Ankle-brachial Index Measurement Research Articles

The effects of auricular acupuncture on vascular parameters on the risk factors for diabetic foot: A randomized clinical trial

Aims and objectivesTo evaluate the effects of auricular acupuncture on vascular parameters on the risk factors for Diabetic Foot. MethodsRandomized and masked clinical trial. The sample was composed of 44 individuals with type 2 Diabetes Mellitus and they were randomly assigned to two groups: intervention (n = 22), which received five sessions of auricular acupuncture, and control (n = 22), which did not receive the therapy. Three evaluations were performed: before the intervention; one day after the last acupuncture session and 15 days after the second evaluation. For this, the subject's characterization instrument, the Ankle-Brachial Index measurement, and thermography were used. For data analysis, Mann-Whitney, Wilcoxon, Wilcoxon signed-rank, Fisher's Exact and Chi-Square tests were used. ResultsAuriculotherapy provided results in the Ankle-Brachial Index Test, as well as in thermography, which showed significant temperature improvement. ConclusionsThe technique proved to be efficient in improving circulatory conditions and plantar temperature.

Femoral plaque burden by ultrasound is a better indicator of significant coronary artery disease over ankle brachial index

The ankle-brachial index is a commonly used tool for identifying peripheral artery disease for cardiovascular risk stratification. An abnormal ankle-brachial index occurs only following extensive peripheral atherosclerosis occlusion, and thus has poor sensitivity for coronary atherosclerosis. There is a critical need for the development of tools that can detect risk prior to advanced stages of atherosclerosis. We sought to determine the sensitivity of femoral ultrasound for coronary artery disease. In this prospective, cross-sectional study, participants (n = 124) underwent ankle-brachial index measurement and femoral ultrasound for assessment of intima-media thickness, maximal plaque height, and total plaque area following coronary angiography. Receiver operating characteristic areas under the curve were plotted for identifying significant coronary artery disease (≥ 50% stenosis). Logistic regression was utilized to evaluate associations. 64% of participants had significant, angiography-confirmed coronary artery disease. Femoral ultrasound plaque area yielded the highest area under the curve for detecting significant coronary disease (area under the curve = 0.731). In contrast, an abnormal ankle-brachial index (≤ 0.90) produced an area under the curve of 0.568. Femoral ultrasound had a higher sensitivity (85%) than the ankle-brachial index (25%) for ruling out significant coronary artery disease. Both ankle-brachial index and femoral ultrasound have similar capacity to detect peripheral artery disease. Femoral ultrasound has a significantly greater discriminatory power than ankle-brachial index to detect clinically significant coronary artery disease. Ultrasound-captured femoral plaque burden directly delineates the extent of peripheral arterial disease and is better at ruling out significant coronary atherosclerosis than the ankle-brachial index.

Association of Abnormal Brachial Index with Diabetic Nephropathy as an Independent Risk Factor for Coronary Arterial Disease in Type 2 Diabetic Patients - A Retrospective Single Centre Real-World Evidence Study in Indian Population

Objective: To study the association between ankle brachial index (ABI) and microvascular complications in Type 2 diabetes (T2DM) patients with the coronary arterial disease (CAD). Methodology: A retrospective study was carried out on 3,458 T2DM patients reportedly with CAD, G1 (n=33), and without CAD, G2 (n=3125), who had given the ABI test. ABI was defined as normal (1.0 - 1.4) and abnormal (<1.0 and >1.4). The logistic regression analysis was used to identify the determinants of CAD positive outcomes in T2DM patients. Results: Overall, patient percentage-wise CAD 10% (333), abnormal ABI 26% (913), neuropathy 37% (1278), nephropathy, 8% (293), and retinopathy <1% (24). The ABI abnormality and CAD positives were higher in patients with nephropathy (32 and 20%) than in neuropathy (28 and 13%). Age-wise, 52 and 62% of neuropathy and nephropathy patients, respectively, were >60 years and had shown increased ABI abnormality from age 50 years onwards. The logistic model had shown nephropathy patients, [OR-1.8 [1.26-2.58], - p-0.001] in association with abnormal ABI, [OR-1.27 [95% CI, 0.99–1.63], p- 0.057] predicted to have CAD positive outcomes. While neuropathy, OR-0.69, [0.54 - 0.90], and hypertension, OR-0.43 [0.33 - 0.57] were not contributing towards CAD in our study population. Conclusion: Type 2 diabetes patients with abnormal ABI were predicted to have a 27% increased odds ratio of CAD outcome and 80% in the presence of nephropathy. Thus, as part of comprehensive diabetes care, albuminuria screening along with ABI measurement is being suggested.

Two-year single centre results with covered endovascular reconstruction of aortic bifurcation (CERAB) in the treatment of extensive aorto-iliac occlusive disease.

To report the results of a single-centre in the treatment of extensive aorto-iliac occlusive disease (AIOD) by the covered endovascular reconstruction of aortic bifurcation (CERAB) technique. A retrospective analysis was conducted on data obtained from the review of medical charts of all consecutive patients treated with CERAB technique for AIOD between January 2016 and December 2019 in San Giovanni-Addolorata Hospital (Rome, Italy). Clinical examination, duplex ultrasound with ankle-brachial index measurement and contrast-enhanced computed tomography angiography were performed preoperatively. A clinical and ultrasound follow-up was carried out at one month and then half yearly after the intervention to evaluate patients' clinical status, limb salvage, target lesion revascularization rate, primary and secondary patency rate. During the study period, 24 patients (14 men, 58.3%; 10 women, 41.7%; median age 59 years, range 37-79 years) underwent CERAB for AIOD (TASC II C 29.2%, TASC II D 70.8%). Indications for treatment were: intermittent claudication in 18 patients (75%) and critical limb ischemia in 6 (25%). Technical success was achieved in all cases. Perioperative minor complications occurred in three cases (12.5%). One patient reported an intraoperative iliac rupture requiring adjunctive covered stenting. Median hospital length of stay was two days (range 1-9). No patient died perioperatively nor at the last follow-up. At a median follow-up of 18 months (range 6-48 months), mean ankle-brachial index increased significantly (from 0.62 ± 0.15 before the procedure to 0.84 ± 0.18) (P < 0.001) and target lesion revascularization rate was 12.5%. At two years, the limb salvage rate was 100%, and primary and secondary patency rates were 87.5% and 100%, respectively. CERAB technique demonstrated to be effective at the mid-term follow-up with low rate of complications and short length of stay. Long-term results and more robust data are needed to affirm this technique as the first-line treatment for extensive AIOD. However, it could become the preferred option especially in fragile patients and during contemporary COVID-19 pandemic due to the current limitations in vascular and critical care bed capacity.

Impact of Buerger-Allen Exercises on Foot Perfusion and Pain Level for Diabetic Patients Risk with Peripheral Arterial Disease

Abstract The risk of peripheral arterial disease is markedly increased among individuals with diabetes. The current study aimed to evaluate diabetic patients' foot perfusion and their pain level after applying Buerger-Allen exercises. Subjects & methods: Quasi-experimental research design was used on a purposive sample of 100 type II diabetic patient in the General medical department and diabetic out-patient clinic, at Minia university hospital. Patients' interview questionnair, Ankle-brachial Index test and Numerical pain rating scale were used as tools for data collection. Results: There were highly statistically significant differences between the study group and control group regard Ankle-brachial Index measurements only post-application of Buerger-Allen exercises for six weeks (p ≤ 0.004). Moreover, results stated that the highest percentage (54.0%) among the study group who had moderate pain pre-application exercises but after they were performed exercises, their pain description became mild or no pain constituted (50.0% & 20.0%) respectively with highly statistical significant. Conclusion: Buerger-Allen exercise was efficient for improvement of lower peripheral arterial perfusion and there are highly statistically significant improvements in pain level among the study group. Recommendations: Diabetic patient must attend health education sessions based on evidence guidelines regard Buerger-Allen exercise which had a positive effect on the improvement of lower peripheral circulation.

Atrial fibrillation influences automatic oscillometric ankle-brachial index measurement.

IntroductionRepeated measurements of ankle-brachial index (ABI) using Doppler method were shown to be accurate during atrial fibrillation. Oscillometric devices are effective in ABI measurement, but their accuracy during atrial fibrillation is unknown. The purpose of the study was to investigate whether atrial fibrillation influences ABI obtained with the automatic oscillometric method.Material and methodsNinety-nine patients with atrial fibrillation (mean age: 66.6 +(SD = 11) years, M/F − 63/36) who underwent electrical cardioversion were investigated (198 lower extremities). The ABI measurements using oscillometric and Doppler methods were performed on both lower extremities before and after procedure.ResultsThe ABI measured using the oscillometric method on both lower limbs did not change after cardioversion (1.21 (IQR: 1.13−1.27) vs. 1.22 (IQR: 1.14−1.26), p = 0.664, respectively). The ABI measured before and after cardioversion using Doppler and oscillometric methods showed a significant difference (1.14 (IQR: 1.07−1.22) vs. 1.21 (IQR: 1.13−1.27), p < 0.001 and 1.18 (IQR: 1.09−1.13) vs. 1.22 (IQR: 1.14−1.26), p < 0.001 respectively). Both methods showed a weak correlation before (r = 0.35, p < 0.001) and no correlation after cardioversion (r = 0.12, p = 0.07). The Bland-Altman plot showed poor agreement between measurements performed with the Doppler and oscillometric methods in sinus rhythm and during atrial fibrillation.ConclusionsThe automated oscillometric method of ABI measurements should not replace the reference Doppler method in patients with atrial fibrillation. More research related to the oscillometric measurements is needed in subjects with peripheral artery disease and atrial fibrillation.

Lower Extremity Arterial Disease as a Predictor of Incident Atrial Fibrillation and Cardiovascular Events

ObjectiveTo evaluate the relationship between peripheral arterial disease (PAD) and incident atrial fibrillation (AF) and its clinical and pathophysiologic implications on ischemic stroke and all-cause mortality. Patients and MethodsWe identified all adult patients in the Mayo Clinic Health System without a previous diagnosis of AF undergoing ankle-brachial index (ABI) testing for any indication from January 1, 1996, to June 30, 2018. Retrospective extraction of ABI data and baseline echocardiographic data was performed. The primary outcome of interest was incident AF. The secondary outcomes of interest were incident ischemic stroke and all-cause mortality. ResultsA total of 33,734 patients were included in the study. After adjusting for demographic and comorbidity variables, compared with patients who had normal ABI (1.0 to 1.39), there was an increased risk of incident AF in patients with low ABI (<1.0) (adjusted hazard ratio, 1.14; 95% CI, 1.06 to 1.22) and elevated ABI (≥1.4) (adjusted hazard ratio, 1.18; 95% CI, 1.06 to 1.31). The risk was greater in patients with increasing severity of PAD. Patients with abnormal ABIs had an increased risk of ischemic stroke and all-cause mortality. We found that patients with PAD and incident AF have certain baseline echocardiographic abnormalities. ConclusionIn this large cohort of ambulatory patients undergoing ABI measurement, patients with PAD were at increased risk for incident AF, ischemic stroke, and mortality. In these high-risk patients with abnormal ABI, particularly severe PAD and cardiac structural abnormalities, routine monitoring for AF and management of cardiovascular risk factors may be warranted.

Ultrasound-Guided Retrograde Infrapopliteal Artery Access for Recanalization of Complex Femoral-Popliteal Artery Occlusions

The aim of the study was to review the outcomes of femoral-popliteal artery (FPA) interventions using an ultrasound (US)-guided retrograde infrapopliteal artery access after the failure of an antegrade recanalization. From Jan 2016 to Jan 2019, 37 patients with chronic total occlusion (CTO) of the FPA underwent ultrasound (US)-guided retrograde infrapopliteal artery access after failure of an antegrade procedure. Treated limbs were classified as Rutherford class 5 or 6 (29.7%) and class 4 (62.2%). Data collected included success rate and time to access using US. Immediate in-hospital and follow-up outcomes were also documented. US-guided retrograde infrapopliteal artery access was successful in 100% of the patients (anterior tibial = 11, posterior tibial = 19, Peroneal = 4, Dorsalis pedis = 3). Retrograde revascularization was achieved in all 37 patients (100%) using balloon angioplasty (17/37, 45.9%) and additional stent placement (20/37, 54.1%). Ankle-brachial index (ABI) measurements changed from 0.25 ± 0.1 preinterventionally to 0.75 ± 0.07 at 1 day postinterventionally (<0.001). Minor complications occurred in 2/37 patients (5.4%) including one bleeding and vasospasm at the posterior tibial artery, both of which were treated conservatively. No patient experienced access-related thrombosis, aneurysm, compartment syndrome or death. Thirty of 37 (81%) patients completed for at least 12 months of follow-up. None of the successful revascularized patients had major or minor amputations during the follow-up period. US-guided retrograde infrapopliteal artery access is a safe and successful technique, which expands revascularization options after the failure of conventional endovascular antegrade approaches.

HIV clinical stages and lower extremity arterial disease among HIV infected outpatients in Burundi

Chronic disease of people living with human immunodeficiency virus (HIV) infection are now approaching those of the general population. Previous, in vitro studies shown that HIV causes arterial injuries resulting in inflammation and atherosclerosis but direct relationship between HIV infection clinical stages and lower extremity arterial disease (LEAD) remain controversial. No study assessed, with an accurate method, both the prevalence of LEAD and the influence of HIV severity on LEAD in HIV outpatients in Central Africa. A cross-sectional study was conducted among 300 HIV-infected outpatients, aged ≥ 40 years in Bujumbura, Burundi. All patients underwent ankle-brachial index (ABI) measurement and LEAD was diagnosed by ABI ≤ 0.9. The prevalence of LEAD was 17.3% (CI 95% 13.2–22.1). The mean age was 49.6 ± 7.1 years. On multivariable analysis, factors associated with LEAD were hypertension (OR = 2.42; 95% CI 1.10–5.80), and stage IV HIV clinical infection (OR = 4.92, 95% CI 1.19–20.36). This is the first study performed on a large HIV population in Central Africa, reporting high LEAD prevalence. It underlines the influence of HIV infection on peripheral atherosclerosis at latest clinical stages and the need for LEAD screening in HIV-infected patients.

Can ankle-brachial index be used as a predictor for carotid artery shunt application during carotid endarterectomy?

Objectives: This study aims to investigate the possible relationship between low ankle-brachial index (ABI) and shunt requirement during carotid endarterectomy (CEA) operations. Patients and methods: Medical records of a total of 56 patients (40 males, 16 females; mean age: 65.6±8.4 years; range, 48 to 82 years) who underwent CEA between January 2013 and December 2016 were retrospectively reviewed. The ABI was measured in all patients at the time of hospital admission. Peripheral arterial disease was defined as having an ABI of ≤0.90 in either leg. Selective carotid artery shunt strategy was applied to all patients who underwent CEA under regional anesthesia. Results: Forty-eight (85.8%) patients were symptomatic. Peripheral arterial disease was diagnosed in 25 (44.6%) patients with ABI measurements. Eleven (19.6%) patients required shunt placement due to neurological deterioration during the carotid clamping test. The mean ABI of 11 (19.6%) patients was 0.8±0.15, while the ABI was less than 0.90 in 10 (17.8%) patients. There was a statistically significant correlation between perioperative shunt usage and peripheral arterial disease (odds ratio [OR]: 19.68, 95% confidence interval [CI]: 2.3-164.4; p=0.001). Conclusion: Low ABI appears to be related to a higher rate of shunt requirement in patients undergoing CEA under regional anesthesia with a selective shunt strategy in our modest cohort.

Correlation between ankle-brachial index and thermography measurements in patients with peripheral arterial disease.

To correlate the ankle-brachial index and photographic thermography findings in patients with peripheral arterial disease. Photographic thermography was performed at the foot level, and ankle-brachial index was measured in 72 lower limbs of 53 patients with peripheral arterial disease who were divided into calcified artery, patients with an ankle-brachial index greater than 1.4; and non-calcified artery classified as asymptomatic, mild, moderate, and severe on the basis of peripheral arterial disease severity. Fisher's exact test was used for categorical data, and Wilcoxon test was used for numerical data. Spearman's correlation analysis showed a strong correlation (R = 0.7) between the ankle-brachial index and the mean plantar temperature in patients without lower limb artery calcification. Linear regression yielded the predictor equation Y = 3.296 × X + 29.75, wherein ankle-brachial index (X) can be predicted on the basis of temperature values. Spearman's correlation test showed no significance (p = 0.2174) in patients with arterial calcification. Kruskal-Wallis test with post hoc analysis using Dunn's test for multiple comparisons showed that the mean plantar temperature was lower in patients with arterial calcification. Photographic thermography findings show a strong correlation with ankle-brachial index in patients with non-calcified arteries.

Angiographic Assessment of Coronary Artery Disease and its Correlation with Ankle-brachial Index in Patients with Diabetes Mellitus

ABSTRACT Background Coronary artery disease (CAD) due to atherosclerosis is like an epidemic in India. The role of diabetes mellitus (DM) with CAD is believed to be as important as CAD itself. Owing to the similar vascular involvement, patients with DM were frequently combined with peripheral artery disease (PAD). Although in outpatients, clinically suspected of having CAD, the relationship and interaction between DM and PAD remain unknown. Aim and objective The aim and objective of this study is to evaluate the relation of the ankle-brachial index (ABI) with the angiographic characteristics of CAD in patients with DM. Materials and methods This is a tertiary hospital study in which 50 adult patients were admitted and taken according to inclusion and exclusion criteria for the study. All patients in this study population underwent ABI measurement and coronary angiography was done. Patients were subdivided into two groups according to ABI, that is, patients with ABI &gt;0.90 and ABI &lt;0.90. Results There was a significant relationship between low ABI and severity of CAD. Low ABI group patients had a more severe form of CAD with a higher prevalence of triple vessel diseases, severe stenosis, and more involvement of the left anterior descending (LAD)artery. Risk factors like hypertension, diabetes mellitus, and low ABI were predictors of significant severe stenosis of coronary arteries. Conclusion Low ABI is a surrogate index of the severity of CAD. So it could be used in our everyday clinical cardiology practice as a noninvasive, easy, and cheap bedside test to assess and predict the severity of CAD. How to cite this article Mohan G, Mohan G, Singh B, et al. Angiographic Assessment of Coronary Artery Disease and Its Correlation with Ankle-brachial Index in Patients with Diabetes Mellitus. AMEI's Curr Trends Diagn Treat 2020;4(2):69–73.

Association of Ankle Brachial Index with Clinical Outcomes Following Percutaneous Coronary Intervention in Patients with Aortic Aneurysm.

Objective Since patients with thoracic aortic aneurysm (TAA)/abdominal aortic aneurysm (AAA) are often complicated with coronary artery disease, it is common for those patients to undergo percutaneous coronary intervention (PCI). The ankle brachial index (ABI) is usually measured in patients with TAA/AAA to screen the presence of peripheral arterial disease. The present study investigated the association between the ABI and clinical outcomes following PCI in patients with TAA/AAA. Methods We divided 200 TAA/AAA patients who underwent PCI into a normal ABI group (n=137) and an abnormal ABI group (n=63) according to the ABI cut-off level of 1.00. The primary endpoint was one-year major adverse cardiovascular events (MACE), defined as the composite of cardiovascular death, non-fetal myocardial infarction, stroke, target vessel revascularization, and hospitalization for heart failure. Results Mean ABIs in the normal and abnormal ABI groups were 1.12±0.09 and 0.86±0.11, respectively (p<0.01). Kaplan-Meier curves showed MACE were more frequent in the abnormal ABI group than in the normal ABI group (p=0.01). A multivariate Cox hazard analysis revealed that an abnormal ABI was significantly associated with 1-year MACE (vs. ABI ≥1.0: HR 3.02, 95% confidence interval 1.00-9.08, p=0.049). Conclusion Among patients with TAA/AAA who underwent PCI, abnormal ABI was significantly associated with 1-year MACE, suggesting the utility of the ABI measurement in this high-risk population.

Abnormal vascular physiology in the lower extremities as a risk factor for ischemic stroke and mortality

Peripheral artery disease (PAD) is highly prevalent in the general population, affecting up to 25% of patients 55 years or older. There is a known association with acute ischemic stroke, but limited large-cohort studies exist pertaining to the relationship between PAD severity and incident ischemic stroke.The objective of this study is to evaluate the risk of incident ischemic stroke and mortality along the spectrum of low and elevated ankle brachial index (ABI) measurement. We performed a retrospective extraction of ABI data of all adult patients who underwent lower extremity physiology study for any indication from January 1, 1996 to June 30, 2018 in the Mayo Clinic health system. PAD was categorized into severe, moderate, mild, and borderline based on ABI measurements and poorly compressible arteries (PCA). These were compared with normal ABI measurements. Associations of PAD/PCA with new ischemic stroke events and all-cause mortality were analyzed. Hazard ratios (HR) were calculated using multivariable Cox proportional regression with 95% confidence intervals. A total of 39,834 unique patients were included with a median follow up duration of 4.59 years. All abnormal ABI groups, except borderline PAD, were associated with increased risk of incident ischemic stroke aftermultivariate regression compared to normal ABI. A severity-dependent association was observed between PAD and ischemic stroke with moderate (HR, 1.22 [95% CI, 1.10-1.35]) and severe (HR, 1.19 [95% CI, 1.02-1.40]) categories conferring similar risk in comparison to normal ABI. Patients with PCA carried the greatest ischemic stroke risk (HR, 1.30 [95% CI, 1.15-1.46]). Similarly, abnormal ABI groups were associated with a significant risk for all-cause mortality in a severity-dependent manner, with severe PAD conferring the greatest risk (HR, 3.07 [95% CI, 2.88-3.27]). This study adds to the growing body of evidence that both PAD and PCA are independent risk factors for incident ischemic stroke and all-cause mortality. The association of PAD severity and PCA with risk of ischemic stroke may help clinicians with risk stratification and determining treatment intensity.

Risk Factors Associated With Diabetic Foot Ulcers and Its Relationship With ABI and Brachial-Ankle Pulse Wave Velocity.

To evaluate the risk factors associated with diabetic foot ulcers (DFUs) and to analyze the relationship of DFUs and the value of Ankle-Brachial Index (ABI) and brachial-ankle pulse wave velocity (baPWV). In this retrospective study, the risk factors associated with DFUs were analyzed, and the value of ABI and baPWV were measured to find its relationship with DFUs. Binary logistic regression analysis indicated that neuropathy and ABI were independent risk factors for DFUs. The patients were divided into 2 groups according to the value of ABI. For patients with DFUs, the value of baPWV decreased with the decrease of ABI. In normal or high ABI group, about a quarter of patients who suffered from DFUs had a higher value of baPWV than the others without DFUs. The pathogenesis of DFUs was multifactorial. Regarding the occurrence and development of foot ulcers, the action of vascular occlusion was more important than vascular sclerosis. ABI measurements should be taken more seriously in patients with DFUs. baPWV should be taken with care in the follow-up of the patients without DFUs. However, in patients with a normal value of ABI, the degree of vascular sclerosis of patients with DFUs may be greater than those without ulceration.

Wound healing: what is the NICE guidance from the UK?

Alteration of wound healing increases the risk of a patient's morbidity and mortality. This can lead to scarring, infection, malignant transformation and a reduction in quality of life. Management of wounds costs the UK an estimated £5.3 billion annually which is paid for by the state, with further financial burden due to health related productivity loss. Wound care is managed by a broad spectrum of different health professionals leading to different standards of care. For example, only 16% of lower leg wounds have either an ankle-brachial pressure index measurement or Doppler scan. Due to this variation in wound care, we have summarised all available NICE guidelines and guidance up to February 2021 on the topic of wound healing listed in the National Institute for Health and Care Excellence (NICE) archives. The goal is to provide an easy to access summary of wound care interventions. Our search provided us with 18 technology appraisals related to wound healing which have been summarised.

Patterns of change in cardiovascular risk assessments and ankle brachial index among Puerto Rican adults.

BackgroundPuerto Rican adults have higher odds of peripheral artery disease (PAD) compared with Mexican Americans. Limited studies have examined relationships between clinical risk assessment scores and ABI measures in this population.MethodsUsing 2004–2015 data from the Boston Puerto Rican Health Study (BPRHS) (n = 370–583), cross-sectional, 5-y change, and patterns of change in Framingham Risk Score (FRS) and allostatic load (AL) with ankle brachial index (ABI) at 5-y follow-up were assessed among Puerto Rican adults (45–75 y). FRS and AL were calculated at baseline, 2-y and 5-y follow-up. Multivariable linear regression models were used to examine cross-sectional and 5-y changes in FRS and AL with ABI at 5-y. Latent growth mixture modeling identified trajectories of FRS and AL over 5-y, and multivariable linear regression models were used to test associations between trajectory groups at 5-y.ResultsGreater FRS at 5-y and increases in FRS from baseline were associated with lower ABI at 5-y (β = -0.149, P = 0.010; β = -0.171, P = 0.038, respectively). AL was not associated with ABI in cross-sectional or change analyses. Participants in low-ascending (vs. no change) FRS trajectory, and participants in moderate-ascending (vs. low-ascending) AL trajectory, had lower 5-y ABI (β = -0.025, P = 0.044; β = -0.016, P = 0.023, respectively).ConclusionsFRS was a better overall predictor of ABI, compared with AL. Puerto Rican adults, an understudied population with higher FRS over 5 years, may benefit from intensive risk factor modification to reduce risk of PAD. Additional research examining relationships between FRS and AL and development of PAD is warranted.

Outcome of percutaneous transluminal angioplasty for subacute lower limb ischemia

Context Management of acute limb ischemia ( Aim The aim of this study was to evaluate the clinical and hemodynamic outcome of percutaneous transluminal angioplasty for subacute lower limb ischemia. Settings and design A total of 22 limbs that presented with subacute leg ischemia admitted to Alexandria Main University Hospital have been studied prospectively. All patients had femoro-popliteal occlusions shown by multislice computed tomographic angiography and severe leg ischemic pain +/− crippling claudication. Patients with acute leg ischemia or extensive foot necrosis necessitating amputation were excluded from the study. Patients and methods All patients were subjected to ankle-brachial index (ABI) measurement, color duplex ultrasound (CDU) scan, and multislice computed tomographic angiography before intervention. Percutaneous transluminal angioplasty (balloon angioplasty +/− stent deployment) was performed for all participants. Clinical follow-up with ABI measurement was done at 1-, 3-, and 6-month intervals. CDU after 6 months for patency and restenosis was performed. Statistical analysis Statistical Package for the Social Sciences, version 15.0 was used. Values were compared with a paired samples t test. P values less than 0.05 were considered significant. Results Mean follow-up period was 6.2 months. The mean (±SD) ABI before and at 1-, 3-, and 6-month interval was 0.4 (±0.2), 0.53 (±0.11), 0.62 (±0.12), and 0.86 (±0.16), respectively, with P value less than 0.0001. Limb salvage rate for those patients who had constant ischemic pain and had primary technical success was 89%. As for those patients who had severe claudication, at 6-month follow-up, they had no complaint. Primary patency rate by CDU was 95%. Conclusions Balloon angioplasty is a safe and effective tool for management of subacute leg ischemia. It avoids high surgical risks and carries promising patency and limb salvage rates.

Endothelial and Autonomic Assessments in the Management of COVID-19

Background: The goal of this peer review is to outline the benefits of the TM Flow system and Lifeprobes Kiosk assessing the endothelial and autonomic system functions in the management of COVID-19 for triage of the patients at risk and diagnostic of autonomic nervous system dysfunction to understand the long COVID symptoms. Material and Methods: The TM Flow system is a non-invasive medical device that relies on pulse oximetry, blood pressure measurements, and very low electrical current stimulation of the skin via disposable electrodes to provide instantaneous assessments of patients’ vital signs, endothelial function, sudomotor and autonomic nervous system functions, and ankle brachial index measurements. The Lifeprobes Kiosk performs automated pre-consultation patient assessments via an online patient check-in form and medical questionnaire, as well as determines the patient’s vital signs, endothelial function markers and estimated body composition. COVID-19: Current Scientific Data: In the majority of cases, COVID-19 infection will manifest through mild to moderate symptoms (such as cough, runny nose, sore throat, headache, muscle aches, and fever) which would resolve without the need for special treatment or hospitalization. On the other hand, older individuals and those who suffer from underlying medical conditions—such as obesity, diabetes, cardiovascular disease, chronic respiratory disease, and/or cancer—are more susceptible to developing serious illness, often with a fatal outcome. Available evidence further indicates that COVID-19 vaccines reduce the number of new cases, while also lessening the risk of complications that would require hospitalization. However, these findings do not apply to the new delta variant, which leads to more severe complications in younger people than previous variants, even in those who have been vaccinated and/or do not have any underlying medical problems. Research conducted to date indicates that COVID-19 complications result from endothelial dysfunction or damage. In addition, COVID-19 patients are increasingly reporting a wide range of debilitating conditions long after they have tested negative for the presence of the virus, giving rise to the term “Long COVID” which has been attributed to autonomic nervous system dysfunction and small fiber neuropathy. TM Flow markers have been investigated by several clinical studies in the US, India, and Brazil. The clinical studies showed the relevance of the TM Flow endothelial and autonomic nervous markers. Conclusion: Findings yielded by peer-reviewed clinical studies confirm that the TM Flow system and Lifeprobes Kiosk are beneficial and effective non-invasive tools that provide immediate results. Therefore, both should be employed for the triage of COVID-19 patients to expediently identify those at risk of complications, as this would reduce the hospitalization and mortality rates. The TM Flow system is also capable of diagnosing “Long COVID” symptoms related to the autonomic nervous system and small fiber neuropathy.

Peripheral Arterial Disease among Patient Undergoing Maintenance Hemodialysis in Dakar (Senegal)

Background: Peripheral arterial disease (PAD) is common in patients with chronic kidney disease (CKD). It is a surrogate marker of generalized atherosclerosis. In sub-Saharan Africa, PAD remains understudied in CKD. Ankle-brachial index (ABI) is a non-invasive and cost-effective tool to diagnose PAD. Objectives: Our aim was to determine the prevalence and associated risk factors for PAD in hemodialysis patients. Patients and Methods: We conducted a cross-sectional study from July 1 to December 31, 2012 in the department of Nephrology of the University Hospital Aristide le Dantec of Dakar. All consenting patients, aged above 18 years, on hemodialysis for at least 6 months were included. ABI measurements were performed using a handled pulse doppler. PAD was defined as an ABI of <0.9 or the history of surgical revascularization and/or amputation due to vascular disease. The patients were divided into two groups according to the presence or not of PAD. Standard blood tests and anthropometrical parameters were recorded. Results: A total of 53 patients with a mean age of 49.15 ± 15.18 were included. The sex ratio was 0.70. Hypertension (83.01%), low HDL-cholesterol (26.41%) and cigarette smoking (20.75%) were the main cardiovascular risk factors. Prevalence of PAD was 47.16%. Among patients with PAD, 52% had no suggestive symptoms. Lower pre-dialysis (p = 0.0384) and post-dialysis (p = 0.0447) diastolic blood pressure (BP) were significantly associated with PAD. The conventional risk factors (tobacco consumption, diabetes, alcohol consumption, dyslipidemia, hypertension, age), iPTH and CRP levels were not correlated with PAD. Conclusion: PAD is common among patients undergoing maintenance hemodialysis in Senegal. Early diagnosis and management of PAD should be routinely performed in CKD patients.