RESUMEN

Aortic augmentation index (AIx) is a marker of central aortic pressure burden and is modulated by antihypertensive drugs. In patients with peripheral arterial disease (PAD) undergoing antihypertensive treatment, aortic pressures parameters, heart rate-adjusted augmentation index (AIx75), and unadjusted AIx were determined. The (aortic) systolic and diastolic blood pressure did not differ between PAD patients who were taking ß-blockers (n=61) and those who were not taking ß-blockers (n=80). In patients taking ß-blockers, augmentation pressure and pulse pressure were higher than in patients who did not take ß-blockers (augmentation pressure, P=.02; pulse pressure, P=.005). AIx75 was lower in PAD patients taking ß-blockers than in patients not taking ß-blockers (P=.04), while the AIx did not differ between PAD patients taking and not taking ß-blockers. The present study demonstrates that ß-blockers potentially affect markers of vascular hemodynamics in patients with PAD. Because these markers are surrogates of cardiovascular risk, further studies are warranted to clarify the impact of selective ß-blocker treatment on clinical outcome in patients with PAD.

Asunto(s)

Antagonistas Adrenérgicos beta/administración & dosificación , Antihipertensivos/administración & dosificación , Hipertensión/tratamiento farmacológico , Enfermedad Arterial Periférica/fisiopatología , Antagonistas Adrenérgicos beta/efectos adversos , Antagonistas Adrenérgicos beta/farmacología , Anciano , Anciano de 80 o más Años , Índice Tobillo Braquial , Antihipertensivos/efectos adversos , Antihipertensivos/farmacología , Presión Arterial/efectos de los fármacos , Estudios Transversales , Femenino , Hemodinámica/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Análisis de la Onda del Pulso , Rigidez Vascular/efectos de los fármacos

RESUMEN

BACKGROUND: Tumescent anaesthesia (TA) is an important but sometimes very painful step during endovenous thermal ablation of incompetent veins. The aim of this study was to examine whether the use of fixed 50% nitrous oxide/oxygen mixture (N2O/O2), also called equimolar mixture of oxygen and nitrous oxide, reduces pain during the application of TA. PATIENTS AND METHODS: Patients undergoing endovenous laser ablation (EVLA) of incompetent saphenous veins were included. Thirty consecutive patients inhaled N2O/O2 during the application of TA. Thirty consecutive patients received TA alone (controls). Patients were asked to complete a questionnaire immediately after the intervention to assess satisfaction with the intervention and pain-levels during the different steps of the intervention (0=not at all, 10=very much). Adverse events during the treatment were monitored. RESULTS: 30 patients (14 men, mean age of 44 years) were included in the N2O/O2 group and 30 patients (9 men, mean age 48 years) were included in the control group. In the N2O/O2 group a significantly lower pain score was noted (mean 2.45 points, range 0-6) compared to the controls (mean 4.3 points, range 1-9, p<0.001). Overall, 64.5% of the patients were perfectly satisfied with the N2O/O2-Inhalation. Only 4 patients receiving N2O/O2 complained of adverse effects such as unpleasant loss of control (2 patients), headache (1 patient) and dizziness (1 patient). CONCLUSIONS: N2O/O2 is a safe and effective method to reduce pain during the application of tumescent anaesthesia for EVLA.

Asunto(s)

Analgésicos no Narcóticos/administración & dosificación , Anestesia Local/métodos , Terapia por Láser/métodos , Óxido Nitroso/administración & dosificación , Dolor/prevención & control , Vena Safena/cirugía , Várices/cirugía , Administración por Inhalación , Adulto , Anciano , Analgésicos no Narcóticos/efectos adversos , Anestesia Local/efectos adversos , Femenino , Humanos , Terapia por Láser/efectos adversos , Masculino , Persona de Mediana Edad , Óxido Nitroso/efectos adversos , Dolor/etiología , Dimensión del Dolor , Satisfacción del Paciente , Encuestas y Cuestionarios , Resultado del Tratamiento , Várices/diagnóstico , Adulto Joven

RESUMEN

BACKGROUND: Central augmentation index (cAIx) is an indicator for vascular stiffness. Obstructive and aneurysmatic vascular disease can affect pulse wave propagation and reflection, causing changes in central aortic pressures. AIM: To assess and compare cAIx in patients with peripheral arterial disease (PAD) and / or abdominal aortic aneurysm (AAA). METHODS: cAIx was assessed by radial applanation tonometry (Sphygmocor) in a total of 184 patients at a tertiary referral centre. Patients were grouped as having PAD only, AAA only, or both AAA and PAD. Differences in cAIx measurements between the three patient groups were tested by non-parametric tests and stepwise multivariate linear regression analysis to investigate associations with obstructive or aneurysmatic patterns of vascular disease. RESULTS: In the study sample of 184 patients, 130 had PAD only, 20 had AAA only, and 34 patients had both AAA and PAD. Mean cAIx (%) was 30.5 ± 8.2 across all patients. It was significantly higher in females (35.2 ± 6.1, n = 55) than males (28.4 ± 8.2, n = 129), and significantly higher in patients over 80 years of age (34.4 ± 6.9, n = 22) than in those under 80 years (30.0 ± 8.2, n = 162). Intergroup comparison revealed a significant difference in cAIx between the three patient groups (AAA: 27.3 ± 9.5; PAD: 31.4 ± 7.8; AAA & PAD: 28.8 ± 8.5). cAIx was significantly lower in patients with AAA, higher in patients with both AAA and PAD, and highest in patients with PAD only (beta = 0.21, p = 0.006). CONCLUSION: Non-invasive assessment of arterial stiffness in high-risk patients indicates that cAIx differs according to the pattern of vascular disease. Measurements revealed significantly higher cAIx values for patients with obstructive peripheral arterial disease than for patients with aneurysmatic disease.

Asunto(s)

Aneurisma de la Aorta Abdominal/patología , Aneurisma de la Aorta Abdominal/fisiopatología , Enfermedad Arterial Periférica/patología , Enfermedad Arterial Periférica/fisiopatología , Rigidez Vascular , Adulto , Femenino , Humanos , Masculino , Manometría/métodos , Persona de Mediana Edad , Medición de Riesgo

RESUMEN

Increased arterial stiffness results from reduced elasticity of the arterial wall and is an independent predictor for cardiovascular risk. The gold standard for assessment of arterial stiffness is the carotid-femoral pulse wave velocity. Other parameters such as central aortic pulse pressure and aortic augmentation index are indirect, surrogate markers of arterial stiffness, but provide additional information on the characteristics of wave reflection. Peripheral arterial disease (PAD) is characterised by its association with systolic hypertension, increased arterial stiffness, disturbed wave reflexion and prognosis depending on ankle-brachial pressure index. This review summarises the physiology of pulse wave propagation and reflection and its changes due to aging and atherosclerosis. We discuss different non-invasive assessment techniques and highlight the importance of the understanding of arterial pulse wave analysis for each vascular specialist and primary care physician alike in the context of PAD.

Asunto(s)

Biomarcadores/sangre , Presión Sanguínea/fisiología , Enfermedad Arterial Periférica , Flujo Pulsátil/fisiología , Rigidez Vascular/fisiología , Elasticidad , Humanos , Enfermedad Arterial Periférica/sangre , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/fisiopatología , Análisis de la Onda del Pulso

RESUMEN

AIM: Haemodynamic stability of patients during haemodialysis (HD) sessions is of pivotal importance and accurate determination of dry weight remains a challenge. Little information is available about central venous and aortic pressure during dialysis. In this pilot study we used a non-invasive technique to describe the changes in central venous pressure (CVP) during dialysis. METHODS: An ultrasound-assisted pressure-manometer was used at the cephalic vein during haemodialysis to quantify CVP. Central aortic pressure changes were assessed as aortic augmentation index and subendocardial viability ratio. Bioimpedance was applied to measure total body water, as well as extracellular and intracellular water before and after HD. Measurements were performed prior during and after 1 and 2 h on HD. RESULTS: Ten patients were included with a median age of 72 years (23-82). Haemodialysis reduced the weight by 2.0 kg, corresponding to a measured decrease in total body water of 1.9 L. The mean CVP showed a significant decrease (9.0-0.8 cmH2O; P = 0.0005) during dialysis. The significant drop in CVP was found during the first hour (9-2.8 cmH2O). Starting and stopping dialysis was reflected by a reduction of 2.6 cmH2O and a rise of 2.8 cmH2O (n.s.). Aortic augmentation index decreased from 26.1% to 21.0% (n.s.). Subendocardial viability ratio increased from 126% to 156% (P < 0.05) during HD, and decreased to 139% direct after HD (n.s.). CONCLUSION: This is the first study that illustrates a prominent reduction of CVP during the first hour of haemodialysis. Non-invasive CVP measurement is feasible during haemodialysis and adds another piece in the puzzle of factors involved in haemodynamic stability.

Asunto(s)

Presión Arterial , Enfermedades Cardiovasculares/etiología , Presión Venosa Central , Diálisis Renal/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Composición Corporal , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/fisiopatología , Impedancia Eléctrica , Femenino , Humanos , Masculino , Manometría , Persona de Mediana Edad , Proyectos Piloto , Factores de Tiempo , Equilibrio Hidroelectrolítico , Pérdida de Peso , Adulto Joven

RESUMEN

PURPOSE: In patients suffering from symptomatic peripheral artery disease (PAD), percutaneous revascularization is the treatment of choice. However, restenosis may occur in 10 to 60% in the first year depending on a variety of factors. Small dense low density lipoprotein (sdLDL) particles are associated with an increased risk for cardiovascular events, but their role in the process of restenosis is not known. We conducted a prospective study to analyze the association of sdLDL particles with the outcome of balloon angioplasty in PAD. The composite primary endpoint was defined as improved walking distance and absence of restenosis. METHODS: Patients with angiographically documented PAD of the lower extremities who were scheduled for lower limb revascularization were consecutively recruited for the study. At baseline and at three month follow-up triglyceride, total cholesterol, LDL size and subclasses and HDL cholesterol and ankle-brachial index (ABI) were measured. Three months after the intervention duplex sonography was performed to detect restenosis. RESULTS: Sixty-four patients (53% male) with a mean age of 68.6±9.9 years were included. The proportion of small- dense LDL particles (class III and IV) was significantly lower (33.1±11.0% vs. 39.4±12.1%, p = 0.038) in patients who reached the primary end-point compared with those who did not. Patients with improved walking distance and without restenosis had a significantly higher LDL size at baseline (26.6±1.1 nm vs. 26.1±1.1 nm, p = 0.046) and at follow-up (26.7±1.1 nm vs. 26.2±0.9 nm, p = 0.044) than patients without improvement. CONCLUSIONS: Small-dense LDL particles are associated with worse early outcome in patients undergoing percutaneous revascularization for symptomatic PAD.

Asunto(s)

Angioplastia , Lipoproteínas LDL/metabolismo , Tamaño de la Partícula , Enfermedad Arterial Periférica/terapia , Anciano , Femenino , Humanos , Modelos Lineales , Masculino , Factores de Riesgo , Resultado del Tratamiento

RESUMEN

In this retrospective study, cardiovascular risk factors of patients with acute limb ischemia (ALI) were compared with those of intermittent claudication (IC). Furthermore, the association of ALI with environmental temperature and/or hematocrit level was tested. A total of 436 patients treated for ALI and 832 patients with IC were included in the analysis. Diabetes (P = .0001), smoking (P < .0001), and hypertension (P < .0001) were significantly less prevalent in the patients with ALI. Patients with IC had a higher rate of coronary artery disease (P = .003), and patients with ALI had a higher rate of cerebrovascular disease (P < .0001). There was no association between the outside temperature or hematocrit level and the occurrence of ALI. The hypothesis of seasonal incidence of ALI could not be confirmed, and there was no association of ALI with the hematocrit level.

Asunto(s)

Claudicación Intermitente/epidemiología , Isquemia/epidemiología , Anciano , Trastornos Cerebrovasculares/epidemiología , Enfermedad de la Arteria Coronaria/epidemiología , Diabetes Mellitus/epidemiología , Femenino , Hematócrito , Humanos , Hipertensión/epidemiología , Pierna/irrigación sanguínea , Masculino , Estudios Retrospectivos , Factores de Riesgo , Fumar/epidemiología , Suiza/epidemiología , Temperatura

RESUMEN

BACKGROUND: Femoropopliteal bruits indicate flow turbulences and increased blood flow velocity, usually caused by an atherosclerotic plaque or stenosis. No data exist on the quality of bruits as a means for quantifying the degree of stenosis. We therefore conducted a prospective observational study to investigate the sensitivity and specificity of femoropopliteal auscultation, differentiated on the basis of bruit quality, to detect and quantify clinically relevant stenoses in patients with symptomatic and asymptomatic peripheral arterial disease (PAD). METHODS: Patients with known chronic and stable PAD were recruited in the outpatient clinic. We included patients with known PAD and an ankle-brachial index (ABI) <0.90 and/or an ABI ≥0.90 with a history of lower limb revascularisation. Auscultation was performed independently by three investigators with varied clinical experience after a 10-minute period of rest. Femoropopliteal lesions were classified as follows: normal vessel wall or slight wall thickening (<20%), atherosclerotic plaque with below 50% reduction of the vessel lumen, prestenotic/intrastenotic ratio over 2.5 (<70%), over 3.5 (<99%) and complete occlusion (100%). RESULTS: Weighted Cohen's κ coefficients for differentiated auscultation were low in all vascular regions and did not differ between investigators. Sensitivity was low in most areas with an increase after exercise. The highest sensitivity in detecting relevant (>50%) stenosis was found in the common femoral artery (86%). CONCLUSION: Vascular auscultation is known to be of great use in routine clinical practice in recognising arterial abnormalities. Diagnosis of PAD is based on various diagnostic tools (pulse palpation, ABI measurement) and auscultation can localise relevant stenosis. However, auscultation alone is of limited sensitivity and specificity in grading stenosis in femoropopliteal arteries. Where PAD is clinically suspected further diagnostic tools, especially colour-coded duplex ultrasound, should be employed to quantify the underlying lesion.

Asunto(s)

Auscultación/métodos , Enfermedad Arterial Periférica/diagnóstico , Arteria Poplítea/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Velocidad del Flujo Sanguíneo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/diagnóstico por imagen , Estudios Prospectivos , Reproducibilidad de los Resultados , Ultrasonografía Doppler en Color

RESUMEN

Anticoagulant and antiplatelet drugs are used and studied in numerous trials for primary and secondary prevention of atherothrombosis since decades. The annual rate for cardiovascular morbidity and mortality is high in patients following an acute coronary syndrome and in patients with peripheral arterial disease (PAD) due to concomitant cardiac and cerebrovascular diseases. Plaque rupture and subsequent thrombosis involves activation of both platelets and coagulation factors. Therefore the combination of aspirin and warfarin to improve prevention of atherothrombosis compared to antiplatelet therapy alone was studied but could not be established due to significantly increased risk of major bleeding compared to a nonsignificant reduction in ischemic events. During the past two decades, clinical trials focused on combined antiplatelet therapies for the prevention of secondary events following acute coronary syndromes and very recently on the new oral anticoagulants in combination with antiplatelet therapy. This review discusses the role of the new oral anticoagulants such as Factor IIa (thrombin) and Factor Xa inhibitors in atherothrombosis, their pharmacological properties and recently published clinical data in secondary prevention of atherothrombotic events and potential implications for patients with PAD.

Asunto(s)

Anticoagulantes/uso terapéutico , Enfermedad de la Arteria Coronaria/tratamiento farmacológico , Enfermedad Arterial Periférica/tratamiento farmacológico , Humanos , Trombosis/tratamiento farmacológico , Trombosis/prevención & control

RESUMEN

Ankle-brachial index (ABI) assessment by Doppler is operator dependent and limited in calcified arteries. For the detection of peripheral arterial disease (PAD), we evaluated ABI and toe-finger (ToFi) pressures by infrared (IR) sensors at the digits and compared with standard Doppler (Doppler-ABI) in 100 patients with PAD and in 15 controls. Pressure indices were obtained in 86% for Doppler-ABI, 82% for IR-ABI, and 94% for IR-ToFi (P < .01). According to Bland-Altmann analysis, IR-ABI and Doppler-ABI are exchangeable (limits of agreement [loa] -0.30; 0.30, bias -0.003, 95% confidence interval [CI] -0.02; 0.02), whereas IR-ToFi was not (loa -0.23; 0.61, bias of 0.2, 95% CI 0.16; 0.23). The IR-ToFi revealed the best inter- and intrarater agreement (0.92/0.98) followed by IR-ABI (0.74/0.98) and Doppler-ABI (0.66/0.89). Ankle-brachial arterial pressure index can be assessed by IR photosensors. Although toe-finger index is not exchangeable with standard Doppler, it will need further exploration to define its value for the diagnosis of PAD due to its excellent inter- and intrarater agreement.

Asunto(s)

Índice Tobillo Braquial , Rayos Infrarrojos , Enfermedades Vasculares Periféricas/diagnóstico , Anciano , Femenino , Dedos , Humanos , Flujometría por Láser-Doppler , Masculino , Dedos del Pie , Adulto Joven

RESUMEN

Peripheral arterial disease (PAD) is associated with increased cardiovascular mortality that correlates with peripheral perfusion impairment as assessed by the ankle-brachial arterial pressure index (ABI). Furthermore, PAD is associated with arterial stiffness and elevated aortic augmentation index (AIx). The purpose of this study was to investigate whether ABI impairment correlates with AIx and subendocardial viability ratio (SEVR), a measure of cardiac perfusion during diastole. AIx and SEVR were assessed by radial applanation tonometry in 65 patients with stable PAD (Rutherford stage I-III) at a tertiary referral center. AIx corrected for heart rate and SEVR were tested in a multivariate linear and logistic regression model to determine the association with ABI. Mean ABI was 0.8±0.2, AIx 31%±7%, and SEVR 141%±26%. Multiple linear regression with AIx as a dependent variable revealed that AIx was significantly negatively associated with ABI (ß=-11.5; 95% confidence interval [CI], -18.6 to -4.5; P=.002). Other variables that were associated with AIx were diastolic blood pressure (ß=0.2; 95% CI, 0.1-0.4; P<.001), height (ß=-46.2; 95% CI, -62.9 to -29.4; P<.001), body mass index (ß=-0.4; 95% CI, -0.8 to -0.1; P=.023), and smoking (ß=3.6; 95% CI, 0.6-6.6; P=.019). Multiple regression with SEVR as a dependent variable showed a significant correlation with ABI (ß=33.2; 95% CI, 2.3-64.1; P=.036). Severity of lower limb perfusion impairment is related to central aortic pressure augmentation and to subendocardial viability ratio. This may be a potential pathophysiologic link that impacts cardiac prognosis in patients with PAD.

Asunto(s)

Índice Tobillo Braquial/métodos , Presión Arterial/fisiología , Cardiopatías , Enfermedad Arterial Periférica , Rigidez Vascular/fisiología , Anciano , Femenino , Cardiopatías/diagnóstico , Cardiopatías/etiología , Cardiopatías/mortalidad , Cardiopatías/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Perfusión/métodos , Enfermedad Arterial Periférica/complicaciones , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/fisiopatología , Análisis de la Onda del Pulso/métodos , Análisis de Regresión , Medición de Riesgo , Índice de Severidad de la Enfermedad , Estadística como Asunto

RESUMEN

Morbus Castleman is a benign non-clonal lymphoproliverative disorder. Immunomodulatory and antiproliferative drugs are used to treat this plasma cell disorder. We report the case of a 46-year old female patient with multicentric Castleman's disease and limb ischemia. Thrombotic occlusions of the popliteal and tibioperoneal arteries were treated by percutaneous thrombus aspiration. We discuss the role of increased interleukin-6 plasma levels during therapy with Tocilizumab, an antibody to interleukin-6 receptor, as a potential cause for arterial thrombosis.

Asunto(s)

Anticuerpos Monoclonales Humanizados/efectos adversos , Arteriopatías Oclusivas/inducido químicamente , Enfermedad de Castleman/tratamiento farmacológico , Factores Inmunológicos/efectos adversos , Interleucina-6/sangre , Arteria Poplítea , Trombosis/inducido químicamente , Arterias Tibiales , Arteriopatías Oclusivas/sangre , Arteriopatías Oclusivas/diagnóstico por imagen , Arteriopatías Oclusivas/inmunología , Arteriopatías Oclusivas/terapia , Enfermedad de Castleman/sangre , Enfermedad de Castleman/inmunología , Constricción Patológica , Quimioterapia Combinada , Femenino , Humanos , Persona de Mediana Edad , Arteria Poplítea/diagnóstico por imagen , Esteroides/efectos adversos , Trombosis/sangre , Trombosis/diagnóstico por imagen , Trombosis/inmunología , Trombosis/terapia , Arterias Tibiales/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Regulación hacia Arriba

RESUMEN

Approximately one quarter of all patients with leg ulcers do not have a "vascular" ulcer, i.e. an ulcer of venous, mixed venous-arterial, or arterial origin. The differential diagnosis encompasses approximately 70 entities, amongst a selection of particular clinical relevance. Martorell hypertensive-ischemic leg ulcer and its two "imitators" pyoderma gangrenosum and necrotizing vasculitides of the skin, necrotic skin infections (e.g., ecthyma, tropical ulcer, and others), chronic wounds caused by physical trauma (contusion (deep dissecting hematoma), radiotherapy or cryotherapy of skin cancers at the leg), leg ulcers in the context of congenital diseases (e. g., Klinefelter syndrome or sickle cell anemia), skin ulcers caused by medical toxicity (hydroxyurea, anagrelide, methotrexate), and last not least ulcerating skin cancer at the legs, primary or secondary in an area of chronic inflammation. Clinical presentations and a pragmatical algorhythm to diagnosis and treatment of these entities are discussed.

Asunto(s)

Diagnóstico por Imagen/métodos , Enfermedades de la Piel/clasificación , Enfermedades de la Piel/diagnóstico , Diagnóstico Diferencial , Humanos

RESUMEN

OBJECTIVES: We aimed to investigate clinical practice patterns for the outpatient management of acute deep vein thrombosis (DVT). METHODS: In the prospective Outpatient Treatment of Deep Vein Thrombosis in Switzerland (OTIS-DVT) registry, 534 consecutive outpatients with acute DVT (49% proximal, 24% recurrent, and 12% cancer-associated) were enrolled: 41% patients were managed in private angiology practice, 34% in an outpatient hospital department, and 25% in private general or internal medicine practice. RESULTS: For diagnosis, ultrasound was used in 95% and D-dimer testing in 53%. Low-molecular-weight heparin (LMWH) was prescribed for a median (IQR) duration of 7 (5-12) days in 83% of patients, and vitamin K-antagonists for 163 (92-183) days in 81%. Mechanical measures to prevent post-thrombotic syndrome were prescribed in 83%; compression stockings or bandages for a median (IQR) duration of 364 (101-730) days from hospital physicians, and 92 (45-183) days from private practice physicians (p < 0.001). Among patients with symptomatic proximal DVT, mechanical measures were prescribed for at least 2 years in 24% patients; 55% in hospital, and 6% in private practice (p < 0.001). Among patients with cancer-associated DVT, the median (IQR) duration of LMWH therapy was 16 (8-45) days, and 35% received LMWH for less than 90 days. CONCLUSIONS: The OTIS-DVT registry provides representative information on clinical practice patterns for outpatients with acute DVT managed by hospital or private practice physicians. The use of mechanical measures in patients with symptomatic proximal DVT and the administration of LMWH for a long-term therapy of cancer-associated DVT require improvement to comply with current guidelines.

Asunto(s)

Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/terapia , Enfermedad Aguda , Atención Ambulatoria , Anticoagulantes/uso terapéutico , Femenino , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sistema de Registros , Sobrevivientes , Ultrasonografía , Trombosis de la Vena/tratamiento farmacológico

RESUMEN

INTRODUCTION: The role of elevated homocysteine in primary and secondary Raynaud phenomenon (RP) and in patients with atherosclerosis has been reported controversially. In secondary RP due to connective tissue disease specific alterations of nailfold capillaries might be present. An association between these microvascular changes and homocysteine has been suggested. AIM: The aim of this study was to determine whether homocysteine level differs between patients with primary and secondary RP and to test the hypothesis that homocysteine or other cardiovascular risk factors are associated with specific features of microangiopathy in secondary RP. PATIENTS AND METHODS: Eighty-one consecutive patients with RP referred for vascular assessment were studied by nailfold capillaroscopy. Homocysteine, C-reactive protein and cholesterol were measured and other cardiovascular risk factors and comorbidities assessed. RESULTS: Homocysteine, C-reactive-protein and cholesterol levels did not differ between patients with primary (n=60) and secondary RP (n=21). Likewise, no differences in the prevalence of cardiovascular risk factors and comorbidities were found. In secondary RP no correlation was found between microvascular involvement and homocysteine or C-reactive protein. CONCLUSION: Plasma homocysteine is not different in patients with either primary or secondary RP and is therefore not a marker for the distinction of these diseases. The extent of microvascular involvement in secondary RP does not correlate with plasma homocysteine.

RESUMEN

BACKGROUND: Obesity is a risk factor for chronic venous insufficiency and venous thromboembolism. The aim of this study was to compare venous flow parameters of the lower limbs assessed by duplex ultrasound scanning in obese and nonobese individuals according to body mass index (BMI). METHODS: Venous hemodynamics were studied in a prospective cohort study in nonobese (BMI <25 kg/m(2)) and obese individuals (BMI >30 kg/m(2)). Diameter, flow volume, peak, mean, and minimum velocities were assessed. RESULTS: The study examined 36 limbs in 23 nonobese individuals and 44 limbs in 22 obese individuals. The diameter of the femoral vein was significantly greater in obese (8.5 +/- 2.2 mm) vs nonobese (7.1 +/- 1.6 mm; P = .0009) limbs. Venous peak and minimum velocities differed between nonobese and obese individuals (14.8 +/- 7.2 vs 10.8 +/- 4.8 cm/s [P = .0071] and 4.0 +/- 3.6 vs 1.7 +/- 6.3 cm/s [P = .056]). Calculation of venous amplitude and shear stress showed significantly higher values in nonobese vs obese (18.8 +/- 9.4 vs 12.5 +/- 9.3 cm/s [P = .003] and 2.13 +/- 2.2 dyn/cm(2) vs 1.6 +/- 2.7 dyn/cm(2) [P = .03]). Spearman rank correlation revealed a significant inverse correlation between waist-to-hip ratios and waist circumference and venous peak velocity, mean velocity, velocities amplitude (peak velocity-minimum velocity), and shear stress. CONCLUSION: Lower limb venous flow parameters differ significantly between healthy obese and nonobese individuals. These findings support the mechanical role of abdominal adipose tissue potentially leading to elevated risk for both venous thromboembolism and chronic venous insufficiency.

Asunto(s)

Hemodinámica , Extremidad Inferior/irrigación sanguínea , Obesidad/fisiopatología , Adulto , Anciano , Velocidad del Flujo Sanguíneo , Índice de Masa Corporal , Estudios de Casos y Controles , Enfermedad Crónica , Femenino , Humanos , Flujometría por Láser-Doppler , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Estudios Prospectivos , Flujo Sanguíneo Regional , Factores de Riesgo , Estrés Mecánico , Suiza , Ultrasonografía Doppler en Color , Venas/diagnóstico por imagen , Venas/fisiopatología , Insuficiencia Venosa/etiología , Insuficiencia Venosa/fisiopatología , Tromboembolia Venosa/etiología , Tromboembolia Venosa/fisiopatología , Relación Cintura-Cadera

RESUMEN

OBJECTIVE: To test the hypothesis that endovascular revascularization of femoropopliteal lesions improves the impaired venoarteriolar response (VAR) in patients with atherosclerosis. METHODS: We prospectively compared VARs in 15 healthy controls (18 legs) and 14 patients (17 legs) with mild to moderate peripheral arterial disease before and after successful peripheral endovascular angioplasty of femoropopliteal lesions. In all subjects, foot skin blood flow was assessed by laser Doppler flowmetry in the horizontal (HBF) and sitting (SBF) positions. VAR was calculated as (HBF - SBF)/HBF x 100. RESULTS: In patients with peripheral arterial disease, mean HBF (in arbitrary units [AU]; mean +/- SD) was similar before (25.6 +/- 15.3 AU) and after (27.0 +/- 16.4 AU) angioplasty (P = .67), whereas SBF was significantly lower after than before the endovascular procedure (11.6 +/- 7.7 AU to 18.4 +/- 14.1 AU; P < .05). Intragroup differences between SBF and HBF were significant before and after angioplasty (P < .001). VAR was higher after angioplasty (55.1% +/- 21.2%) compared with VAR before intervention (33.4% +/- 20.2%; P = .015). Although VAR increased after the intervention, VAR was still lower than in healthy controls (68.4% +/- 20.5%; P = .025). During the 6 months of follow-up, the ankle-brachial index and VAR remained unchanged (P > .05). CONCLUSIONS: Patients with mild to moderate peripheral arterial disease have an impaired orthostatic autoregulation that improves after successful endovascular revascularization of femoropopliteal obstructive lesions. The effect on VAR is sustained in the absence of restenosis.

Asunto(s)

Angioplastia/métodos , Aterosclerosis/cirugía , Sistema Nervioso Autónomo/fisiopatología , Mareo/etiología , Pierna/irrigación sanguínea , Postura/fisiología , Anciano , Anciano de 80 o más Años , Aterosclerosis/complicaciones , Velocidad del Flujo Sanguíneo , Mareo/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Flujometría por Láser-Doppler , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Piel/irrigación sanguínea , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

PURPOSE: To report the midterm outcome after stent-assisted angioplasty of occlusive disease at the common femoral artery bifurcation. METHODS: Between 1995 and 2002, 27 consecutive patients (18 men; mean age 70 years, range 47-90) underwent angioplasty with stent implantation in 33 limbs; target sites included 19 common femoral arteries, the origins of 2 superficial or 4 profunda femoris arteries, and 8 bypass anastomoses. RESULTS: Technical success was 100%. Patients were followed for a mean 30 months (95% CI 21 to 39), at which time the cumulative primary patency was 86% (95% CI 85% to 88%). At 3 years, 83% of the arteries were patent. Five restenoses were due to neointimal hyperplasia in 4 cases (3 bypass grafts) and strut failure of the only balloon-expandable stent used in this series. Restenoses due to neointimal hyperplasia at bypass anastomoses (3/ 8) were more common than in native arteries (2/25) (p=0.078); cumulative primary patency for the bypass subgroup was 71% (95% CI 59% to 82%) at a mean 23-month follow-up; 75% and 60% of the anastomoses were patent after 1 and 2 years, respectively. CONCLUSIONS: Angioplasty of obstructions in the common femoral artery and its bifurcation with implantation of self-expanding stents shows good midterm primary patency. Native artery lesions have a better outcome than stenoses at bypass anastomoses. The procedure does not preclude further endovascular interventions at the puncture site.

Asunto(s)

Angioplastia de Balón/instrumentación , Arteriopatías Oclusivas/terapia , Arteria Femoral , Isquemia/terapia , Pierna/irrigación sanguínea , Stents , Anciano , Anciano de 80 o más Años , Derivación Arteriovenosa Quirúrgica , Femenino , Estudios de Seguimiento , Oclusión de Injerto Vascular/terapia , Humanos , Masculino , Persona de Mediana Edad , Falla de Prótesis , Recurrencia , Retratamiento , Estudios Retrospectivos