performed three symptom-limited exercise tests on an ergometer that could be operated from a wheelchair with both legs or with one leg and both arms. The three exercise conditions were both legs (arms stabilized), left leg plus both arms, and right leg plus both arms. The exercise parameters compared were maximum oxygen consumption, maximum heart rate, and duration of exercise. Blood pressure was monitored at two-minute intervals and oxygen saturation and electrocardiogram were monitored continuously. The mean VO2 max +/- standard deviation for both legs, right leg plus both arms, and left leg plus both arms were 14.36 +/- 6.15, 14.86 +/- 4.09, 14.01 +/- 4.14 ml O2/kg-min, respectively. The mean duration of exercise +/- standard deviation were 12.01 +/- 5.74, 10.94 +/- 4.68, and 9.81 +/- 4.70 minutes respectively. The mean maximum heart rate +/- standard deviation were 126 +/- 24, 137 +/- 23, 136 +/- 23, respectively for the same exercise conditions. The Pearson Correlation Coefficients for VO2 for both legs versus right leg plus both arms and left leg plus both arms were .639 and .873, respectively. The Pearson Correlation Coefficients for duration of exercise for both legs versus right leg plus both arms and left leg plus both arms were .837 and .877, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

Silent brain infarcts in patients with manifest vascular disease.

BACKGROUND AND PURPOSE: Silent infarcts are frequently found on MRIs of brains of healthy elderly persons (aged >60 years). The purpose of this study was to investigate the prevalence and determinants of silent infarcts in a population of patients with clinically manifest vascular disease. METHODS: To detect silent infarcts, MR images were made in 308 participants of the Second Manifestations of ARTerial disease (SMART) study (mean age, 58 years) without prior stroke or transient ischemic attack. These are patients referred to the University Medical Center Utrecht because of atherosclerotic vascular disease. Risk factors were assessed by questionnaire and by physical, ultrasonographic, and laboratory examinations. RESULTS: Silent infarcts were found in 51 patients (17%). Most infarcts (62%) were located in white matter, 20% in basal ganglia, 14% in brain stem and cerebellum, and 4% in cortical area. Categorical determinants for presence of silent infarct(s) that remained (borderline) significant after adjustment for age were hypertension (odds ratio [OR]=2.2; 95% CI, 1.2 to 4.2), abdominal aortic aneurysm (OR=2.4; 95% CI, 0.9 to 6.4), severe renal failure (OR=7.3; 95% CI, 2.1 to 25.2), and hyperhomocysteinemia (OR=2.6; 95% CI, 1.1 to 5.9). CONCLUSIONS: Patients with manifest vascular disease are at risk for silent infarcts at a younger age. In particular, patients with the aforementioned risk factors should be considered for treatment or (secondary) prevention.

Adult↗
PubMedDate not supplied

In vivo study of angiogenic plasmid preparations--the bicistronic plasmid as a new type of drug for vascular diseases.

Angiogenic gene therapy is thought to be a new method for the treatment for vascular diseases. Plasmid preparations encoding angiogenic factors like a vascular endothelial growth factor (VEGF) or a fibroblast growth factor (FGF) effectively stimulate the formation of new vessels. The first clinical trials with novel angiogenic drugs--genetic preparations have already been reported. Nevertheless, gene transfer and expression efficiency still require a lot of experimental work. Here, three different angiogenic preparations were studied. We used monocistronic vectors encoding VEGF165 or FGF-2 and bicistronic construct expressing both of them. The angiogenic potency of the plasmids was evaluated by in vivo angiogenesis tests. We also tested the plasmid DNA maintenance in mouse tissue as well as the transcriptional activity of the angiogenic preparations. We saw that all plasmids effectively stimulate the formation of new vessels in in vivo conditions up to 20 days. The most powerfull angiogenic potency was demonstrated by the bicistronic vector. It was shown that after 3, 13, 21, 31 and 41 days post-transfection the plasmid DNA still persisted in tissue, more or less on the same level but the mRNA transcripts after 13 days slowly decreased. This work confirmed effectiveness of gene therapy, and gave new information about angiogenic plasmid preparations useful for practical applications.

Animals↗
PubMed1993

A comparison of different methods of assessing free radical activity in type 2 diabetes and peripheral vascular disease.

Increased free radical activity in diabetes mellitus may contribute to the higher prevalence and mortality from macrovascular disease in diabetic patients. To investigate this, levels of plasma antioxidants (superoxide dismutase, caeruloplasmin, plasma, and lysate thiol), diene conjugates, lipid peroxides, and chemiluminescence were measured in diabetic and non-diabetic patients with peripheral vascular disease compared with healthy control subjects. Caeruloplasmin, diene conjugate ratio, and lipid peroxides were significantly increased in patients with vascular disease but there was no difference between diabetic and non-diabetic patients. Conjugated diene ratio correlated with caeruloplasmin (r = 0.40, p < 0.02) and inversely with superoxide dismutase level (r = 0.36, p < 0.05) but there was no significant correlation between other antioxidants and diene conjugates, lipid peroxides or chemiluminescence. The relationship between different indirect measurements of free radical activity is variable but there appears to be no additive effect of diabetes on the increased free radical activity associated with vascular disease.

Aged↗
PubMed2006

Errors that result from using the TC/HDL C ratio rather than the apoB/apoA-I ratio to identify the lipoprotein-related risk of vascular disease.

The objective of this analysis was to demonstrate the frequency and extent of error that results from using the TC/HDL C ratio rather than the apoB/apoA-I ratio to estimate the lipoprotein-related risk of vascular disease within 94,667 men and 75,675 women in the Apoprotein-related Mortality Risk (AMORIS) cohort. The odds ratio (OR) for the risk of fatal myocardial infarction was determined for 1 SD change in the apoB/apoA-I ratio and all the conventional cholesterol ratios--TC/HDL C ratio, LDL C/HDL C ratio, non-HDL C/HDL C ratio. In both men and women, the apoB/apoA-I ratio was significantly greater than any of the cholesterol ratios, which, in fact, differed little. Therefore, the apoB/apoA-I ratio was taken as the most accurate index of the lipoprotein-related risk of vascular disease. Using Receiver Operating Characteristic analysis, it was demonstrated that the diagnostic accuracy of the apoB/apoA-I ratio was significantly greater than any cholesterol ratio in those with an LDL cholesterol <3.6 mmol L(-1) compared to those with an LDL cholesterol >3.6 mmol L(-1). Indeed, the difference between the apoB/apoA-I OR compared with the TC/HDL C OR progressively widened as risk increased. This suggests that the advantage of the apoB/apoA-I ratio is greatest in the population at highest risk. The distribution of subjects by quintiles showed in both genders that whilst agreement was greatest at the extremes, even at these points there was substantial discordance between the TC/HDL C and the apoB/apoA-I ratios. Within the middle of the distribution, less than 50% of the values were concordant. Finally, when comparing the ORs, the TC/HDL C ratio underestimated risk in 69.4% of male subjects and overestimated risk in 26.1% of male subjects, whereas in the female subjects, the TC/HDL C ratio underestimated risk in 84.9% of the subjects and overestimated risk in 12.0%. Thus, using the conventional cholesterol ratios rather than the apoB/apoA-I ratio results in frequent and substantial error in the estimation of the lipoprotein-related risk of vascular disease.

Apolipoprotein A-I↗
PubMed2000

Prevalence and risk factors of peripheral vascular disease in a selected South Indian population: the Chennai Urban Population Study.

OBJECTIVE: The epidemiology of peripheral vascular disease has rarely been studied in non-European populations. The purpose of this study was to determine the prevalence and risk factors of peripheral vascular disease (PVD) among South Indians. RESEARCH DESIGN AND METHODS: The Chennai Urban Population Study is an epidemiological study involving 2 residential areas in Chennai in South India. Of the 1,399 eligible subjects (> or =20 years of age), 1,262 (90.2%) participated in the study. All of the study subjects underwent an oral glucose tolerance test and were categorized as having normal glucose tolerance (NGT), impaired glucose tolerance (IGT), or diabetes. Peripheral Doppler studies were performed on 50% of the study subjects, and PVD was defined as an ankle-brachial index (ABI) <0.9. RESULTS: The prevalence rates of PVD were 2.7, 2.9, and 6.3% in individuals with NGT, IGT, and diabetes, respectively The overall prevalence rate was 3.2%. Known diabetic subjects had a higher prevalence of PVD (7.8%) compared with newly diagnosed diabetic subjects (3.5%). PVD was uncommon until middle-age and then the prevalence rate increased dramatically. Univariate regression analysis showed age >50 years (odds ratio [OR] 6.3, 95% CI 2.1-20.6, P<0.001) and hypertension (OR 2.7, 0.9-7.3, P = 0.08) to be associated with PVD, whereas smoking and serum lipid levels showed no association. Multivariate regression analysis identified age as the most significant risk factor for PVD. Of the 90 subjects who had coronary artery disease (CAD), only 6 had PVD, and the positive predictive value of the ABI for CAD was only 30%. CONCLUSIONS: The prevalence of PVD in this urban South Indian population is considerably lower than that reported in European and U.S. studies and is in marked contrast to the high prevalence rate of CAD reported in this population.

Adult↗
PubMed1993

Disordered methionine/homocysteine metabolism in premature vascular disease. Its occurrence, cofactor therapy, and enzymology.

Mild homocysteinemia occurs surprisingly often in patients with premature vascular disease. We studied the possible enzymatic sources of this mild hyperhomocysteinemia and the control of homocysteine levels in plasma by treatment of patients with the cofactors and cosubstrates of homocysteine catabolism. We assessed homocysteine metabolism in 131 patients who had premature disease in their coronary, peripheral, or cerebrovascular circulation by using a standard oral methionine-load test. Impaired homocysteine metabolism occurred in 28 patients. We assayed levels of the primary enzymes of homocysteine catabolism in cultured skin fibroblast extracts from 15 of these 28 patients. The patients' cystathionine beta-synthase levels (3.68 +/- 2.52 nmol/h per milligram of cell protein, mean +/- SD) were markedly depressed compared with those from 31 healthy adult control subjects (7.61 +/- 4.49, P < .001). The patients' levels of 5-methyltetrahydrofolate: homocysteine methyltransferase were normal. While betaine: homocysteine methyltransferase was not expressed in skin fibroblasts, 24-hour urinary betaine and N,N-dimethylglycine measurements were consistent with normal or enhanced remethylation of homocysteine by betaine: homocysteine methyltransferase in the 13 patients tested. When treated daily with choline and betaine, pyridoxine, or folic acid, there was a normalization of the postmethionine plasma homocysteine level in 16 of 19 patients. Our results indicate that mild homocysteinemia in premature vascular disease may be caused by either a folate deficiency or deficiencies in cystathionine beta-synthase activity. It does not necessarily involve deficiencies of either 5-methyltetrahydrofolate:homocysteine methyltransferase or betaine:homocysteine methyltransferase. Effective treatment regimens are also defined.

5-Methyltetrahydrofolate-Homocysteine S-Methyltran↗
PubMed2004

Echocardiography in pulmonary vascular disease.

The assessment of pulmonary artery pressure, right ventricular function, right ventricular filling pressure, and tricuspid regurgitation provides invaluable information in the care of patients with pulmonary vascular disease. Echocardiography provides a rapid, noninvasive, portable, and accurate method to evaluate these parameters and also provides information on left ventricular and valvular function. Echocardiography has therefore become one of the most commonly performed diagnostic studies in patients with pulmonary vascular disease, and the technique's applications in this area are likely to grow. This article presents an overview of the current uses of echocardiography in pulmonary vascular disease and pulmonary hypertension.

Echocardiography↗
PubMed1995

[Hypertension and vascular diseases: molecular and cellular mechanisms].

Increased blood pressure can be observed in about 15-20% of the Swiss population. Hypertension causes few or no symptoms, but is an important risk factor for myocardial infarction, stroke, renal failure and peripheral vascular disease. All these clinical complications of hypertension are preceded by functional changes of blood vessels and the myocardium (left ventricular hypertrophy). In conduit arteries, hypertension is associated with atherosclerotic changes, while in resistance arteries only increased medial thickness can be observed. In atherosclerosis, functional changes of the endothelium, vascular smooth muscle, platelets and monocytes occur. These changes lead to hypercontractility, increased interaction of circulating blood cells with the blood vessel wall, and to proliferation and migration of vascular smooth muscle cells. These events impair local blood flow and eventually may cause vascular occlusion. The endothelium plays a particularly important role as a regulator of these mechanisms. Accordingly, it is likely that an endothelial dysfunction occurs at the very beginning of the atherosclerotic process. In resistance arteries, remodeling of vascular smooth muscle cells leads to thickening of the media with encroachment on the lumen due to an increased media lumen ratio. These hypertension-induced vascular changes are in part reversible by antihypertensive drugs. Hypertension-induced vascular disease is preceded by numerous alterations in the expression, secretion and action of mediators and receptors of endothelial cells, vascular smooth muscle, platelets and monocytes. It is hoped that increased understanding of the cellular/molecular mechanisms of hypertensive vascular disease will allow more effective therapy (and in the future also gene therapy) as well as better prevention of coronary artery disease in hypertensive patients.

Arteriosclerosis↗
PubMed1998

[Digital rotational angiography in the study of vascular diseases: technical note and initial clinical applications].

INTRODUCTION: Digital rotational angiography is a technique characterized by a C-arm acquiring images as it rapidly rotates around the patient. We studied the clinical potentials of this technique in the assessment of vascular diseases of the abdominal aorta and of the carotid, lower limbs and renal arteries. MATERIAL AND METHODS: We examined 108 patients (66 men and 42 women; mean age: 54.3 years, range: 34-69): 42 had vascular diseases in the carotid arteries, 47 in the abdominal aorta and lower limbs and 19 in the renal arteries. All the patients underwent digital rotational and non-rotational angiography and we analyzed the diagnostic yield, amount of contrast agent and the utility of additional views for each technique. All the examinations were reviewed with(out) subtraction, in cine-loop mode and frame by frame, as well as with(out) magnification. Finally, we considered background noise in both rotational and non-rotational images. RESULTS: The diagnostic quality of the digital rotational technique was always the same as or superior to that of the non-rotational technique. The former allows better 3D rendering, especially when viewed in the cine-loop mode; the examination is shorter and less contrast agent is needed. In contrast, image noise was increased, especially in lateral and oblique views. Digital rotational angiography was fairly well tolerated but the long breath-hold required was a problem especially to elderly patients. CONCLUSIONS: Digital rotational angiography is a useful tool to study vascular diseases in the carotid arteries and lower limbs using a lower radiation dose and less contrast agent than non-rotational examinations. As for the abdominal aorta and renal arteries, the rotational technique can be a valid adjunct to the conventional one.

Adult↗
PubMed1986

Association between cutaneous occlusive vascular disease, cigarette smoking, and skin slough after rhytidectomy.

This prospective study attempted to determine if nonreversible occlusive vascular changes in the skin contribute to skin slough after rhytidectomy. The dermal microvasculature from 83 consecutive rhytidectomies was evaluated for intimal proliferation and/or hyalin sclerosis. Occlusive vascular disease increased progressively with age in all patients, but smokers and ex-smokers had significantly greater involvement than nonsmokers at any given age (p = 0.03). Severe occlusive vascular disease and skin slough were associated (p = 0.02), and there was a strong trend toward an association between active smoking and skin slough (p = 0.06). Among smokers, there was a significant relationship between skin slough and failure to abstain from smoking postoperatively (p = 0.006). We conclude that with aging, nonreversible occlusive changes develop in the dermal microvasculature. These changes appear to be accelerated by cigarette smoking. Our data, however, show that these nonreversible occlusive vascular changes by themselves do not completely account for the occurrence of skin slough after rhytidectomy.

Adult↗