268 Automated combination of the oscillometric ankle-brachial index and of the Edinburgh questionnaire for the screening and follow-up of Peripheral Arterial Disease

Background: Obtaining adequate lipid control (LDL-Cholesterol [LDL] <100 mg/dL) in patients with peripheral arterial disease (PAD) is a critical, guideline-directed secondary prevention target. Current compliance with this recommendation is unknown. Methods: A total of 616 patients had their LDL levels measured at 2 vascular specialty clinics in the Netherlands (March 2006-November 2011) during the evaluation of new PAD symptoms. A year following this evaluation, 417 (68%) patients had their LDL levels re-assessed. Information about patients’ demographic and clinical factors was systematically abstracted from medical records. Categories of patients were created based on the attainment of the recommended LDL target (<100 mg/dL [on target] vs. ≥100 mg/dL [off target]). Predictors of being off target at initial evaluation and at 1-year follow-up were identified through multivariable logistic regression analyses. Results: Of the total group, 57% (351/616) were off target at initial evaluation and 81% (496/616) were on lipid-lowering drugs after the initial evaluation at the PAD specialty clinic. One year later, only 25% (103/417) got on target, while 35% (147/417) patients remained off target, and an additional 10% (43/417) saw an increase in LDL to become off target. A total of 30% (124/417) remained on target. Patients with hypertension, diabetes, a history of myocardial infarction, and a lower ankle-brachial index were less likely to be off target at initial evaluation. Predictors of being off target at 1-year follow-up were male sex, and having a higher ankle-brachial index ( Table ). Conclusion: About half of patients with PAD seen at vascular specialty clinics had above-target LDL levels both upon entry and 1 year later. Patients with existing cardiovascular risk factors were much better controlled, as compared with patients without such risk factors. Males and those with higher ankle-brachial indices were less likely to be on target 1 year following management at the specialty clinic. Reasons for poorly regulated lipids need to be further explored, and appropriate quality-of-care improvement strategies will likely be needed to optimize secondary prevention.

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Associations of Symptomatic or Asymptomatic Peripheral Arterial Disease with All-Cause and Cardiovascular Mortality after 3 Years Follow Up: The China Ankle-Brachial Index Cohort Study

Journal of Hypertension Open Access ◽

10.4172/2167-1095.1000124 ◽

2013 ◽

Vol 02 (03) ◽

Author(s):

Xiankai Li Yidong Wei ◽

DachunXu Yang Han ◽

Chang Liang Jianying Shen

Keyword(s):

Cohort Study ◽

Peripheral Arterial Disease ◽

Cardiovascular Mortality ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Peripheral Arterial

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Lipoprotein-associated phospholipase A2 and risk of incident peripheral arterial disease in a multi-ethnic cohort: The Multi-Ethnic Study of Atherosclerosis

Vascular Medicine ◽

10.1177/1358863x16671424 ◽

2016 ◽

Vol 22 (1) ◽

pp. 5-12 ◽

Cited By ~ 9

Author(s):

Parveen K Garg ◽

Neal W Jorgensen ◽

Robyn L McClelland ◽

Nancy S Jenny ◽

Michael H Criqui ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Significant Interaction ◽

Regression Models ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Logistic Regression Models ◽

Increased Risk ◽

Adjusted Logistic Regression ◽

Peripheral Arterial

Prospective studies supporting a relationship between elevated lipoprotein-associated phospholipase A2 (Lp-PLA2) and incident peripheral arterial disease (PAD) are limited. We evaluated the association of Lp-PLA2 with incident PAD in a multi-ethnic cohort without clinical cardiovascular disease. A total of 4622 participants with measurement of Lp-PLA2 mass and Lp-PLA2 activity and an ankle–brachial index (ABI) between 0.9 and 1.4 were followed for the development of PAD (median follow-up = 9.3 years), defined as an ABI ⩽0.9 and decline from baseline ⩾0.15. There were 158 incident PAD events during follow-up. In adjusted logistic regression models, each higher standard deviation of both Lp-PLA2 activity and mass did not confer an increased risk of developing PAD [odds ratios, (95% confidence intervals)]: 0.92 (0.66–1.27) for Lp-PLA2 activity and 1.06 (0.85–1.34) for mass. Additionally, no significant interaction was found according to ethnicity: p=0.43 for Lp-PLA2 activity and p=0.55 for Lp-PLA2 mass. We found no evidence of an association between Lp-PLA2 and incident PAD.

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Drug-coated balloons used in peripheral artery disease: experience from a single center

Journal of International Medical Research ◽

10.1177/0300060520940157 ◽

2020 ◽

Vol 48 (8) ◽

pp. 030006052094015

Author(s):

Jinbo Liu ◽

Tianrun Li ◽

Wei Huang ◽

Na Zhao ◽

Huan Liu ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Intermittent Claudication ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Single Center ◽

Single Center Study ◽

Before And After ◽

Artery Disease ◽

Peripheral Arterial

Objective This retrospective single-center study aimed to analyze immediate and follow-up results of using drug-coated balloons (DCBs) for treating peripheral arterial disease. Methods In this study, we identified a total of 75 patients who underwent DCB therapy at our institution. The ankle–brachial index (ABI) was measured before and after intervention. Intermittent claudication and whether there was healing of ulcers were determined by telephone. Results The cohort consisted of 56 men and 19 women aged 38 to 87 years (68 ± 12 years). Twenty-three patients had Rutherford grade III, 15 had Rutherford grade IV, and 37 had Rutherford grade V. Seventeen patients had stents and 18 had the Rotarex system used. The postoperative ABI was significantly greater than the preoperative ABI (0.911 ± 0.173 vs 0.686 ± 0.249). Good results for treatment were obtained. Intermittent claudication and rest pain did not occur in subjects with Rutherford grades III and IV during follow-up. The amputation rate was 4.1% among all patients using DCB therapy during follow-up. Conclusions DCB therapy is safe and effective for treating peripheral arterial disease in real-world patients. Future prospective studies on this issue are recommended.

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Increased apoB/apoA-I Ratio is Predictive of Peripheral Arterial Disease in Initially Healthy 58-Year-old Men during 8.9 Years of Follow-up

Angiology ◽

10.1177/0003319708324925 ◽

2008 ◽

Vol 60 (5) ◽

pp. 539-545 ◽

Cited By ~ 3

Author(s):

L. Johansson ◽

C. Schmidt

Keyword(s):

Peripheral Arterial Disease ◽

Femoral Artery ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Increased Risk ◽

Peripheral Arterial ◽

Old Men ◽

The City

The aim of the present study was to investigate, if increased levels of apoB/apoA-I ratios are associated with future peripheral arterial disease as measured by ankle-brachial index. Increased apoB/apoA-I levels are defined as 0.9, which has been suggested for men, and as 0.63, which has observed to be associated with plaques in the femoral artery. The study was performed in a cohort of initially clinically healthy 58-year-old men living in the city of Göteborg, Sweden. The group with an apoB/apoA-I ratio ≥0.9 had a significantly increased risk of having PAD during 8.9 years of follow-up than the group below that level (OR: 2.15 CI: 1.21 to 3.82, p < 0.01). When applying the lower apoB/apoA-I cut off, results showed that the group with a level >0.63 had more than a three-fold risk of future PAD compared to the group ≤0.63 (OR: 3.28 CI: 1.14 to 9.40, p < 0.05).

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Asymptomatic Peripheral Arterial Disease in Type 2 Diabetes Patients: A 10-Year Follow-Up Study of the Utility of the Ankle Brachial Index as a Prognostic Marker of Cardiovascular Disease

Annals of Vascular Surgery ◽

10.1016/j.avsg.2010.06.001 ◽

2010 ◽

Vol 24 (8) ◽

pp. 985-993 ◽

Cited By ~ 38

Author(s):

Magdalena Bundó ◽

Laura Muñoz ◽

Carmen Pérez ◽

Juan José Montero ◽

Núria Montellà ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Peripheral Arterial Disease ◽

Prognostic Marker ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Follow Up Study ◽

Peripheral Arterial

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Presence of Peripheral Arterial Disease Predicts Loss of Residual Renal Function in Incident CAPD Patients

Peritoneal Dialysis International ◽

10.3747/pdi.2010.00109 ◽

2012 ◽

Vol 32 (1) ◽

pp. 67-72 ◽

Cited By ~ 9

Author(s):

Shun-li Tian ◽

Xin-kui Tian ◽

Qing-feng Han ◽

Jonas Axelsson ◽

Tao Wang

Keyword(s):

Renal Function ◽

Peripheral Arterial Disease ◽

Strong Predictor ◽

Univariate Analysis ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Residual Renal Function ◽

Cox Proportional Hazards Model ◽

Peripheral Arterial

BackgroundAccelerated cardiovascular disease (CVD), including peripheral arterial disease (PAD), is very common in patients with end-stage renal disease. Residual renal function (RRF) is a strong predictor of patient survival that is suggested to be linked to the degree of CVD. However, the relationship between PAD and decline in RRF has not previously been measured.MethodsWe studied incident continuous ambulatory peritoneal dialysis patients from Peking University Third Hospital. An ankle brachial index of less than 0.9 was used to diagnose PAD. Residual renal function (RRF) was determined as the mean of 24-hour urea and creatinine clearances (glomerular filtration rate). The Cox proportional hazards model was used to identify factors predicting loss of RRF.ResultsThe study included 86 patients (age: 61 ± 14 years; men: 51%), 23 of whom had PAD at baseline. Mean follow-up was 19 months (median: 18 months; range: 6 – 30 months). In univariate analysis, baseline PAD, peritonitis during follow-up, inflammation (C-reactive protein), serum uric acid, CaxP, and serum phosphate were all significantly associated with a greater-than-50% decrease in RRF during follow-up. In multivariate analysis, only baseline PAD, CaxP, and peritonitis were independently associated with a decline in RRF.ConclusionsOur study suggests that PAD may be a clinically important marker of CVD predicting the loss of RRF. It remains to be determined whether interventions aimed at decreasing PAD may also improve renal vascular status and thus slow the rate of RRF decline.

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Abstract P190: Younger Women With Peripheral Arterial Disease Are at Increased Risk of Depressive Symptoms

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_1.ap190 ◽

2011 ◽

Vol 4 (suppl_1) ◽

Author(s):

Kim G Smolderen ◽

John A Spertus ◽

Patrick W Vriens ◽

Steef Kranendonk ◽

Maria M Nooren ◽

...

Keyword(s):

Depressive Symptoms ◽

Peripheral Arterial Disease ◽

Age Groups ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Younger Women ◽

Increased Risk ◽

Gender And Age ◽

Peripheral Arterial

Objectives: Gender disparities, particularly among young women with cardiovascular disease, are a growing cause for concern. Depression is a prevalent and prognostically important comorbidity in peripheral arterial disease (PAD), but its prevalence has not been described as a function of gender and age. We compared depressive symptoms at the time of PAD diagnosis and 6 months later by gender and age. Methods: In this 2-center observational follow-up study, 444 Dutch outpatients with newly diagnosed PAD (32% females) completed the 10-item CES-D at baseline and 6 months later (significant depressive symptoms reflected by scores ≥4). Results: Initially, 33% of women <65 years had significant depressive symptoms, and 6 months later, 19% of the younger women without significant depressive symptoms at baseline developed them. These rates were much higher than other gender-age groups (range at baseline=11-16%, 6-month incidence=6-10%; P ≤.03). Adjusting for demographic and clinical factors, women <65 years experienced a 4-fold greater odds of baseline (OR=4.3 [95%CI 2.2-8.7]) and follow-up depressive symptoms (OR=4.1 [2.0-8.4]) as compared with men ≥65 years. Other gender-age groups were not at increased risk (Figure). Adjusting for changes in ankle-brachial index did not erradicate the increased risk in younger women (OR=3.5 [1.2-10.2]). Conclusions: Depressive symptoms are more common in younger women with PAD than in other gender-age groups, both at the time of diagnosis and 6 months later. To eradicate gender-based disparities in PAD, depression screening and monitoring in younger women may be an important direction for future research and intervention.

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Hallucal thenar index: A new index to detect peripheral arterial disease using laser speckle flowgraphy

Vascular ◽

10.1177/1708538120938935 ◽

2020 ◽

pp. 170853812093893

Author(s):

Kazuhiro Tsunekawa ◽

Fumio Nagai ◽

Tamon Kato ◽

Ikkei Takashimizu ◽

Daisuke Yanagisawa ◽

...

Keyword(s):

Blood Flow ◽

Peripheral Arterial Disease ◽

Operating Characteristic ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Laser Speckle ◽

Laser Speckle Flowgraphy ◽

Skin Perfusion ◽

Peripheral Arterial ◽

Cutaneous Blood

Objectives Laser speckle flowgraphy is a technology using reflected scattered light for visualization of blood distribution, which can be used to measure relative velocity of blood flow easily without contact with the skin within a short time. It was hypothesized that laser speckle flowgraphy may be able to identify foot ischemia. This study was performed to determine whether laser speckle flowgraphy could distinguish between subjects with and without peripheral arterial disease. Materials and methods All subjects were classified based on clinical observations using the Rutherford classification: non-peripheral arterial disease, class 0; peripheral arterial disease group, class 2–5. Rutherford class 6 was one of the exclusion criteria. Laser speckle flowgraphy measured the beat strength of skin perfusion as an indicator of average dynamic cutaneous blood flow change synchronized with the heartbeat. The beat strength of skin perfusion indicates the strength of the heartbeat on the skin, and the heartbeat strength calculator in laser speckle flowgraphy uses the blood flow data to perform a Fourier transform to convert the temporal changes in blood flow to a power spectrum. A total of 33 subjects with peripheral arterial disease and 40 subjects without peripheral arterial disease at a single center were prospectively examined. Laser speckle flowgraphy was used to measure hallucal and thenar cutaneous blood flow, and the measurements were repeated three times. The hallucal and thenar index was defined as the ratio of beat strength of skin perfusion value on hallux/beat strength of skin perfusion value on ipsilateral thenar eminence. The Mann–Whitney U-test was used to compare the median values of hallucal and thenar index and ankle brachial index between the two groups. A receiver operating characteristic curve for hallucal and thenar index of beat strength of skin perfusion was plotted, and a cutoff point was set. The correlation between hallucal and thenar index of beat strength of skin perfusion and ankle brachial index was explored in all subjects, the hemodialysis group, and the non-hemodialysis (non-hemodialysis) group. Results The median value of the hallucal and thenar index of beat strength of skin perfusion was significantly different between subjects with and without peripheral arterial disease (0.27 vs. 0.87, respectively; P < 0.001). The median value of ankle brachial index was significantly different between subjects with and without peripheral arterial disease (0.8 vs. 1.1, respectively; P < 0.001). Based on the receiver operating characteristic of hallucal and thenar index, the cutoff was 0.4416 and the sensitivity, specificity, positive predictive value, and negative predictive value were 68.7%, 95%, 91.7%, and 77.6%, respectively. The correlation coefficients of all subjects, the hemodialysis group, and the non-hemodialysis group were 0.486, 0.102, and 0.743, respectively. Conclusions Laser speckle flowgraphy is a noninvasive, rapid, and widely applicable method. Laser speckle flowgraphy using hallucal and thenar index would be helpful to determine the differences between subjects with and without peripheral arterial disease. The correlation between hallucal and thenar index of beat strength of skin perfusion and ankle brachial index indicated that this index was especially useful in the non-hemodialysis group.

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