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PubMed2004

Increased nitrotyrosine production in patients undergoing abdominal aortic aneurysm repair.

BACKGROUND: Vascular inflammation is implicated in the pathogenesis of atherosclerosis and abdominal aortic aneurysm (AAA), and is thought to involve reactive species such as the nitric oxide-derived oxidant peroxynitrite. In the present study nitrotyrosine was measured as a stable marker of peroxynitrite production in vivo. METHODS: Perioperative blood samples were obtained from patients undergoing elective open or endovascular repair of an AAA and from patients with intermittent claudication, smoking aged-matched controls, non-smoking aged-matched controls and non-smoking young healthy controls. Plasma nitrotyrosine was measured by an enzyme-linked immunosorbent assay. RESULTS: The median plasma nitrotyrosine concentration in patients with an AAA (0.46 nmol nitrated bovine serum albumin equivalents per mg protein) was significantly higher than that in patients with intermittent claudication (0.35 nmol; P = 0.002), smoking controls (0.36 nmol; P = 0.001), non-smoking controls (0.35 nmol; P = 0.002) and young healthy controls (0.27 nmol; P < 0.001). Nitrotyrosine concentrations increased during early reperfusion in open AAA repair, but not during endovascular repair. AAA exclusion from the circulation reduced levels to control values (P = 0.001). CONCLUSION: Patients with an AAA had raised levels of circulating nitrated proteins compared with patients with claudication and controls, suggesting a greater degree of ongoing inflammation that was not related to smoking.

Adult↗
PubMed1976

A general cardiovascular risk profile: the Framingham Study.

Persons at high risk of cardiovascular disease can be effectively identified from a measurement of their serum cholesterol and blood pressure, a smoking history, an electrocardiogram and a determination of glucose intolerance. One general function for identifying persons at high risk of cardiovascular disease is also effective in identifying persons at risk for each of the specific diseases, coronary heart disease, atherothrombotic brain infarction, hypertensive heart disease and intermittent claudication, even though the variables used have a different impact on each particular disease. The 10 percent of persons identified with use of this function as at highest risk accounted for about one fifth of the 8 year incidence of coronary heart disease and about one third of the 8 year incidence of atherothrombotic brain infarction, hypertensive heart disease and intermittent claudication. Hence the function provides an economic and efficient method of identifying persons at high cardiovascular risk who need preventive treatment and persons at low risk who need not be alarmed about one moderately elevated risk characteristic.

Adult↗
PubMed2000

Nonsurgically managed patients with degenerative spondylolisthesis: a 10- to 18-year follow-up study.

OBJECT: Controversy exists concerning the indications for surgery and choice of surgical procedure for patients with degenerative spondylolisthesis. The goals of this study were to determine the clinical course of nonsurgically managed patients with degenerative spondylolisthesis as well as the indications for surgery. METHODS: A total of 145 nonsurgically managed patients with degenerative spondylolisthesis were examined annually for a minimum of 10 years follow-up evaluation. Radiographic changes, changes in clinical symptoms, and functional prognosis were surveyed. Progressive spondylolisthesis was observed in 49 patients (34%). There was no correlation between changes in clinical symptoms and progression of spondylolisthesis. The intervertebral spaces of the slipped segments were decreased significantly in size during follow-up examination in patients in whom no progression was found. Low-back pain improved following a decrease in the total intervertebral space size. A total of 84 (76%) of 110 patients who had no neurological deficits at initial examination remained without neurological deficit after 10 years of follow up. Twenty-nine (83%) of the 35 patients who had neurological symptoms, such as intermittent claudication or vesicorectal disorder, at initial examination and refused surgery experienced neurological deterioration. The final prognosis for these patients was very poor. CONCLUSIONS: Low-back pain was improved by restabilization. Conservative treatment is useful for patients who have low-back pain with or without pain in the lower extremities. Surgical intervention is indicated for patients with neurological symptoms including intermittent claudication or vesicorectal disorder, provided that a good functional outcome can be achieved.

Activities of Daily Living↗
PubMed1998

Popliteal artery entrapment syndrome: collaborative experience of the Joint Vascular Research Group.

BACKGROUND: Popliteal artery entrapment syndrome (PAES) is rare and probably underdiagnosed. This study reviewed a collected experience. METHODS: Patients were identified by the Joint Vascular Research Group (vascular surgeons from ten hospitals serving a population of approximately four million) during 1984-1995. Case notes were reviewed. RESULTS: Twenty-one legs in 17 patients were identified with PAES. There were 15 men and two women. The median age at presentation was 29 (range 14-45) years. One patient was excluded because no further information was available. PAES was bilateral in four patients in whom three legs were asymptomatic. At presentation, the duration of symptoms ranged from a few hours (acute leg ischaemia) to intermittent claudication of 6 years' duration. Primary investigation included angiography (20 patients), duplex imaging (four), plain radiography (one) and magnetic resonance imaging (one). In two cases, attempted thrombolysis failed. Surgery was carried out on 17 legs but failed in two. No amputations were required. Following surgery, 12 legs were asymptomatic and five had residual symptoms. CONCLUSION: PAES should be excluded in young patients with intermittent claudication or acute ischaemia.

Adolescent↗
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↗
PubMed1989

The characteristics of the peripheral-limb-circulation in congestive heart failure.

The regulation of the peripheral-limb circulation was investigated in 21 patients suffering from chronic cardiac failure (NYHA stage II and III). In 11 patients the extremital circulation was intact, while 10 patients suffered from peripheral obliterative arterial disease, too (intermittent claudication or rest pain). The control group consisted of 75 subjects with normal cardiac condition. In 35 of the control subjects the peripheral circulation was intact, the remaining 40 suffered from extremital venous isotope dilution technique. In congestive heart failure the limb blood flow and the limb oxygen consumption slightly diminished, but remained in the normal range. The limb vascular resistance significantly increased. In patients suffering from intermittent claudication or rest pain, the marked diminution of the limb blood flow and elevation of the vascular resistance was more pronounced in congestive heart failure than in healthy subjects. The pathologically elevated limb vascular resistance decreased and the limb blood flow significantly increased in congestive heart failure on administration of vasodilator drugs. A pathological and mostly reversible increase in extremital vascular resistance is the most characteristic sign of the peripheral circulation in congestive heart failure.

Adult↗
PubMed1985

Problems in diagnosis of popliteal aneurysms.

Clinical features and errors in diagnosis have been assessed in a retrospective study of 62 popliteal aneurysms in 40 patients, 22 of whom had bilateral aneurysms. Only 29% of patients complained of pain or swelling behind the knee, while 31% of aneurysms had produced distal ischaemia presenting as intermittent claudication, 9 aneurysms had thrombosed producing ischaemic rest pain in 6 legs, and 4 aneurysms had ruptured. Although 94% of aneurysms were suspected or confidently diagnosed by palpation alone, only 43% of patients had had the correct diagnosis made at the time of initial referral. Treatment was delayed in 12 patients, 8 of whom subsequently required amputation. Popliteal aneurysm should be suspected in patients with a prominent popliteal pulse who present with intermittent claudication, and in patients with acute ischaemia of the leg who may have a thrombosed aneurysm requiring surgical exploration.

Adult↗
PubMed1994

Platelet-derived growth factor (PDGF) in patients with different degrees of chronic arterial obstructive disease.

Platelet activation and platelet-derived growth factor (PDGF) play a pivotal role in the pathogenesis of atherosclerosis. Evidence has been accumulating that in the evolution of chronic arterial obstructive disease (CAOD) platelets are also crucially important. The aim of the present study was, therefore, to assess plasma levels of PDGF in patients with different degrees of CAOD according to Fontaine. Twenty patients (17 men, 3 women, mean age sixty-eight +/- seven years) with intermittent claudication (Fontaine stage II) entered the study and their PDGF levels were assessed by radioimmunoassay. Ten additional patients (7 men, 3 women, mean age seventy-three +/- seven years) with more severe CAOD (leg pain at rest/skin ulcers) were also studied. Ten healthy subjects (6 men, 4 women, mean age fifty-four +/- six years) comprised the control group. Patients in stage II were reinvestigated after sixty days of a "training" procedure. Patients with both intermittent claudication and more severe disease had higher levels of PDGF than controls (controls 165.9 +/- 119.1 pg/mL; Fontaine stage II 403.5 +/- 218.4; Fontaine stage III/IV 578.1 +/- 637.2: ANOVA P = 0.04) with no difference between the two groups of patients. After the training period, PDGF levels were significantly higher than at baseline (863.7 +/- 819.6 pg/mL vs 403.5 +/- 218.4) but without significant improvement of physical performance. The elevation of PDGF levels in blood from CAOD patients could be the result of marked platelet activation due to interaction with a widely damaged peripheral vasculature. The same was not true for coronary heart disease, in which normal values of PDGF in venous blood were found.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2002

[Intestinal necrosis as clinical presentation of Takayasu arteritis].

A 32 years old female was admitted to hospital due to acute abdominal pain, nausea, vomiting and liquid stools. Physical examination was normal except for pain on her left inferior abdominal quadrant without peritoneal irritation signs. An abdominal CAT-scan suggested thrombosis at celiac trunk, although the echo Doppler showed no alterations except for signs of ischemia in the distal branch of the superior mesenteric artery. An exploratory laparotomy was performed disclosing a necrosis of the distal ileum and cecum, diffuse peritonitis and thrombosis of the ileocecoapendiculocolic artery. No vasculitis lesions were found in the arteries of medium size examined. A history of intermittent claudication for the past 3 years as well as acrocyanosis, asymmetry of pulses and blood pressure in the superior extremities was ascertained after the surgery. A MRI angiogram showed multiple stenoses and irregularities at the celiac trunk, hepatic, superior mesenteric and fibular arteries. No abnormalities at the aortic arch and its main branches were documented. A sepsis due to Candida sp complicated her postoperative period. After recovery, prednisone 1 mg/kg/day was started and the anticoagulation continued. The abdominal pain, intermittent claudication and superior limb acrocyanosis disappeared. This is an unusual case of type IV Takayasu's arteritis with acute abdominal signs as the first manifestation.

Abdominal Pain↗
PubMed1993

[Differences in prognoses of aorto-iliac and femoro-popliteal reconstructions in peripheral arterial occlusive disease. Results after at least 15 to 25 years].

The results of 729 extremities, operated for peripheral vascular disease and followed for at least 15 up to 29 years are presented. 457 aortoiliac reconstructions are compared with 272 in the femoropopliteal area. All patients suffered only from intermittent claudication. The two groups were compared as to patency rate, reocclusion, amputation rate and mortality. It is of great interest, that the great majority of patients dying in the follow up have open reconstructions and have taken therefore advantage of surgery in being free of walking difficulties up to their death. The results of aortoiliac reconstructions are better, the patency rate is higher, the amputation rate lower, but even femoropopliteal reconstructions do better and have lower amputation rates than in natural course of the disease. Patients with intermittent claudication below 50 years of age should not be admitted to femoropopliteal surgery, because the risk of amputation before death is higher.

Adult↗
PubMedDate not supplied

[Prognosis of the outcome of the surgical treatment of the acquired lumbar spinal stenosis].

Not clear-cut indications exist until now for surgical interventions in lumbar spinal stenosis. The satisfying surgical results range from 55% to 98%. The purpose of the present case study was to optimize the data related with the neurological status, magnetic-resonance tomography and with defining the factors having an influence on surgical results. A total of 77 patients were divided into 2 groups: group 1 comprised patients with the signs of intermittent claudication and group 2 comprised patients with pains in legs. The surgical treatment consisted in decompression of the spinal neural structures and, in cases of instability, in fixing the damaged spinal segments. The splendid surgical results were registered in 20 patients (66%) of group 1 and good results were obtained, in this group, in 10 patients (34%); the splendid results were obtained in 10 patients (21%) of group 2, good results--in 17 patients (37%), satisfactory results--in 11 patients (23%) and unsatisfactory--in 9 patients (19%) of group 2. The surgical treatment in neurogenic intermittent claudication with a scanty neurological symptomatology ensures good results. While, in case of pain in legs with definitely pronounced neurological symptomatology, the surgical treatment does not provide for a full-value regression of symptoms.

Adult↗
PubMed1988

Intraluminal stents in atherosclerotic iliac artery stenosis: preliminary report of a multicenter study.

Fifteen patients with symptomatic iliac artery stenosis were treated with intraluminal placement of balloon-expandable stents. Before treatment, 14 patients had intermittent claudication, and one had a limb at risk for amputation. One patient had diabetes mellitus, nine had hypertension, and all were long-term smokers. Two patients had surgical placement of the stent; in one patient this was part of a combined revascularization procedure. All other stents were placed percutaneously. The transstenotic gradient after injection of vasodilating drugs distal to the lesion decreased from a mean of 32.3 mm Hg +/- 16.7 to 3.1 mm Hg +/- 4.2 after stent placement. Ankle-arm Doppler systolic pressure index increased from a mean of 0.68 +/- 0.22 to 0.96 +/- 0.24 after the procedure. The treatment eliminated intermittent claudication in 14 patients and increased exercise tolerance to 500 m in the patient with a limb at risk for amputation before the procedure. The improved condition persisted in all patients during the follow-up of 6-12 months. Stent placement may be a valuable adjunct in the management of iliac artery disease.

Angiography↗
PubMed1994

A prospective investigation of elevated lipoprotein (a) detected by electrophoresis and cardiovascular disease in women. The Framingham Heart Study.

BACKGROUND: Sinking prebeta lipoprotein is a putative marker for elevated levels of lipoprotein (a). Although prospective data suggest that increased plasma lipoprotein (a) is an independent risk factor for coronary heart disease in men, no prospective studies are available in women. METHODS AND RESULTS: From 1968 through 1975, sinking prebeta lipoprotein was determined by paper electrophoresis in 3103 women Framingham Heart Study participants who were free of prevalent cardiovascular disease. A sinking prebeta lipoprotein band was detectable in 434 of the women (14%) studied. The median follow-up interval was approximately 12 years. Incident cardiovascular disease was associated with band presence using a proportional hazards model that included age, smoking, body mass index, systolic blood pressure, glucose intolerance, low- and high-density lipoprotein cholesterol, and ECG left ventricular hypertrophy. Multivariable adjusted relative risk estimates (with 95% confidence intervals) for outcomes in the band present versus absent groups were as follows: myocardial infarction (82 events), 2.37 (1.48 to 3.81); intermittent claudication (62 events), 1.94 (1.07 to 3.50); cerebrovascular disease (83 events), 1.88 (1.12 to 3.15); total coronary heart disease (174 events), 1.61 (1.13 to 2.29); and total cardiovascular disease (305 events), 1.44 (1.09 to 1.91). A subset analysis indicated that band presence was 50.9% sensitive and 95.4% specific for detecting plasma lipoprotein (a) levels of > 30 mg/dL, the threshold value linked to increased cardiovascular disease risk in men. CONCLUSIONS: Sinking prebeta lipoprotein was a valid surrogate for elevated lipoprotein (a) levels in Framingham Heart Study women. Band presence and, equivalently, elevated plasma lipoprotein (a), was a strong, independent predictor of myocardial infarction, intermittent claudication, and cerebrovascular disease. Confirmation of these findings in other longitudinal studies of women is needed.

Adult↗
PubMed1975

Blood changes in atherosclerosis and long after myocardial infarction and venous thrombosis.

The following clinical groups of volunteers were studied: patients long after recovery from myocardial infarction (MI), others after recovery from deep vein thrombosis (DVT), patients with intermittent claudication, with diabetes, and male and female controls who were well matched. All were subjected to many platelet and clotting tests together with clinical, biochemical and haematological measurements in an attempt to find long term abnormalities in these various diseases. The male MIs differed very significantly from the controls in having much more heparin neutralizing activity (P less than 0.001)and less anti-thrombin (P less than 0.01). Less significantly, some bleeding time tests indicated less bleeding and the patients' platelets were larger. The females with MI had in general the same abnormalities but to a lesser degree. The patients with intermittent claudication, none of whom had a history of MI, had almost the same abnormalities and to the same degree. In deep vein thrombosis the heparin neutralizing activity was also clearly increased; the other tests were generally in the same direction but many were not significant. The diabetics had shorter bleeding times but little else abnormal relative to the controls, suggesting a different pathological process. When all male patients and controls were "scored" according to the degree of atherosclerosis there was a close overall correlation between the degree of atherosclerosis and the increase in the HNA level (r = --0.50, n = 66, P less than 0.001) and the decreased anti-thrombin (r = 0.25, n = 66, P less than 0.05).

Antithrombins↗
PubMed2004

[Individual background factors for "cannot go out alone to distant places" among medium elderly persons living alone in a metropolitan suburb].

OBJECTIVE: To verify whether the statement "cannot go out alone to distant places" should be considered a risk factor for disability among medium elderly persons living alone autonomously in a metropolitan suburban environment, the present cross-sectional study was performed. METHODS: Self-rated mobility levels in elderly persons living alone were surveyed by questionnaire in 1,216 elderly people (209 male, 1007 female) aged 65 to 74 years, living in a metropolitan suburb, who had autonomy and ambulation competence. Two categories were used for evaluation of the self-rated mobility level: the A group were those who were able to go out alone to distant places and the B group were those who were able to do so in the locality, but not to distant places without help (cannot go out alone to distant places). Factors such as everyday lifestyle, self-rated health, and psychological, functional, physical and social items were investigated. RESULTS: Although the frequency of going out was nearly the same between the A and B groups, the B group showed the lower hobby and association activity in social communities. Individual factors such as self-rated health, instrumental activities of daily living (Tokyo Metropolitan Institute of Gerontology), eyesight, masticatory ability, 1 km continuous walking, pedestrian crossing walking on a green light, and fracture history, medicine intake, cerebrovascular disorder related subjective symptoms, intermittent claudication related subjective symptoms, physical pain, symptoms of depression, daytime sleep, number of meals, and no regular walking and light gymnastic exercises demonstrated significant differences in levels between the A and B groups. The B group had characteristics of lower social activities in social communities, deterioration of physical functions, subjective symptoms of sickness and depression, and a worse self-rated level of health. On stepwise multiple logistic regression analysis, individual frailty-risk factors related to "cannot go out alone to distant places", were "inability to continuously walk a distance of 1 km", "lower masticatory ability", "having depressive symptoms", and "having symptoms of intermittent claudication". CONCLUSIONS: The findings from this study show that with autonomous medium elderly persons, those who "cannot go out alone to distant places" have risk factors for a trend toward disability.

Activities of Daily Living↗
PubMed1992

Adverse outcome in surgery for chronic leg ischaemia--risk factors and risk prediction when using different statistical methods.

OBJECTIVE: to compare two different statistical methods in predicting the outcome of surgery for chronic leg ischaemia. MATERIAL: the present study from the Swedvasc registry is based on an inception cohort of 1635 patients with chronic leg ischaemia (intermittent claudication in 609 and critical ischaemia in 1026 patients), who have been followed until 1 year after surgery. Outcome was classified as improved vs. not improved, amputated or dead in claudication and as the intact leg vs. amputation or death in critical ischaemia. METHODS: logistic regression analysis was compared to the inductive expert system program, Assistant Professional, in the prediction of outcome. Seventy per cent of cases in the data base were used to create a risk factor model including 17 variables registered in Swedvasc. These variables included an assessment of patients overall health status, severity of disease, the surgeon's experience and surgical procedures. This model was then evaluated using the remaining 30% of the patients in the data base. RESULTS: a risk score indicating a probability of an adverse outcome exceeding 0.5 was, in patients with intermittent claudication, associated with a sensitivity of 38% using logistic regression and 26% using Assistant Professional. The percentages of correctly predicted adverse outcomes were 29 and 50%, respectively. In patients with critical ischaemia, the sensitivities with the two methods were 68 and 38% and the predictive values 42 and 57%, respectively. CONCLUSIONS: the risk scores created with the two methods gave low sensitivities. It is concluded that risk functions could not be used to predict an adverse outcome in patients operated on for chronic leg ischaemia with the data set used.

Aged↗
PubMed2002

[Spontaneous dissection of the external iliac artery due to fibromuscular dysplasia].

Spontaneous dissection of the external iliac artery due to fibromuscular dysplasia. A case of spontaneous dissection of the external iliac artery due to fibromuscular dysplasia is presented. In a 45-year-old man with a history of sudden onset of intermittent claudication a dissection of the right external iliac artery was found by duplex ultrasound. The patient, who was first treated with conservative therapy, subsequently required operative treatment because of further progression of the dissection. Considering the age of the patient a retrograde thrombendarterectomy manoeuver over guide wire was performed. Angiographic control at the end of operation demonstrated a good reconstructive result without any changes in the right common iliac artery and the aorta. Histopathological examination of the removed material showed fibromuscular dysplasia of the media. In the postoperative course the patient was clinically asymptomatic with ankle/brachial pressure indices of 1.0 on both legs. But shortly after discharge the intermittent claudication in the right leg recurred. Angiography and duplex ultrasound revealed focal stenosis of the right common iliac artery as well as retrograde dissection of the right common iliac artery extending into the distal aorta. Conservative therapy was recommended to the patient by the local hospital and no further progression of clinical and duplex findings within the last six months was found.

Aortic Dissection↗
PubMed2002

Vascular disease and cognitive function in older men in the Caerphilly cohort.

OBJECTIVES: Stroke can impair cognitive function, but the associations between other manifestations of vascular disease and cognitive function have not been adequately studied in representative population samples of subjects. We report the associations between cardiac and peripheral vascular disease and cognitive function for a large representative sample of men in Caerphilly, South Wales, UK. DESIGN: The Caerphilly cohort is the basis of on-going studies of vascular disease, of cognitive function and of predictors of these. We have made intensive attempts to identify all cases of vascular disease: myocardial infarction, angina, ECG ischaemia, peripheral vascular disease (intermittent claudication) and stroke. Here we present data on associations between vascular disease and cognitive function. SETTING: The study is based upon a representative population sample of over 1,500 men in South Wales, aged 55-69 years when cognitive function was measured. The men, and hospital and GP notes relating to them, had been repeatedly examined for evidence of vascular disease during the previous ten years. MAIN OUTCOME MEASURES: Standard tests of cognitive function: the AH4, CAMCOG, MMSE and choice reaction time. RESULTS: After the omission of men who had had a stroke, we detected significant associations between cognitive function and the presence of angina, ECG ischaemia, past myocardial infarction and intermittent claudication. The strength of the associations between cognitive function and the various manifestations of vascular disease were similar, and the various cognitive function tests showed effects of similar size. Overall, cardiac and peripheral vascular disease is associated with a significant reduction in cognitive function equivalent to about one sixth of the standard deviation of a number of tests of cognitive function. The size of this effect is roughly equivalent to the decline in cognitive performance over five years of ageing. CONCLUSIONS: Subjects with evidence of cardiac or peripheral vascular disease have on average a significant reduction in cognitive function equivalent to about four or five years of additional age. The effect of long-term, low-dose aspirin on cognitive decline should now be tested.

Aged↗