Ankle Branchial Index Research Articles

Effects of additional exercise therapy after a successful vascular intervention for people with symptomatic peripheral arterial disease.

Effects of additional exercise therapy after a successful vascular intervention for people with symptomatic peripheral arterial disease.

Use of Rotational Atherectomy-Assisted Balloon Angioplasty in the Treatment of Isolated Below-the-Knee Atherosclerotic Lesions in Patients with Chronic Limb-Threatening Ischemia.

The aim of the study is to evaluate the safety and effectiveness of rotational atherectomy-assisted balloon angioplasty (BTK-RA) for the treatment of isolated below the knee (BTK) atherosclerotic lesions and to compare the outcomes to plain old balloon angioplasty (POBA). Between January 2020 and September 2023, 96 consecutive patients with chronic limb threatening ischemia (CTLI) and isolated BTK-lesions underwent POBA (group A) or BTK-RA (group B). The primary outcome measures were: periprocedural technical success, primary patency, postoperative increase of the ankle branchial index (ABI), target lesion revascularization (TLR), limb salvage, minor amputation and death. Both techniques had similar technical success, operative time, intraprocedural complications and bailout stent implantations, independently of the operator's experience. Group B had significantly higher primary patency rates (93.5% vs. 72.0%, respectively, p = 0.006), TLR (2.1% vs. 24%, p = 0.057), lower in-hospital stay (2.0-3.0 vs. 4.0-6.0 days, respectively, p < 0.001) and higher postoperative ABI (0.8-0.2 vs. 0.7-0.1, respectively, p = 0.008), compared to group A. Significant differences (POBA n: 20, 40%, BTK-RA n = 3, 6.5%) were found in minor amputation rates between the two groups (p < 0.001), while the respective limb salvage rates were similar in both groups (94.0% vs. 97.8%, p = 0.35). The use of BTK-RA for the treatment of BTK-lesions in patients with CTLI showed significant clinical advantages in comparison to POBA.

The effects of CYP2C19 genotype polymorphism and clopidogrel resistance on ischemic event occurrence in patients with peripheral arterial disease undergoing revascularization: A prospective cohort study

IntroductionPeripheral arterial disease (PAD) affects approximately 236 million people worldwide. Therefore, this study aimed to investigate the relationship between CYP2C19 genotype polymorphisms and clopidogrel resistance (CR) following revascularization in patients with PAD. Materials and methodsIn total, 345 patients who underwent PAD revascularization were monitored for five years and risk factors for ischemic events were identified. Platelet reactivity and CYP2C19 genotypes were measured, and patients were classified as normal, intermediate, or poor metabolizers based on their genotypes. The study endpoint was defined as an ischemic event, that encompassed major adverse cardiovascular or limb events, or all-cause death. ResultsIn this study, ischemic events following PAD revascularization were associated with patient age, prior minor amputation, the Rutherford category before revascularization, indications for revascularization, index ankle-branchial index before revascularization, CYP2C19 phenotypes, and CR. Intermediate and poor metabolism, the Rutherford category before revascularization, and CR were independent risk factors for ischemic events in patients after PAD revascularization. Similarly, intermediate and poor metabolism, the Rutherford category before revascularization, and CR were independent risk factors for ischemic events in patients with PAD after revascularization within five years. Intermediate and poor metabolizers had a higher platelet reactivity and risk of CR than normal metabolizers. However, poor metabolizers had a higher platelet reactivity and risk of CR than intermediate metabolizers. Furthermore, the hazard ratio for ischemic events increased with platelet reactivity. This effect was more prevalent in intermediate and poor metabolizers than in normal metabolizers. ConclusionsIschemic events in patients after PAD revascularization were affected by independent risk factors. Decreased clopidogrel metabolism increased the platelet reactivity and CR in patients after PAD revascularization. Furthermore, high platelet reactivity was associated with an increased risk of ischemic events in patients with intermediate and poor metabolism.

Effect of fecal microbiota transplantation on primary hypertension and the underlying mechanism of gut microbiome restoration: protocol of a randomized, blinded, placebo-controlled study

BackgroundHypertension is currently the leading modifiable cause of global morbidity and mortality, leading to substantial health and financial burdens. Although multiple studies of management models and innovative therapeutic strategies for hypertension have been conducted, there are still gaps in the field, with a poor control rate reflecting a lack of novel, effective, clinically translated medication or intervention options. Recent animal and human studies repeatedly confirmed a link between the microbiota and hypertension. Of note is our previous study establishing a cause-and-effect relationship between the gut microbiota and blood pressure elevation. A hypothesis of gut microbiota intervention for treating hypertension is thus postulated, and fecal microbiota transplantation (FMT) from healthy donors was performed.MethodsA multicenter, randomized, placebo-controlled, blinded clinical trial will be performed in 120 grade 1 hypertensive patients for 3 months. All recruited patients will be randomly assigned in a 1:1 ratio to take oral FMT capsules or placebo capsules on day 1, day 7, and day 14 and will be followed up on day 30, day 60, and day 90. The primary outcome is the change in office systolic blood pressure from baseline to day 30. The main secondary outcomes are BP indicators, including changes in systolic and diastolic blood pressure from office and 24-h ambulatory blood pressure monitoring; assessments of ankle-branchial index and pulse wave velocity; profiling of fecal microbial composition and function; profiling of fecal and serum metabolome; changes in levels of blood glucose, blood lipids, and body mass index; and assessment of adverse events as a measure of safety.DiscussionExpanding upon our previous research on the role of the gut microbiota in the pathogenesis of hypertension, this study serves as a clinical translation advancement and explores the potential of fecal microbiota transplantation for treating hypertension. The underlying mechanisms, particularly the roles of specific microorganisms or their postbiotics in blood pressure amelioration, will also be investigated via multiple approaches, such as metagenomic sequencing and metabolomic profiling.Trial registrationClinicalTrials.govNCT04406129. Registered on May 28, 2020

Skin Autofluorescence a Non-Invasive Biomarker of Ages and Its Association to Metabolic Parameters in a Greek Diabetic Population

Objectives This cross-sectional study aims to evaluate the association between advanced glycation end-products (AGEs) accumulation, assessed by skin autofluorescence (SAF) measured using the AGE Reader, and the prevalence of several metabolic variables in a diabetic population. Methods The measurement of SAF has become a non-invasive method of assessing the accumulation of AGEs as a marker of the long-term impact of glycemic and oxidative stress in humans. In contrast to blood glucose and to hemoglobin A1C (HbA1c), which reflect a short period of glucose levels, the AGE is a marker of the metabolic legacy effect and reflect a long period of glucose levels. AGEs play a pivotal role in the development and progression of diabetic complications. SAF has been validated as a simple, non-invasive method for assessment of AGEs accumulation in the body. Results In this study 100 diabetic patients were participated. We non-invasively measured SAF, in all the participants using the AGE Reader (DiagnOptics Technologies BV, Groningen, The Netherlands). We also measured the body mass index (BMI), the blood pressure and the patients underwent arterial duplex sonogram (Doppler examination) in the legs at the level of the ankle and calculated the ankle-branchial index (ABI), which is an important index for diagnosing peripheral artery disease, which is a severe complication of diabetes. The SAF was positive correlated with age, duration of diabetes and systolic blood pressure (BP) and was negative correlated with ABI. Conclusion The measurement of SAF has become a non-invasive and reliable method of assessing the accumulation of AGEs in humans. In contrast to blood glucose and to HbA1c, which reflect a short period of glucose levels, the AGEs reflect a long period of glucose levels, correlate with certain metabolic parameters and with peripheral artery disease.

2-6SCREENING FOR PERIPHERAL ARTERY DISEASE IN HYPERTENSIVE PATIENTS AT A PRIMARY HEALTH CARE CENTRE IN BONTANG, EAST BORNEO: A STUDY USING ANKLE BRACHIAL INDEX BY PALPATION METHOD

Background: Hypertension is a significant risk factor for peripheral artery disease (PAD). Early identification and treatment of PAD could minimize disease progression and reduce cardiovascular mortality. Studies have validated ankle branchial index (ABI) by palpation as a simple and useful method for screening PAD in the setting of primary health care. Objective: To screen for PAD in hypertensive patients at a primary health care centre in Bontang, East Borneo. Methods: This was a cross-sectional study conducted in Puskesmas Bontang Utara II from August to September 2019. We did the screening of PAD in hypertensive patients aged ≥50 years using ABI by palpation method. PAD was defined as ABI &lt;0.9 in either leg. Hypertension is defined as systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg or taking antihypertensive medications. Patients with a history of diabetes mellitus, dyslipidemia, and smoking were excluded from this study. Results: A total of 139 hypertensive patients were included, 76 (54.7%) of them were female, with a mean age was 62.45 ± 8.92 years. There were 26 (18.7%) patients diagnosed with PAD, 7 (27%) of them were asymptomatic, and 19 (73%) were symptomatic. PAD was significantly higher in patients aged ≥65 years (OR = 7.51; p &lt; 0.001) and in patients who have suffered hypertension more than five years (OR = 3.18; p = 0.023). Sex and hypertension stage did not show a significant association with PAD. Conclusion: PAD affected almost one-fifth of hypertensive patients in this study population. Screening of PAD in primary health care needs to be done for hypertensive patients aged ≥50 years, especially emphasized in patients aged ≥65 years and have suffered hypertension for more than 5 years.

MON-683 Assessment of Features Associated with Diabetic Foot Risk in General Hospital in Lima-Peru

Objectives: To determine the frequency of diabetic foot risk of ulceration and associated factors in patients with type 2 diabetes mellitus. Methods and materials: We used a cross-sectional descriptive design. Data collection was performed in the foot at risk office at Maria Auxiliadora hospital over a period of 3 years, dating from the october 2016 to september 2019.Foot risk assessment was based on the International Working Group of Diabetic Foot (IWGDF) system, which evaluates peripheral neuropathy (with monofilament or tuning fork), biomechanical deformity, peripheral arterial disease (altered pulse or ankle branchial index) or a history of foot ulcer1,2. Foot risk frequency was found according to epidemiological characteristics, and the prevalence ratios with 95% confidence interval were calculated to association analysis, we perform bivariate and multivariate analysis using a generalized linear model. This study has the approval of the María Auxiliadora HospitaĹs Ethics Committee. Results: a total of 402 subjects were included in this study, 63.3% were women, average age 62 yo and diabetes duration <10 years in 56%. 76.6% presented risk to develop ulcer, of which 54.7% presented biomechanical deformation, 37.3% Peripheral Neuropathy (NP), 35.4% Peripheral Arterial Disease (PAD), and 12.7% history of foot ulcer. Patients with foot at risk were associated with older age (RP 1,006, 95% CI 1,001-1.01), and with a score> 5 with respect to <5 in the Total Symptom Score (RP 1.26, 95% CI 1.05-1.51). Conclusions: 3 of 4 patients have a foot at risk of ulceration, predominantly due to biomechanical deformation and peripheral neuropathy, and this risk was associated with older age and greater pain symptomatology.

Correlation of Ankle-Brachial Index with Diabetic Retinopathy in Patients of Type 2 Diabetes

Objectives: To find out a relationship of diabetic retinopathy with ankle-brachial (ABI) in patients of type 2 diabetes.&#x0D; Material and Methods&#x0D; It was a cross-sectional observational study carried out in Arif Memorial Teaching hospital and Rashid Latif Medical College from January 2019 to June 2019. 120 patients were selected by purposive convenient sampling from outpatient department of Arif Memorial Teaching hospital. After clinical history, complete ocular examination was performed. Random blood sugar levels were measured using Glucometer. Ankle-brachial index was calculated by dividing the systolic pressure at ankle by the systolic blood pressure at arm.&#x0D; Statistical analysis was done using SPSS 25. Independent sample t test and chi square tests were used to find out the significance of the results.&#x0D; Results:&#x0D; In this study of 120 diabetic patients, 80 (66.7%) were female and 40 (33.3%) were males. Mean Ankle Branchial Index (ABI) of Males was 0.96±0.11 and for females was 0.97±0.14. Among 120 participants of this study, 73 (60.83 %) patients had no signs of diabetic retinopathy, 35 (29.16 %) patients had NPDR and 12 (10%) patients had PDR. ABI was not associated with gender and duration of diabetes. However, there was negative and weak linear relationship between BSR and ABI (r= -0.221). This correlation was higher in diabetics of less than 5 year duration (r=-0.286) than in patients of more than 5 years duration of diabetes (r=-0.129). &#x0D; Conclusion: &#x0D; Our study indicates that ABI is not significantly related with diabetic retinopathy. However, there is a positive relationship of ABI with high blood sugar levels.

One-year results of drug-coated balloons for long and occlusive Femoropopliteal artery disease: a single-arm trial

BackgroundThe performance of drug-coated balloons (DCBs) in femoropopliteal interventions has been proven through randomized trials in short lesions and lesions with relatively low proportion of occlusions. There is limited evidence of DCBs in long or occlusive lesions. This study is to investigate the efficacy of the paclitaxel-coated balloon for treatment of long and occlusive femoropopliteal arterial lesions.MethodsA single-arm trial including 44 femoropopliteal lesions (chronic total occlusion (CTO) plus > 10 cm) treated with DCBs was performed to collect data of average 1-year follow-up. Endpoints contain primary patency, target lesion revascularization (TLR), amelioration of the Rutherford classification, change of ankle brachial index (ABI) and major adverse events.ResultsTechnical success is 97.7% while device success is 100%. Mean lesion length was 186 ± 86.3 cm. Stent implantation was performed in 13.6%. Cumulative probability of primary patency was 78.8% ± 6.8% at 1 year while that of freedom from TLR was 91.4% ± 4.9%. Rutherford classification improved from average 3.3 ± 1.0 to 2.1 ± 1.4 (p < 0.001) at follow-up with a 72.7% amelioration rate. Ankle-branchial index changed from 0.33 ± 0.40 to 0.67 ± 0.37 (p = 0.002). No major adverse event was observed.ConclusionThese results suggest that it is safe and effective to treat long and totally occlusive femoropopliteal artery disease with DCBs. Further studies are demanded to confirm these results.

Correlation of Ankle-Brachial Index with Diabetic Retinopathy in Patients of Type 2 Diabetes

Objectives: To find out a relationship of diabetic retinopathy with ankle-brachial (ABI) in patients of type 2 diabetes.&#x0D; Material and Methods&#x0D; It was a cross-sectional observational study carried out in Arif Memorial Teaching hospital and Rashid Latif Medical College from January 2019 to June 2019. 120 patients were selected by purposive convenient sampling from outpatient department of Arif Memorial Teaching hospital. After clinical history, complete ocular examination was performed. Random blood sugar levels were measured using Glucometer. Ankle-brachial index was calculated by dividing the systolic pressure at ankle by the systolic blood pressure at arm.&#x0D; Statistical analysis was done using SPSS 25. Independent sample t test and chi square tests were used to find out the significance of the results.&#x0D; Results:&#x0D; In this study of 120 diabetic patients, 80 (66.7%) were female and 40 (33.3%) were males. Mean Ankle Branchial Index (ABI) of Males was 0.96±0.11 and for females was 0.97±0.14.Among 120 participants of this study, 73 (60.83 %) patients had no signs of diabetic retinopathy, 35 (29.16 %) patients had NPDR and 12 (10%) patients had PDR. ABI was not associated with gender and duration of diabetes.However, there was negative and weak linear relationship between BSR and ABI (r= -0.221). This correlation was higher in diabetics of less than 5 year duration (r=-0.286) than in patients of more than 5 years duration of diabetes (r=-0.129). &#x0D; Conclusion: &#x0D; Our study indicates that ABI is not significantly related with diabetic retinopathy. However, there is a positive relationship of ABI with high blood sugar levels.

Association between physical activity level and ankle-branchial index in patients with risk factors of peripheral arterial disease

Introduction: Peripheral arterial disease (PAD) causes a three-fold increase in risk of mortality and major cardiovascular events. PAD is typically diagnosed with ankle-branchial index (ABI) ≤0.90. World Health Organization recommends to address behavioural risk factors to prevent further burden of cardiovascular diseases. Purpose: The aim of this study was to examine correlation between physical activity level and ABI among patients with risk factors of PAD and ABI in normal range or ABI indicating some or moderate arterial disease. Methods: 71 patients who were over 65 years old and had minimum of two additional PAD risk factors were recruited. Physical activity level was measured by International Physical Activity Questionnaire, walking ability was assessed by 6-minute Walking Test (6MWT). Results: Mean ABI was in normal range (1.08, SD 0.15). Mean Body Mass Index of the group indicated obesity (30.6, SD 5.5 kg/m2). Among modifiable PAD risk factors, hypertension and dyslipidaemia were the most prevalent. Most of the participants (62%) were moderately active. Mean total physical activity was 5310.2 MET-min per week. The average person has been sitting for around 5 hours per day. The mean result of 6MWT was 432.2 meters (SD 103.4). Following correlations were observed: between total physical activity level and ABI (r=0.17), between walking ability and ABI (r=0.39), sitting time and ABI (r=-0.32). Conclusions: older people with PAD risk factors could benefit from everyday walking and housework. Incorporating walking while transportation can exert PAD prevention effect. Sitting time should be avoided. These recommendations apply not only for patients with some or moderate PAD, but also for older individuals with normal range ABI, but with PAD risk factors.

Contrast-enhanced Sonothrombolysis to Accelerate Treatment of Acute Peripheral Arterial Occlusions: The Preliminary Results of the Must Trial (A Feasibility and Safety Phase-II Trial)

Introduction: Catheter-directed thrombolysis is a well-established less-invasive alternative to surgical thrombo-embolectomy. However, the risk of hemorrhagic events in patients with an acute peripheral arterial occlusion remains high with up to 10% of patients experiencing bleeding complications, 2% of which are intracranial hemorrhages. The addition of microbubbles and ultrasound (i.e. contrast enhanced sonothrombolysis) could make the thrombus more susceptible for thrombolysis. We are the first to investigate the safety and technical feasibility of this therapy in patients with an acute peripheral arterial occlusion. Methods: The MUST (Microbubble-accelerated sonothrombolysis) trial is a single-centre phase-II trial focusing on patients with acute peripheral arterial occlusions. In this study, 20 patients will receive intravenous infusion of microbubbles and ultrasound in the first hour of the thrombolytic therapy. Primary endpoints are mortality and other serious adverse events. Secondary endpoints are technical, angiographic and clinical success, conversion, additional interventions, treatment duration and complications. During hospitalization, treatment efficacy will be monitored by daily angiography, duplex examination every six hours, ankle-branchial index, microcirculation and pain scores. Results: Currently, we have included 7 out of 20 patients. No mortality or serious adverse events related to the experimental treatment occurred. In 6 patients, thrombolysis was successful and revascularisation was established after 52.3 hours (range 8.0-81.0). The total therapy duration was on average 70.8 hours (range 49.5-99.5). Additional endovascular interventions included three percutaneous transluminal angioplasties and one thrombosuction. In one patient, open surgical treatment was required after 24 hours of unsuccessful thrombolysis due to no inflow in an occluded iliaco-crucal prosthetic bypass proximal of the treated lesion. Conclusion: Preliminary results show promising study outcomes without major complications. We report no mortality or treatment-related serious adverse events. Further inclusions are necessary to evaluate the safety and feasibility of contrast-enhanced sonothrombolysis for patients with acute peripheral arterial occlusions. Successive studies would help to determine the success of this treatment and its applicability in clinical practice worldwide.

Prevalence of peripheral artery disease in diabetic patients of a tertiary care hospital

Background: Peripheral Arterial disease (PAD) is a major microvascular complication of diabetic mellitus. Patients with diabetes have an increased prevalence of PAD. The Ankle branchial Index (ABI) is an easy, noninvasive and often underutilized tool for diagnosis of PAD. The aim of this study is to detect the prevalence of PAD in diabetic patients using Ankle Brachial Index (ABI). Since most of the patients with PAD are asymptomatic, routine screening for the same is necessary to avoid lower limb ulcerations and amputation.Methods: In this cross-sectional study, 200 diabetic patients attending a tertiary care hospital in the Kancheepuram district of Tamilnadu were screened for the prevalence of PAD using ABI and to find out risk factors associated with it.Results: Among the 200 diabetic patients who underwent ABI measurements using handheld Doppler, 19.5% were found to be having PAD. Most of them were symptomatic. Age more than 50 years and female gender were considered as statistically significant (P&lt;0.05) determinants of PAD.Conclusions: PAD is relatively common in elderly diabetics. ABI measurement is a valid tool in early detection of PAD and therefore regular follow up will decrease disabilities in the diabetic population.

Using maximal systolic acceleration to diagnose and assess the severity of peripheral artery disease in a flow model study

BackgroundBecause of the presence of medial calcific sclerosis, both ankle-branchial index and toe pressure measures can yield misleading results when attempting to diagnose peripheral artery disease (PAD). A new ultrasound parameter, maximal systolic acceleration (ACCmax), can be an accurate tool for diagnosing PAD, including in diabetic patients. However, it has not been evaluated thoroughly. The aim of this study was to assess the feasibility of using ACCmax to diagnose and assess the severity of PAD. MethodsThe human circulatory system was simulated using an in vitro circulatory system driven by a pulsatile pneumatic pump. Arterial stenosis of various degrees (50%, 70%, 80%, and 90%) was simulated in order to investigate the change in several ultrasound parameters (including ACCmax), as well as the intraluminal mean arterial pressure gradient. In a separate set of measurements, interobserver variability was measured using two investigators who were unaware of the degree of stenosis. ResultsACCmax significantly decreased (P < .001), and the pressure gradient increased (P < .001) as the degree of stenosis increased. Moreover, we found a strong correlation between ACCmax and the pressure gradient (R2 = 0.937). Finally, interobserver variability with respect to ACCmax was extremely low, with an intraclass correlation coefficient of 0.99. ConclusionsThe results of this flow model study suggest that ACCmax can be a valid, noninvasive tool for diagnosing PAD. Moreover, our finding that ACCmax decreases as the severity of stenosis increases, together with the strong correlation between ACCmax and the pressure gradient, suggests that ACCmax may be useful as an alternative diagnostic tool for assessing the severity of PAD. These promising in vitro data warrant further study in a clinical setting.

Clinical Manifestation of Peripheral Artery Disease in Type 2 Diabetes Melitus with Ankle Branchial Index Measurement

Diabetes mellitus (DM) is a metabolic disease that has a high prevalence in Asia, including Indonesia. One of the complications of DM is Peripheral Artery Disease (PAP). Ankle Brachial Index (ABI) measurement is a simple and non-invasive methods that can be used for PAP evaluation. This study aims to provide an overview of the clinical manifestations of PAP and the value of ABI as early detection of PAP in patients with type-2 DM. This research uses quantitative descriptive design studies. The research variables used to assess PAP were ABI values, age, sex, duration of diabetes mellitus, hypertension, and clinical manifestations of PAP such as pain, intermittent claudication, muscle atrophy, skin discoloration, sweating, wound healing impairment, and gangrene. This study involved 92 research subjects. From the study we found out that the normal ABI value and the ABI value of the PAP category in patients with type 2 diabetes were 91.3% and 7.6%. The ABI value of the PAP category in DM patients is more commonly found in women (6.5%), adult patients (5.4%), duration of DM up to 2 years (5.4%), and with hypertension (5.4%) . Pain and numbness are the most common clinical manifestations of PAP in DM patients.&#x0D; &#x0D; &#x0D; Keywords: diabetes mellitus, ankle brachial index, peripheral artery disease.

A study to correlate arterial doppler sonography with ankle branchial index among diabetics and hypertensive in tertiary care hospital

A study to correlate arterial doppler sonography with ankle branchial index among diabetics and hypertensive in tertiary care hospital

The value of ankle-branchial index screening for cardiovascular disease in type 2 diabetes.

To investigate the relationship between ankle-branchial index (ABI) and cardiovascular disease in type 2 diabetes patients. A total of 634 inpatients with type 2 diabetes were recruited in this cross-sectional study. All patients were measured with ABI and computed tomography angiography (CTA) scan for coronary artery disease (CAD). According to ABI values, patients were divided into three groups: low-ABI group (ABI<0.9, n=259), normal-ABI group (ABI=0.9-1.3, n=272), and high-ABI group (ABI>1.3, n=103). According to the manifestation of coronary CTA, the patients were divided into CAD group (n=348) and non-CAD group (n=286). Their clinical data and biochemical parameters were compared and analysed. The prevalence of CAD in low-ABI group (90%) was significantly higher than that of normal-ABI group (33%) and high-ABI group (25%) (both P<0.01). Spearman correlation analysis showed that age, sex, duration, spontaneous bacterial peritonitis, total cholesterol (TC), triglyceride, low-density lipoprotein cholesterol (LDL-C), serum creatinine, and glycosylated haemoglobin (HbA1c ) were positively correlated with CAD, and high-density lipoprotein cholesterol (HDL-C), glomerular filtration rate, and ABI were negatively correlated with CAD. Logistic regression analysis further revealed that age, sex, duration, TC, HDL-C, LDL-C, HbA1c , and ABI were independent risk factors of CAD. After all potential confounders is adjusted, the risk of CAD in low-ABI group still increased over four times than the normal-ABI group (odds ratio [OR], 5.32; 95% CI, 1.973-16.5; P<0.001). In female patients, this risk increased more than nine times (OR, 10.63; 95% CI, 3.416-17.8; P<0.001). Receiver-operating characteristic analysis indicated that ABI<1.045 predicted the occurrence of CAD (sensitivity, 79.7%; specificity, 71.5%; P<0.01). ABI is an independent risk factor for CAD and may be a potential simple screening instrument for CAD in Chinese type 2 diabetic patients, especially in elder women.

PP-211 - Successful Percutaneous İntervention of Chronic Limb Threatiening İschaemia

Case report: A 64 year old female patient was refered to our clinic with leg pain. She had suffered this pain for 1 year and an increasing severity during the last month made her refer to our hospital. At rest she had a burning and aching feeling especially at the calf and foot that had become prominent at rest since the last month. Her medical history included dibetes mellitus, hypertension and coronary bypass surgery and amputaiton of the left 3rd toe due to a gangrenous infection. On admission her blood pressure was 150/90 mm Hg with a sinus rhythm and heart rate of 90 beats per minute. Lung and cardiac examination was unremarkable. Astonishingly her left foot had marked, large and deep wounds extending to the bone and infectious drainage with unpleasant smell (Figure 1). laboratory showed leucocytosis and high levels of C-reactive protein. The right Ankle branchial index (ABI) was in normal range (1,2), however the left ABI was not proficiently performed due to leg pain during the cuff inflation. So we made duppler ultrasonography showing monophasic flow at the left distal posterior tibialis artery in the ankle location with increased pik systolic flow in the proximal region of the posterior tibialis artery. After that, a detailed cleaning of the wounds and broad spectrum antibiotics were administered. Antiplatelet therapy with antihypertensive and intensive insulin therapy stabilised the patient. After one week of intensive treatment the patient was in a more stable condition with a diminished feeling of pain. Then a peripheral angiography was performed. As both the femoral pulses were weak a radial approach was decided for peripheral angiography. Right leg angiography showed unremarkable atherosclerotic lesions, however a critical stenosis was found in the proximal region of the posterior tibialis artery and other tandem lesions as well in the anterior tibialis anterior of the left leg. These lesions were accurately seen with selective angiography by an antegrade approach introducing a 6 French radial sheath at the left femoral artery. the collaterals between the main arteries however insufficient, maintained the blood flow downstream the foot (Video 1). We decided to relieve the critical stenosis of the proximal posterior tibialis artery as the plantar side of the foot is almostly perfused by this artery. A predilatation with 3,0 × 20 mm bare balloon was performed. The residual stenosis was finally dilated with 3,0 × 80 mm drug coated balloon and a successful intervention with a prominent downstream blood flow was achieved (Videos 2, 3). We decided not to intervene to the anterior tibialis artery as there were multiple collaterals perfusing pre and post oclussion segments of the artery. After the successful intervention a podographic analysis was performed. Pes planus was diagnosed and a special tipe of anti trauma shoes was suggested. The patient was healthily discharded on dual antiplatelet therapy, cilostazol, antihypertensive, statin and intensive insuline therapy. At follow-up her left foot was markedly recovered and the previously deep infectious wounds were closed (Figure 2, Figure 3). Figure 2 View Large Image Figure Viewer Download Hi-res image Figure 3 View Large Image Figure Viewer Download Hi-res image

Effectiveness and feasibility of nailfold microcirculation test to screen for diabetic peripheral neuropathy.

The nailfold microcirculation index (MI) is a non-invasive, objective, and highly sensitive blood capillary detection method. This study evaluated the diagnostic efficiency of the nailfold MI relative to the more subjective vibration perception threshold (VPT) examination for early diagnostic screening of diabetic peripheral neuropathy (DPN). From February 2015 to February 2016, 227 diabetes mellitus patients and 39 healthy individuals were enrolled. Each subject underwent the MI test and the VPT examination. MI was more closely associated with DPN than age, diabetic duration, smoking, drinking, systolic pressure, serum creatinine, 24-h urinary protein, hypoxia-inducible factor-1α (HIF1A), vascular endothelial growth factor (VEGF), the VEGF receptors Flt-1 and Flt-4, ankle branchial index (ABI), DPN, or DPN stage (OR=11.819). Both the MI and VPT closely correlated with age, diabetic duration, serum creatinine, 24-h urinary protein, HIF1A, VEGF, Flt-1, Flt-4, ABI, DPN, and DPN stage. By the receiver operating characteristic (ROC) curve, the MI diagnostic cutoff point was 2.56, where the corresponding Youden's index was maximum and the area under ROC curve was 0.943. The diagnostic efficiency of MI and VPT were similar. MI and VPT indicated similar percentages of diabetic patients with DPN at the most severe stage, while MI achieved a higher diagnostic rate for the earliest stages. The nailfold MI is a feasible method for clinical early diagnostic screening of DPN in diabetic patients, and is more objective and reliable than VPT.

MODELING AND HEMODYNAMIC SIMULATION OF HUMAN ARTERIAL STENOSIS VIA TRANSMISSION LINE MODEL

Arterial stenosis plays a key role in the development and formation of cardiovascular diseases. The effects of arterial stenosis on the global hemodynamic characteristics of human artery tree were studied based on a previously proposed transmission line model of 55 segment arterial tree. Different position, degree and length of the arterial stenosis were simulated to discuss the changes of blood pressure and flow waveform in human arterial tree. The stenosis degree of 50% to 90% were specified to represent a mild, moderate or severe stenosis. Three representative stenosis positions: aorta, carotid and iliac artery were selected. The stenosis length was specified to be 1[Formula: see text]cm to 4[Formula: see text]cm. The results of simulation were compared with the literature data. And ankle branchial index (ABI) was calculated to show its relationship with the stenosis position. The results showed that the influence of aorta stenosis on the blood pressure and flow waveforms of upstream artery is more obvious than those of downstream artery; branch artery stenosis has more influence on the blood pressure and flow waveforms of downstream artery than those of upstream artery. When the stenosis degree increased to 80%, the blood pressure and flow waveforms are affected significantly. The stenosis length causes a obvious change in the pressure and flow waveforms of stenosis inlet and outlet. The comparisons of literature and ABI demonstrated that the modeling method is a feasible tool to simulate and study the hemodynamics of the human artery stenosis.