Diagnosis Of Peripheral Vascular Disease Research Articles

Normative data of Ankle brachial pressure Index and Toe brachial index in normal healthy male adult using fully automated vascular Doppler

ABSTRACT Context: Peripheral vascular disease affects some 12%–14% of the general population, and the majority of people with the disease are asymptomatic. Risk factors for it are smoking, diabetes mellitus, hyperlipidemia, hypertension, obesity, and syndrome X. The Ankle Brachial Pressure Index (ABPI) is one of the screening noninvasive methods for the diagnosis of peripheral vascular disease. Assessment is performed by fully automated vascular Doppler, which is considered to be accurate; however, normative data are limited. Aims: To measure the normative data of ABPI and Toe brachial index (TBI) in a healthy adult Settings and Design: A cross-sectional study done in male (n = 59) volunteers in the age group of 18 to 50 years of age group Methods and Material: Smartdop XT fully automatic Doppler-14 ports (Hadeco, Japan) was used to measure ABPI and Toe brachial index (TBI) Statistical analysis used: Normative value (Mean, SD, Range) was calculated using Systac 13 software Results: Right-side Ankle Brachial Pressure Index (ABPI) and left-side ABPI at the posterior tibial artery (PT) were 1.061 ± 0.098, and 1.105 ± 0.139, respectively. Right-side ABPI and left-side ABPI at the dorsal pedis artery were 0.86 ± 0.129 and 0.86 ± 0.115. Right-side toe Brachial Pressure Index (TBPI) and left-side ABPI was 0.85 ± 0.185 and 0.822 ± 0.2, respectively. Conclusions: ABPI index of more than 0.9 may be considered normal in the male population in Bhopal; however, we recommend further Multicentric trials across the Indian population.

Photoplethysmography in Wearable Devices: A Comprehensive Review of Technological Advances, Current Challenges, and Future Directions

Photoplethysmography (PPG) is an affordable and straightforward optical technique used to detect changes in blood volume within tissue microvascular beds. PPG technology has found widespread application in commercial medical devices, enabling measurements of oxygen saturation, blood pressure, and cardiac output; the assessment of autonomic nerve function; and the diagnosis of peripheral vascular disease. Recently, the growing demand for non-invasive, portable, cost-effective technology, along with advancements in small semiconductor components, has led to the integration of PPG into various wrist-worn wearable devices. Multiple sensor structures have been proposed and, through appropriate signal processing and algorithmic application, these wearable devices can measure a range of health indicators during daily life. This paper begins by addressing the market status of wrist-worn wearable devices, followed by an explanation of the fundamental principles underlying light operation and its interaction with living tissue for PPG measurements. Moving on to technological advancements, the paper addresses the analog front end for the measurement of the PPG signal, sensor configurations with multiple light emitters and receivers, the minimum sampling rate required for low-power systems, and the measurement of stress, sleep, blood pressure, blood glucose, and activity using PPG signals. Several challenges in the field are also identified, including selecting the appropriate wavelength for the PPG sensor’s light source, developing low-power interpolation methods to extract high-resolution inter-beat intervals at a low sampling rate, and exploring the measurement of physiological phenomena using multi-wavelength PPG signals simultaneously collected at the same location. Lastly, the paper presents future research directions, which encompass the development of new, reliable parameters specific to wearable PPG devices and conducting studies in real-world scenarios, such as 24-h long-term measurements.

Variations of branching pattern of the dorsalis pedis artery: A cadaveric study

Background: Dorsalis pedis artery (DPA) is the chief artery of foot. It provides nutrition to the dorsum of the foot. Palpation of DPA is essential for the diagnosis of peripheral vascular diseases. Cutaneous flaps supplied by branches of DPA are used in various reconstruction surgeries. Methodology: 50 meticulously dissected lower limbs of both sides and known sex were observed for morphometry, asymmetry and sexual dimorphism of DPA and its branches. Variations like absent arcuate artery and extra lateral tarsal arteries were looked for. Results: Absent arcuate artery was seen in 12%. Three tarsal metatarsal arteries and two tarsal metatarsal arteries were seen in 4% and 16%, respectively. An extremely rare case of U-shaped loop joining two tarsal metatarsal arteries was seen in two limbs. Conclusion: Rare variations like multiple tarsal arteries joined by U-shaped loop and absent arcuate artery seen in our study are of importance for reconstruction surgeries using DPA flaps.

PS-C27-5: ASSOCIATION BETWEEN ANKLE-BRACHIAL INDEX AND KIDNEY OUTCOMES IN PATIENTS WITH HYPERTENSION

Background: Ankle-brachial index (ABI) used for diagnosis of peripheral vascular disease is related to endothelial dysfunction. Previous studies showed the relationship between endothelial dysfunction and chronic kidney disease (CKD). Therefore, we aimed to investigate the association between ankle-brachial index and CKD progression in patients with hypertension. Methods: A total of 2,429 patients with hypertension were enrolled from the prospective observational cohort of CMERC-HI (Cardiovascular and Metabolic Disease Etiology Research Center-High Risk). Patients were classified into quartile based on ABI (A1: ABI < 1.11, A2: ABI 1.11 to 1.17, A3: ABI 1.17 to 1.23, A4: ABI> 1.23). Primary outcome was progression of CKD, which was composite of at least 50% decrease in estimated glomerular filtration rate (eGFR) from baseline or end stage kidney disease requiring dialysis, or incident CKD which was defined as eGFR < 60 ml/min/1.73m2. Results: The mean age of study subjects was 60.1 ± 11.3 years and 1,346 (55.4%) were male. There were statistically significant differences in DM status (40.1%, 41.1%, 43.7%, 51.7% in A1, A2, A3, A4 group, respectively, P < 0.001) among ABI quartile groups. During a median follow-up of 42.5 months, the primary outcome met the pre-specified CKD progression in 490 (20.2%). In multivariate Cox analysis, A1 and A3 group were associated with increased risk of CKD progression (HR, 2.28; 95% CI, 1.30–4.00, P = 0.004, HR, 2.22: 95% CI, 1.27–3.90, P = 0.005) compared to A2 group. Moreover, low ABI showed increased risk of CKD progression (HR, 1.57; 95% CI, 1.04–2.38; P = 0.03) after adjusting confounding factors. Conclusions: Ankle-brachial index may be an independent predictor of renal outcome in patients with hypertension.

An analytical study of peripheral arterial disease at Government General Hospital, Nizamabad

Background: Peripheral arterial disease (PAD) is linked to a decrease in functional ability as well as a higher risk of cardiovascular morbidity and mortality. Despite its widespread incidence, links to mortality, morbidity, and impaired quality of life, PAD is underdiagnosed and undertreated. Aims and Objectives: The aim of the study was to review the available literature on this subject and analyze the mode of presentation, symptoms, signs, age incidence and results of conservative management and angioplasty, and stenting as measured by limb salvage and amputation rates. Materials and Methods: The study was carried out on 40 patients chosen from the patients admitted in Government General Hospital, Nizamabad, with a diagnosis of peripheral vascular disease from May 2019 to April 2022. Results: It is revealed from the study that out of 28 patients with Atherosclerosis, 10 patients weremanaged conservatively, 12 underwent primary amputation, two secondary amputation, and four patients were managed with angioplasty and stenting of anterior tibial artery. Among the eight patients with Thromboangiitis Obliterans, six patients were managed conservatively, and two patients underwent primary amputations. Two patients with acute embolic disease were referred to higher center for embolectomy and remaining two patients with inconclusive etiology were managed conservatively. Conclusion: Atherosclerosis is mainly a disease of old age but now the trend is moving towards earlier decades as well. Hence, risk factor modification and awareness remain the best method of prevention. Embolectomy should be carried out aggressively in all cases with potentially salvageable limbs.

Impact of Socioeconomic Status on Major Amputation in Patients with Peripheral Vascular Disease and Diabetes Mellitus

Both peripheral vascular disease (PVD) and diabetes mellitus (DM) are leading causes of lower extremity amputation. The Area Deprivation Index (ADI) is a tool used to estimate socioeconomic status (SES) based off a person's 9-digit zip code, and this value has been shown to correlate with poor health outcomes. We sought to understand the effect of SES on major amputation in diabetic patients with PVD in a single healthcare system. All patients presenting to a single healthcare system with dual diagnosis of PVD and DM from January 2012 to December 2017 were identified using International Classification of Diseases (ICD) 9/10 codes. Patients undergoing major amputation (below-knee and above-knee) were identified by Current Procedural Terminology (CPT) codes and compared to those who did not have amputation. The ADI score and comorbid disease processes were identified. The Mann-Whitney U-test was performed to compare ADI scores between the amputation and nonamputation groups. Categorical variables were analyzed using the Chi-squared or Fisher's exact test, and t-tests were used for continuous variables. A logistic regression was performed to test the association between SES and amputation status. A total of 2,009 patients were identified, of which 85 underwent major amputation. After adjusting for comorbidities, patients in the amputation group had higher ADI scores as compared to those who did not have amputation (median ADI score 8 vs. 6, P < 0.05). Logistic regression modeling demonstrated an Odds Ratio of 1.10 (95% confidence interval: 1.01-1.19), indicating the odds of being in the amputation group are increased by 10% for every 1-point increase in the ADI score. After controlling for comorbidities, patients with PVD and DM residing in neighborhoods with lower SES have increased odds of undergoing major lower-limb amputation than those from neighborhoods with higher SES despite receiving care at the same healthcare system. Further study is warranted to determine factors contributing to this difference.

Impact of Socioeconomic Status on Major Amputation In Patients With Peripheral Vascular Disease And Diabetes Mellitus

<h3>INTRODUCTION</h3> Both peripheral vascular disease (PVD) and diabetes mellitus (DM) are leading causes of lower extremity amputation. The Area Deprivation Index (ADI) is a tool used to estimate socioeconomic status based off a persons' 9 digit zip-code, and this value has been shown to correlate with poor health outcomes. We sought to understand the effect of socioeconomic status on major amputation in diabetic patients with PVD in a single center. <h3>METHODS</h3> All patients presenting to a single center with dual diagnosis of PVD and DM from 2012 to 2017 were identified using ICD 9/10 codes. Patients undergoing major amputation (below knee and above) were compared to those who did not have amputation. ADI as well as comorbid disease processes were identified. Categorical variables were analyzed using Chi-Square or Fisher's exact test, and t-tests were used for continuous variables. Logistic regression was performed to test the association between socioeconomic status and amputation status. <h3>RESULTS</h3> A total of 2009 patients were identified, of which 85 underwent major amputation. After adjusting for comorbidities, patients in the amputation group had higher ADI scores as compared to those who did not have amputation (median ADI score 8 vs. 6, p<0.05). Logistic regression modeling demonstrated an Odds Ratio of 1.10 (95% confidence interval: 1.01-1.19) indicating the odds of being in the amputation group was increased by 10% for every 1 point increase in the ADI score. <h3>CONCLUSION</h3> After controlling for comorbidities, patients with DM and PVD residing in neighborhoods with lower socioeconomic status have increased odd of undergoing major lower-limb amputation than those from neighborhoods with higher socioeconomic status despite receiving care at the same institution. Further study is warranted to determine factors contributing to this difference.

Lack of Association between Interarm Systolic Blood Pressure Difference and Coronary Artery Disease in Patients Undergoing Elective Coronary Angiography.

Aim Peripheral vascular disease (PVD) and coronary artery disease (CAD) are, in many cases, asymptomatic and not usually diagnosed. The timely diagnosis of peripheral vascular diseases can act as an indicator or practical evidence of CAD. Therefore, this study was conducted to determine the relationship between interarm systolic blood pressure difference (IASBPD) and severity and number of coronary artery stenosis. Methods The samples in this cross-sectional study consisted of 578 patients who were candidates for coronary angiography, with an average age of 57.5 ± 10.5 years. Patients were classified according to CAD and number and severity of coronary artery stenosis. The relationship between IASBPD and presence or lack of CAD as well as the number and severity of coronary artery stenosis was studied. The sensitivity, specificity, and positive predictive value of IASBPD index were calculated for the detection of CAD using the Kappa coefficient. Results There was no statistically significant relationship between IASBPD, CAD, and severity and number of coronary artery stenosis. This index had low sensitivity and predictive value in the diagnosis of CAD and stenosis in coronary arteries in comparison with angiography. Conclusion The results showed that the IASBPD index cannot be a valid criterion for the diagnosis of CAD as well as the number and severity of coronary artery stenosis. More studies with larger sample sizes and different designs are needed in this regard to achieve more conclusive results.

Abstract P832: Stroke Disease-Specific Quality of Life Trajectories After Rehabilitation Discharge and Their Sociodemographic and Clinical Predictors: A Longitudinal, Multicenter Study

Introduction: Research on the trajectory of survivors’ quality of life over time has generally focused on the first six months post-stroke, and results are inconsistent. Indeed, while some studies found an improvement of the stroke survivors’ quality of life from one to six months post-stroke, other studies showed an improvement during inpatient rehabilitation but a worsening at six months after discharge. Aim: To investigate the longitudinal growth trajectories of disease-specific quality of life dimensions and their predictors over one year. Methods: A multicentric longitudinal design were used for this study. Four hundred and fifteen stroke survivors (mean age 70.6 + 12.2 years; 81% ischemic stroke) were recruited after discharge from rehabilitation hospitals and were followed up every three months for one year. Changes in stroke impact scale dimension scores were evaluated using hierarchical linear models and linear, logarithmic, quadratic, and cubic time slope. Results: We observed a significant linear and quadratic increase in most stroke impact scale dimensions from the baseline to 12-month follow-up. The communication dimension was stable over time, while the memory dimension increased only linearly. Higher physical dimensions scores were predicted by lower age, hypercholesterolemia, and better physical functioning at baseline, while higher communication was predicted by lower age, better physical functioning, and a diagnosis of peripheral vascular disease. Better memory was predicted by lower age, married status, better physical functioning, and left-hemisphere stroke. Better participation was predicted by lower age and better physical functioning. No predictors were observed for emotion. Conclusions: Disease-specific quality of life significant increase from the baseline to 12-month follow-up, especially in physical dimensions. Lower age, hypercholesterolemia, better physical functioning and diagnosis of peripheral vascular disease seem to be predictors or better quality of life. Through the analyses of predictors, we identified stroke survivors who are more at risk and who need more tailored interventions to improve quality of life.

Stroke disease-specific quality of life trajectories after rehabilitation discharge and their sociodemographic and clinical associations: A longitudinal, multicentre study.

To investigate the longitudinal growth trajectories of disease-specific quality of life (QoL) dimensions and their associations over 1year. A longitudinal design. Data were collected between February 2015-May 2017. Four hundred and fifteen stroke survivors (mean age 70.6years; 81% ischaemic stroke) were recruited after discharge from rehabilitation hospitals and were followed up every 3months for 1year. Changes in Stroke Impact Scale (SIS) dimension scores were evaluated using hierarchical linear models (HLMs) and linear, logarithmic, quadratic, and cubic time slope. We observed a significant linear and quadratic increase in most SIS dimensions from the baseline to 12-month follow-up, especially in physical dimensions. The communication dimension was stable over time, while the memory dimension increased only linearly. Higher physical dimension scores were significantly associated with lower age, hypercholesterolaemia, and better physical functioning at baseline, while higher communication was associated with lower age, better physical functioning, and a diagnosis of peripheral vascular disease. Better memory was associated with lower age, married status, better physical functioning, and left-hemisphere stroke. Better participation was associated with lower age and better physical functioning. No significant associations were observed for emotion. This study provides important information about the trajectories of stroke survivors' specific QoL and their associated variables. Stroke has a great impact on stroke survivors' QoL. Disease-specific QoL significantly increases from the baseline to 12-month follow-up, especially in physical dimensions. Lower age, hypercholesterolaemia, better physical functioning, and diagnosis of peripheral vascular disease seem to be associated with better QoL. Through the analyses of associated variables, we identified stroke survivors who are more at risk and who need more tailored interventions to improve their physical, psychological, emotional, and social dimensions.

Comparison of Color Doppler Ultrasound and Ankle-Brachial Pressure Index Measurement in Peripheral Vascular Diseases

Peripheral vascular diseases (PVD) are a group of common degenerative (organic) and vasospastic (functional) disease processes that result in significant morbidity and are strong predictors of subsequent mortality. It is diagnosed by definitive history of intermittent claudication or if one or more of peripheral pulses are absent in one or both lower limbs. A variety of non-invasive techniques, viz., ankle-brachial pressure index (ABPI) test and color Doppler imaging, are available to diagnose the presence of PVD as well as to localize areas of stenosis, assess severity of disease, and follow patients for disease progression or response to therapy. Therefore, the focus of this study is to compare color Doppler ultrasound and ABPI individually and in combination in diagnosing cases of peripheral vascular diseases, considering CT angiography the gold standard investigation. Patients were assessed on the basis of history; clinical examination and relevant investigations done were noted in the data sheet according to the proforma including the Edinburgh Claudication Questionnaire. Comparison of color Doppler ultrasound and ankle-brachial pressure index measurement in peripheral vascular diseases was determined using relevant statistical tests. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for comparison of ABPI and color Doppler imaging with CT angiography. Color Doppler ultrasound proved to be a better modality as compared to the ankle-brachial pressure index for diagnosis of peripheral vascular disease, considering CT angiography the gold standard investigation.

Evaluation of the Effectiveness of Screening for Iliac Arterial Calcification in Kidney Transplant Candidates.

BackgroundPeripheral vascular disease and iliac arterial calcification are prevalent in kidney transplant candidates and jeopardize graft outcomes. We report our experience with computed tomography (CT) screening for iliac arterial calcification.Material/MethodsWe retrospectively reviewed electronic medical records of 493 renal transplant candidates from protocol initiation in 2014. Non-contrast CT was performed or retrospectively reviewed if any of the following criteria were present: diabetes, ESRD >6 years, 25 pack-years of smoking or current smoker, diagnosis of peripheral vascular disease, parathyroidectomy, and coronary artery disease intervention. Differences in evaluation and transplant outcomes between groups were compared with chi-squared analysis. Multivariate logistic regression identified predictive criteria for presence of iliac arterial calcification.ResultsOf 493 candidates evaluated, CTs were reviewed in 346 (70.2%). Iliac arterial calcification was identified in 119 screened candidates (34.4%). Of candidates with iliac arterial calcification identified on CT, 16 (13.4%) were excluded for CT findings, and 9 (7.6%) had their surgical management plan changed. Overall, 91 (76.5%) candidates with iliac arterial calcification on CT were approved, compared to 203 (89.4%) without calcification (P<0.001). The percentage of screened patients with iliac arterial calcification on CT increased with increasing age (P<0.0005). Age and diabetes mellitus were predictive of calcification.ConclusionsMany kidney transplant candidates are at risk for iliac arterial calcification, although such calcification does not prevent transplantation for most candidates who have it. Algorithmic pre-operative screening has clinical value in determining transplant candidacy and potentially improving postoperative outcomes in patients requiring kidney transplantation.

Reassessing Mortality After Lower Extremity Amputation With a Multidisciplinary Approach Focused on Function

The recently published Global Vascular Guidelines on the management of chronic limb-threatening ischemia discuss the necessary role of lower extremity amputation (LEA). Five-year mortality rates after LEA in the chronic wound population have long been regarded as high and ineviTable with accepted 5-year mortality rates exceeding 50%. While acknowledging the high risk of mortality, the Global Vascular Guidelines emphasize that major LEA is an important option in a vascular surgeon’s armamentarium which can achieve good functional outcomes when a well-planned surgical approach is utilized. The aim of this study was to assess 5-year mortality after LEA performed with a multidisciplinary approach focused on function. We retrospectively enrolled all patients who underwent nontraumatic LEA at our institution from 2010 to 2013. Patients were stratified by LEA type: minor (toe, ray, transmetatarsal amputation, Lisfranc, Chopart, Symes) or major (below the knee amputation, above the knee amputation) to compare mortality. Key tenets of our major LEA surgical technique include myodesis of the peroneal muscle to the anterior tibialis and tibia, tenodesis of the Achilles tendon to the tibia, and utilization of the posterior myocutaneous flap (gastrocnemius-soleus complex) for closure. This optimizes joint motion and prevents atrophy of the gastrocnemius-soleus complex ensuring soft tissue bulk necessary for prosthesis use is maintained. Our multidisciplinary team, consisting of wound care, reconstructive, podiatric, vascular, and prosthetic specialists, ensures recovery and post-LEA function. Mortality was established via medical records and a commercial database. Kaplan-Meier estimates and log-rank tests were used to analyze 5-year mortality. Four hundred eighteen patients were identified: 223 minor and 195 major LEA. The Charlson Comorbidity Index was 5.0 ± 2.5. Seventy-five percent of patients were diabetic while 53% had a known diagnosis of peripheral vascular disease. Five-year mortality was 31% (Fig 1). Five-year mortality was not significantly different for minor (30%) versus major (33%) LEA (Fig 2; P = .5044). Within the major LEA cohort, peripheral vascular disease was not statistically significant for mortality at 5 years (P = .1620). We have demonstrated improved 5-year mortality after LEA with multidisciplinary care focused on functional outcomes. Major LEA can achieve comparable survival to minor podiatric amputations when performed with meticulous surgical technique that creates a stump optimal for future prosthesis wear and ambulation. These techniques are essential to achieving successful limb salvage, which is evaluated by preservation of function instead of limb length.Fig 2Comparison of mortality estimates for major versus minor amputation cohorts. Mortality at five years was comparable between cohorts (p=0.5044).View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Prevalence of Peripheral Vascular Disease in Diabetic Foot Infections and its Effect on Management Outcome

Background: Foot infection is a common problem affecting diabetics. Ischemia is a major factor contributing to progress and morbidity of the disease. The prevalence of peripheral vascular disease is higher in diabetics with faster progression.&#x0D; Aim: This study aimed to observe the prevalence of peripheral vascular disease in patients with diabetic foot infections presenting to this tertiary care centre.&#x0D; Methods: This prospective observational study evaluated 250 patients with diabetic foot infection admitted to Ibrahim Medical College and BIRDEM General Hospital, Dhaka, from 1st January 2015 to 31st December 2015.Total 72 patients were selected for Duplex study of lower limb vessels, Ankle Brachial Pressure Index (ABPI) and Pulse oxymetrywhich established the diagnosis of peripheral vascular disease and all patients were treated according to the standard protocol.&#x0D; Results: Of the 72 patients peripheral vascular disease was found in 25 patients (34.7%) and majority of them (88%) had distal below the knee vessel stenosis. There was significant correlation with older age (75%) and history of tobacco use (64%). The clinical presentations and outcomes such as hospital stay, healing time, pain were worse in individuals with peripheral vascular compromise on Duplex study of lower limb vessels, ABPI and pulse oxymetry.&#x0D; Conclusion: In this study we observed that significant number of diabetics presenting with foot infections have underlying peripheral vascular disease .The patients might not all be symptomatic or show obvious signs of PVD but need to be investigated for the same. Early detection of peripheral vascular disease in patients presenting with diabetic foot infection, using Duplex study,ABPI and Pulse oxymetrywith routine clinical and laboratory assessment can be of great value in long term care of these individuals.&#x0D; J Bangladesh Coll Phys Surg 2020; 38(1): 12-17

Unilateral Vocal Fold Immobility After Prolonged Endotracheal Intubation

Endotracheal intubation and mechanical ventilation are life-saving treatments for acute respiratory failure but are complicated by significant rates of dyspnea and dysphonia after extubation. Unilateral vocal fold immobility (UVFI) after extubation can alter respiration and phonation, but its incidence, risk factors, and pathophysiology remain unclear. To determine the incidence of UVFI after prolonged (>12 hours) mechanical ventilation in a medical intensive care unit and investigate associated clinical risk factors for UVFI after prolonged mechanical ventilation. This subgroup analysis of a prospective cohort study was conducted in a single-center medical intensive care unit from August 17, 2017, through May 31, 2018, among 100 consecutive adult patients who were intubated for more than 12 hours. Patients were identified within 36 hours of extubation and recruited for study enrollment. Those with an established tracheostomy prior to mechanical ventilation, known laryngeal or tracheal pathologic characteristics, or a history of head and neck radiotherapy were excluded. Invasive mechanical ventilation via an endotracheal tube. The incidence of UVFI as determined by flexible nasolaryngoscopy. One hundred patients (62 men [62%]; median age, 58.5 years [range, 19.0-87.0 years]) underwent endoscopic evaluation after extubation. Seven patients had UVFI, of which 6 cases (86%) were left sided. Patients with hypotension while intubated (odds ratio [OR], 10.8; 95% CI, 1.6 to ∞), patients requiring vasopressors while intubated (OR, 16.7; 95% CI, 2.4 to ∞), and patients with a preadmission diagnosis of peripheral vascular disease (OR, 6.2; 95% CI, 1.2-31.9) or coronary artery disease (OR, 5.1; 95% CI, 1.0-25.5) were more likely to develop UVFI. Unilateral vocal fold immobility occurred in 7 of 100 patients in the medical intensive care unit who were intubated for more than 12 hours. Unilateral vocal fold immobility was associated with inpatient hypotension and preadmission vascular disease, suggesting that ischemia of the recurrent laryngeal nerve may play a role in disease pathogenesis.

Peripheral Vascular Disease is Associated with Increased Risk of Acute Postoperative Infection and Failure of Total Ankle Replacements

Category:Ankle ArthritisIntroduction/Purpose:Peripheral vascular disease (PVD) is often cited as a contraindication for total ankle replacement (TAR); however, there are no studies looking at its impact on postoperative complications. The primary purpose of our study was to identify whether preoperative PVD increased the rate of infection, postoperative irrigation and debridement, or failure of the implant in patients undergoing total ankle arthroplasty using a large dataset.Methods:The PearlDiver Database was used to identify Medicare patients who underwent a TAR from 2005 to 2014 using ICD- 9 and CPT codes. The cohort was queried for postoperative infections within 90 days, subsequent irrigation and debridement, and failure of TAR. Failure of TAR was defined was a revision, conversion to tibiotalar arthrodesis, lower extremity amputation, or implant removal. A diagnosis of preoperative PVD only included those patients who had PVD as an ICD-9 diagnosis code and underwent a preoperative lower extremity angiogram prior to TAR. Preoperative co-morbidities including prior corticosteroid injections, diabetes mellitus, smoking, rheumatoid arthritis, congestive heart failure, hypertension, obesity, and end-stage renal disease requiring dialysis were taken into consideration. Three multivariable logistic regression models were then developed in order to identify risk factors associated with postoperative infections and failure after TAR.Results:10,698 Medicare patients who underwent a primary TAR were identified. 334 patients had a postoperative infection within 90 days of their TAR and 95 of those patients required an irrigation and debridement. Patients with a preoperative diagnosis of PVD had the highest acute infection rate at 10.5% as well as the highest incidence of failure at 12.3%. Multivariable logistic regression modeling demonstrated that patients with PVD had the greatest risk of developing a postoperative infection within 90 days (OR 2.85, 95% CI 1.45-5.13, P<0.01). Preoperative PVD was the most important risk factor for requiring an irrigation and debridement postoperatively (OR 4.87, 95% CI 1.94–10.6, P<0.001) (Table 1) and placed patients at the highest risk of TAR failure (OR 2.67, 95% CI 1.43–4.63, P<0.001).Conclusion:Our study suggests that a preoperative diagnosis of PVD has significant negative effects on outcomes following TAR. Preoperative PVD is an independent risk factor for an acute postoperative infection, postoperative irrigation and debridement, and failure of the implant.

Correlation of Ankle Brachial Index with Peripheral Vascular Disease in Type 2 Diabetes Mellitus

Objective : The aim of this study was to correlate ankle brachial index (ABI) with peripheral vascular disease (PVD) in type 2 diabetes mellitus . Material and methods : This was a hospital based interdisciplinary prospective study. A total of 100 patients in the age group of 30 to 80 years having peripheral vascular disease with predefined inclusion criteria were included in the study. Patients with other causes of raised blood sugar or peripheral vascular disease were excluded by relevant investigations. Ankle Brachial Index (ABI) was calculated using sphygmomanometer, and Colour Doppler Ultrasound (CDU) was used to diagnose PVD. Both the ABI method and the CDU method were compared for detecting PVD. Results : In our study, mean age was 60.04 ± 5.03 years, mean body mass index was 27.10 ± 2.67 kg/m2 and mean duration of diabetes was 7.75 ± 1.50 years. Among the 68 diagnosed cases of PVD on CDU, 70.6% cases were detected to have PVD by the ABI method (true positive) whereas 20 (29.4%) cases remained undiagnosed when ABI alone was used for the diagnosis (false negative). Conversely, among 51 diagnosed cases of PVD by ABI method 5.9% cases were found to be normal on CDU (false positive). The ABI method was found to have specificity of 88.5% but the sensitivity was only 70.6%. Conclusion: ABI has a very high specificity but the sensitivity is low compared to colour Doppler ultrasound. Therefore, if ABI is abnormal, the diagnosis of PVD is almost certain but in symptomatic cases with normal ABI; colour Doppler should be performed to exclude the PVD. Keywords : Ankle Brachial Index, peripheral vascular disease, Colour Doppler Ultrasound, type 2 diabetes mellitus. DOI : 10.7176/JMPB/57-02 Publication date : July 31 st 2019

Noncontrast Magnetic Resonance Angiography for the Diagnosis of Peripheral Vascular Disease.

Contrast-enhanced magnetic resonance angiography (MRA) provides excellent assessment of the peripheral arterial vasculature and is considered an important adjunctive diagnostic modality for the assessment of peripheral arterial disease. However, given the high prevalence of chronic kidney disease in patients with peripheral arterial disease, the association of gadolinium contrast media with nephrogenic systemic fibrosis, and recent concern with consequences of long-term deposition of gadolinium in the brain, there has been a renewed interest in noncontrast MRA approaches. Recent improvements in pulse sequences combined with instrumentation have facilitated the development of newer noncontrast MRA sequences that provide high spatial resolution, allowing the evaluation of distal (infrageniculate and pedal) vessels of importance in patients with critical limb ischemia. Further, many of these sequences are time efficient and versatile, allowing rapid evaluation of the entire lower extremity vasculature. In this comprehensive review, we outline historic techniques and compare these with newer approaches such as quiescent interval slice-selective MRA, 3-dimensional fast spin echo , and velocity-sensitive MRA that are emerging as an alternative to computed tomographic angiography or digital subtraction angiography for the evaluation of lower limb arteries in patients with peripheral arterial disease. Technical details and applications in clinical practice will be discussed.

Risk of mortality and cardiovascular events following macrolide prescription in chronic rhinosinusitis patients: a cohort study using linked primary care electronic health records.

Macrolide antibiotics have demonstrated important anti-inflammatory and immunomodulatory properties in chronic rhinosinusitis (CRS) patients. However, reports of increased risks of cardiovascular events have led to safety concerns. We investigated the risk of all-cause and cardiac death, and cardiovascular outcomes, associated with macrolide use. Observational cohort (1997-2016) using linked data from the Clinical Practice Research Datalink, Hospital Episodes Statistics, and the Office for National Statistics. Patients aged 16-80 years with CRS prescribed a macrolide antibiotic or penicillin were included, comparing prescriptions for macrolide antibiotics to penicillin. Outcomes were all-cause mortality, cardiac death, myocardial infarction, stroke, diagnosis of peripheral vascular disease, and cardiac arrhythmia. Analysis included 320,798 prescriptions received by 66,331 patients. There were 3,251 deaths, 815 due to cardiovascular causes, 925 incident myocardial infarctions, 859 strokes, 637 diagnoses of peripheral vascular disease, and 1,436 cardiac arrhythmias. A non-statistically significant trend towards increased risk of myocardial infarction during the first 30 days following macrolide prescription was observed. No statistically significant short- or long-term risks were observed for macrolide prescription. No significant risks were identified for clarithromycin in particular. Although not statistically significant, our best estimates suggest an increased short-term risk of myocardial infarction in patients with CRS following macrolide prescription, supporting previous observational evidence. However, confounding by indication remains a possible explanation for this apparent increased risk. We found no evidence of longer term increased risks.

Four-Limb Blood Pressure Measurement with an Oscillometric Device: a Tool for Diagnosing Peripheral Vascular Disease.

Traditionally, the term peripheral vascular disease (PAD) is restricted to the occlusive arterial disease in the leg, but now, the connotation of PAD is more widespread as it encompasses all extracoronary and extracerebral vascular disease. The incidence of PAD is increasing worldwide; therefore, it is necessary to diagnose PAD at an early stage. Oscillometric BP device is widely used for four-limb measurement in clinical practice and provides several parameters for evaluating inter-limb BP difference, such as ankle-brachial index (OS-ABI), inter-arm BP differences (IAD), and inter-ankle BP difference (IAND). Using angiographic results as reference, the ABI, IAD, and IAND from an oscillometric BP device have been demonstrated having high accuracy for diagnosis of PAD. Meanwhile, combination of these parameters could further improve the accuracy of PAD, including the occlusive artery disease in the arm, leg, and aorta. For example, some patients with severe PAD in the leg have normal ABI; in this situation, an increased sIAND could confirm the diagnosis of PAD in the leg. Because ABI, IAD, and IAND from inter-limb oscillometric BP measurement can also predict adverse prognosis, we encourage the use of an oscillometric device to measure four-limb BP and to evaluate the inter-limb BP difference.