scholarly journals Calf muscle stimulation with the Veinoplus device results in a significant increase in lower limb inflow without generating limb ischemia or pain in patients with peripheral artery disease

2013 ◽  
Vol 57 (3) ◽  
pp. 714-719 ◽  
Author(s):  
Pierre Abraham ◽  
Victor Mateus ◽  
Francois Bieuzen ◽  
Nafi Ouedraogo ◽  
Fallou Cisse ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Calf Muscle ◽  
Muscle Stimulation ◽  
Peripheral Artery ◽  
Artery Disease

scholarly journals Abnormal Microvascular Architecture, Fibrosis, and Pericyte Characteristics in the Calf Muscle of Peripheral Artery Disease Patients with Claudication and Critical Limb Ischemia

2020 ◽  
Vol 9 (8) ◽  
pp. 2575
Author(s):  
Constance J. Mietus ◽  
Timothy J. Lackner ◽  
Petros S. Karvelis ◽  
Gregory T. Willcockson ◽  
Christina M. Shields ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Stage Iv ◽  
Limb Ischemia ◽  
Vessel Diameter ◽  
Calf Muscle ◽  
Stage Ii ◽  
Vascular Pathology ◽  
Peripheral Artery ◽  
Microvascular Architecture ◽  
Artery Disease

Work from our laboratory documents pathological events, including myofiber oxidative damage and degeneration, myofibrosis, micro-vessel (diameter = 50–150 μm) remodeling, and collagenous investment of terminal micro-vessels (diameter ≤ 15 µm) in the calf muscle of patients with Peripheral Artery Disease (PAD). In this study, we evaluate the hypothesis that the vascular pathology associated with the legs of PAD patients encompasses pathologic changes to the smallest micro-vessels in calf muscle. Biopsies were collected from the calf muscle of control subjects and patients with Fontaine Stage II and Stage IV PAD. Slide specimens were evaluated by Quantitative Multi-Spectral and Fluorescence Microscopy. Inter-myofiber collagen, stained with Masson Trichrome (MT), was increased in Stage II patients, and more substantially in Stage IV patients in association with collagenous thickening of terminal micro-vessel walls. Evaluation of the Basement Membrane (BM) of these vessels reveals increased thickness in Stage II patients, and increased thickness, diameter, and Collagen I deposition in Stage IV patients. Coverage of these micro-vessels with pericytes, key contributors to fibrosis and BM remodeling, was increased in Stage II patients, and was greatest in Stage IV patients. Vascular pathology of the legs of PAD patients extends beyond atherosclerotic main inflow arteries and affects the entire vascular tree—including the smallest micro-vessels.

scholarly journals Major adverse cardiovascular and limb events in patients with diabetes and concomitant peripheral artery disease treated with sodium glucose cotransporter 2 inhibitor versus dipeptidyl peptidase-4 inhibitor

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Hsin-Fu Lee ◽  
Shao-Wei Chen ◽  
Jia-Rou Liu ◽  
Pei-Ru Li ◽  
Lung-Sheng Wu ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Study Groups ◽  
Dipeptidyl Peptidase ◽  
Research Database ◽  
Peripheral Artery ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Artery Disease

Abstract Background Whether sodium glucose co-transporter 2 inhibitors (SGLT2i) are associated with a lower risk of cardiovascular as well as adverse lower limb events in patients with type-2 diabetes mellitus (T2DM) and concomitant peripheral artery disease (PAD) is unclear. We aimed to evaluate the risk of cardiovascular and limb events, and death associated with the use of SGLT2i compared with dipeptidyl peptidase-4 inhibitors (DPP4i) among a longitudinal and national cohort of patients with T2DM. Methods In this nationwide retrospective cohort study based on the Taiwan National Health Insurance Research Database, we identified a total of 11,431 and 93,972 consecutive T2DM patients with PAD taking SGLT2i and DPP4i, respectively, from May 1, 2016, to December 31, 2017. We used 1:1 propensity score matching (PSM) to balance covariates across study groups. Patients were followed from the drug index date until the occurrence of clinical outcomes, death, discontinuation of the index drug, or the end of the study period, whichever occurred first. Results Overall, 56% and 44% of the patients were treated with dapagliflozin and empagliflozin, respectively. The use of SGLT2i had comparable risks of ischemic stroke and acute myocardial infarction, and was associated with lower risks of congestive heart failure (CHF) [hazard ratio (HR): 0.66; 95% confidence interval (CI) 0.49–0.89; p = 0.0062], lower limb ischemia requiring revascularization (HR: 0.73; 95% CI 0.54–0.98; p = 0.0367) or amputation (HR: 0.43; 95% CI 0.30–0.62; p < 0.0001), and cardiovascular death (HR: 0.67; 95% CI 0.49–0.90; p = 0.0089) when compared with the DDP4i group after PSM. The subgroup analysis revealed consistent results for CHF and major adverse limb outcomes for SGLT2i versus DPP4i among patients aged ≥ 75 years, the presence of chronic kidney disease and established cardiovascular disease was consistent with the main analysis. Conclusions SGLT2i were associated with lower risks of CHF and adverse lower limb events compared with DPP4i among patients with T2DM and PAD in real-world practice.

THE ROLE OF X-RAY ENDOVASCULAR SURGERY IN THE TREATMENT OF OBLITERATING ATHEROSCLEROSIS OF THE LOWER EXTREMITY ARTERIES IN ELDERLY AND SENILE PATIENTS

2020 ◽  
Vol 4 (2) ◽  
pp. 1069-1073
Author(s):  
S.V. Mshar ◽  
◽  
V. Yanushko ◽  
Keyword(s):  
High Risk ◽  
Peripheral Artery Disease ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Peripheral Artery ◽  
Lower Limb Ischemia ◽  
X Ray ◽  
Surgical Methods ◽  
Artery Disease ◽  
Methods Of Treatment

Obliterating atherosclerosis ranks third in the system of cardiovascular disease. With age the incidence of peripheral artery disease increases and makes 3-5% in general population. The most difficult group of patients with peripheral artery disease (PAD) or obliterating atherosclerosis is elderly patients. Currently there is a tendency to increase the life expectancy and aging of the Belarusian population. Elderly and senile patients with obliterating atherosclerosis (PAD) are characterized by a multi-level lesion and damage to the distal parts of the arterial bed, an increase in the number of comorbidities, a high risk of cardiovascular death, and seeking medical help often at the stage of critical lower limb ischemia. Patients at high risk of cardiovascular complications with intermittent lameness are subject to conservative treatment. When developing a clinic for critical lower limb ischemia, due to the low effectiveness of conservative methods of treatment, it is worth considering revascularization of the lower limb arteries. Open surgical methods of treatment are associated with a high risk of complications and mortality. X-ray endovascular methods of treatment of patients of the older age group are characterized by a lower risk of complications, lower injury rate. The use of low-injury x-ray endovascular and hybrid methods of treatment in elderly and senile patients can improve the results of treatment (reduce the frequency of amputations, reduce the risk of complications, improve the quality of life).

scholarly journals Angiogenin—A Proposed Biomarker for Cardiovascular Disease—Is Not Associated With Long-Term Survival in Patients With Peripheral Artery Disease

Angiology ◽  
2021 ◽  
pp. 000331972110043
Author(s):  
Clemens Höbaus ◽  
Gerfried Pesau ◽  
Bernhard Zierfuss ◽  
Renate Koppensteiner ◽  
Gerit-Holger Schernthaner
Keyword(s):  
Peripheral Artery Disease ◽  
Cox Regression ◽  
Ankle Brachial Index ◽  
Limb Ischemia ◽  
Cross Sectional Study ◽  
Enzyme Linked Immunosorbent Assay ◽  
Peripheral Artery ◽  
Cross Sectional ◽  
Term Survival ◽  
Artery Disease

We evaluated angiogenin as a prospective biomarker in peripheral artery disease (PAD) patients with and without claudication symptoms. A pilot study suggested an elevation of angiogenin in critical limb ischemia. However, in PAD patients, the predictive value of angiogenin has not yet been evaluated. For this purpose, 342 patients with PAD (age: 69 ± 10 years, 34.5% women) were followed-up for 7 years in a cross-sectional study. Angiogenin was measured by enzyme-linked immunosorbent assay. All-cause and cardiovascular mortality were analyzed by Cox regression. Angiogenin levels were higher in men ( P = .001) and were associated with patient waist-to-hip ratio ( P < .001), fasting triglycerides ( P = .011), and inversely with estimated glomerular filtration rate ( P = .009). However, angiogenin showed no association with age, characteristics of diabetes, markers of lipid metabolism, or C-reactive protein. Angiogenin did not correlate with markers of angiogenesis such as vascular endothelial growth factor, angiopoietin-2, or tie-2. Furthermore, angiogenin was not associated with PAD Fontaine stages or with patient ankle-brachial index in addition to all-cause mortality (hazard ratio [HR] = 1.09 [95% CI: 0.89-1.34]) or cardiovascular morality (HR = 1.05 [0.82-1.35]). These results suggest that angiogenin does not provide further information regarding outcome prediction in patients with PAD.

Multi-Level Lower Extremity Arterial Revascularization Via Retrograde Pedal Access Under Local Anesthesia in a Patient With Severe Cardiopulmonary Comorbidities: A Case Report

2021 ◽  
pp. 153857442110264
Author(s):  
Hee Korleski ◽  
Laura DiChiacchio ◽  
Luiz Araujo ◽  
Michael R. Hall
Keyword(s):  
Case Report ◽  
General Anesthesia ◽  
Peripheral Artery Disease ◽  
Critical Limb Ischemia ◽  
Treatment Modality ◽  
Conventional Treatment ◽  
Limb Ischemia ◽  
Peripheral Artery ◽  
Endovascular Revascularization ◽  
Artery Disease

Background: Chronic limb-threatening ischemia is a severe form of peripheral artery disease that leads to high rates of amputation and mortality if left untreated. Bypass surgery and antegrade endovascular revascularization through femoral artery access from either side are accepted as conventional treatment modalities for critical limb ischemia. The retrograde pedal access revascularization is an alternative treatment modality useful in specific clinical scenarios; however, these indications have not been well described in literature. This case report highlights the use of retrograde pedal access approach as primary treatment modality in a patient with an extensive comorbidities precluding general anesthesia nor supine positioning. Case Presentation: The patient is a 60-year-old female with multiple severe cardiopulmonary comorbidities presenting with dry gangrene of the right great toe. Her comorbidities and inability to tolerate supine positioning precluded her from receiving open surgery, general anesthesia or monitored sedation, or percutaneous femoral access. Rather, the patient underwent ankle block and retrograde endovascular revascularization via dorsalis pedis artery access without post-operative complications. Discussion: The prevalence of comorbidities related to peripheral artery disease is increasing and with it the number of patients who are not optimal candidates for conventional treatment methods for critical limb ischemia. The retrograde pedal access revascularization as initial treatment modality offers these patients an alternative limb salvaging treatment option.

scholarly journals Plasma concentrations of lipoproteins and risk of lower-limb peripheral artery disease in people with type 2 diabetes: the SURDIAGENE study

Diabetologia ◽  
2021 ◽  
Vol 64 (3) ◽  
pp. 668-680
Author(s):  
Capucine Bertrand ◽  
◽  
Pierre-Jean Saulnier ◽  
Louis Potier ◽  
Mikaël Croyal ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Peripheral Artery Disease ◽  
Lower Limb ◽  
Plasma Concentrations ◽  
Peripheral Artery ◽  
Artery Disease

Advances in Revascularization for Peripheral Artery Disease: Revascularization in PAD

2021 ◽  
Vol 128 (12) ◽  
pp. 1885-1912
Author(s):  
Joshua A. Beckman ◽  
Peter A. Schneider ◽  
Michael S. Conte
Keyword(s):  
Intermittent Claudication ◽  
Peripheral Artery Disease ◽  
Clinical Presentation ◽  
Rapid Development ◽  
Microvascular Disease ◽  
Limb Ischemia ◽  
Medical Emergency ◽  
Acute Limb Ischemia ◽  
Peripheral Artery ◽  
Artery Disease

Effective revascularization of the patient with peripheral artery disease is about more than the procedure. The approach to the patient with symptom-limiting intermittent claudication or limb-threatening ischemia begins with understanding the population at risk and variation in clinical presentation. The urgency of revascularization varies significantly by presentation; from patients with intermittent claudication who should undergo structured exercise rehabilitation before revascularization (if needed) to those with acute limb ischemia, a medical emergency, who require revascularization within hours. Recent years have seen the rapid development of new tools including wires, catheters, drug-eluting technology, specialized balloons, and biomimetic stents. Open surgical bypass remains an important option for those with advanced disease. The strategy and techniques employed vary by clinical presentation, lesion location, and lesion severity. There is limited level 1 evidence to guide practice, but factors that determine technical success and anatomic durability are largely understood and incorporated into decision-making. Following revascularization, medical therapy to reduce adverse limb outcomes and a surveillance plan should be put in place. There are many hurdles to overcome to improve the efficacy of lower extremity revascularization, such as restenosis, calcification, microvascular disease, silent embolization, and tools for perfusion assessment. This review highlights the current state of revascularization in peripheral artery disease with an eye toward technologies at the cusp, which may significantly impact current practice.

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