Ankle-brachial Index Research Articles

Foot Sole Temperature Correlates with Ankle-Brachial Index, Pulse Wave Velocity, and Arterial Age in Diabetic Patients Without Diagnosis of Peripheral Arterial Disease.

Background/Objectives: Some vascular alterations such as peripheral arterial disease (PAD) or arterial stiffness can alter perfusion of the limbs, so we wondered if this is reflected in the temperature of the soles of the feet of diabetic patients who did not have a diagnosis of peripheral arterial disease. Foot sole temperature was correlated with the ankle-brachial index (ABI), carotid-femoral pulse wave velocity (cfPWV), brachial-ankle pulse wave velocity (baPWV), and arterial age. Methods: A total of 175 patients with type 2 diabetes mellitus, without a previous diagnosis of PAD, were recruited. Comorbidities, anthropometry, biochemical analysis results, temperature, ABI, cfPWV, baPWV, and arterial age were recorded. Forty-two temperature records were obtained from the sole of the foot with an FLIR T865 thermal imaging camera. ABI, cfPWV, baPWV, and arterial age were obtained using plethysmographic and oscillometric methods. Statistical analysis was performed with SPSS v.29.0 (correlations and multiple linear regression models). Results: All temperature points analyzed correlated negatively with ABI (p < 0.001) and rho values ranged from -0.168 to -0.210. Likewise, cfPWV, baPWV, and arterial age had similar results, since most temperature records showed low rho values and a negative correlation with these parameters. Four models were developed to explain the variables of interest. Temperature was involved in all of them. The temperature of the first toe was included in the prediction of cfPWV, baPWV, and arterial age. Conclusions: There is an inversely proportional relationship between temperature and ABI, cfPWV, baPWV, and arterial age in diabetic patients without a previous diagnosis of arterial disease. Temperature can be a predictor of these hemodynamic variables.

Plasma Lipidomic Profiles Improve upon Traditional Risk Factors for the Prediction of Arterial Stiffness Among Patients with Type 2 Diabetes Mellitum: A Randomized, Placebo-Controlled Trial.

Exercise or vitamin D intervention can reduce the risk of arterial stiffness; however, the underlying mechanisms of lipid metabolism remain unexplored. To examine the effects of a 12-week moderate and vigorous exercise program (65-80% maximal heart rate, 60 min/time, 2~3 times/week) with or without vitamin D supplementation (1000 IU/day) on the reduction in arterial stiffness and further explore whether the effects of interventions could be associated with the basal lipidome among patients with Type 2 diabetes mellitum (T2DM). 61 patients with T2DM were randomly assigned to the following groups: control (CON, n = 15), exercise (EX, n = 14), vitamin D (VD, n = 16), and exercise + vitamin D (EX + VD, n = 16). Arterial stiffness risk factors (ankle-brachial index (ABI); brachial-ankle pulse wave velocity (baPWV), systolic blood pressure (SBP), and diastolic blood pressure (DBP)) were evaluated before and after the intervention. The plasma lipidome was determined using ultra-performance liquid chromatography coupled with tandem mass spectrometry. Machine learning was applied to establish prediction models for the responsiveness to arterial stiffness. Vitamin D supplementation could inhibit the decrease in the ankle-brachial index (mean ± SD: EX + VD and VD, -0.001 ± 0.058; EX + CON, -0.047 ± -0.089; p = 0.03). We observed high inter-individual variability in the arterial stiffness risk factors in response to the interventions. We also found that optimally selecting the lipid predictors at baseline, such as SM d44:6, LPE 18:2, and Hex2Cer 29:0, could enhance the predictive power by 100% for arm SBP changes in the exercise group. Basal levels of Cer (33:1) and GM3 (44:4) could enhance the predictive power by 100% for changes in baPWV in the vitamin D group. A 12-week vitamin D supplementation was beneficial in preventing arterial stiffness. Compared with traditional clinical risk factors, specific lipids at baseline could significantly improve the ability to predict intervention-induced changes in the reduction of arterial stiffness.

The use of a novel toe-thumb pressure index for assessing arterial status in the lower limb. A reliability and validity study.

This study explored the reliability, validity and perceived comfort of a novel thumb pressure measure and calculation of a toe-thumb index to identify their suitability as an adjunct or alternatives to ankle-brachial and toe-brachial indices. Repeated manual thumb and toe systolic blood pressures were conducted using two raters, over two time points, on 34 healthy participants. Concurrent automated toe, thumb and brachial systolic blood pressures as well as comfort ratings for these measures (using a 10mm visual analogue scale) were captured once by a research assistant. Automated thumb and brachial measures showed fair correlation (ρ=0.36, p=0.03) and a toe-thumb index and toe-brachial index good correlation (ρ=0.62, p<0.01). Intraclass correlation coefficients (ICC) identified moderate intra-rater reliability for manual thumb pressures for Rater 1 and 2 (ICC 0.57, 95% CI [0.14, 0.79] and ICC 0.74, 95% CI [0.49, 0.87], respectively), while inter-rater reliability was poor (ICC=0.16, 95% CI [-0.85, 0.47]). Concurrent validity comparing manual and automated measures for thumb pressure was also poor (ICC -0.05, 95% CI [-1.06, 0.72] and ICC 0.42, 95% CI [-0.16, 0.72] Rater 1 and 2 respectively). Thumb measures were significantly more comfortable than brachial measures (5mm, p<0.00). Thumb systolic pressures are correlated with brachial systolic pressures, with reasonable intra-rater reliability, however, correlation is only fair and measurement error wider than clinically acceptable. Furthermore, manual measures are poorly correlated with automated units. Consequently, caution is required in applying these techniques. As thumb measures were perceived as significantly more comfortable than brachial measures and have an advantage where brachial pressures cannot, or should not, be obtained, further evaluation is warranted.

Technical aspects of the new BYCROSSTM atherectomy device - preliminary results after 28 patients.

Purpose: Technical aspects are crucial for the planning and performing of the atherectomy to treat peripheral arterial disease. This report illustrates the use of a novel atherectomy device and investigates the feasibility, efficacy, and safety procedures involved in performing the atherectomy on 28 patients. We performed a prospective analysis of patients who underwent an atherectomy with the BYCROSSTM Atherectomy device between August 2022 and September 2023 at a tertiary referral centre. Patients with a lesion below the aortic bifurcation (vessel diameter ≥ 3mm) having a de novo or restenotic (stent-included) present were recruited. Major adverse events (MAE) are defined as amputation, death, myocardial infarction, or angiographic distal embolization that require a separate intervention. Of the 28 patients treated with the BYCROSS device, 23 were men with a mean age of 65.6 ± 9,6 years and a mean BMI of 24,6 ± 3.9 kg/m2. Most patients had a typical atherogenic risk profile as well as multiple preexisting comorbidities. In all patients, a symptomatic peripheral arterial disease (PAD) was the main reason for an intervention. The most common Rutherford category was 5 (12/28). The most common lesion region was the femoropopliteal segment (25/28) with 23 de novo stenosis. Mean lesion length was 218,0 ± 93,7 mm. The mean PACCS Score was 3,0 ± 1,0. Stenosis grade was by mean 99,3 ± 3,7%. Ankle Brachial Index (ABI) increased significantly after BYCROSS atherectomy (pre- 0,44 ± 0,43 vs. post-procedure 0,84 ± 0,30 P<0,001. Target lesion/vessel revascularization (TLR/TVR) within the first 30 days was 3,6% (1/28). 30-day MAE rate was 14,3% (vessel perforation in 3/28 patients, embolism in 1/28). There were no deaths, index limb amputations, or myocardial infarctions. The BYCROSSTM atherectomy system is a new device with numerous advantages in treating high-grade, calcifying stenosis and occlusion processes in PAD. Based on the above findings, the BYCROSSTM Atherectomy device represents a feasible, safe, and effective method for endovascular treatment of peripheral arterial disease.

Temporary decrease in microvascular tissue saturation after transcatheter aortic valve implantation.

Data on the effect of transcatheter aortic valve implantation (TAVI) on peripheral microcirculation are limited. The aim of this study is to evaluate peripheral microvascular tissue saturation (StO2) before and after TAVI in relation to central and peripheral hemodynamics, cardiac and renal function. In this single-center prospective study, patients with severe aortic stenosis (sAS) scheduled for TAVI or cardiac catheterization (control) were assessed before and up to five days after the procedure. Cardiac function including cardiac output (CO) was assessed by echocardiography. Brachial (bBP) and central blood pressure (cBP), ankle brachial index (ABI), and parameters of arterial stiffness, including augmentation pressure (AP) and augmentation index adjusted for heart rate (AIx@HR75) were measured to assess hemodynamic changes. StO2 was measured in all extremities using a near-infrared spectroscopy (NIRS) camera. Renal function was measured by creatinine levels. 26 patients underwent TAVI and 11 patients served as control. Cardiac output was significantly increased, whereas hemodynamic parameters and peripheral StO2 were significantly decreased after TAVI. At follow-up, StO2 returned to baseline values. Changes in StO2 were negatively related to creatinine levels. Transcatheter aortic valve implantation causes a temporary decrease in microvascular tissue saturation that is associated with renal function.

Prognostic factors and outcomes of chronic limb threatening ischaemia in patients post kidney transplant: a systematic review

BackgroundKidney Transplantation (KT) is widely recognized as the optimal treatment for patients with End Stage Renal Disease (ESRD), improving not only life expectancy but also quality of life. Undetected peripheral arterial disease (PAD) in patients undergoing KT may lead to lower limb ischaemic ulceration and gangrene which is associated with an increased mortality rate. If undiagnosed and untreated this may lead to limb loss and graft failure. This review aims to evaluate the current evidence related to the prognosis of chronic limb-threatening ischemia (CLTI) in patients with a KT.MethodsWe conducted a systematic review of the literature in PubMed and MEDLINE, the Cochrane database of systematic reviews, Elsevier, Web of Science, and CINAHL using relevant search keywords to identify the prognosis and progression of CLTI in patients with a KT. Outcomes of interest were CLTI and progression rate in terms of haemodynamic measurement. This systematic review adhered to the guidelines set forth by the Cochrane Collaboration. The study design, population selection, and follow-up time frame were outlined in accordance with the PRISMA guidelines.ResultsStudies have shown a decline in the ankle-brachial index (ABI) post-KT, indicating vascular deterioration. Surgical interventions and amputations are more likely, particularly on the ipsilateral side of KT. The infrapopliteal artery is the most compromised in this cohort. A low ABI was found to be an independent predictor of graft failure, doubling the risk of mortality post-KT. Quality of evidence was observed to be low primarily due to confounding and selection bias.ConclusionsThe available evidence regarding the prognosis of CLTI in individuals with KT is limited to a small number of studies offering predominantly low-quality evidence and conflicting results pertaining to PAD and its progression into CLTI. Further research is required on CLTI prognosis and progression among KT recipients.

Leukotrienes E4 and B4 and vascular endothelium – New insight into the link between vascular inflammation and peripheral arterial

Leukotrienes are proinflammatory mediators that participate in the process of atherogenesis and contribute to the development of symptomatic peripheral arterial disease. The aim was to evaluate the relationship between leukotriene E4 (LTE4) and B4 (LTB4) with parameters reflecting endothelial vascular function in patients with chronic lower limb ischemia. This prospective observational study enrolled 50 consecutive patients undergoing endovascular treatment due to chronic lower limb ischemia (Rutherford 3). All participants were followed-up for one year (after 1, 3, 6 and 12 months), with a sequential assessment of urinary LTE4 and LTB4, as well as measures of endothelial and vascular function: Flow-Mediated Dilatation (FMD), Intima-Media Thickness (IMT), corrected Augmentation Index (AI75), Shear Rate (SR), Ankle-Brachial Index (ABI), Toe-Brachial Index (TBI). There was a significant relationship between LTE4 and measures of vascular function: FMD (R2 = 0.69, P < 0.001), IMT (R2 = 0.12, P < 0.01), AI75 (R2 = 0.43, P < 0.001), SR (R2 = 0.48, P < 0.001). Similar findings were noted for LTB4: FMD (R2 = 0.47, p < 0.001), IMT (R2 = 0.23, P < 0.001), AI75 (R2 = 0.61, P < 0.001) and SR (R2 = 0.33, P < 0.001). Alterations in parameters were significantly related: ΔLTE4 vs ΔFMD(R2 = 0.63, P < 0.001), ΔSR (R2 = 0.42, P < 0.001) and ΔLTB4 vs AI75(R2 = 0.40, P < 0.001), SR(R2 = 0. 29, P < 0.001). We conclude, that increasing concentrations of LTE4 and LTB4 are associated with impairment of vascular and endothelial function, which may lead to worse endovascular treatment clinical outcomes.

Impact of vascular biomarkers and supine hypertension on cardiovascular outcomes in hypertensive patients: first results from the Cardiovascular Prognostic COUPLING Study in Japan.

The prognostic impact of vascular biomarkers and supine blood pressure (BP) is not well understood. The multicenter, prospective Coupling study determined the prognostic impact of vascular biomarkers and supine BP in outpatients aged ≥30 years with ≥1 cardiovascular risk factor. Occurrence of major cardiovascular events during follow-up was recorded. The primary outcome was time to onset of a major cardiovascular event. Office and supine BP, the cardio-ankle vascular index (CAVI), and the ankle-brachial index (ABI) were determined annually. Of the 5109 participants in the Coupling study, 4716 were analyzed (51.9% male, mean age 68.5 ± 11.4 years); participants mostly had hypertension treated based on seated office/home BP according to relevant guidelines. During a median follow-up of 5.0 years (interquartile range 3.6-5.2), 231 major cardiovascular events occurred. After adjustment for age, sitting office systolic BP, and other covariates, a 1-unit increase in CAVI (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.01-1.24) and a 0.1-unit decrease in ABI (HR 1.41, 95% CI 1.18-1.68) were significantly associated with cardiovascular event risk; risk was greatest when CAVI was ≥8.0 and ABI was ≤1.10. Uncontrolled supine hypertension (≥140/90 mmHg) was also significantly associated with adjusted cardiovascular event risk (HR 1.36, 95% CI 1.02-1.81); seated office BP control was not significantly associated with cardiovascular event risk. Increased arterial stiffness, mildly lower ABI, and supine hypertension are risk factors for cardiovascular events during standard clinical practice. Supine evaluation of BP and vascular biomarkers has highlighted a blind spot in current hypertension management (Clinical trial registration: University Hospital Medical Information Network Clinical Trials Registry, UMIN000018474).

Associations of Circulating ANGPTL3, C-Terminal Domain-Containing ANGPTL4, and ANGPTL3/8 and ANGPTL4/8 Complexes with LPL Activity, Diabetes, Inflammation, and Cardiovascular Mortality.

ANGPTL3/4/8 (angiopoietin-like proteins 3, 4, and 8) are important regulators of LPL (lipoprotein lipase). ANGPTL8 forms complexes with ANGPTL3 and ANGPTL4. ANGPTL4/8 complex formation converts ANGPTL4 from a furin substrate to a plasmin substrate, and both cleavages generate similar C-terminal domain-containing (CD)-ANGPTL4 fragments. Whereas several studies have investigated associations of free ANGPTL proteins with cardiovascular risk, there are no data describing associations of the complexes and CD-ANGPTL4 with outcomes or describing the effects of the complexes on LPL bound to GPIHBP1 (glycosylphosphatidylinositol HDL-binding protein 1). Recombinant protein assays were used to study ANGPTL protein and complex effects on GPIHBP1-LPL activity. ANGPTL3/8, ANGPTL3, ANGPTL4/8, and CD-ANGPTL4 were measured with dedicated immunoassays in 2394 LURIC (Ludwigshafen Risk and Cardiovascular Health) study participants undergoing coronary angiography and 6188 getABI study (German Epidemiological Trial on Ankle Brachial Index) participants undergoing ankle brachial index measurement. There was a follow-up for cardiovascular death with a median (interquartile range) duration of 9.80 (8.75-10.40) years in the LURIC study and 7.06 (7.00-7.14) years in the getABI study. ANGPTL3/8 potently inhibited GPIHBP1-LPL activity and showed positive associations with LDL-C (low-density lipoprotein cholesterol) and triglycerides (both P<0.001). However, in neither study did ANGPTL3/8 correlate with cardiovascular death. Free ANGPTL3 was positively associated with cardiovascular death in the getABI study but not the LURIC study. ANGPTL4/8 and especially CD-ANGPTL4 were positively associated with the prevalence of diabetes, CRP (C-reactive protein; all P<0.001), and cardiovascular death in both studies. In the LURIC and getABI studies, respective hazard ratios for cardiovascular mortality comparing the third with the first ANGPTL4/8 tertile were 1.47 (1.15-1.88) and 1.68 (1.25-2.27) when adjusted for sex, age, body mass index, and diabetes. For CD-ANGPTL4, these hazard ratios were 2.44 (1.86-3.20) and 2.76 (2.00-3.82). ANGPTL3/8 potently inhibited GPIHBP1-LPL enzymatic activity, consistent with its positive association with serum lipids. However, ANGPTL3/8, LDL-C, and triglyceride levels were not associated with cardiovascular death in the LURIC and getABI cohorts. In contrast, concentrations of ANGPTL4/8 and particularly CD-ANGPTL4 were positively associated with inflammation, the prevalence of diabetes, and cardiovascular mortality.

Screening for Peripheral Vascular Disease: The Role of Ankle-Brachial Index (ABI) and Estimated Glomerular Filtration Rate (eGFR) Changes in Chronic Kidney Disease.

Background Chronic kidney disease (CKD) is a significant public health issue worldwide, closely linked with cardiovascular events such as atherosclerosis, peripheral arterial disease (PAD), stroke, coronary artery disease (CAD), and heart failure. The ankle-brachial index (ABI) is a simple tool that compares blood pressure in the ankle and arm, helping to detect PAD and assess the risk of cardiovascular events. An increased ABI signifies an increased risk of cardiovascular disease (CVD), whereas a diminished ABI correlates with angiographically verified atherosclerosis along with heightened death rates. Recent research indicates a U-shaped relationship between ABI and mortality, underscoring the necessity for early detection and action to mitigate potential consequences. Aim This study aimed to correlate ABI changes with estimated glomerular filtration rate (eGFR) changes in CKD patients to screen for the development of peripheral vascular disease. Materials and methods This prospective cross-sectional study was conducted in the outpatient department of a tertiary care hospital in India, focusing on patients diagnosed with CKD admitted to the general medicine department. The inclusion criteria were CKD patients with an eGFR less than 60 ml/min/1.73 m², accompanied by indicators of renal damage such as albuminuria, reduced kidney size on ultrasound, abnormal urinary sediment, or biopsy-proven kidney disease. Patients with peripheral vascular disease, with end-stage renal disease (on dialysis), with limb amputations, with hemodynamic instability, or who declined participation were excluded. eGFR was calculated using the Modification of Diet in Renal Disease (MDRD) equation, and the ABI was measured at baseline, three months, and six months. ABI values below 0.9 indicated peripheral vascular disease, and the study aimed to correlate changes in ABI with eGFR to assess vascular disease development in non-dialyzed CKD patients. Results By the end of the third month, a positive correlation was observed between ABI and eGFR (r=0.259), which persisted at the end of the sixth month (r=0.245). Conclusion The study concludes that a direct relationship exists between decreasing eGFR and ABI, which increases susceptibility to PAD and CVD. A low ABI is linked to an accelerated decline in eGFR, indicating that systemic atherosclerosis predicts kidney function deterioration.

Obese have comparable ankle brachial pressure index but higher β-cell function and insulin resistance as compared to normal-weight type 2 diabetes mellitus patients.

To compare ankle brachial pressure index (ABPI) in normal weight and obese/overweight type 2 diabetes mellitus patients (T2DM) to see the impact of obesity on the occurrence of peripheral artery disease (PAD) in T2DM patients. Secondly to investigate the relationship between ABPI, insulin resistance, and beta cell function and between adipocytokines and obesity parameters. A total of 120 BMI-categorized Normal weight (NW) T2DM (n = 53) patients and obese/overweight T2DM (n = 67) patients were recruited in this study. ABPI measurements were performed for the assessment of PAD. The anthropometry and body composition of the patients were measured. Plasma fasting insulin, adiponectin, and IL-6 levels were measured by ELISA kits. ABPI scores were found to be comparable between both groups of patients (p = 0.787). A significant positive correlation was observed between ABPI and beta cell function. Insulin resistance was found to correlate positively while adiponectin negatively with obesity parameters. The ABPI score was comparable between both groups of patients, suggesting that vascular complications may occur at the same rate in NW as well as in obese/overweight diabetic patients. The positive association of insulin resistance as well as the negative association of adiponectin with obesity parameters, are suggestive of the importance of body fat distribution in predicting insulin resistance and the inflammatory status of the cells.

First diagnosis of severe coarctation of the aorta necessitation percutaneous intervention during pregnancy, a case report

Abstract Background Coarctation of the aorta (CoA) is a common congenital heart defect that affects about 3-4 in every 10,000 live births. Despite clear signs on clinical examination, the diagnosis is sometimes not made until adulthood. An increasing number of patients with CoA are reaching child-bearing age. Unrepaired CoA or severe recurrent stenosis during pregnancy is a significant concern, as it poses a high risk of maternal and foetal complications and even death. Case summary A 21-year-old women was referred to the cardiology department at 17 weeks’ gestation for management of arterial hypertension and unexplained systolic murmur. She had been diagnosed with hypertension elsewhere the year before presentation, but unfortunately this remained unexplored. She had been started on labetalol early in the pregnancy. Clinical examination showed a loud systolic heart murmur extending from parasternal to subclavicular and scapular areas. Pulses in the lower extremities were very weak and blood pressure was slightly elevated with a significant gradient between the upper and lower extremities. Echocardiography showed remarkable absence of pulsatile flow in the abdominal aorta and narrowing just distal to the subclavian artery with typical diastolic tail pattern on suprasternal imaging. Cardiac magnetic resonance confirmed the presence of a severe coarctation distal to the subclavian artery and presence of multiple collaterals allocating this patient in the extremely high-risk category with a risk of up to up 40-100% of maternal cardiac event during pregnancy. An extensive multidisciplinary team meeting was convened. After initial medical optimisation, increased claudication and signs of placental hypoperfusion necessitated an endovascular procedure under general anaesthesia at 23 weeks’ gestation. A Bentley BeGraft Plus stent (16x38 mm) was successfully placed. Postoperative ultrasound showed biphasic placental perfusion and normalisation of blood pressure and ankle-brachial indices. At 36 weeks’ gestation, the patient gave birth to a healthy child. Conclusion CoA should be considered in any young patient with arterial hypertension. Altered maternal haemodynamics during pregnancy resulted in severe symptomatic CoA and reduced placental flow necessitating percutaneous intervention during pregnancy. A multidisciplinary pregnancy heart team is essential for optimal treatment management in these high-risk patients.

7796 The Profile And Associated Risk Factors Of Diabetic Foot Disease Among Patients With Type 2 Diabetes Mellitus Seen At Outpatient Clinics In A Tertiary Private Hospital In Quezon City, Philippines

Abstract Disclosure: D.C. Lopez: None. K.T. Lim: None. B.C. S.: None. O.C. Dampil: None. The Profile and Associated Risk Factors of Diabetic Foot Disease Among Patients with Type 2 Diabetes Mellitus Seen at Outpatient Clinics in a Tertiary Private Hospital in Manila, Philippines. Background: Diabetic foot disease is a debilitating complication of diabetes mellitus and is a major source of morbidity, mortality, and reduced quality of life. Determining the risk factors of diabetic foot ulcer is important to prevent the devastating consequences among patients with diabetes. This study aims to determine the profile and associated risk factors of diabetic foot disease among patients diagnosed with type 2 diabetes mellitus being seen in private specialty clinics. Methodology: A single center, analytical cross-sectional study was conducted among patients with type 2 diabetes mellitus at outpatient clinics in a tertiary private hospital in the Philippines. Clinical information and laboratory results were obtained during the time of consult; and patients were classified as either low risk, moderate risk, high risk for diabetic foot disease or in active foot disease. Interaction between various risk factors was explored by multivariate analysis. Results: A total of 129 adult patients with diabetes mellitus were evaluated using the Diabetes Foot Screening and Risk Stratification Tool from January to May 2021. The demographic and clinical profile of the study showed that proportion of patients with neuropathy (χ2=60.66, p=0.001), long duration of diabetes (F=5.92, p=0.004), and low estimated glomerular filtration rate (eGFR) (F=3.70, p=0.023) was significantly higher in patients with moderate to high risk for diabetic foot disease. Univariate polynomial logistic regression analyses showed that neuropathy greatly increased the odds of having moderate (OR=115.63, p=0.001) and high risk stratification (OR=166.50, p=0.001). Other factors were also noted to affect the risk stratification for diabetic foot disease such as duration of diabetes (OR=1.09, p=0.004) and hypertension (OR=2.45, p=0.027). On the other hand, normal eGFR (OR=–1.02, p=0.011), left normal ankle brachial pressure index (OR=–4.32, p=0.042), and good glycemic control (OR=–5.41, p=0.050) significantly decrease the likelihood of having high risk stratification for diabetic patients. Conclusion: Those most susceptible to developing high risk for diabetic foot disease were patients with neuropathy, hypertension, and long duration of diabetes. High-risk patients with the given profile should be followed closely in order to prevent complications brought by diabetes. Keywords:Diabetes mellitus, Diabetic foot disease, Foot ulcer Presentation: 6/3/2024

Jetstream Atherectomy with Paclitaxel-Coated Balloons: 3-Year Outcomes of the Prospective Randomized JET-RANGER Study

AbstractThe JET-RANGER study (NCT03206762) was a multicenter (11 U.S. centers), randomized trial, core-lab adjudicated and designed to demonstrate the superiority of Jetstream + paclitaxel-coated balloon (JET + PCB) versus percutaneous transluminal angioplasty (PTA) + PCB in treating femoropopliteal arterial disease. The 1- and 2-year outcomes have been recently published. The 3-year outcome data are presented in this report. The JET-RANGER trial initially had 47 patients with 48 lesions. Thirty-one in the JET-PCB arm and 16 in the PTA + PCB arm (2:1 randomization). At 3-year follow-ups, there were 20 patients in the JET-PCB arm and 14 patients in the PTA + PCB arm. Kaplan–Meier survival analysis was performed to estimate the freedom from target lesion revascularization (TLR) at 3 years. Bailout stenting was not considered a TLR in this analysis. Statistical significance was determined by a p-value &lt; 0.05. Freedom from TLR was statistically similar between the two groups at 3 years between JET + PCB and PTA + PCB (freedom from TLR was 88.0 vs. 67.8%, respectively, p = 0.1380). There was also no significant difference in the change of ankle-brachial index (ABI) between the PTA + PCB and JET + PCB from baseline at 6 months (p = 0.7890), 1 year (p = 0.4070), 2 years (p = 0.7410), and 3 years (p = 0.8010). There was also no statistical difference between the JET + PCB and PTA + PCB arms for RCC improvement by one or more categories from baseline to 3 years (p = 0.8949). There were no minor or major amputations for either arm throughout the 3-year follow-up. Five JET + PCB patients died before the 3-year specified window and none in the PTA + PCB arm (p = 0.137). Two of the deaths were due to cancer and three due to cardiac causes. None were deemed related to the device or procedure. JET + PCB had similar freedom from TLR and improvement in ABI and RCC at 3-year follow-up with no difference in amputation or mortality between the 2 arms. A trend toward less TLR was seen in the JET + PCB arm.

Diuretics and risk of major adverse limb events in patients with type-2 diabetes: An observational retrospective study

AimIn patients with type-2 diabetes mellitus (T2DM), sodium-glucose co-transporter 2 inhibitors are suspected to increase the risk of amputation. “Traditional” diuretics may increase major adverse limb events (MALEs), but the evidence is weak. We studied the association between common diuretics (i.e. thiazides, loop- and potassium-sparing diuretics) and MALEs/amputations in patients with T2DM. MethodsConsecutive T2DM patients without cardiovascular history referred to our center for cardiovascular check-ups were retrospectively studied. Follow-up data on MALEs were collected. We used Cox models to assess the association between diuretics and MALEs, or amputation alone. A propensity score with inverse probability of diuretic treatment weighting (IPTW) analysis was performed. ResultsWe studied 1309 patients, (59.5 ± 10.7 years, 51 % females) with diabetes duration of 9.1 ± 8.5 years, among whom 402 (30 %) were taking diuretics. During a follow-up of 3.8 ± 1.64 years, 121 (9.1 %) had MALEs, including 19 (1.4 %) amputations. Death occurred in 111 patients and the proportion of death was significantly different between groups: patients with diuretics n = 49, 44.1% vs patients without diuretics n = 62, 55.9 %, P = 0.001. Diuretics, in multivariable analysis, were associated with MALEs (aHR[95 %CI] 1.96[1.32;2.91] P = 0.001), even after adjustment on propensity score (aHR 1.66[1.08;2.56] P = 0.02) and IPTW analysis (aHR 1.76[1.67;1.84] P < 0.0001). This risk was particularly increased in case of an abnormal ankle-brachial index (aHR 2.29[1.32;3.96], P = 0.003) at baseline. Looking at diuretic classes separately, the adjusted risk was increased with loop diuretics (aHR 2.56[1.16;5.64] P = 0.020), thiazides (aHR 2.21[1.37;3.57] P = 0.001) or potassium sparing diuretics (aHR 2.56[1.16;5.64] P = 0.020). ConclusionDiuretic treatment weighting may be associated with increased risk of MALEs. We identified several markers of increased risk of limb events where the use of diuretics should be considered with caution.

Comparing BlueDop Vascular Expert to ankle-brachial index in the identification of peripheral vascular disease in all-comers and diabetic patients

ObjectiveWe compared the screening capabilities of the BlueDop Vascular Expert (BVE) and ankle-brachial index (ABI) in peripheral arterial disease for all-comer patients and those with diagnosed diabetes mellitus (DM). MethodsData were collected retrospectively and prospectively at a single center in 104 all-comers from BVE and ABI compared with conventional full leg arterial duplex on the same patient, same limb, and at the same appointment. A final comparison was made between the BVE and ABI using full leg arterial duplex as the diagnostic comparison. 104 all-comers were included, and 35 of those patients had diagnosed DM. ResultsFor all-comers, BVE sensitivity was 90%, specificity was 96%, accuracy was 94.5%, and κ = 0.84. In contrast, ABI sensitivity was 53%, specificity was 95%, accuracy was 86%, and κ = 0.53. Of the 35 patients with DM, BVE screened 65 limbs and ABI screened 63 limbs. For patients with DM, BVE sensitivity was 90%, specificity was 98%, accuracy was 95.4%, and κ = 0.89. In contrast, ABI sensitivity was 40%, specificity was 81%, accuracy was 68.3%, and κ = 0.23. ConclusionsThe need for a device that is easy to use, easy to interpret, portable, and, most important, accurate, is critical in reducing long-term complications of peripheral artery disease. As a cuffless arterial assessment system, the BVE was found to have superior sensitivity, specificity, and accuracy when compared with ABI in all-comers. In patients with DM, BVE also showed greater sensitivity, specificity, and notably an accuracy of 95.4% compared with ABI's accuracy of 68.3%. The data support that BVE is an accurate and easy-to-use lower limb blood flow assessment device, even when assessing the most challenging patients.

Lipoprotein Apheresis Alleviates Treatment-Resistant Peripheral Artery Disease Despite the Normal Range of Atherogenic Lipoproteins: The LETS-PAD Study.

Peripheral artery disease (PAD) severely impairs patient prognosis and quality of life (QOL). Although lipoprotein apheresis (LA) has been applied to patients with PAD and elevated serum atherogenic lipoproteins, we hypothesized that LA can be effective for treating PAD even in patients with controlled serum lipoproteins through pleiotropic anti-atherosclerotic effects beyond lipoprotein removal. This study aimed to evaluate the efficacy of LA in patients with treatment-resistant PAD and controlled serum lipoproteins focusing on QOL. In a single-arm prospective study, 30 patients with refractory PAD who had controlled serum lipoproteins underwent sequential LA sessions using dextran sulfate adsorption columns, aiming to complete 10 sessions. The ankle-brachial pressure index (ABI) and vascular QOL (VascuQOL) score were evaluated as the primary outcomes. Secondary outcomes included reactive hyperemia index (RHI) and biological antioxidant potential (BAP) as an endothelial function test and serum antioxidative-capacity evaluation, respectively. ABI significantly increased after LA sessions (pre-treatment 0.60±0.09 vs. post-treatment 0.65±0.13, p=0.023). Total VascuQOL score (3.7±1.1 vs 4.6±1.1, p＜0.001) and RHI (1.70±0.74 vs 2.34±1.76, p=0.023) significantly improved after the LA sessions. BAP tended to increase after the LA sessions, and the change reached statistical significance 3 months after treatment. ABI and QOL improved after a series of LA sessions in conventional treatment-resistant PAD patients with controlled serum lipoprotein levels. Increased antioxidative capacity and ameliorated endothelial function were observed after the LA treatment.

Clinical Outcomes following Invasive Treatment of Femoropopliteal Artery Disease: A Retrospective Single-Center Cohort Study

PurposeTo identify predictors of clinical success in invasive treatment for femoropopliteal arterial disease aiding clinical decision-making. Materials and MethodsA retrospective analysis was performed on 676 consecutive patients who underwent a first episode of invasive treatment for femoropopliteal disease, either endovascular therapy (EVT) or femoropopliteal bypass (FPB), between 2004 and 2015. Primary end points were primary and secondary clinical patency and amputation rate. Kaplan–Meier curves were used to evaluate clinical patency. A Cox proportional hazard model explored predictors of primary end points. ResultsMost patients (58%) underwent EVT as primary intervention, while 42% underwent FPB. Median follow-up was 43 months. The only independent predictor for loss of primary clinical patency was critical limb-threatening ischemia (CLTI) (P = .008; hazards ratio [HR], 1.25; 95% CI, 1.07–1.47). Secondary clinical patency was positively associated with FPB surgery (P = .037; HR, 0.66; 95% CI, 0.44–0.97), a higher pre-interventional ankle–brachial index (P = .029; HR, 0.43; 95% CI, 0.20–0.92), more distal runoff vessels (P = .036; HR, 0.77; 95% CI, 0.60–0.98), and the absence of ischemic heart disease (P = .006; HR, 1.69; 95% CI, 1.16–2.47). In patients with CLTI, chronic renal failure predicted loss of primary and secondary clinical patency and increased amputation risk. ConclusionsIn this cohort, CLTI was independently associated with decreased primary clinical patency in invasive treatment for femoropopliteal disease. Secondary clinical patency was positively associated with FPB, higher ankle–brachial index, more runoff vessels, and the absence of ischemic heart disease.

Symptom Descriptors in Individuals Living With Undiagnosed Lower Extremity Peripheral Artery Disease.

Most individuals with lower extremity peripheral artery disease (PAD) experience symptoms other than claudication and live with undiagnosed PAD yet no tools exist to detect atypical PAD symptoms. The purpose of this study was to identify discriminating PAD symptom descriptors from a community-based sample of patients with no current diagnosis of PAD. Symptoms descriptors were obtained in a sample of 22 participants with persistent lower extremity symptoms pre/post exercise. An ankle brachial index with exercise was used to classify participants as "PAD" or "No PAD." Thirteen (59%) participants had a positive ankle brachial index (<0.9, ≥20% drop postexercise, or 30 mmHg drop postexercise). Symptoms do not disappear while walking, trouble keeping up with friends/family, positive response to pain or discomfort while sitting, and pain outside of the calves and thighs were associated with a positive ankle brachial index. Atypical symptoms were common among study participants. Symptoms while sitting and symptoms outside of the calf and thigh were negatively associated with a positive ankle brachial index. More precise descriptions of symptom characteristics are needed to improve PAD symptom recognition.

Results of endovascular interventions for peripheral arterial diseases on the targeted arterial segments.

Endovascular interventions (EVIs) are an effective and minimally invasive therapeutic option for peripheral arterial diseases (PADs). This study aimed to evaluate the results of EVIs for PADs on the targeted arterial segments (TASs). One hundred and sixteen (116) participants with PADs were included in this cohort study. The diagnosis of PAD in this study was based on the ankle-brachial index (ABI) and Rutherford classification, confirmed by Duplex ultrasound and computed tomography angiography (CTA). The targeted arterial segments (TASs) were treated using either balloon angioplasty or endovascular stenting. At the end of each EVI, a post-procedure angiography was performed to evaluate the EVIs' results (i.e., balloon angioplasty and endovascular stenting) for PADs on the TASs. The results of EVIs were classified as either satisfactory or unsatisfactory. Satisfactory if the TASs were recanalized or had <30% stenosis after the EVIs. Unsatisfactory if the TASs were still occluded or had >30% stenosis after the EVIs. The mean participants' age was 54.42±7.74 years; 35.3% of them were diabetic, 36.2% were hypertensive, and 28.5% had multiple medical disorders. Based on Rutherford classification, 44.83% of the participants had grade I, category 2 chronic ischemia, 23.28% had grade I, category 3 chronic ischemia, 12.93% had grade II, category 4 chronic ischemia, and 18.96% had grade III, category 5 chronic ischemia. About 87.1% of the participants' PADs were managed using balloon angioplasty. The affected arteries were the superficial femoral arteries in 47.5%, popliteal arteries in 18.8%, posterior tibial arteries in 18.8%, and anterior tibial arteries in 14.9%. About 12.9% of the participants' PADs were managed using endovascular stenting and the affected arteries were the common iliac arteries in 60%, and external iliac arteries in 40%. The results of EVIs were satisfactory in 98.28% of the participants, while it was unsatisfactory in 1.72% of them. Endovascular interventions in this study were an effective and minimally invasive therapeutic option for PADs, with satisfactory results in 98.28%. Further studies, including the long-term and clinical outcomes after EVIs for PADs, are required.