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Ghirardini F, Martini R. Current Opinion on Diagnosis of Peripheral Artery Disease in Diabetic Patients. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1179. [PMID: 39064610 PMCID: PMC11279131 DOI: 10.3390/medicina60071179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024]
Abstract
Peripheral arterial disease (PAD) prevalence and diabetes mellitus (DM) prevalence are continuously increasing worldwide. The strong relationship between DM and PAD is highlighted by recent evidence. PAD diagnosis in diabetic patients is very important, particularly in patients with diabetic foot disease (DFD); however, it is often made difficult by the characteristics of such diseases. Diagnosing PAD makes it possible to identify patients at a very high cardiovascular risk who require intensive treatment in terms of risk factor modification and medical therapy. The purpose of this review is to discuss the diagnostic methods that allow for a diagnosis of PAD in diabetic patients. Non-invasive tests that address PAD diagnosis will be discussed, such as the ankle-brachial index (ABI), toe pressure (TP), and transcutaneous oxygen pressure (TcPO2). Furthermore, imaging methods, such as duplex ultrasound (DUS), computed tomography angiography (CTA), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA), are described because they allow for diagnosing the anatomical localization and severity of artery stenosis or occlusion in PAD. Non-invasive tests will also be discussed in terms of their ability to assess foot perfusion. Foot perfusion assessment is crucial in the diagnosis of critical limb ischemia (CLI), the most advanced PAD stage, particularly in DFD patients. The impacts of PAD diagnosis and CLI identification in diabetic patients are clinically relevant to prevent amputation and mortality.
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Affiliation(s)
| | - Romeo Martini
- Department of Angiology, San Martino Hospital, 32100 Belluno, Italy;
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Roshan R, Chaudhary N, Chouhan U, Huda F, Basu S. Correlation of ankle-wrist pressure index with ankle-brachial pressure index to assess lower limb perfusion in diabetic foot ulcer: a pilot study. J Wound Care 2024; 33:519-525. [PMID: 38967344 DOI: 10.12968/jowc.2021.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
OBJECTIVE The presence of peripheral artery disease (PAD) in patients with diabetic foot ulcers (DFUs) is a significant risk factor for chronicity and amputation. Ankle-brachial pressure index (ABPI) is a screening tool for PAD. Brachial systolic pressure measurement, used as a denominator in the calculation of ABPI, produces inaccurate results in patients with obesity and the presence of heavy clothing. The wrist, however, is easily accessible, and the ankle-wrist pressure index (AWPI), if comparable with ABPI, may be useful in screening selected patients. This study aimed to assess the efficacy of AWPI in diagnosing perfusion in DFUs and compare it to ABPI in patients with DFUs. METHOD ABPI and AWPI were calculated by measuring systolic blood pressure in the arteries of the ankle, arm and wrist with a handheld Doppler. Actual perfusion was determined by the presence or absence of PAD by duplex ultrasound. RESULTS A total of 46 lower extremities in 41 patients were studied. The prevalence of PAD was 61%. Duplex ultrasound confirmed that the sensitivity of ABPI and AWPI in detecting PAD in patients with DFUs was 67.9% and 71.4% respectively, whereas the specificity of ABPI and AWPI was 94.4% and 88.9% respectively. On receiver operating characteristic analysis, the area under the curve of ABPI and AWPI was 0.804 and 0.795, respectively. A statistically significant positive correlation between ABPI and AWPI was found (r=0.986; p<0.001). CONCLUSION There was a good correlation between ABPI and AWPI over a wide range of values. ABPI and AWPI may have a similar role in predicting perfusion in patients with DFUs. AWPI could be used in place of ABPI in selected patients in whom measuring ABPI may be difficult. DECLARATION OF INTEREST The authors have no conflicts of interest to declare.
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Affiliation(s)
- Ravi Roshan
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Natasha Chaudhary
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Udit Chouhan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, India
| | - Farhanul Huda
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Somprakas Basu
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, India
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Yanamandala M, Goudot G, Gerhard-Herman MD. Peripheral artery disease and outcomes: how can we improve risk prediction? Eur Heart J 2024; 45:1750-1752. [PMID: 38607986 PMCID: PMC11107121 DOI: 10.1093/eurheartj/ehae154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Affiliation(s)
- Mounica Yanamandala
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02116, USA
| | - Guillaume Goudot
- Université Paris Cité, Vascular Medicine Department, Georges Pompidou European Hospital, APHP, Paris, France
| | - Marie Denise Gerhard-Herman
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02116, USA
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Varaki ES, Gargiulo GD, Malone M, Breen PP. Arterial and venous peripheral vascular assessment using wearable electro-resistive morphic sensors. Sci Rep 2024; 14:1327. [PMID: 38225286 PMCID: PMC10789795 DOI: 10.1038/s41598-023-50534-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 12/21/2023] [Indexed: 01/17/2024] Open
Abstract
Peripheral vascular diseases (PVDs) represent a significant burden on global human health and healthcare systems. With continued growth in obesity and diabetes, it is likely that the incidence of these conditions will increase. As many PVDs remain undiagnosed, low-cost and easy to use diagnostic methods are required. This work uses newly developed wearable electro-resistive morphic sensors to assess venous and arterial competence in the lower limbs of 36 healthy subjects. Comparison of this HeMo device was made to currently available benchtop light reflection rheography and photoplethymography devices. Results indicate that HeMo can detect the physiological signals of interest for both chronic venous insufficiency and peripheral arterial disease and all subjects were interpreted as healthy by each system. However, measurement repeatability of HeMo was highlighted as an issue that requires further system development. Furthermore, as HeMo captures changes in a section of limb circumference due to changes in underlying blood movement, rather than at a single point, the recorded signal is typically damped by comparison. This factor should be considered in any future developments.
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Affiliation(s)
- Elham Shabani Varaki
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, Australia
| | - Gaetano D Gargiulo
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, Australia
- School of Engineering, Design and Built Environment, Western Sydney University, Sydney, Australia
| | - Matthew Malone
- South Western Sydney Limb Preservation and Wound Research, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, Australia
- Infectious Diseases and Microbiology, School of Medicine, Western Sydney University, Sydney, Australia
| | - Paul P Breen
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, Australia.
- Translational Health Research Institute, Western Sydney University, Sydney, Australia.
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Fendrik K, Biró K, Endrei D, Koltai K, Sándor B, Tóth K, Késmárky G. Oscillometric measurement of the ankle-brachial index and the estimated carotid-femoral pulse wave velocity improves the sensitivity of an automated device in screening peripheral artery disease. Front Cardiovasc Med 2023; 10:1275856. [PMID: 38155988 PMCID: PMC10754531 DOI: 10.3389/fcvm.2023.1275856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/24/2023] [Indexed: 12/30/2023] Open
Abstract
Background and aims To overcome the time and personnel constraints of the Doppler method, automated, four-limb blood pressure monitors were recently developed. Their additional functions, such as measuring the estimated carotid-femoral pulse wave velocity (ecfPWV), have been, thus far, less studied. We aimed to compare the sensitivity and specificity of different ankle-brachial index (ABI), toe-brachial index (TBI), and ecfPWV measurement methodologies to evaluate their contribution to peripheral artery disease (PAD) screening. Methods Among 230 patients (mean age 64 ± 14 years), ABI measurements were performed using a Doppler device and a manual sphygmomanometer. The Doppler ABI was calculated by taking the higher, while the modified Doppler ABI by taking the lower systolic blood pressure of the two ankle arteries as the numerator, and the higher systolic blood pressure of both brachial arteries as the denominator. The automated ABI measurement was carried out using an automatic BOSO ABI-system 100 PWV device, which also measured ecfPWV. TBI was obtained using a laser Doppler fluxmeter (Periflux 5000) and a photoplethysmographic device (SysToe). To assess atherosclerotic and definitive PAD lesions, vascular imaging techniques were used, including ultrasound in 160, digital subtraction angiography in 66, and CT angiography in four cases. Results ROC analysis exhibited a sensitivity/specificity of 70.6%/98.1% for the Doppler ABI (area under the curve, AUC = 0.873), 84.0%/94.4% for the modified Doppler ABI (AUC = 0.923), and 61.5%/97.8% for the BOSO ABI (AUC = 0.882) at a cutoff of 0.9. Raising the cutoff to 1.0 increased the sensitivity of BOSO to 80.7%, with the specificity decreasing to 79.1%. The ecfPWV measurement (AUC = 0.896) demonstrated a 63.2%/100% sensitivity/specificity in predicting atherosclerotic lesions at a cutoff of 10 m/s. Combining BOSO ABI and ecfPWV measurements recognized 89.5% of all PAD limbs. Conclusion The combined BOSO ABI and ecfPWV measurements may help select patients requiring further non-invasive diagnostic evaluation for PAD. The user-friendly feasibility may make it suitable for screening large populations.
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Affiliation(s)
- Krisztina Fendrik
- Division of Angiology, 1st Department of Medicine of the Clinical Centre University of Pécs, University of Pécs Medical School, Pécs, Hungary
| | - Katalin Biró
- Division of Angiology, 1st Department of Medicine of the Clinical Centre University of Pécs, University of Pécs Medical School, Pécs, Hungary
| | - Dóra Endrei
- Division of Angiology, 1st Department of Medicine of the Clinical Centre University of Pécs, University of Pécs Medical School, Pécs, Hungary
| | - Katalin Koltai
- Division of Angiology, 1st Department of Medicine of the Clinical Centre University of Pécs, University of Pécs Medical School, Pécs, Hungary
| | - Barbara Sándor
- Division of Cardiology, 1st Department of Medicine of the Clinical Centre University of Pécs, University of Pécs Medical School, Pécs, Hungary
| | - Kálmán Tóth
- Division of Cardiology, 1st Department of Medicine of the Clinical Centre University of Pécs, University of Pécs Medical School, Pécs, Hungary
| | - Gábor Késmárky
- Division of Angiology, 1st Department of Medicine of the Clinical Centre University of Pécs, University of Pécs Medical School, Pécs, Hungary
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Fendrik K, Biró K, Endrei D, Koltai K, Sándor B, Tóth K, Késmárky G. Screening for Peripheral Artery Disease Using an Automated Four-Limb Blood Pressure Monitor Equipped with Toe-Brachial Index Measurement. J Clin Med 2023; 12:6539. [PMID: 37892678 PMCID: PMC10607258 DOI: 10.3390/jcm12206539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/01/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Toe-brachial index (TBI) measurement helps to detect peripheral artery disease (PAD) in patients with incompressible ankle arteries due to medial arterial calcification, which is most frequently associated with diabetes. We aimed to evaluate how an automated four-limb blood pressure monitor equipped with TBI measurement could contribute to PAD screening. In 117 patients (mean age 63.2 ± 12.8 years), ankle-brachial index (ABI) measurement was performed using the Doppler-method and the MESI mTablet. TBI was obtained via photoplethysmography (MESI mTablet, SysToe) and a laser Doppler fluxmeter (PeriFlux 5000). Lower limb PAD lesions were evaluated based on vascular imaging. A significant correlation was found between Doppler and MESI ankle-brachial index values (r = 0.672), which was stronger in non-diabetic (r = 0.744) than in diabetic (r = 0.562) patients. At an ABI cut-off of 0.9, Doppler (AUC = 0.888) showed a sensitivity/specificity of 67.1%/97.4%, MESI (AUC 0.891) exhibited a sensitivity/specificity of 57.0%/100%; at a cut-off of 1.0, MESI demonstrated a sensitivity/specificity of 74.7%/94.8%. The TBI values measured using the three devices did not differ significantly (p = 0.33). At a TBI cut-off of 0.7, MESI (AUC = 0.909) revealed a sensitivity/specificity of 92.1%/67.5%. Combining MESI ABI and TBI measurements recognised 92.4% of PAD limbs. Using an ABI cut-off level of 1.0 and sequential TBI measurement increases the sensitivity of the device in detecting PAD. The precise interpretation of the obtained results requires some expertise.
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Affiliation(s)
- Krisztina Fendrik
- Division of Angiology, 1st Department of Medicine, Clinical Centre University of Pécs, University of Pécs Medical School, Ifjúság útja 13, H-7624 Pécs, Hungary; (K.B.); (D.E.); (K.K.); (G.K.)
| | - Katalin Biró
- Division of Angiology, 1st Department of Medicine, Clinical Centre University of Pécs, University of Pécs Medical School, Ifjúság útja 13, H-7624 Pécs, Hungary; (K.B.); (D.E.); (K.K.); (G.K.)
| | - Dóra Endrei
- Division of Angiology, 1st Department of Medicine, Clinical Centre University of Pécs, University of Pécs Medical School, Ifjúság útja 13, H-7624 Pécs, Hungary; (K.B.); (D.E.); (K.K.); (G.K.)
| | - Katalin Koltai
- Division of Angiology, 1st Department of Medicine, Clinical Centre University of Pécs, University of Pécs Medical School, Ifjúság útja 13, H-7624 Pécs, Hungary; (K.B.); (D.E.); (K.K.); (G.K.)
| | - Barbara Sándor
- Division of Cardiology, 1st Department of Medicine, Clinical Centre University of Pécs, University of Pécs Medical School, Ifjúság útja 13, H-7624 Pécs, Hungary; (B.S.); (K.T.)
| | - Kálmán Tóth
- Division of Cardiology, 1st Department of Medicine, Clinical Centre University of Pécs, University of Pécs Medical School, Ifjúság útja 13, H-7624 Pécs, Hungary; (B.S.); (K.T.)
| | - Gábor Késmárky
- Division of Angiology, 1st Department of Medicine, Clinical Centre University of Pécs, University of Pécs Medical School, Ifjúság útja 13, H-7624 Pécs, Hungary; (K.B.); (D.E.); (K.K.); (G.K.)
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Li LG, Ma X. Early identification and treatment for peripheral arterial disease in patients with ischemic cerebrovascular disease. Eur J Med Res 2023; 28:93. [PMID: 36823655 PMCID: PMC9948380 DOI: 10.1186/s40001-023-01050-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 02/07/2023] [Indexed: 02/25/2023] Open
Abstract
Ischemic cerebrovascular disease (ICVD) is a major cause of mortality and disability worldwide and is often caused by atherosclerosis. As a systemic disease, atherosclerosis usually affects multiple vascular beds, mainly including cerebral, coronary, and peripheral arteries. Therefore, ICVD is easily complicated by lower-extremity peripheral arterial disease (PAD). ICVD patients with PAD have more serious symptoms and a worse prognosis, however, neurologists might neglect the evaluation and management of the coexistent PAD, and there is still a lack of consensuses about the diagnosis and treatment for such patients. By summarizing relevant research progresses, this review showed that duplex ultrasound had more advantages in the early screening and evaluation of PAD in ICVD patients among multiple methods to diagnose PAD. Furthermore, the current evidence seems to support that single-drug antiplatelet can be used as the basic treatment, and new antithrombotic strategies, such as ticagrelor only or aspirin combined with low-dose rivaroxaban are expected to further reduce the incidence of stroke for ICVD patients with PAD. More effective treatments would be explored by large-scale trials to guide the clinical management to prevent secondary stroke for such patients.
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Affiliation(s)
- Lu-guang Li
- grid.24696.3f0000 0004 0369 153XDepartment of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053 China ,National Clinical Research Center for Geriatric Disorders, Beijing, China ,grid.24696.3f0000 0004 0369 153XClinical Center for Cardio-Cerebrovascular Disease of Capital Medical University, Beijing, China
| | - Xin Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China. .,National Clinical Research Center for Geriatric Disorders, Beijing, China. .,Clinical Center for Cardio-Cerebrovascular Disease of Capital Medical University, Beijing, China.
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Choi JCB, Miranda J, Greenleaf E, Conte MS, Gerhard-Herman MD, Mills JL, Barshes NR. Lower-extremity pressure, staging, and grading thresholds to identify chronic limb-threatening ischemia. Vasc Med 2023; 28:45-53. [PMID: 36759932 DOI: 10.1177/1358863x221147945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
INTRODUCTION The Society for Vascular Surgery Threatened Limb Classification System ('WIfI') is used to predict risk of limb loss and identify peripheral artery disease in patients with foot ulcers or gangrene. We estimated the diagnostic sensitivity of multiple clinical and noninvasive arterial parameters to identify chronic limb-threatening ischemia (CLTI). METHODS We performed a single-center review of 100 consecutive patients who underwent angiography for foot gangrene or ulcers. WIfI stages and grades were determined for each patient. Toe, ankle, and brachial pressure measurements were performed by registered vascular technologists. CLTI severity was characterized using Global Limb Anatomic Staging System (GLASS stages) and angiosomes. Medial artery calcification in the foot was quantified on foot radiographs. RESULTS GLASS NA (not applicable), I, II, and III angiographic findings were seen in 21, 21, 23, and 35 patients, respectively. A toe-brachial index < 0.7 and minimum ipsilateral ankle-brachial index < 0.9 performed well in identifying GLASS II and III angiographic findings, with sensitivity rates 97.8% and 91.5%, respectively. The diagnostic accuracy rates of noninvasive measures peaked at 74.7% and 89.3% for identifying GLASS II/III and GLASS I+ angiographic findings, respectively. The presence of medial artery calcification significantly diminished the sensitivity of most noninvasive parameters. CONCLUSIONS The use of alternative noninvasive arterial testing parameters improves sensitivity for detecting PAD. Abnormal noninvasive results should suggest the need for diagnostic angiography to further characterize arterial anatomy of the affected limb. Testing strategies with better accuracy are needed.
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Affiliation(s)
- Justin Chin-Bong Choi
- Michael E. DeBakey Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Jorge Miranda
- Michael E. DeBakey Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Erin Greenleaf
- Michael E. DeBakey Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Michael S Conte
- Division of Vascular & Endovascular Surgery, University of California at San Francisco, San Francisco, CA, USA
| | | | - Joseph L Mills
- Michael E. DeBakey Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA.,Baylor-St Luke's Medical Center, Houston, TX, USA
| | - Neal R Barshes
- Michael E. DeBakey Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
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Abstract
PURPOSE OF REVIEW Hypertension (HTN) is a well known risk factor for atherosclerosis and peripheral arterial disease (PAD). PAD affects more than 250 million people globally and is associated with worse clinical outcomes. Although multiple studies have been performed to evaluate treatment of HTN in patients with PAD, blood pressure management in this high-risk cohort remains poor. RECENT FINDINGS There has been conflicting evidence regarding blood pressure goals in PAD with some recent studies showing adverse outcomes with low blood pressure in this patient population. Current guidelines, however, continue to recommend treatment goals in PAD patients similar to patients without PAD. To date, no single antihypertensive drug class has shown a clear benefit in PAD population over other antihypertensive drug classes. SUMMARY Prospective randomized trials enrolling PAD patients are required that can shed light on optimum blood pressure target and also distinguish between different antihypertensive drugs in terms of reducing adverse outcomes.
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Wung CH, Wang YH, Lee YC, Chang CW, Wu PY, Huang JC, Tsai YC, Chen SC, Chang JM, Hwang SJ. Association between Flow-Mediated Dilation and Skin Perfusion Pressure with Peripheral Artery Disease in Hemodialysis Patients. J Pers Med 2021; 11:jpm11121251. [PMID: 34945724 PMCID: PMC8708979 DOI: 10.3390/jpm11121251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/21/2022] Open
Abstract
Flow-mediated dilation (FMD) is used to noninvasively assess the health of blood vessels and it has been shown to have a similar predictive ability for cardiovascular disease to traditional risk factors. Skin perfusion pressure (SPP) refers to the blood pressure required to restore capillary or microcirculatory flow after controlled occlusion and the return of flow. SPP has been shown to be an important measurement when making clinical decisions for patients with limb ischemia and to be a predictor of the likelihood of wound healing. Peripheral artery disease is common in hemodialysis (HD) patients. However, little is known about the association between FMD or SPP and peripheral artery disease. The aim of this study was to evaluate the association between FMD and SPP with brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI) in HD patients in Taiwan, an area with a high rate of ESRD. This study was conducted at a regional hospital in southern Taiwan. ABI and baPWV values were measured using an ABI automated device. FMD and SPP were measured using ultrasound and a microvasculature blood flow monitor, respectively. Eighty patients were enrolled in this study. Compared to the patients with an ABI ≥ 0.95, those with an ABI < 0.95 had lower SPP of the feet (dorsal and plantar portions, both p < 0.001). After multivariable adjustments, low triglycerides (p = 0.033) and high calcium–phosphate product (p = 0.018) were significantly associated with low FMD. Further, low ABI (p = 0.001) and low baPWV (p = 0.036) were significantly associated with low SPP of dorsal portions. Old age (p = 0.005), low high-density lipoprotein cholesterol (p = 0.016), and low ABI (p = 0.002) were significantly associated with low SPP of plantar portions. This study demonstrated an association between FMD and SPP with peripheral artery disease in HD patients. Patients with low ABI and baPWV had a high risk of low SPP of the feet. However, there was no significant correlation between FMD and ABI or baPWV.
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Affiliation(s)
- Chih-Hsuan Wung
- Department of Post Baccalaureate Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Yu-Hsiu Wang
- Department of Nursing, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (Y.-H.W.); (Y.-C.L.); (C.-W.C.)
| | - Yuang-Chi Lee
- Department of Nursing, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (Y.-H.W.); (Y.-C.L.); (C.-W.C.)
| | - Chieh-Wei Chang
- Department of Nursing, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (Y.-H.W.); (Y.-C.L.); (C.-W.C.)
| | - Pei-Yu Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (P.-Y.W.); (J.-C.H.)
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (Y.-C.T.); (J.-M.C.)
| | - Jiun-Chi Huang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (P.-Y.W.); (J.-C.H.)
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (Y.-C.T.); (J.-M.C.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Yi-Chun Tsai
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (Y.-C.T.); (J.-M.C.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Szu-Chia Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (P.-Y.W.); (J.-C.H.)
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (Y.-C.T.); (J.-M.C.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: (S.-C.C.); (S.-J.H.); Tel.: +886-7-8036783 (ext. 3440) (S.-C.C.); +886-7-3121101 (ext. 7351) (S.-J.H.); Fax: +886-7-8063346 (S.-C.C.)
| | - Jer-Ming Chang
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (Y.-C.T.); (J.-M.C.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Shang-Jyh Hwang
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (Y.-C.T.); (J.-M.C.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: (S.-C.C.); (S.-J.H.); Tel.: +886-7-8036783 (ext. 3440) (S.-C.C.); +886-7-3121101 (ext. 7351) (S.-J.H.); Fax: +886-7-8063346 (S.-C.C.)
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Stivalet O, Paisant A, Belabbas D, Le Faucheur A, Landreau P, Le Pabic E, Omarjee L, Mahé G. Combination of Exercise Testing Criteria to Diagnose Lower Extremity Peripheral Artery Disease. Front Cardiovasc Med 2021; 8:759666. [PMID: 34901219 PMCID: PMC8660124 DOI: 10.3389/fcvm.2021.759666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Nothing is known about the interest of the combination of exercise tests to diagnose Lower-extremity Peripheral Artery Disease (LEPAD). The aim of this study was to assess if combining exercise testing criteria [post-exercise Ankle-Brachial Index (ABI) + exercise-oximetry (exercise-TcPO2)] improves the detection of lower limbs arterial stenoses as compared with post-exercise ABI using American Heart Association (AHA) criteria, or exercise-TcPO2 alone. Material and Methods: In a prospective monocentric study, consecutive patients with exertional-limb pain and normal resting-ABI referred to our vascular center (Rennes, France) were assessed from May 2016 to February 2018. All included patients had a computed tomography angiography (CTA), a resting-ABI, a post-exercise ABI and an exercise-TcPO2. AHA post-exercise criteria, new validated post-exercise criteria (post-exercise ABI decrease ≥18.5%, post-exercise ABI decrease <0.90), and Delta from Rest of Oxygen Pressure (Total-DROP) ≤-15mmHg (criterion for exercise-TcPO2) were used to diagnose arterial stenoses ≥50%. For the different combinations of exercise testing criteria, sensitivity or specificity or accuracies were compared with McNemar's test. Results: Fifty-six patients (mean age 62 ± 11 years old and 84% men) were included. The sensitivity of the combination of exercise testing criteria (post-exercise ABI decrease ≥18.5%, or post-exercise ABI decrease <0.90 or a Total-DROP ≤-15mmHg) was significantly higher (sensitivity = 81% [95% CI, 71-92]) than using only one exercise test (post-exercise AHA criteria (sensitivity = 57% [43-70]) or exercise-TcPO2 alone (sensitivity = 59% [45-72]). Conclusions: Combination of post-exercise ABI with Exercise-TcPO2 criteria shows better sensitivity to diagnose arterial stenoses compared with the AHA post-exercise criteria alone or Exercise-TcPO2 criteria used alone. A trend of a better accuracy of this combined strategy was observed but an external validation should be performed to confirm this diagnostic strategy.
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Affiliation(s)
| | | | | | | | | | - Estelle Le Pabic
- Institut National de la Santé Et de la Recherche Médicale (INSERM), CIC1414, Rennes, France
| | - Loukman Omarjee
- Vascular Medicine Unit, CHU Rennes, Rennes, France
- Vascular Medicine, Centre Hospitalier de Redon, Redon, France
| | - Guillaume Mahé
- Vascular Medicine Unit, CHU Rennes, Rennes, France
- University of Rennes 2, M2S-EA 7470, Rennes, France
- Institut National de la Santé Et de la Recherche Médicale (INSERM), CIC1414, Rennes, France
- University of Rennes 1, Rennes, France
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12
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Nattagh-Eshtivani E, Barghchi H, Pahlavani N, Barati M, Amiri Y, Fadel A, Khosravi M, Talebi S, Arzhang P, Ziaei R, Ghavami A. Biological and pharmacological effects and nutritional impact of phytosterols: A comprehensive review. Phytother Res 2021; 36:299-322. [PMID: 34729825 DOI: 10.1002/ptr.7312] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/01/2021] [Accepted: 09/30/2021] [Indexed: 12/20/2022]
Abstract
Phytosterols (PSs), classified into plant sterols and stanols, are bioactive compounds found in foods of plant origin. PSs have been proposed to exert a wide number of pharmacological properties, including the potential to reduce total and low-density lipoprotein (LDL) cholesterol levels and thereby decreasing the risk of cardiovascular diseases. Other health-promoting effects of PSs include anti-obesity, anti-diabetic, anti-microbial, anti-inflammatory, and immunomodulatory effects. Also, anticancer effects have been strongly suggested, as phytosterol-rich diets may reduce the risk of cancer by 20%. The aim of this review is to provide a general overview of the available evidence regarding the beneficial physiological and pharmacological activities of PSs, with special emphasis on their therapeutic potential for human health and safety. Also, we will explore the factors that influence the physiologic response to PSs.
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Affiliation(s)
- Elyas Nattagh-Eshtivani
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hanieh Barghchi
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Naseh Pahlavani
- Nutrition and Biochemistry Department, School of Medicine, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran.,Department of Clinical Biochemistry and Nutrition, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mehdi Barati
- Department of Immunology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Yasaman Amiri
- Medical School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Abdulmannan Fadel
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Maryam Khosravi
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeedeh Talebi
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Pishva Arzhang
- Department of Biochemistry and Diet Therapy, Faculty of Nutritional Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rahele Ziaei
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abed Ghavami
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
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13
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Re: Plantar Acceleration Time: A Novel Technique to Evaluate Arterial Flow to the Foot. Ann Vasc Surg 2021; 75:e8-e9. [PMID: 33901618 DOI: 10.1016/j.avsg.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 11/24/2022]
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14
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Herraiz-Adillo Á, Cavero-Redondo I, Álvarez-Bueno C, Pozuelo-Carrascosa DP, Solera-Martínez M. The accuracy of toe brachial index and ankle brachial index in the diagnosis of lower limb peripheral arterial disease: A systematic review and meta-analysis. Atherosclerosis 2020; 315:81-92. [DOI: 10.1016/j.atherosclerosis.2020.09.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/05/2020] [Accepted: 09/24/2020] [Indexed: 12/24/2022]
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15
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Abola MTB, Golledge J, Miyata T, Rha SW, Yan BP, Dy TC, Ganzon MSV, Handa PK, Harris S, Zhisheng J, Pinjala R, Robless PA, Yokoi H, Alajar EB, Bermudez-delos Santos AA, Llanes EJB, Obrado-Nabablit GM, Pestaño NS, Punzalan FE, Tumanan-Mendoza B. Asia-Pacific Consensus Statement on the Management of Peripheral Artery Disease: A Report from the Asian Pacific Society of Atherosclerosis and Vascular Disease Asia-Pacific Peripheral Artery Disease Consensus Statement Project Committee. J Atheroscler Thromb 2020; 27:809-907. [PMID: 32624554 PMCID: PMC7458790 DOI: 10.5551/jat.53660] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/01/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Peripheral artery disease (PAD) is the most underdiagnosed, underestimated and undertreated of the atherosclerotic vascular diseases despite its poor prognosis. There may be racial or contextual differences in the Asia-Pacific region as to epidemiology, availability of diagnostic and therapeutic modalities, and even patient treatment response. The Asian Pacific Society of Atherosclerosis and Vascular Diseases (APSAVD) thus coordinated the development of an Asia-Pacific Consensus Statement (APCS) on the Management of PAD. OBJECTIVES The APSAVD aimed to accomplish the following: 1) determine the applicability of the 2016 AHA/ACC guidelines on the Management of Patients with Lower Extremity Peripheral Artery Disease to the Asia-Pacific region; 2) review Asia-Pacific literature; and 3) increase the awareness of PAD. METHODOLOGY A Steering Committee was organized to oversee development of the APCS, appoint a Technical Working Group (TWG) and Consensus Panel (CP). The TWG appraised the relevance of the 2016 AHA/ACC PAD Guideline and proposed recommendations which were reviewed by the CP using a modified Delphi technique. RESULTS A total of 91 recommendations were generated covering history and physical examination, diagnosis, and treatment of PAD-3 new recommendations, 31 adaptations and 57 adopted statements. This Asia-Pacific Consensus Statement on the Management of PAD constitutes the first for the Asia-Pacific Region. It is intended for use by health practitioners involved in preventing, diagnosing and treating patients with PAD and ultimately the patients and their families themselves.
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Affiliation(s)
- Maria Teresa B Abola
- Department of Clinical Research, Philippine Heart Center and University of the Philippines College of Medicine, Metro Manila, Philippines
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, and Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia
| | - Tetsuro Miyata
- Vascular Center, Sanno Hospital and Sanno Medical Center, Tokyo, Japan
| | - Seung-Woon Rha
- Dept of Cardiology, Internal Medicine, College of Medicine, Korea University; Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea
| | - Bryan P Yan
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Timothy C Dy
- The Heart Institute, Chinese General Hospital and Medical Center, Manila, Philippines
| | | | | | - Salim Harris
- Neurovascular and Neurosonology Division, Neurology Department, Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | | | | | | | - Hiroyoshi Yokoi
- Cardiovascular Center, Fukuoka Sanno Hospital; International University of Health and Welfare, Fukuoka, Japan
| | - Elaine B Alajar
- Section of Cardiology, Department of Internal Medicine, Manila Doctors Hospital; University of the Philippines College of Medicine, Manila, Philippines
| | | | - Elmer Jasper B Llanes
- Division of Cardiology, Department of Medicine, College of Medicine, University of the Philippines Philippine General Hospital, Manila, Philippines
| | | | - Noemi S Pestaño
- Section of Cardiology, Department of Internal Medicine, Manila Doctors Hospital, Manila, Philippines
| | - Felix Eduardo Punzalan
- Division of Cardiology, Department of Medicine, College of Medicine, University of the Philippines; Philippine General Hospital, Manila, Philippines
| | - Bernadette Tumanan-Mendoza
- Department of Clinical Epidemiology, University of the Philippines College of Medicine, Manila, Philippines
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Huang J, Tang J, Zhang Y, Zhang J, Tan Z, Shi S. Association between Ankle Brachial Index, Brachial-Ankle Pulse Wave Velocity, and Mild Cognitive Impairment in Patients with Acute Lacunar Infarction. Eur Neurol 2020; 83:147-153. [PMID: 32570253 DOI: 10.1159/000504844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/15/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The link between arterial stiffness and mild cognitive impairment (MCI) is receiving increasing attention, and the goal of this study was to explore the relationship among the ankle brachial index (ABI), brachial-ankle pulse wave velocity (Ba-PWV), and MCI in patients with acute lacunar infarction (ALI). METHODS A total of 103 hospitalized patients with ALI were divided into a non-MCI group (n = 41) and an MCI group (n = 62) according to their Montreal Cognitive Assessment (MoCA) scores. A binary logistic regression model was used to assess the association among ABI, Ba-PWV, and MCI after adjusting for confounding factors. Spearman correlation was utilized to analyse the correlations between ABI, Ba-PWV, and MoCA total scores and sub-scores in ALI patients. RESULTS Participants with cognitive impairment had significantly higher Ba-PWV and lower ABI than those with normal cognition. Correlation analysis suggested that Ba-PWV (r = -0.854, p < 0.05) and ABI (r = 0.734, p < 0.05) were correlated with MoCA total scores; of all MoCA sub-scores, visuospatial/executive function was the most strongly correlated with the vascular variables. In the binary logistic regression analysis, Ba-PWV (odds ratio [OR] = 4.507, 95% confidence interval [CI] = 2.152-9.441) and ABI (OR = 1.124, 95% CI = 1.015-1.254) were significantly associated with MCI, even after adjusting for lipoprotein (a) and systolic and diastolic blood pressure. CONCLUSION The present study suggested that a higher Ba-PWV and a lower ABI were independent risk factors for MCI in patients with ALI.
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Affiliation(s)
- Junling Huang
- Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jian Tang
- Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yueling Zhang
- Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jian Zhang
- Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhong Tan
- Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shengliang Shi
- Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China,
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17
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Félix-Redondo FJ, Subirana I, Baena-Diez JM, Ramos R, Cancho B, Fernández-Bergés D, Robles NR. [Prognostic importance of diagnosticated peripheral arterial disease through the ankle brachial index in spanish general population]. Aten Primaria 2020; 52:627-636. [PMID: 32505482 PMCID: PMC7713094 DOI: 10.1016/j.aprim.2020.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/14/2020] [Accepted: 03/02/2020] [Indexed: 10/29/2022] Open
Abstract
OBJECTIVE The objectives have been to determine the prognostic value of having a low ankle-brachial index (ABI) for different cardiovascular diseases and whether it improves the predictive capacity of the main cardiovascular risk scores proposed for Spain. DESIGN Population-based cohort study LOCATION: A health area of the province of Badajoz (Spain) PARTICIPANTS: 2,833 subjects, representative of residents, between 25 and 79 years old, MEASUREMENTS: The ABI was measured at baseline and the first episode of ischemic heart disease or stroke, cardiovascular and total mortality, was recorded during 7 years of follow-up. The hazard ratio (HR) adjusted for cardiovascular risk factors and net reclassification index (NRI) by category, clinical and continuous for the risk functions REGICOR, FRESCO coronary heart disease, FRESCO cardiovascular disease and SCORE, were calculated. RESULTS 2,665 subjects were analysed after excluding people with cardiovascular history and loss of follow-up. Low ABI was associated with adjusted HR (95% CI): 6.45 (3.00 - 13.86), 2.60 (1.15 - 5.91), 3.43 (1.39 - 8.44), 2.21 (1.27 - 3.86) for stroke, ischemic heart disease, cardiovascular mortality and total mortality respectively. The ABI improved the NRI (95% CI) in the intermediate risk category according to FRESCO cardiovascular equation by 24.1% (10.1 - 38.2). CONCLUSIONS Low ABI is associated with a significant increase in the risk of stroke, ischemic heart disease, cardiovascular mortality and total mortality in our population. The inclusion of ABI improved the reclassification of people at intermediate risk, according to FRESCO cardiovascular, so its use in that risk category would be justified.
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Affiliation(s)
- Francisco J Félix-Redondo
- C.S. Villanueva Norte, Servicio Extremeño de Salud. Villanueva de la Serena, Badajoz, España; Unidad de Investigación, Área de Salud Don Benito - Villanueva de la Serena, Servicio Extremeño de Salud, Fundesalud, Villanueva de la Serena, Badajoz, España.
| | - Isaac Subirana
- Grupo de Investigación de Epidemiologia Cardiovascular y Genética, IMIM, Barcelona, España
| | - José Miguel Baena-Diez
- Grupo de Investigación de Epidemiologia Cardiovascular y Genética, IMIM, Barcelona, España; C.S. La Marina, Instituto Catalán de la Salud, Barcelona, España
| | - Rafel Ramos
- Grupo de Investigación en Salud Vascular (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España
| | - Bárbara Cancho
- Servicio de Nefrología, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - Daniel Fernández-Bergés
- Unidad de Investigación, Área de Salud Don Benito - Villanueva de la Serena, Servicio Extremeño de Salud, Fundesalud, Villanueva de la Serena, Badajoz, España
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18
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Firth C, Tseng AS, Abdelmalek M, Girardo M, Atwal D, Cooper L, McBane R, Pollak A, Liedl D, Wennberg P, Shamoun FE. Discordant Values in Lower Extremity Physiologic Studies Predict Increased Cardiovascular Risk. J Am Heart Assoc 2020; 9:e015398. [PMID: 32419570 PMCID: PMC7428982 DOI: 10.1161/jaha.119.015398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Ankle‐brachial indexes (ABI) are a noninvasive diagnostic tool for peripheral arterial disease and a marker of increased cardiovascular risk. ABI is calculated using the highest systolic blood pressure of the 4 ankle arteries (bilateral dorsalis pedis and posterior tibial). Accordingly, patients may be assigned a normal ABI when the result would be abnormal if calculated using one of the other blood pressure readings. Cardiovascular outcomes for patients with discordant ABIs are undescribed. Methods and Results We performed a retrospective study of patients who underwent ABI measurement for any indication between January 1996 and June 2018. Those with normal ABIs (1.00–1.39) were included. We compared patients with all 4 normal ABIs (calculated using all 4 ankle arteries; n=15 577, median age 64.0 years, 54.4% men) to those with discordant ABIs (at least 1 abnormal ABI ≤0.99; n=2095, median age 66.0 years, 47.8% men). The outcomes assessed were ischemic stroke, myocardial infarction, and all‐cause mortality. Compared with patients with concordant normal ABIs, patients with discordant ABIs were older; women; smoked; and had chronic kidney disease, coronary artery disease, diabetes mellitus, chronic obstructive pulmonary disease, hypertension, or prior stroke. Patients with discordant ABIs had a greater risk of myocardial infarction (hazard ratio [HR], 1.31; 95% CI, 1.10–1.56), ischemic stroke (HR, 1.53; 95% CI, 1.37–1.72), and all‐cause mortality (HR, 1.27; 95% CI, 1.16–1.39), including after adjustment for baseline comorbidities. Conclusions Discordant ABI results were associated with an increased risk of myocardial infarction, stroke, and all‐cause mortality in the studied population. Clinicians should examine ABI calculations using all 4 ankle arteries to better characterize a patient's cardiovascular risk.
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Affiliation(s)
- Christine Firth
- Department of Cardiovascular Medicine Mayo Clinic Scottsdale AZ
| | - Andrew S Tseng
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Mina Abdelmalek
- Department of Cardiovascular Medicine Mayo Clinic Scottsdale AZ
| | - Marlene Girardo
- Department of Health Science Research Mayo Clinic Scottsdale AZ
| | - Danish Atwal
- Department of Cardiovascular Medicine Mayo Clinic Scottsdale AZ
| | - Leslie Cooper
- Department of Cardiovascular Medicine Mayo Clinic Jacksonville FL
| | - Robert McBane
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Amy Pollak
- Department of Cardiovascular Medicine Mayo Clinic Jacksonville FL
| | - David Liedl
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Paul Wennberg
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
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19
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Babaei MR, Malek M, Rostami FT, Emami Z, Madani NH, Khamseh ME. Non-invasive vascular assessment in people with type 2 diabetes: Diagnostic performance of Plethysmographic-and-Doppler derived ankle brachial index, toe brachial index, and pulse volume wave analysis for detection of peripheral arterial disease. Prim Care Diabetes 2020; 14:282-289. [PMID: 31624003 DOI: 10.1016/j.pcd.2019.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 09/07/2019] [Accepted: 09/09/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE There is evidence that standard assessment techniques for detecting PAD might be of less diagnostic accuracy in people with type 2 diabetes. The aim of this study was to examine diagnostic performance of Plethysmographic-and-Doppler derived ankle brachial index, toe brachial index, and Pulse volume waveform analysis for detecting PAD in people with T2DM. METHODS In this cross-sectional study 303 patients with T2DM were included in the study. The participants underwent ABI measurement, applying both Plethysmographic and Doppler derived devices, as well as TBI, PVW was also recorded for each patient. Diagnostic performance of each test for detecting PAD, applying ultrasound Doppler scan as the reference standard, was measured. Moreover, the best cut-off point for each method to detect PAD was determined. RESULTS PVW showed the highest sensitivity (81.8%) for detecting PAD, followed by ABIDOP (72.7%), and ABIPLE (20%). However, all devices showed an excellent specificity for detecting PAD. The optimal cut-off point for diagnosis of PAD was 0.9 for ABIDOP, 1.2 for ABIPLE, and 0.38 for TBI. CONCLUSION Within this population of patients with T2DM, TBI less than 0.38 provided the best sensitivity for detection of PAD followed by PVW, ABIDOP≤0.9, and ABIPLE<1.2.
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Affiliation(s)
- Mohammad Reza Babaei
- Department of Interventional Radiology, Firouzgar Hospital, Iran University of Medical Science (IUMS), Tehran, Iran.
| | - Mojtaba Malek
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran.
| | - Fatemeh Tajik Rostami
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran.
| | - Zahra Emami
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran.
| | - Nahid Hashemi Madani
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran.
| | - Mohammad Ebrahim Khamseh
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran.
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Tehan PE, Barwick AL, Casey SL, Lanting SM, Chuter VH. Accurate Noninvasive Arterial Assessment of the Wounded Lower Limb: A Clinical Challenge for Wound Practitioners. INT J LOW EXTR WOUND 2020; 19:215-226. [DOI: 10.1177/1534734620913705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Arterial investigations are an essential part of lower extremity wound assessment. The results of these investigations assist the wound clinician to determine the etiology of the wound, predict healing capacity, and inform further management. There are a number of noninvasive testing methods available to practitioners, all with varying levels of reliability and accuracy. Clinical wound assessment guidelines give varied recommendations when it comes to lower limb vascular assessment in the presence of a wound. This leaves clinicians with little guidance on how to choose the most appropriate test, and uncertainty remains about which tests provide the most accurate information in different patient-specific contexts. Conditions such as advanced age, diabetes, and renal disease are known to affect the accuracy of some commonly used lower limb arterial assessment methods, and alternate testing methods should be considered in these cases. This seminal review discusses the reliability and accuracy of lower limb vascular assessment methods used to guide lower limb arterial assessment in the presence of wounds.
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Affiliation(s)
- Peta Ellen Tehan
- University of Newcastle, Ourimbah, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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21
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Lan Y, Liu H, Liu J, Zhao H, Wang H. The Relationship Between Serum Bilirubin Levels and Peripheral Arterial Disease and Gender Difference in Patients With Hypertension: BEST Study. Angiology 2020; 71:340-348. [PMID: 32013527 DOI: 10.1177/0003319719900734] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We evaluated the relationship between serum bilirubin levels and ankle-brachial index (ABI) to determine whether gender affected the relationship between bilirubin levels and peripheral arterial disease (PAD) in patients with hypertension. A total of 543 patients were included in our studies (78 patients with PAD and 465 without PAD). Peripheral arterial disease was defined as ABI <0.90 for either and/or both sides. Serum bilirubin levels were measured with a vanadate oxidation method by using fasting venous blood samples. Serum total bilirubin (TBiL) and direct bilirubin (DBiL) levels were higher in males compared with females (both P < .05). Total bilirubin and DBiL were significantly lower in the PAD group. After adjustment for cardiovascular risk factors, PAD was independently negatively related to TBiL and DBiL, with odds ratios (OR) 0.914 (95% confidence interval [CI]: 0.845-0.990) and 0.748 (95% CI: 0.572-0.977). In addition, there was a relationship between PAD and bilirubin levels (TBiL-OR = 0.884, 95% CI: 0.792-0.985; DBiL-OR = 0.621; 95% CI: 0.424-0.909) only in males but not in females. Future studies should further evaluate whether interventions that increase serum bilirubin levels will have a particular role in PAD prevention in males.
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Affiliation(s)
- Yang Lan
- Vascular Medicine Center, Peking University Shougang Hospital, Beijing, China
| | - Huan Liu
- Vascular Medicine Center, Peking University Shougang Hospital, Beijing, China
| | - Jinbo Liu
- Vascular Medicine Center, Peking University Shougang Hospital, Beijing, China
| | - Hongwei Zhao
- Vascular Medicine Center, Peking University Shougang Hospital, Beijing, China
| | - Hongyu Wang
- Vascular Medicine Center, Peking University Shougang Hospital, Beijing, China
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22
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Brindisino F, Pennella D, Giovannico G, Rossettini G, Heick JD, Maselli F. Low back pain and calf pain in a recreational runner masking peripheral artery disease: A case report. Physiother Theory Pract 2019; 37:1146-1157. [PMID: 31661344 DOI: 10.1080/09593985.2019.1683922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Running is one of the most popular sports worldwide due to its low costs and its beneficial impact on health. Recent evidence suggests 11% to 85% of recreational runners experience at least one running-related injury each year and most of these are related to musculoskeletal conditions. The aim of this case report is to describe the clinical decision-making process that guided a physiotherapist to suspect a non-musculoskeletal cause in a recreational runner presenting with low back pain and calf pain secondary to Peripheral Artery Disease.Case Presentation: This case report describes the clinical history, clinical exam, laboratory and imaging tests, and surgical procedure of a 65 y.o. amateur runner suffering low back pain and left calf pain for 3 months. The patient's clinical findings suggested that referral to another health-care provider was required to explore potential non-musculoskeletal sources of pain. An angioplasty was necessary to solve the patient's clinical situation.Discussion and Conclusion: In this patient case, clinical findings along with a comprehensive family and personal history, ruled out a musculoskeletal condition and implicated a vascular condition.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise C/da Tappino c/o Cardarelli Hospital, Campobasso, Italy.,FTM, Physiotherapy and Manual Therapy, Physiotherapy Department, Lizzanello, Italy
| | - Denis Pennella
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise C/da Tappino c/o Cardarelli Hospital, Campobasso, Italy
| | - Giuseppe Giovannico
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise C/da Tappino c/o Cardarelli Hospital, Campobasso, Italy.,FTM, Physiotherapy and Manual Therapy, Physiotherapy Department, Lizzanello, Italy
| | - Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - John D Heick
- Northern Arizona University Flagstaff, Flagstaff, AZ, USA.,Department of Physical Therapy and Athletic Training, Flagstaff, AZ, USA
| | - Filippo Maselli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
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Ratio of Early Mitral Inflow Velocity to the Global Diastolic Strain Rate and Global Left Ventricular Longitudinal Systolic Strain Predict Overall Mortality and Major Adverse Cardiovascular Events in Hemodialysis Patients. DISEASE MARKERS 2019; 2019:7512805. [PMID: 31583030 PMCID: PMC6748193 DOI: 10.1155/2019/7512805] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/18/2019] [Accepted: 07/30/2019] [Indexed: 01/15/2023]
Abstract
Background The ratio of early mitral inflow velocity to the global diastolic strain rate (E/E'sr) and global longitudinal systolic strain (GLS) of the left ventricle (LV) are emerging indices of diastolic and systolic functions, respectively, for the LV. Their prognostic significance in the prediction of mortality and cardiovascular (CV) outcomes remains underexplored in hemodialysis (HD) patients. Methods This prospective study included 190 maintenance HD patients. The E/E'sr ratio and GLS were assessed using two-dimensional speckle tracking echocardiography. The clinical outcomes included overall mortality, CV mortality, and major adverse cardiovascular events (MACE). The associations between the E/E'sr ratio, GLS, and clinical outcomes were evaluated using multivariate Cox regression analysis. The incremental values of the E/E'sr ratio and GLS in outcome prediction were assessed by χ 2 changes in Cox models. Results Over a median follow-up period of 3.7 years, there were 35 overall deaths, 16 CV deaths, and 45 MACE. Impaired diastolic function with a higher E/E'sr ratio was associated with overall mortality (HR, 1.484; 95% CI, 1.201-1.834; p < 0.001), CV mortality (HR, 1.584; 95% CI, 1.058-2.371; p = 0.025), and MACE (HR, 1.205; 95% CI, 1.040-1.397; p = 0.013) in multivariate adjusted Cox analysis. Worsening GLS was associated with overall mortality (HR, 1.276; 95% CI, 1.101-1.480; p = 0.001), CV mortality (HR, 1.513; 95% CI, 1.088-2.104; p = 0.014), and MACE (HR, 1.214; 95% CI, 1.103-1.337; p < 0.001). The E/E'sr ratio and GLS had better outcome prediction than the E to early diastolic mitral annular velocity (E/E') ratio and left ventricular ejection fraction (LVEF). Moreover, adding the E/E'sr ratio and GLS to Cox models containing relevant clinical and conventional echocardiographic parameters improved the prediction of overall mortality (p < 0.001), CV mortality (p < 0.001), and MACE (p < 0.001). Conclusion The E/E'sr ratio and GLS, as emerging indices of LV diastolic and systolic functions, significantly predict mortality and CV outcomes and outperform conventional echocardiographic parameters in outcome prediction in HD patients.
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Kwan TW, Parikh S, Patel A, Htun WW, Shah S, Huang Y, Liou M, Ruzsa Z. Functional hemodynamics assessment during endovascular Tibio-pedal retrograde intervention of peripheral arterial disease. Catheter Cardiovasc Interv 2019; 94:256-263. [PMID: 31094088 DOI: 10.1002/ccd.28337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 04/04/2019] [Accepted: 04/30/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We sought to use a novel technique to measure the functional hemodynamics of peripheral arterial lesions during endovascular interventions. BACKGROUND Functional hemodynamics has not been thoroughly evaluated during endovascular interventions. The aim of our study is to evaluate the feasibility and the potential benefits of pedal pressures measurements from tibio-pedal access. METHODS We retrospectively reviewed 100 consecutive patients who underwent endovascular interventions via tibio-pedal artery access between October 3, 2018 and December 15, 2018. Baseline and postintervention pedal pressures from the pedal sheaths were measured. We also evaluated the pedal-brachial index (PBI) which is defined as the pedal sheath pressure divided by the simultaneously brachial cuff pressure. We compared baseline pedal pressures, postintervention pedal pressures, baseline PBI, postintervention PBI, % change of PBI ([postintervention PBI minus baseline PBI]/baseline PBI), and resting ankle-brachial index (ABI) versus baseline PBI in this cohort of patients. RESULTS All 100 patients had successful tibio-pedal artery access. Baseline pedal pressure was 70 + 30 mmHg with post intervention pedal pressure of 133 + 27 mmHg (p < .001). Baseline PBI was 0.75 + 0.24 with post intervention PBI of 1.09 + 0.19 (p < .001). The correlation coefficient of resting ABI vs. baseline PBI was 0.55. The % change of PBI was 63.2 + 52.4%. There was significant improvement of postintervention PBI when compared to baseline PBI in the majority of patients. CONCLUSIONS Obtaining pedal pressures and PBI from tibio-pedal access can be a feasible tool for endovascular interventions. This simple technique can provide us important functional hemodynamics information before and after peripheral revascularization.
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Affiliation(s)
- Tak W Kwan
- Department of Cardiology, Mount Sinai Beth Israel, New York, New York.,Department of Cardiology, Mount Sinai West, New York, New York.,Department of Cardiology, Chinatown Cardiology, PC, New York, New York
| | - Sahil Parikh
- Department of Cardiology, Columbia University Medical Center, New York, New York
| | - Apurva Patel
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Wah Wah Htun
- Department of Cardiology, Mount Sinai Beth Israel, New York, New York.,Department of Cardiology, Chinatown Cardiology, PC, New York, New York
| | - Sooraj Shah
- Department of Cardiology, Mount Sinai Beth Israel, New York, New York.,Department of Cardiology, Mount Sinai West, New York, New York.,Department of Cardiology, Chinatown Cardiology, PC, New York, New York
| | - Yili Huang
- Department of Cardiology, Mount Sinai Beth Israel, New York, New York.,Department of Cardiology, Chinatown Cardiology, PC, New York, New York
| | - Michael Liou
- Department of Cardiology, Mount Sinai Beth Israel, New York, New York.,Department of Cardiology, Chinatown Cardiology, PC, New York, New York
| | - Zoltan Ruzsa
- Department of Cardiology, Semmelweis University, Budapest, Hungary
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25
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Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, Fleisher LA, Fowkes FGR, Hamburg NM, Kinlay S, Lookstein R, Misra S, Mureebe L, Olin JW, Patel RAG, Regensteiner JG, Schanzer A, Shishehbor MH, Stewart KJ, Treat-Jacobson D, Walsh ME. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019; 69:e71-e126. [PMID: 27851992 DOI: 10.1016/j.jacc.2016.11.007] [Citation(s) in RCA: 438] [Impact Index Per Article: 87.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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26
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Thurston B, Dawson J. Ankle Brachial Pressure Index: An update for the vascular specialist and general practitioner. Vascular 2019; 27:560-570. [PMID: 30952202 DOI: 10.1177/1708538119842395] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objectives Ankle brachial pressure index (ABPI) is an invaluable tool for assessing the severity of peripheral arterial disease. In addition, it can be used as an independent marker of cardiovascular risk, with a predictive ability similar to the Framingham criteria. Identification of an abnormal ABPI should therefore trigger aggressive cardiac risk factor modulation for a patient. Unfortunately, the significance of abnormal ABPIs is poorly understood within the general medical community. This is compounded by the influence of various comorbidities on accurate measurement of ABPI, potentially leading to a wide variability in readings that need to be considered before interpretation in these patient populations. We aim to address these issues by revealing several common misunderstandings and pitfalls in ABPI measurement, describing accurate methodology, and highlighting patient cohorts in whom additional or alternative approaches may be required. Methods We present a narrative review of the role of ABPI in both the community and hospital setting. We have performed a literature review, exploring the validity and reproducibility of methodology for obtaining ABPI, alongside the utility of ABPI in different clinical scenarios. Results The measurement of ABPI is often performed incorrectly. Common pitfalls include inadequate patient preparation, failure to obtain the blood pressure from the correct lower limb artery in patients with tibial disease, failure to account for differences in brachial blood pressure between the arms, inappropriately chosen equipment and patient factors such as highly calcified arteries. Standardisation of methodology greatly improves reliability of the test. Exercise ABPI can identify significant peripheral arterial disease in patients with normal resting ABPI. In addition to its role in peripheral arterial disease, ABPI measurement has a role in assessing venous ulcers, entrapment syndromes and injured extremities; conversely, it has a more limited utility in the diabetic population. Conclusions A thorough understanding of the correct technique and associated limitations of ABPI measurement is essential in accurately generating and interpreting the data it provides. With this knowledge, the ABPI is an invaluable tool to help manage patients with peripheral arterial disease. Perhaps more importantly, ABPI can be used to identify and risk stratify patients with asymptomatic peripheral arterial disease, itself a major indicator of significant underlying cardiovascular disease. With the emergence of best medical therapy, targeted pharmacotherapy and lifestyle changes can reduce the risk of major cardiovascular events in high-risk patients by approximately 30%, particularly in diabetic patients. Therefore, the utility of ABPI transgresses vascular surgery, with an essential role in general practice and public health.
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Affiliation(s)
- Benjamin Thurston
- Department of Vascular & Endovascular Surgery, Royal Adelaide Hospital, Adelaide, Australia
| | - Joseph Dawson
- Department of Vascular & Endovascular Surgery, Royal Adelaide Hospital, Adelaide, Australia.,Discipline of Surgery, University of Adelaide, Adelaide, Australia
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27
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Liu S, Li P, Su H. Four-Limb Blood Pressure Measurement with an Oscillometric Device: a Tool for Diagnosing Peripheral Vascular Disease. Curr Hypertens Rep 2019; 21:15. [PMID: 30747289 DOI: 10.1007/s11906-019-0917-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Traditionally, the term peripheral vascular disease (PAD) is restricted to the occlusive arterial disease in the leg, but now, the connotation of PAD is more widespread as it encompasses all extracoronary and extracerebral vascular disease. The incidence of PAD is increasing worldwide; therefore, it is necessary to diagnose PAD at an early stage. RECENT FINDINGS Oscillometric BP device is widely used for four-limb measurement in clinical practice and provides several parameters for evaluating inter-limb BP difference, such as ankle-brachial index (OS-ABI), inter-arm BP differences (IAD), and inter-ankle BP difference (IAND). Using angiographic results as reference, the ABI, IAD, and IAND from an oscillometric BP device have been demonstrated having high accuracy for diagnosis of PAD. Meanwhile, combination of these parameters could further improve the accuracy of PAD, including the occlusive artery disease in the arm, leg, and aorta. For example, some patients with severe PAD in the leg have normal ABI; in this situation, an increased sIAND could confirm the diagnosis of PAD in the leg. Because ABI, IAD, and IAND from inter-limb oscillometric BP measurement can also predict adverse prognosis, we encourage the use of an oscillometric device to measure four-limb BP and to evaluate the inter-limb BP difference.
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Affiliation(s)
- Songtao Liu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, 330006, NO 1 Mingde Road, Nanchang, Jiangxi, China
| | - Ping Li
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, 330006, NO 1 Mingde Road, Nanchang, Jiangxi, China
| | - Hai Su
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, 330006, NO 1 Mingde Road, Nanchang, Jiangxi, China.
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28
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Saini A, Wallace A, Albadawi H, Naidu S, Alzubaidi S, Knuttinen MG, Panda A, Oklu R. Quiescent-Interval Single-Shot Magnetic Resonance Angiography. Diagnostics (Basel) 2018; 8:diagnostics8040084. [PMID: 30567304 PMCID: PMC6315503 DOI: 10.3390/diagnostics8040084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/15/2018] [Accepted: 12/15/2018] [Indexed: 01/22/2023] Open
Abstract
Lower extremity peripheral arterial disease (PAD) is a chronic, debilitating disease with a significant global burden. A number of diagnostic imaging techniques exist, including computed tomography angiography (CTA) and contrast-enhanced magnetic resonance angiography (CEMRA), to aid in PAD diagnosis and subsequent treatment planning. Due to concerns of renal toxicity or nephrogenic systemic fibrosis (NSF) for iodinated and gadolinium-based contrasts, respectively, a number of non-enhanced MRA (NEMRA) protocols are being increasingly used in PAD diagnosis. These techniques, including time of flight and phase contrast MRA, have previously demonstrated poor image quality, long acquisition times, and/or susceptibility to artifacts when compared to existing contrast-enhanced techniques. In recent years, Quiescent-Interval Single-Shot (QISS) MRA has been developed to overcome these limitations in NEMRA methods, with promising results. Here, we review the various screening and diagnostic tests currently used for PAD. The various NEMRA protocols are discussed, followed by a comprehensive review of the literature on QISS MRA to date. A particular emphasis is placed on QISS MRA feasibility studies and studies comparing the diagnostic accuracy and image quality of QISS MRA versus other diagnostic imaging techniques in PAD.
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Affiliation(s)
- Aman Saini
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, Arizona 85054, USA.
| | - Alex Wallace
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, Arizona 85054, USA.
| | - Hassan Albadawi
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, Arizona 85054, USA.
| | - Sailendra Naidu
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, Arizona 85054, USA.
| | - Sadeer Alzubaidi
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, Arizona 85054, USA.
| | - M Grace Knuttinen
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, Arizona 85054, USA.
| | - Anshuman Panda
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, Arizona 85054, USA.
| | - Rahmi Oklu
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, Arizona 85054, USA.
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29
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Takahashi I, Cologne J, Haruta D, Yamada M, Takahashi T, Misumi M, Fujiwara S, Matsumoto M, Kihara Y, Hida A, Ohishi W. Association Between Prevalence of Peripheral Artery Disease and Radiation Exposure in the Atomic Bomb Survivors. J Am Heart Assoc 2018; 7:e008921. [PMID: 30486720 PMCID: PMC6405541 DOI: 10.1161/jaha.118.008921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 09/25/2018] [Indexed: 12/27/2022]
Abstract
Background Past reports suggested that total-body irradiation at 0.5 to 1.0 Gy could be responsible for atherosclerosis. Peripheral artery disease ( PAD ) is a manifestation of systematic atherosclerosis. Whether the consequences of a low-to-moderate dose of radiation include increased risk of PAD remains to be determined. The purpose of this study was to examine the association between radiation exposure and prevalence of PAD among Japanese atomic bomb survivors. Methods and Results Radiation exposure from the atomic bombing was assessed in 3476 participants (41.1% men, mean age 74.8 years with SD 6.4 years) with a cross-sectional survey in 2010 to 2014. Left- and right-side ankle-brachial indexes and upstroke time ( UT ) were obtained using oscillometric VP -2000. PAD was defined as an ankle-brachial index of 1.0 or less or a prior history related to revascularization. UT was considered a sensitive marker of early-stage PAD . Association between radiation exposure and PAD or UT was assessed using multivariable regression analyses with adjustment for potential confounding factors. Of 3476 participants, 79 (2.3%) were identified as having prevalent PAD . Multivariate logistic regression analysis indicated that radiation dose was unrelated to PAD prevalence (odds ratio, 0.83; 95% confidence interval [0.57-1.21]). UT appeared to increase with radiation dose, but the increase was not statistically significant (1.09 ms/Gy; 95% confidence interval [-0.17 to 2.36]). Conclusions We found no clear association of radiation dose with PAD , but it remains to be determined whether UT is associated with radiation dose.
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Affiliation(s)
- Ikuno Takahashi
- Department of Clinical StudiesRadiation Effects Research Foundation (RERF)HiroshimaJapan
| | - John Cologne
- Department of StatisticsRadiation Effects Research Foundation (RERF)HiroshimaJapan
| | - Daisuke Haruta
- Department of Clinical StudiesRadiation Effects Research Foundation (RERF)NagasakiJapan
| | - Michiko Yamada
- Department of Clinical StudiesRadiation Effects Research Foundation (RERF)HiroshimaJapan
| | - Tetsuya Takahashi
- Department of Clinical Neuroscience and TherapeuticsHiroshima UniversityHiroshimaJapan
| | - Munechika Misumi
- Department of StatisticsRadiation Effects Research Foundation (RERF)HiroshimaJapan
| | - Saeko Fujiwara
- Department of Clinical StudiesRadiation Effects Research Foundation (RERF)HiroshimaJapan
- Hiroshima Atomic‐bomb Casualty CouncilHiroshimaJapan
| | - Masayasu Matsumoto
- Department of Clinical Neuroscience and TherapeuticsHiroshima UniversityHiroshimaJapan
- Japan Community Health care OrganizationHoshigaoka Medical CenterOsakaJapan
| | - Yasuki Kihara
- Department of Cardiovascular MedicineHiroshima UniversityHiroshimaJapan
| | - Ayumi Hida
- Department of Clinical StudiesRadiation Effects Research Foundation (RERF)NagasakiJapan
| | - Waka Ohishi
- Department of Clinical StudiesRadiation Effects Research Foundation (RERF)HiroshimaJapan
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30
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Weledji EP, Alemnju NT, Nouediou C. The use of ankle brachial pressure indices in a cohort of black African diabetic patients. Ann Med Surg (Lond) 2018; 35:20-24. [PMID: 30263113 PMCID: PMC6156742 DOI: 10.1016/j.amsu.2018.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 08/14/2018] [Accepted: 09/12/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Peripheral arterial disease is very common in patients with diabetes, but it remains grossly under-recognized in this type of patients. Ankle brachial index (ABI) is a simple, non-invasive and reproducible method for detection and improving risk stratification. However, the sensitivity appears to be lower in diabetic patients and, false 'high' readings occur because of the arterial calcification of the vessel media which render the vessels incompressible. MATERIALS AND METHODS The study evaluated the prevalence of a low ABI <0.9 in diabetic patients in a hospital-based cross sectional observational study. The study has been registered. RESULTS The prevalence of peripheral arterial disease in diabetics with ABI< 0.9 was 18%. The majority (77%) of responders were asymptomatic with mild PAD (ABI 0.7-0.9). Age >60 years, hypertension (systolic BP > 140 mmHg) and presence of foot ulcer were identified as independent risk factors. 22 participants (4.4%) of the 500 had ABI greater than 1.3 but were excluded in the analysis. CONCLUSION The prevalence of PAD in diabetics measured by the ABI index was low and the majority in our setting had mild PAD and were asymptomatic. ABI could be used in patients with diabetes, but values should be interpreted with precision, according to the clinical situation as higher values are common.
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31
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Pulse Oximetry as a Screening Test for Hemodynamically Significant Lower Extremity Peripheral Artery Disease in Adults with Type 2 Diabetes Mellitus. J ASEAN Fed Endocr Soc 2018; 33:130-136. [PMID: 33442118 PMCID: PMC7784151 DOI: 10.15605/jafes.033.02.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/26/2018] [Indexed: 01/05/2023] Open
Abstract
Objective The main objective is to determine if digital pulse oximetry is an acceptable screening tool to detect hemodynamically significant lower extremity peripheral artery disease (PAD) in patients 50 years old and above with type 2 diabetes mellitus (T2DM) seen at the University of Santo Tomas Hospital (USTH). Methodology A total of 78 subjects (155 limbs) were included. Using duplex ultrasonography as the reference standard for the presence of hemodynamically significant lower extremity PAD, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were obtained for abnormal percent oxygen saturation (SpO2) gradients and for ankle-brachial index (ABI). Results Of the 155 limbs, 38.7% had hemodynamically significant stenosis. Pulse oximetry had 76.7% sensitivity (95% CI, 65.2% to 88.1%), 85.3% specificity (95% CI, 78.0% to 92.6%), 76.7% PPV (95% CI, 66.5% to 84.4%) and 85.3% NPV (95% CI, 78.4% to 90.2%). ABI had 40.7% sensitivity (95% CI, 30.1% to 51.3%), 88.2% specificity (95% CI, 80.0% to 96.3%), 68.6% PPV (95% CI, 53.6% to 80.4%) and 70.1% NPV (95% CI, 65.1% to 74.5%). Combining both produces 88.1% sensitivity (95% CI, 78.5% to 97.8%), 74.2% specificity (95% CI, 65-83.4%), 68.4 PPV (95% CI, 60.3% to 75.6%) and 90.8% NPV (95% CI, 83.0% to 95.2%). Conclusion The results of this study suggest that pulse oximetry has a higher sensitivity than ABI as a screening tool for hemodynamically significant lower extremity PAD in T2DM patients 50 years old and above. Combining these two tests may be done to achieve a higher sensitivity.
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32
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Computing the ankle-brachial index with parallel computational fluid dynamics. J Biomech 2018; 82:28-37. [PMID: 30385003 DOI: 10.1016/j.jbiomech.2018.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 01/16/2023]
Abstract
The ankle-brachial index (ABI), a ratio of arterial blood pressure in the ankles and upper arms, is used to diagnose and monitor circulatory conditions such as coarctation of the aorta and peripheral artery disease. Computational simulations of the ABI can potentially determine the parameters that produce an ABI indicative of ischemia or other abnormalities in blood flow. However, 0- and 1-D computational methods are limited in describing a 3-D patient-derived geometry. Thus, we present a massively parallel framework for computational fluid dynamics (CFD) simulations in the full arterial system. Using the lattice Boltzmann method to solve the Navier-Stokes equations, we employ highly parallelized and scalable methods to generate the simulation domain and efficiently distribute the computational load among processors. For the first time, we compute an ABI with 3-D CFD. In this proof-of-concept study, we investigate the dependence of ABI on the presence of stenoses, or narrowed regions of the arteries, by directly modifying the arterial geometry. As a result, our framework enables the computation a hemodynamic factor characterizing flow at the scale of the full arterial system, in a manner that is extensible to patient-specific imaging data and holds potential for treatment planning.
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33
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Nirala N, Periyasamy R, Kumar A. Noninvasive Diagnostic Methods for Better Screening of Peripheral Arterial Disease. Ann Vasc Surg 2018; 52:263-272. [DOI: 10.1016/j.avsg.2018.03.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/10/2018] [Accepted: 03/10/2018] [Indexed: 10/16/2022]
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34
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Mathew RC, Kramer CM. Recent advances in magnetic resonance imaging for peripheral artery disease. Vasc Med 2018; 23:143-152. [PMID: 29633922 DOI: 10.1177/1358863x18754694] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The global burden of peripheral artery disease (PAD) is significant. This has led to numerous recent advances in magnetic resonance imaging (MRI) techniques in PAD. Older techniques such as time of flight MRI or phase contrast MRI are burdened by long acquisition times and significant issues with artifacts. In addition, the most used MRI modality, contrast-enhanced MR angiography (CE-MRA) is limited by the use of gadolinium contrast and its potential toxicity. Novel MRI techniques such as arterial spin labeling (ASL), blood-oxygen-level dependent imaging (BOLD), and first-pass perfusion gadolinium enhancement are advancing the field by providing skeletal muscle perfusion/oxygenation data while maintaining excellent spatial and temporal resolution. Perfusion data can be critical to providing objective clinical data of a visualized stenosis. In addition, there are a number of new MRI sequences assessing plaque composition and lesion severity in the absence of contrast. These approaches used in combination can provide useful clinical and prognostic data and provide critical endpoints in PAD research.
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Affiliation(s)
- Roshin C Mathew
- Departments of Medicine (Cardiology) and Radiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Christopher M Kramer
- Departments of Medicine (Cardiology) and Radiology, University of Virginia Health System, Charlottesville, VA, USA
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35
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Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, Fleisher LA, Fowkes FGR, Hamburg NM, Kinlay S, Lookstein R, Misra S, Mureebe L, Olin JW, Patel RAG, Regensteiner JG, Schanzer A, Shishehbor MH, Stewart KJ, Treat-Jacobson D, Walsh ME, Halperin JL, Levine GN, Al-Khatib SM, Birtcher KK, Bozkurt B, Brindis RG, Cigarroa JE, Curtis LH, Fleisher LA, Gentile F, Gidding S, Hlatky MA, Ikonomidis J, Joglar J, Pressler SJ, Wijeysundera DN. 2016 AHA/ACC Guideline on the Management of Patients with Lower Extremity Peripheral Artery Disease: Executive Summary. Vasc Med 2018; 22:NP1-NP43. [PMID: 28494710 DOI: 10.1177/1358863x17701592] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
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- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information
| | | | - Heather L Gornik
- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information
| | | | | | | | - Douglas E Drachman
- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.,5 Society for Cardiovascular Angiography and Interventions Representative
| | - Lee A Fleisher
- 6 ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Francis Gerry R Fowkes
- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.,7 Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative
| | | | - Scott Kinlay
- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.,8 Society for Vascular Medicine Representative
| | - Robert Lookstein
- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.,3 ACC/AHA Representative
| | - Sanjay Misra
- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.,9 Society of Interventional Radiology Representative
| | - Leila Mureebe
- 10 Society for Clinical Vascular Surgery Representative
| | - Jeffrey W Olin
- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.,3 ACC/AHA Representative
| | - Rajan A G Patel
- 7 Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative
| | | | - Andres Schanzer
- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.,11 Society for Vascular Surgery Representative
| | - Mehdi H Shishehbor
- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.,3 ACC/AHA Representative
| | - Kerry J Stewart
- 3 ACC/AHA Representative.,12 American Association of Cardiovascular and Pulmonary Rehabilitation Representative
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Lin HW, Lee IT. Combination of the ankle-brachial index and percentage of mean arterial pressure to improve diagnostic sensitivity for peripheral artery disease: An observational study. Medicine (Baltimore) 2018; 97:e12644. [PMID: 30278591 PMCID: PMC6181478 DOI: 10.1097/md.0000000000012644] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The ankle-brachial index (ABI) is a noninvasive method for screening for peripheral artery disease (PAD). However, false-negative findings of the ABI may limit its clinical use. The percentage of mean arterial pressure (%MAP) calculated from pulse volume recording has been reported to predict all-cause mortality. We hypothesized that the %MAP would be helpful to screen for PAD in subjects with a normal ABI. We examined whether using a combination of the ABI and %MAP would provide greater diagnostic sensitivity for PAD than using the ABI alone.In this cross-sectional study, we retrospectively reviewed the medical records of patients who had undergone multiple detector computed tomography (MDCT) angiography of the lower extremities following measurement of the ABI with pulse volume recording. PAD was diagnosed based on MDCT angiography.A total of 215 lower extremities of 114 patients were included in our analyses. An optimal cut-off %MAP value of 42.5% was used to diagnose PAD based on MDCT in patients with an ABI > 0.90. Using a combination of an ABI < 0.90 and a %MAP ≥ 42.5% as diagnostic criteria for PAD resulted in better sensitivity (76.9%) than using the ABI alone (56.5% for an ABI < 0.90 and 63.4% for an ABI < 1.00). Using logistic regression analysis, we found that patients having both an ABI < 0.90 and an ABI > 0.90 with a %MAP ≥ 42.5% had a significantly higher risk of PAD than those having an ABI > 0.90 with a %MAP < 42.5% (odds ratio = 7.165, P = .006; odds ratio = 12.544, P < .001; respectively).Both the sensitivity and specificity were better when using a combination of an ABI ≤ 0.90 and a %MAP ≥ 42.5% than when using a low or borderline ABI. The %MAP is helpful for PAD screening in subjects with an ABI > 0.90.
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Affiliation(s)
- Han-Wei Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City
| | - I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City
- School of Medicine, National Yang-Ming University, Taipei City
- School of Medicine, Chung Shan Medical University
- College of Science, Tunghai University, Taichung, Taiwan
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Roy M, Todorov A, Ruel M, Elkouri S, Hardy JF. Anticoagulation Obtained below the Arterial Clamp Using a Single Fixed Bolus of Heparin in Vascular Surgery: A Pilot Study. Ann Vasc Surg 2018; 50:242-248. [DOI: 10.1016/j.avsg.2017.11.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/17/2017] [Accepted: 11/12/2017] [Indexed: 11/30/2022]
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Yu S, Lu Y, Xiong J, Teliewubai J, Chi C, Ji H, Zhou Y, Fan X, Zhang J, Blacher J, Li J, Zhang Y, Xu Y. Comparison of ankle-brachial index and upstroke time in association with target organ damage: the Northern Shanghai Study. ACTA ACUST UNITED AC 2018; 12:703-713. [PMID: 30056134 DOI: 10.1016/j.jash.2018.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 06/15/2018] [Accepted: 06/24/2018] [Indexed: 01/22/2023]
Abstract
A recent study indicated that upstroke time per cardiac cycle (UTCC) in lower extremities is equivalent to ankle-brachial index (ABI) in diagnosing peripheral arterial disease and in predicting cardiovascular mortality. In this study, we aimed to compare ABI and UTCC in relation to target organ damage. A cohort of 1841 elderly participants from the Northern Shanghai Study was studied. ABI and UTCC were measured using VP-1000 device. Target organ damage including left ventricular hypertrophy and diastolic dysfunction, carotid intima-media thickness and plaque, carotid-femoral pulse wave velocity (CF-PWV), and renal damage, were evaluated by standardized methods. In correlation analysis, ABI and UTCC both significantly correlated with CF-PWV, carotid plaque, and estimated glomerular filtration rate, but not with cardiac damage. Compared with ABI, UTCC showed stronger correlation with CF-PWV. When ABI and UTCC separately put into fully adjusted multivariate logistic regression models, both ABI (OR: 2.27; 95% CI: 1.63-3.17) and UTCC (OR: 1.63; 95% CI: 1.18-2.24) significantly associated with carotid plaque, but only UTCC significantly associated with increased CF-PWV (OR: 1.66; 95% CI: 1.15-2.42) and renal damage (OR: 1.63; 95% CI: 1.07-2.47). When ABI and UTCC both put into multivariate stepwise logistic regression models together with covariates, consistent results were observed. In ROC curve analysis, after adjusted for cofounding factors, UTCC showed slightly greater area under curve than ABI in detecting increased CF-PWV (area under curve: 0.79 vs. 0.78; P = .008); however, no difference was observed between UTCC and ABI in discriminating renal damage and carotid plaque. In conclusion, compared with ABI, UTCC showed significantly stronger association with vascular and renal damage in this elderly Chinese cohort.
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Affiliation(s)
- Shikai Yu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuyan Lu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jing Xiong
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiadela Teliewubai
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chen Chi
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hongwei Ji
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yiwu Zhou
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ximin Fan
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jun Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jacques Blacher
- Paris Descartes University, AP-HP, Diagnosis and Therapeutic Center, Hôtel-Dieu, Paris, France
| | - Jue Li
- The Research Institute of Clinical Epidemiology, Tongji University School of Medicine, Shanghai, China
| | - Yi Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
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Shabani Varaki E, Gargiulo GD, Penkala S, Breen PP. Peripheral vascular disease assessment in the lower limb: a review of current and emerging non-invasive diagnostic methods. Biomed Eng Online 2018; 17:61. [PMID: 29751811 PMCID: PMC5948740 DOI: 10.1186/s12938-018-0494-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/02/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Worldwide, at least 200 million people are affected by peripheral vascular diseases (PVDs), including peripheral arterial disease (PAD), chronic venous insufficiency (CVI) and deep vein thrombosis (DVT). The high prevalence and serious consequences of PVDs have led to the development of several diagnostic tools and clinical guidelines to assist timely diagnosis and patient management. Given the increasing number of diagnostic methods available, a comprehensive review of available technologies is timely in order to understand their limitations and direct future development effort. MAIN BODY This paper reviews the available diagnostic methods for PAD, CVI, and DVT with a focus on non-invasive modalities. Each method is critically evaluated in terms of sensitivity, specificity, accuracy, ease of use, procedure time duration, and training requirements where applicable. CONCLUSION This review emphasizes the limitations of existing methods, highlighting a latent need for the development of new non-invasive, efficient diagnostic methods. Some newly emerging technologies are identified, in particular wearable sensors, which demonstrate considerable potential to address the need for simple, cost-effective, accurate and timely diagnosis of PVDs.
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Affiliation(s)
- Elham Shabani Varaki
- The MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Penrith, NSW, 2750, Australia.
| | - Gaetano D Gargiulo
- The MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Penrith, NSW, 2750, Australia
| | - Stefania Penkala
- School of Science and Health, Western Sydney University, Penrith, NSW, 2750, Australia
| | - Paul P Breen
- The MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Penrith, NSW, 2750, Australia.,Translational Health Research Institute, Western Sydney University, Penrith, NSW, 2750, Australia
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Kozarova M, Malachovska Z, Zidzik J, Javorsky M, Demkova K, Habalova V, Tkac I. Risk allele of gene variant rs6584389 is associated with increased intima-media thickness in patients with type 2 diabetes. VASA 2018; 47:279-284. [PMID: 29671694 DOI: 10.1024/0301-1526/a000705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Genome-wide association studies identified several gene variants associated with peripheral arterial disease (PAD). Among them, rs6584389 A>C was significantly associated with PAD defined by decreased ankle-brachial index (ABI). The aim of this study was to investigate whether the rs6584389 variant is also associated with the earlier stages of atherosclerosis assessed by intima-media thickness (IMT) or pulse-wave velocity (PWV) in clinically asymptomatic subjects with type 2 diabetes (T2DM), a group of patients with a high cardiovascular risk. PATIENTS AND METHODS In total, 111 patients with T2DM (56 females, 55 males) with a mean age 63.0 ± 9.1 years were consecutively included in the study. IMT was measured by ultrasound using 7 MHz linear transducer. PWV was measured using a piezoelectric method. Genotyping for rs6584389 was performed by PCR-HRMA method. RESULTS The carriers of the risk C-allele of rs6584389 variant had significantly higher mean left-side IMT (AA: 0.67 ± 0.12, AC 0.77 ± 0.21, CC 0.78 ± 0.22 mm; p = 0.04). In multiple linear regression analysis, rs6586389 genotype was significantly associated with all measured IMT parameters. The presence of each risk C-allele predicted an increase in left-side IMT by 0.056 mm (p = 0.017), right-side IMT by 0.053 mm (p = 0.039), average IMT by 0.054 mm (p = 0.023), and maximal IMT by 0.058 mm (p = 0.021). Age and HbA1c levels were also significantly associated with increased IMT in all multivariate models. CONCLUSIONS Gene variant rs6584389 A>C near to PAX2 gene was associated with increased carotid IMT in patients with type 2 diabetes independently of the other main risk factors for atherosclerosis.
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Affiliation(s)
- Miriam Kozarova
- 1 Safarik University in Kosice, Faculty of Medicine, Department of Internal Medicine 4, Košice, Slovakia.,a These authors contributed equally to this paper
| | - Zuzana Malachovska
- 1 Safarik University in Kosice, Faculty of Medicine, Department of Internal Medicine 4, Košice, Slovakia.,a These authors contributed equally to this paper
| | - Jozef Zidzik
- 2 Safarik University in Kosice, Faculty of Medicine, Department of Medical Biology, Košice, Slovakia
| | - Martin Javorsky
- 1 Safarik University in Kosice, Faculty of Medicine, Department of Internal Medicine 4, Košice, Slovakia
| | - Katarina Demkova
- 1 Safarik University in Kosice, Faculty of Medicine, Department of Internal Medicine 4, Košice, Slovakia
| | - Viera Habalova
- 2 Safarik University in Kosice, Faculty of Medicine, Department of Medical Biology, Košice, Slovakia
| | - Ivan Tkac
- 1 Safarik University in Kosice, Faculty of Medicine, Department of Internal Medicine 4, Košice, Slovakia
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Abstract
Background The ankle-brachial index (ABI) and pulse wave velocity (PWV) are indices of atherosclerosis and arterial stiffness. The Japan-made measuring devices of those indices have spread widely because of their convenience and the significance of the parameters. However, studies that comprehensively discuss the various pitfalls in using these indices are not available. Methods This study presents several representative pitfalls in using the ABI and brachial-ankle PWV (baPWV) by showing the result sheets of the device, “the Vascular Profiler”. Furthermore, some considerations when utilizing these indices in the future are also discussed. Results Several diseases such as arteriosclerosis obliterans (ASO), arterial calcification in the lower limb, arterial stenosis in the right upper-limb, aortic valve diseases, arterial stenosis in the upper-limb of the contralateral side of the hemodialysis access, are the representative pitfalls when evaluating ABI and baPWV. Moreover, a measurement error is found to actually exist. Furthermore, same phenomena are considered most likely to occur when using other similar indices and devices. Conclusion The ABI and baPWV are the useful and significant biomarkers. Nevertheless, caution is sometimes necessary when interpreting them. Moreover, rigorous patient exclusion criteria should be considered when using those indices in the severely conditioned patient population. And the results of this study can be applied to enhance the literacy using other indices, such as the cardio-ankle vascular index and other similar devices.
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Affiliation(s)
- Dai Ato
- Gakujutsu Shien Co., Ltd., Tokyo, Japan
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42
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Prevalence of peripheral arterial disease among diabetic patients in Santo Domingo, Dominican Republic and associated risk factors. ACTA ACUST UNITED AC 2018; 3:e35-e40. [PMID: 30775587 PMCID: PMC6374585 DOI: 10.5114/amsad.2018.73527] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 01/31/2018] [Indexed: 12/28/2022]
Abstract
Introduction Peripheral arterial disease (PAD) is a major risk factor of coronary artery disease and a major complication of atherosclerosis. Peripheral arterial disease can be diagnosed with simple and low cost techniques. There are major risk factors of PAD that have been studied for different countries. However, no such study has been done for the Dominican Republic. We conducted a cross-sectional study to determine the prevalence of PAD and the risk factors among patients with diabetes in Santo Domingo, Dominican Republic. Material and methods Six hundred randomly chosen patients with previously diagnosed diabetes were enrolled in our study. Their blood pressure and ankle brachial index were calculated and a questionnaire was provided to gather information regarding gender, age, weight, ethnicity, known duration of diabetes along with any history of smoking, hypertension and hyperlipidemia. A physical examination was also done to assess for any active diabetic ulcers, previous foot ulcers and non-traumatic amputation. A microfilament test was conducted to check for peripheral neuropathy. Results Eighty-four diabetic patients were diagnosed with PAD with a prevalence of 14% in Santo Domingo, Dominican Republic. Statistically significant associations (p < 0.05) was found for female gender, presence of active foot ulcers, history of past foot ulcer, non-traumatic amputation, hypertension, hyperlipidemia and peripheral neuropathy. Glycated hemoglobin (HbA1c), age and smoking were not statistically significant in our study. Conclusions Diabetic patients who are either female, have active foot ulcers, a history of past foot ulcer, non-traumatic amputation, hypertension, hyperlipidemia or peripheral neuropathy are more at risk of developing PAD.
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Morcos R, Louka B, Tseng A, Misra S, McBane R, Esser H, Shamoun F. The Evolving Treatment of Peripheral Arterial Disease through Guideline-Directed Recommendations. J Clin Med 2018; 7:jcm7010009. [PMID: 29315259 PMCID: PMC5791017 DOI: 10.3390/jcm7010009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/28/2017] [Accepted: 01/02/2018] [Indexed: 01/28/2023] Open
Abstract
Peripheral arterial disease (PAD) refers to partial or complete occlusion of one or more non-coronary arteries that leads to compromised blood flow and ischemia. Numerous processes are involved in arterial stenosis, however, atherosclerosis remains the most common etiology. PAD constitutes a major health economic problem, and it is estimated that over 200 million people around the world suffer from PAD, with at least 20% having some degree of claudication. The purpose of this review is to compare and contrast the guidelines on PAD published in 2005, 2011 and 2016 in terms of new recommendations and level of evidence for practicing clinicians.
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Affiliation(s)
- Ramez Morcos
- Department of Internal Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA;
| | - Boshra Louka
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, USA; (B.L.), (A.T.)
| | - Andrew Tseng
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, USA; (B.L.), (A.T.)
| | - Sanjay Misra
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA;
| | - Robert McBane
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA;
| | - Heidi Esser
- Arizona Center for Urology, Phoenix, AZ 85027, USA;
| | - Fadi Shamoun
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, USA; (B.L.), (A.T.)
- Correspondence: ; Tel.: +1-480-301-6201
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Dąbrowski M, Lewandowski J, Abramczyk P, Łoń I, Gaciong Z, Siński M. Atrial fibrillation does not affect ankle-brachial index measured using the Doppler method. Hypertens Res 2017; 41:60-65. [PMID: 29093567 DOI: 10.1038/hr.2017.89] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/03/2017] [Accepted: 05/05/2017] [Indexed: 11/09/2022]
Abstract
Atrial fibrillation may affect blood pressure measurements. The ankle-brachial index (ABI) is a ratio of systolic blood pressure measured on the lower and upper limbs that may also be affected by arrhythmia. The purpose of the study was to investigate whether atrial fibrillation influenced ABI results. Ninety-nine patients (age 66.6±11 years, 63 males and 36 females) who underwent electrical cardioversion of atrial fibrillation were investigated. ABI measurements using the Doppler method were performed on both lower extremities before and after electrical cardioversion. Measurements were repeated three times and then averaged. The ABI using both lower limbs was lower before electrical cardioversion than after restoration to sinus rhythm (right side: 1.132 (1.065-1.210) during atrial fibrillation vs. 1.179 (1.080-1.242) in sinus rhythm, P=0.019; left side: 1.142 (1.075-1.222) during atrial fibrillation vs. 1.170 (1.098-1.255) in sinus rhythm, P=0.011). However, the upper 95% confidence interval (CI) margins for the median differences in ABI were 0.045 and 0.040 for right and left, respectively, suggesting that the observed difference was clinically insignificant. There was a significant correlation between measurements obtained before and after electrical cardioversion on both lower limbs (r=0.61, P<0.001 and r=0.67, P<0.001). The Bland-Altman plot showed good agreement between measurements performed using the Doppler method during atrial fibrillation and sinus rhythm. Study results showed that atrial fibrillation did not have a clinically important effect on ABI measurements.
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Affiliation(s)
- Michał Dąbrowski
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Jacek Lewandowski
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Abramczyk
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Izabela Łoń
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Zbigniew Gaciong
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Siński
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
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Arao K, Yasu T, Endo Y, Funazaki T, Ota Y, Shimada K, Tokutake E, Naito N, Takase B, Wake M, Ikeda N, Horie Y, Sugimura H, Momomura SI, Kawakami M. Effects of pitavastatin on walking capacity and CD34 +/133 + cell number in patients with peripheral artery disease. Heart Vessels 2017; 32:1186-1194. [PMID: 28466409 PMCID: PMC5614906 DOI: 10.1007/s00380-017-0988-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 04/28/2017] [Indexed: 10/25/2022]
Abstract
This multi-center prospective non-randomized comparative study investigated the effects of pitavastatin in patients with peripheral artery disease (PAD) in terms of exercise tolerance capacities and peripheral CD34+/133+ cell numbers. At baseline, a peripheral blood test was administered to 75 patients with PAD, along with a treadmill exercise test using the Skinner-Gardner protocol to measure asymptomatic walking distance (AWD) and maximum walking distance (MWD). Each patient was assigned to a 6-month pitavastatin treatment group (n = 53) or a control group (n = 22), according to the patient's preference. The tests were repeated in both groups at 3 and 6 months. Baseline AWD and MWD correlated positively with the ankle-brachial pressure index (r = 0.342, p = 0.0032 and r = 0.324, p = 0.0054, respectively). Both AWD and MWD values improved at 3 and 6 months compared with baseline, and the degrees of their improvement were higher in the pitavastatin treatment group. CD34+/133+ cell numbers did not change over time or between groups. Eighty-seven percent of patients in the treatment group attained low-density lipoprotein cholesterol levels below 100 mg/dL after 3 months. The study shows that pitavastatin may be effective in increasing exercise tolerance capacity in patients with PAD.
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Affiliation(s)
- Kenshiro Arao
- First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takanori Yasu
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, 632 Takatoku Nikko, Tochigi, 321-2593, Japan.
| | - Yasuhiro Endo
- Division of Cardiovascular Medicine, Saiseikai Kurihashi Hospital, Saitama, Japan
| | - Toshikazu Funazaki
- Division of Cardiovascular Medicine, Saiseikai Kawaguchi General Hospital, Saitama, Japan
| | - Yoshimi Ota
- Division of Cardiovascular Medicine, Saiseikai Kurihashi Hospital, Saitama, Japan
| | - Kazunori Shimada
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | | | - Naoki Naito
- Division of Cardiovascular Medicine, Saiseikai Kawaguchi General Hospital, Saitama, Japan
| | - Bonpei Takase
- Division of Cardiovascular Medicine, National Defense Medical College, Saitama, Japan
| | - Minoru Wake
- Department of Cardiovascular Medicine, Okinawa Chubu Hospital, Okinawa, Japan
| | - Nahoko Ikeda
- First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yasuto Horie
- Department of Cardiology, Dokkyo Medical University Nikko Medical Center, Tochigi, Japan
| | - Hiroyuki Sugimura
- Department of Cardiology, Dokkyo Medical University Nikko Medical Center, Tochigi, Japan
| | - Shin-Ichi Momomura
- First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masanobu Kawakami
- First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Hishikari K, Hikita H, Nakamura S, Nakagama S, Mizusawa M, Yamamoto T, Doi J, Utsugi Y, Sudo Y, Kimura S, Ashikaga T, Takahashi A, Isobe M. Usefulness of Lipoprotein(a) for Predicting Clinical Outcomes After Endovascular Therapy for Aortoiliac Atherosclerotic Lesions. J Endovasc Ther 2017; 24:793-799. [PMID: 28830274 DOI: 10.1177/1526602817728068] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the usefulness of serum lipoprotein(a) as a biomarker of clinical outcomes after endovascular therapy (EVT) for atherosclerotic aortoiliac lesions. METHODS Serum lipoprotein(a) concentrations were measured at admission in 189 consecutive patients (median age 72 years; 160 men) with peripheral artery disease who underwent EVT for aortoiliac occlusive disease. The patients were dichotomized into 2 groups based on serum lipoprotein(a) levels ≤40 mg/dL (LOW; n=135) or >40 mg/dL (HIGH; n=54). After EVT, the incidences of major adverse limb events (MALE) were analyzed. Predictors of MALE were sought with a Cox proportional hazards analysis; results are presented as the hazard ratio (HR) and 95% confidence interval. RESULTS At the median follow-up of 33 months (interquartile range 11, 54), MALE occurred in 44 (23.3%) patients. The MALE-free survival estimate was significantly lower in patients in the HIGH group (55.6% vs 85.2%, p<0.001). Independent predictors of MALE after EVT were hemodialysis (HR 2.23, 95% CI 1.04 to 4.78, p=0.039) and high lipoprotein(a) levels (HR 2.80, 95% CI 1.44 to 5.45, p=0.003). CONCLUSION High lipoprotein(a) levels were associated with a higher incidence of MALE after EVT for patients with aortoiliac lesions.
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Affiliation(s)
- Keiichi Hishikari
- 1 Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.,2 Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroyuki Hikita
- 1 Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Shun Nakamura
- 1 Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Shun Nakagama
- 1 Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | | | - Tasuku Yamamoto
- 1 Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Junichi Doi
- 1 Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Yuya Utsugi
- 1 Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Yuta Sudo
- 1 Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Shigeki Kimura
- 1 Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Takashi Ashikaga
- 2 Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Mitsuaki Isobe
- 2 Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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47
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Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, Fleisher LA, Fowkes FGR, Hamburg NM, Kinlay S, Lookstein R, Misra S, Mureebe L, Olin JW, Patel RAG, Regensteiner JG, Schanzer A, Shishehbor MH, Stewart KJ, Treat-Jacobson D, Walsh ME. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017; 135:e686-e725. [PMID: 27840332 PMCID: PMC5479414 DOI: 10.1161/cir.0000000000000470] [Citation(s) in RCA: 384] [Impact Index Per Article: 54.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Since 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translated scientific evidence into clinical practice guidelines with recommendations to improve cardiovascular health. These guidelines, based on systematic methods to evaluate and classify evidence, provide a cornerstone of quality cardiovascular care. In response to reports from the Institute of Medicine1 ,2 and a mandate to evaluate new knowledge and maintain relevance at the point of care, the ACC/AHA Task Force on Clinical Practice Guidelines (Task Force) modified its methodology.3 –5 The relationships among guidelines, data standards, appropriate use criteria, and performance measures are addressed elsewhere.5
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Affiliation(s)
| | - Heather L Gornik
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Coletta Barrett
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Neal R Barshes
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Matthew A Corriere
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Douglas E Drachman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Lee A Fleisher
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Francis Gerry R Fowkes
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Naomi M Hamburg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Scott Kinlay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Robert Lookstein
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Sanjay Misra
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Leila Mureebe
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Jeffrey W Olin
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Rajan A G Patel
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Judith G Regensteiner
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Andres Schanzer
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Mehdi H Shishehbor
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Kerry J Stewart
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Diane Treat-Jacobson
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - M Eileen Walsh
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
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Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, Fleisher LA, Fowkes FGR, Hamburg NM, Kinlay S, Lookstein R, Misra S, Mureebe L, Olin JW, Patel RAG, Regensteiner JG, Schanzer A, Shishehbor MH, Stewart KJ, Treat-Jacobson D, Walsh ME. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017; 135:e726-e779. [PMID: 27840333 PMCID: PMC5477786 DOI: 10.1161/cir.0000000000000471] [Citation(s) in RCA: 384] [Impact Index Per Article: 54.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Since 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translated scientific evidence into clinical practice guidelines with recommendations to improve cardiovascular health. These guidelines, based on systematic methods to evaluate and classify evidence, provide a cornerstone of quality cardiovascular care. In response to reports from the Institute of Medicine1 ,2 and a mandate to evaluate new knowledge and maintain relevance at the point of care, the ACC/AHA Task Force on Clinical Practice Guidelines (Task Force) modified its methodology.3 –5 The relationships among guidelines, data standards, appropriate use criteria, and performance measures are addressed elsewhere.5
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Affiliation(s)
| | - Heather L Gornik
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Coletta Barrett
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Neal R Barshes
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Matthew A Corriere
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Douglas E Drachman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Lee A Fleisher
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Francis Gerry R Fowkes
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Naomi M Hamburg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Scott Kinlay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Robert Lookstein
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Sanjay Misra
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Leila Mureebe
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Jeffrey W Olin
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Rajan A G Patel
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Judith G Regensteiner
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Andres Schanzer
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Mehdi H Shishehbor
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Kerry J Stewart
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Diane Treat-Jacobson
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - M Eileen Walsh
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
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49
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The accuracy and cost-effectiveness of strategies used to identify peripheral artery disease among patients with diabetic foot ulcers. J Vasc Surg 2016; 64:1682-1690.e3. [DOI: 10.1016/j.jvs.2016.04.056] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 04/28/2016] [Indexed: 11/17/2022]
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50
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Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, Fleisher LA, Fowkes FGR, Hamburg NM, Kinlay S, Lookstein R, Misra S, Mureebe L, Olin JW, Patel RAG, Regensteiner JG, Schanzer A, Shishehbor MH, Stewart KJ, Treat-Jacobson D, Walsh ME. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2016; 69:1465-1508. [PMID: 27851991 DOI: 10.1016/j.jacc.2016.11.008] [Citation(s) in RCA: 411] [Impact Index Per Article: 51.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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