Edinburgh Claudication Questionnaire Research Articles

Peripheral Arterial Disease in Nova Scotia: Increased Prevalence, Low Public Awareness, and Poor Edinburgh Claudication Questionnaire Sensitivity

BackgroundThis study had the following 3 goals: (i) to assess the prevalence of peripheral arterial disease (PAD) in a Nova Scotian population; (ii) to evaluate the validity of the Edinburgh Claudication Questionnaire (ECQ) in a Nova Scotian context; and (iii) to evaluate Nova Scotian public knowledge about PAD. MethodsParticipants were recruited from 8 sites across Nova Scotia. In 2022, they were recruited at Heartland Tour (HLT) sites—a provincial health-promotion campaign. In 2023, they were recruited in communities coinciding with HLT sites (public [PUB]). Participants completed a demographics questionnaire, ECQ, and had an ankle–brachial index (ABI) measurement. An ABI of < 0.9 was considered positive for presence of PAD. ResultsA total of 417 participants were recruited, 263 from HLT, and 154 from PUB. A total of 398 participants had ABI scores resulting in a PAD prevalence of 2.81% (249 participants) in the HLT group, and 5.37% (149 participants) in the PUB group. A total of 394 participants had both ABI and ECQ scores, with a found sensitivity of 6.67% (confidence interval 0.17%-31.95%) and specificity of 97.63% (confidence interval 95.54%-98.91%). A total of 75% of participants (311 of 417) did not have prior knowledge of PAD. ConclusionsThe PAD prevalences in both cohorts were higher than anticipated, with the PUB cohort being more than double the national average. This finding raises the following question: should specific PAD primary and/or secondary prevention strategies be targeted within the province? Our study demonstrated that a public-awareness campaign would be highly impactful, owing to a low level of awareness of PAD within both cohorts, and that the ECQ was not an effective screening tool when used on the Nova Scotian population.

Peripheral Artery Disease among a High-Risk Asian Population with Ischaemic Stroke, Cardiovascular Disease, or Diabetes Mellitus.

Background: Peripheral artery disease (PAD) affects more than 100 million people globally. Most PAD studies have been performed among predominantly White populations-less is known about other ethnicities. The aim of this cross-sectional study was to determine the prevalence and risk factors of PAD in a high-risk Asian population with ischaemic stroke (IS), myocardial infarction, unstable angina (CVD), or diabetes mellitus (DM). Methods: Patients admitted for IS, CVD, or DM were recruited. Data were collected on age, sex, body mass index (BMI), index condition (CVD, IS, DM), history of hypertension, DM, hypercholesterolaemia, cigarette smoking, and claudication. The Edinburgh Claudication Questionnaire was administered, the ankle brachial index (ABI) was determined, and PAD was diagnosed if ABI was ≤0.9. Results: Of the 450 subjects recruited, 150 were placed in each index disease group, the mean age was 61.9 ± 10.32 years, 43.1% were female, and the mean BMI was 23.9 ± 4.3. Hypertension was reported in 59.3%, DM in 63.6%, hypercholesterolaemia in 39.6%, and smoking in 42.9% of patients. The prevalence of PAD was 27.1%, 22.0% in IS, 29.3% in CAD, and 30.0% in DM. PAD was associated with increasing age (adjusted odds ratio (aOR) 1.04/year, 95% confidence interval [CI] 1.01-1.06; p < 0.001), reduced BMI (aOR 0.94, 95% CI 0.89-0.99; p = 0.026), DM (aOR 1.59, 95% CI 1.20-3.18; p = 0.007), and hypercholesterolaemia (aOR 1.82, 95% CI 1.17-2.28; p = 0.007). It was more frequent in non-lacunar versus lacunar acute IS, non-ST segment elevation versus ST-segment elevation acute myocardial infarction, and insulin-treated versus non-insulin-treated DM. Conclusions: Our study showed a high prevalence of PAD among high-risk Asian patients. This was associated with increasing age, DM, and hypercholesterolaemia and inversely associated with BMI. Different rates were found in sub-groups of IS, CVD, and DM. Systematic approaches were used to identify these high-risk individuals and to improve their outcomes.

Prevalence of Peripheral Arterial Disease in Patients With Coronary Artery Disease After Cardiac Catheterization: A Prospective Observational Study

Peripheral arterial disease (PAD) is a common vascular condition with roughly one-half of patients being asymptomatic. Moreover, PAD is commonly seen in patients with coronary artery disease (CAD) due to their shared atherosclerotic pathway. Our aim was to understand the prevalence and symptomatology of PAD in patients with established CAD seen on coronary angiography. Subjects with CAD were prospectively screened for PAD at a single-site catheterization laboratory (June 2021-April 2022). Following consent, a bedside ankle-brachial-index (ABI) (Microlife WatchBP Office ABI) was performed, and the Edinburgh Claudication Questionnaire (ECQ) (validated for PAD) was administered. PAD was defined as an ABI ≤0.90.We recruited 100 subjects (98 completed investigations: 67.5 age ± 9.5 years, 17.3% female). Twenty-one subjects (21.4%) had PAD as demonstrated by an abnormal ABI or previous diagnosis. There was a strong trend towards a higher prevalence of diabetes in those with PAD (52.4% vs. 29.9%, p=0.055). Kappa agreement between ECQ and ABI was weak (0.27). In conclusion, roughly one-quarter of subjects with CAD had ABI confirmed PAD (even more common in diabetics). The ECQ provided low agreement with ABI suggesting many of these subjects are asymptomatic. ABI can be used as a simple non-invasive tool at the bedside following cardiac catheterization to screen for PAD which has implications on subsequent clinical care.

Neuromuscular electrical stimulation as an adjunct to standard care in improving walking distances in intermittent claudication patients: the NESIC RCT

Background Peripheral arterial disease is common and associated with increased cardiovascular morbidity and mortality. While patients with peripheral arterial disease are known to benefit from supervised exercise therapy, it is not always available. Neuromuscular electrical stimulation devices may offer a similar benefit. A randomised controlled trial was required to ascertain whether such devices can benefit patients who receive supervised exercise therapy and those who do not. Objective(s) The primary objective was to assess the mean difference in absolute walking distance at 3 months in intermittent claudication patients receiving either a neuromuscular electrical stimulation device and local standard care (intervention), or local standard care alone (control). Design A pragmatic, multicentre, randomised controlled trial stratified by centre. Setting Secondary-care National Health Service hospitals in the United Kingdom. Participants Patients aged ≥18 years, with a diagnosis of intermittent claudication according to the Edinburgh Claudication Questionnaire and ankle–brachial pressure index (or stress test), without contraindications to neuromuscular electrical stimulation were deemed eligible to partake. Interventions Participants were randomised 1 : 1 to either local standard care or local standard care and neuromuscular electrical stimulation. Due to the nature of the intervention, it was unfeasible to blind the research nurse or participant to the study allocation. Main outcome measures The primary outcome measure was absolute walking distance measured by treadmill testing at 3 months. Secondary outcomes included change in initial claudication distance, quality of life, compliance with interventions and haemodynamic assessments. Results Two hundred patients underwent randomisation, with 160 patients having analysable primary outcome data for the intention-to-treat analysis intervention (n = 80); control (n = 80). As the data were right-censored, a Tobit regression model was used to analyse the primary outcome, utilising the square root of the absolute walking distance to accommodate the skewed data. However, as this made the data difficult to interpret, a Tobit regression model using raw absolute walking distance data was used as well. Neuromuscular electrical stimulation improved the difference in absolute walking distance at 3 months but this was not statistically significant (square root of absolute walking distance: 0.835 units, 95% confidence interval −0.67 to 2.34 units; p = 0.28/absolute walking distance raw data: 27.18 m, 95% confidence interval −26.92 to 81.28 m; p = 0.323). Supervised exercise therapy participants showed a markedly improved absolute walking distance compared with patients receiving best medical therapy only at 3 months (square root of absolute walking distance: 3.295 units 95% confidence interval 1.77 to 4.82; p &lt; 0.001/absolute walking distance raw data: 121.71 m, 95% confidence interval 67.32 to 176.10; p ≤ 0.001). Neuromuscular electrical stimulation significantly improved absolute walking distance at 3 months for mild claudicants (square root of absolute walking distance: 2.877 units, 95% confidence interval 0.51 to 5.25; p = 0.019/absolute walking distance raw data: 120.55 m, 95% confidence interval 16.03 to 225.06; p = 0.03) compared to the control arm. This was an unplanned (post hoc) analysis. There were no clear differences in mechanistic measurements between the two treatment groups over the follow-up period. Serious adverse events were evenly reported between the two groups; all being classified as either not related or unlikely to be related to the study device. Limitations Absolute walking distance was used as the primary outcome measure; there was a large range of baseline distances in both groups with right-skewed distribution. We did not stratify by baseline absolute walking distance for the primary outcome analysis. Additionally, only 160 patients had analysable primary outcome data due to missing treadmill data. Conclusions Supervised exercise therapy is an effective treatment for intermittent claudication. Neuromuscular electrical stimulation appears to be beneficial as an adjunct to supervised exercise therapy and on its own in mild claudicants. Future work Further studies are needed to confirm the effectiveness of neuromuscular electrical stimulation in combination with supervised exercise therapy, and in mild to moderate claudicants in a larger sample size. Study registration This trial is registered as ISRCTN18242823. Funding This project was funded by the Efficacy and Mechanism Evaluation (EME) Programme, a Medical Research Council (MRC) and National Institute for Health and Care Research (NIHR) partnership (project number 15/180/68). This will be published in full in Efficacy and Mechanism Evaluation; Vol. 10, No. 2. See the NIHR Journals Library website for further project information. Infrastructure support for this research was provided by the NIHR Imperial Biomedical Research Centre (BRC) (with others, e.g. NIHR Imperial CRF, Imperial College ECMC, NIHR Imperial PSTRC, NIHR London MIC, etc.).

Comparison of Doppler and Oscillometric Methods of Assessing Ankle-Brachial Index in Non-diabetic Premenopausal Women in Ghana

Introduction: Peripheral arterial disease (PAD) is a common cardiovascular disorder less commonly diagnosed in female patients. Peripheral arterial disease is objectively diagnosed using the ankle-brachial index (ABI), which can be measured using the “gold standard” Doppler method or the oscillometric method. The agreement between these 2 methods is less investigated in the sub-Saharan African population. Therefore, we compared the diagnostic characteristics of the oscillometric method of measuring ABI with the Doppler method in premenopausal female patients in Ghana. Methods: The ABI was measured in non-diabetic premenopausal women suspected of having PAD using the Doppler method with an 8 MHz handheld Doppler (LifeDop 250, Summit Doppler) and an oscillometric device (Vasera 1500N, Fukuda Denshi) in 160 patients (320 legs). Peripheral arterial disease was defined as an ABI &lt;0.90 in at least one leg. Leg symptoms were assessed using the Edinburgh claudication questionnaire. Results: Leg pain on exertion was present in 101 patients screened with similar mean ABIs in the right and left legs. The prevalence of PAD as screened by the Doppler method was 25.7% (18.9%-33.4%) and that of the oscillometric method was 32.2% (24.9%-40.3%). In comparison with the Doppler method, the accuracy of the oscillometric method was 88.2%, and the sensitivity, specificity, positive predictive value, and negative predictive value were 89.7%, 87.6%, 71.4%, and 96.1%, respectively. The overall agreement between the Doppler and oscillometric methods was high, = 0.78 (0.62-0.91), P &lt; .001, with an intraclass correlation of 0.89 (0.87-0.92, P &lt; .001). In receiver-operating characteristic (ROC) curve analysis, the oscillometric method showed an area under the curve of 0.925 compared with the Doppler method in the diagnosis of PAD. Conclusion: In non-diabetic premenopausal women in our study, oscillometric ABI performed acceptably in the diagnosis of PAD when compared with Doppler ABI.

Abstract 11518: Incidence of Peripheral Arterial Disease in Patients With Coronary Artery Disease Following Cardiac Catheterization: A Prospective Observational Study

Introduction: Peripheral arterial disease (PAD) is a common vascular condition affecting roughly 800,000 Canadians annually with up to 50% being asymptomatic. As such, PAD is underdiagnosed and undertreated, despite being an independent predictor of cardiovascular (CV) risk. Moreover, PAD is commonly seen in patients with coronary artery disease (CAD) due to their shared atherosclerotic pathophysiology. Our aim was to gain a better understanding of the incidence and symptomatology of PAD in patients with established CAD on coronary angiography. Methods: Prospective subjects with CAD demonstrated on coronary angiography were immediately screened for PAD at the Mazankowski Alberta Heart Institute Cardiac Catheterization Laboratory. Following consent, a bedside ankle-brachial-index (ABI) (Microlife WatchBP Office ABI) was performed and the Edinburgh Claudication Questionnaire (ECQ) (validated for PAD) was administered. PAD was defined as an ABI≤0.90. Results: We recruited 100 patients (67.5 age ± 9.5 years, 18.0% female) between June 2021 to April 2022. Eighteen subjects (18.0%) had PAD as demonstrated by an abnormal ABI. In those with diabetes (n=34), PAD was more frequent (26.5% vs. 14.1%, p=0.068). Kappa agreement between ECQ and ABI was 0.32. Conclusions: In a prospective cohort of angiographically confirmed CAD patients, one-quarter had ABI confirmed PAD (even more common in diabetics). The ECQ provided modest agreement with ABI suggesting many of these subjects are asymptomatic. ABI can be used as a simple non-invasive tool at the bedside following cardiac catheterization to screen for PAD which has implications on subsequent guideline-directed medical therapy.

Peripheral Arterial Disease Prevalence in a Population-Based Sample of People with Diabetes on the Caribbean Island of Barbados.

BackgroundPeripheral arterial disease (PAD) is a risk factor for amputation and systemic atherosclerotic disease. Barbados has a high diabetes prevalence, and 89% of diabetes-related hospital admissions are for foot problems. Foot examination is infrequent in Barbados primary care. The prevalence and potential risk factors for PAD in people with diabetes in Barbados were studied.MethodsMultistage probability sampling was used to select a representative population sample of people ≥25 years of age with known diabetes or fasting blood glucose ≥7 mmol/L or HbA1c ≥6.5%. We administered the Edinburgh claudication questionnaire and assessed the ankle brachial pressure index (ABI) and Doppler waveform in both dorsalis pedis and posterior tibial arteries. Participants were classified into categories based on ABI as follows: PAD ≤0.90 in any leg; borderline 0.91 to 0.99 in one leg and the other not ≤0.90 or >0.4; normal 1.00 to 1.40 in both legs; and non-compressible >1.40 in one leg and the other not ≤0.9. Waveforms crossing the zero-flow baseline were categorised as normal. Multivariable logistic regression assessed the associations of potential risk factors with PAD.ResultsOf 236 participants (74% response rate, 33% male, median age 58.6 years), 51% had previously diagnosed diabetes. Of nine people with symptoms of definite or atypical claudication, four had PAD and one had non-compressible arteries. ABI prevalence (95% CI) was PAD 18.6% (13.8, 24.6), borderline 21.9% (16.6, 28.4), normal 55.5% (49.4, 61.5) and non-compressible 3.9% (1.6, 9.3). Increasing age and female gender were independently associated with PAD. Over 80% of normal legs (ABI 1.00 to 1.40) had normal posterior tibial and dorsalis pedis waveforms, while only 23% legs with PAD (ABI ≤0.90) had normal waveforms in both arteries (Kappa = 0.43).ConclusionAsymptomatic PAD is common in people with diabetes and requires ABI screening to detect it. Female gender is associated with PAD.

Abstract EP45: Validation Of The Edinburgh Claudication Questionnaire For Identifying Peripheral Artery Diseasein Outpatient Cardiology Clinic: Single-center Experience

Background: Peripheral artery disease (PAD) is prevalent in patients with chronic heart disease, and portends a worse cardiovascular outcome. Edinburgh Claudication Questionnaire (ECQ) is a commonly used screening tool aimed to identify PAD in general practice. Despite its common use, its accuracy had not been validated in a cardiac population in the USA. We aimed to evaluate the diagnostic accuracy of the ECQ as a means of identifying PAD in an outpatient cardiology clinic. Method: Subjects were recruited at outpatient cardiology clinic at Loma Linda University Medical Center between 2017 and 2019. Patients with previously diagnosed PAD were excluded. 119 patients completed ECQ during their routine clinic visit, and were subsequently referred for duplex ultrasound and Ankle-Brachial Index (ABI) measurement. ABI was used as a reference standard for the diagnosis of PAD. Result: rom a total of 119 patients, 53% were male with mean age was 68. Majority (87%) of patients had hypertension, and 16% were active smokers. There were 16% of patients who tested positive on the ECQ and 47% of them had positive ABI. In patients with a negative ECQ, 23% had a positive ABI result. Receiver operating characteristic curve analysis showed ECQ had sensitivity of 28% (95% CI 13.7-46.7), specificity of 89% (95% CI 79.8-94.3), PPV of 2.5% (95% CI 1.1-5.5) and NPV of 77.8% (0.7 to 1.0), which equates to a positive and negative likelihood ratio of 2.6 and 0.8 respectively. On subgroup analyses, the ECQ performed better among current smokers (AUC=0.64 95% CI 0.43 to 0.84) and among male patients (AUC=0.66 95% CI 0.53 to 0.78). In the subgroup of male patients who were currently smoking, the ECQ performed better with 50% sensitivity and 99% specificity (AUC=0.75 95% CI 0.56 to 0.94). Conclusion: The ECQ had good specificity but poor sensitivity in the cardiology outpatient setting making it a poor tool for screening on its own. Sensitivity was higher in male current smokers. Further study of its utilization in high-risk patients such as in male smokers may be of benefit.

Laser acupuncture for claudication symptoms in peripheral artery disease- Does it work? A randomized trial.

Background:Peripheral artery disease (PAD) receives little attention despite its clinical consequences. Intermittent claudication is the most disturbing symptom of the disease resulting in marked limitations to functional walking performance. Treadmill walking exercise is the first-line non-pharmacological treatment in PAD; however, older patients may be unable to exercise because of the functional disability of the disease itself or deconditioning.Objective:In an attempt to seek an alternative intervention, this study aimed to assess the effect of laser acupuncture on patient-reported claudication symptoms and walk performance in PAD.Methods:Thirty male patients with PAD were assigned randomly to a control group (, years old, kg/m2) or a study group (, years old, kg/m2). Inclusion criteria were mild-to-moderate PAD, Fontaine stage II, unilateral or bilateral claudications, and older men. Exclusion criteria were asymptomatic PAD, resting pain, severe or critical limb ischemia, ischemic ulcers, and patients contraindicated for laser therapy. Both groups received pharmacological treatment, but only the study group received gallium aluminum arsenide (GaAlAs) laser therapy at nine acupuncture points, namely, Liver 2 (LV2), Stomach 41 (ST41), Urinary bladder 40 (UB40), UB60, UB61, Gall bladder 30 (GB30), GB34, GB38, and GB40 for 2 days/week and five consecutive weeks. A pen-type laser device was used at a wavelength of nm, with a power output of mW, a spot size of 0.08 cm2, and an energy density of 2 J/cm2, for 60 s/point. The Edinburgh Claudication Questionnaire (ECQ) and the 6-min walk distance (6-MWD) were the endpoints of the study. The McNemar–Bowker Test and Generalized Estimating Equations Ordinal Logistic Regression Model were used for the within- and between-group statistical analyses of the categorical data of ECQ, respectively; and a mixed model MANOVA was used for the within- and between-group analyses of the 6-MWD data.Results:There was a significant improvement in patients’ response to ECQ only in the study group compared to the baseline () and the controls () after the intervention. The 6-MWD increased significantly in the study group compared to the baseline ( m versus m, ).Conclusion:The GaAlAs laser acupuncture applied at selected acupoints may be a promising intervention complementary to drug therapy that could help relieve claudication symptoms and improve physical functional performance in older men with PAD (Fontaine stage II). Trials were conducted under the Trial Registration No. PACTR201912698539774.

The Edinburgh Claudication Questionnaire has poor diagnostic accuracy in people with intermittent claudication.

The screening and diagnosis of intermittent claudication is a challenging process and often relies on the expertise of specialist vascular clinicians. We sought to investigate the diagnostic performance of the Edinburgh Claudication Questionnaire (ECQ) as a screening tool for referrals of suspected intermittent claudication from primary to secondary care. Prospectively, 100 referrals from primary care with a stated diagnosis or query regarding intermittent claudication were recruited. All participants who completed the ECQ, underwent an anklebrachial pressure index (ABPI) assessment and treadmill exercise testing. Outcomes of the ECQ were compared to clinical diagnoses of intermittent claudication. The ECQ had a sensitivity of 46.8% (95% CI: 27-65%), specificity of 63.2% (95% CI: 43-82%) and accuracy of 53.0% (95% CI: 43-63%). The diagnostic performance was not changed by combining the ECQ with a positive ABPI or post-exercise ABPI outcome for PAD. The ECQ had a poor diagnostic performance in this cohort. Considering the results found here and in other recent studies, the utility of the ECQ as a screening tool and epidemiological survey tool must be questioned. Novel, low-resource diagnostic tools are needed in this population.

Depression among predictors of intermittent claudication: A cross-sectional study.

The aim of the present cross-sectional study was to investigate the relationship between depression and intermittent claudication (IC), independently of traditional risk factors. The sample consisted of 300 individuals (M age = 65.3 ± 8.7 years, 61.0% female) recruited from the offices of 33 general practitioners. Participants' medical history and the presence of major cardiovascular risk factors were recorded. Participants completed the Edinburgh Claudication Questionnaire. The role of depression (assessed by a shortened version of the Beck Depression Inventory) in predicting IC was examined using a binary logistic regression analysis - controlled for sex, age, hypertonia, diabetes, smoking, hypercholesterinemia, hazardous drinking, and body mass index (BMI). The descriptive data indicated that the prevalence of depression was 57.9% in the IC subgroup and 16.1% in those free of IC. The bivariate analyses indicated that hypercholesterinemia, smoking, hazardous drinking, BMI, and depression were significantly associated with IC. Male sex and age showed a trend toward being a significant correlate of IC. Results of the multivariate analyses indicated that depressive symptomatology was significant in predicting IC (OR: 1.08 (1.05-1.11)), even after controlling for lifestyle and traditional risk factors such as smoking, hazardous drinking, and BMI. Among traditional risk factors, smoking (OR: 2.44 (1.26-4.74)), hazardous drinking (OR: 1.19 (1.02-1.40)), and hypercholesterinemia (OR: 2.17 (1.26-3.75)) showed a significant, positive relationship with IC. These results underscore the importance of a multidisciplinary approach that focuses on supporting health-related behavioral changes and managing mental health symptoms when providing care for patients with IC.

Influence of Lumbar Spinal Canal Dimensions on Neurological Claudication Symptomatology - A Case Control Study

Lumbar spinal stenosis (LSS) is abnormal narrowing of spinal canal of lumbar vertebrae causing compression of neural tissue which leads to a neurologic deficit. LSS is diagnosed based on clinical symptoms of patient and it is confirmed using MRI (Magnetic Resonance Imaging). The aim of the study is to determine the association between MRI lumbar spinal canal and foraminal dimensions in on neurological claudication symptomology. A total of 89 patients (45 males ,44 females, age range: 20-60 years) referred for MRI Lumbar spine were included in this prospective study. Patients were categorized into symptomatic (49 cases) and asymptomatic (40 controls) based on Edinburgh claudication questionnaire (ECQ). The Antero-posterior diameter of dural sac, Transverse diameter of dural sac, Cross sectional area of dural sac, Cross sectional area of lateral recess, Lateral recess depth, Angle of lateral recess, Ligamentous interfacet distance was measured from L3 to S1 on Axial T2 weighted MRI images. The strength of association between MRI measurements and clinical symptoms were assessed using logistic regression analysis and Cramer’s V test. The Phi coefficient value for the lumbar spinal canal, foraminal dimensions with neurogenic claudication symptomology based on ECQ was 0.108 &amp; 0.207 respectively, which showed weak positive correlation. Our study concludes that MRI measurements of lumbar spinal canal and foraminal dimensions denoting LSS were found to show weak positive correlation with clinical symptoms assessed based on Edinburgh claudication questionnaire.

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.

The hidden side of calf claudication: Hemodynamic and clinical results of treadmill testing in 584 patients complaining of isolated exertional calf pain

Background and aimsCalf pain is the most frequent symptom of arterial claudication. We hypothesized that patients with self-reported isolated calf claudication have frequent exertional non-calf symptoms during objective laboratory testing, and that many would show not only distal, but also proximal ischemia. MethodsWe retrospectively analyzed the patients referred since 2016 for exercise transcutaneous oxygen pressure (Ex-tcpO2). The Edinburgh Claudication Questionnaire (ECQ) was self-completed before and during a treadmill test. For calf and non-calf (buttock and thigh) Ex-tcpO2, a lowest decrease of rest of oxygen pressure (DROP) < −15 mmHg was indicative of ischemia. We selected the patients that reported calf claudication only and analyzed minimal DROP and per-test ECQ observations. ResultsExertional symptoms on a treadmill occurred in 526 (90.1%) of the 584 patients analyzed (65.6 ± 11.4 years old), with 391 (74.3%) of these symptoms affecting only the calf. Isolated calf ischemia with or without symptoms was found in only 139 (23.8%) patients. Overall, among the 584 patients self-reporting isolated calf symptoms, a perfect concordance between symptoms on a treadmill and Ex-tcpO2 (i.e. calf symptoms associated to calf ischemia) was observed in only 114 (19.5%) cases. ConclusionsOur study demonstrated that patients self-reporting exertional limb pain strictly limited to the calf may also have non-calf claudication on a treadmill and frequently show not-only-calf ischemia. These observations are important when planning reeducation or when studying the tissue consequences of ischemia in patients with claudication.

Peripheral arterial disease and intermittent claudication in coronary heart disease patients

Background and aimPeripheral artery disease (PAD) is associated with an increased risk of fatal and non-fatal coronary heart disease (CHD). The aims of the this study were 1) to investigate the prevalence of PAD and suspected PAD in a large population of established CHD patients, and 2) to assess the prevalence and control of risk factors in these patients as well health-related quality of life. Material and methodsIn the EUROASPIRE V survey, 8243 patients with documented CHD were recruited from 27 ESC member countries and were invited to attend a study visit. Patients were investigated using questionnaires, in-depth interviews and a clinical examination. Intermittent claudication (IC) was assessed using the Edinburgh Claudication Questionnaire. Patients without previously diagnosed PAD were suspected of having PAD if they were found to have IC. ResultsOverall, 6.4% of the patients had already a confirmed diagnosis of PAD and another 6.3% were suspected of having PAD. Independent of age and gender, patients with previously diagnosed PAD were significantly more frequently current smokers, had the lowest smoking cessation rates, were less physically active, reported more often previously diagnosed diabetes and had significantly higher blood pressure levels, compared to patients without PAD. They had also significantly higher levels of serum triglycerides, lower HDL-C levels, and had more often renal insufficiency. In comparison with patients without PAD, those with suspected PAD demonstrated significantly higher smoking cessation rates but their obesity rates were significantly higher. In CHD patients with a history of PAD, the use of calcium channel blockers and diuretics was significantly higher than in patients without PAD. Compared to the latter group, the use of diuretics, anti-arrhythmics and anti-depressants in patients with suspected PAD was significantly higher. Moreover, patients with previously diagnosed PAD had significantly higher levels of anxiety and depression and reported a significantly worse health-related quality of life (HRQoL), in comparison with those without PAD. HRQoL levels were significantly reduced in patients with suspected PAD as well. ConclusionIn CHD patients without a previous diagnosis of PAD, IC is not infrequent. Diagnosed PAD was significantly associated with a worse CHD risk factor profile. Patients with known PAD as well as those with suspected PAD had a considerable loss of health-related quality of life. Therefore, physicians should consider to screen for IC in all their CHD patients.

Peripheral artery disease in outpatients with a recent history of acute coronary syndrome or at high atherothrombotic risk.

The frequency and implications of peripheral artery disease (PAD) in some risk groups are not entirely characterized in Latin America. We studied PAD prevalence, risk factors, and six-month outcomes in stable outpatients with a history of a recent acute coronary syndrome (ACS), or at high coronary risk. We recruited 830 outpatients in 43 Mexican sites (median age: 64.8 years; 57.8% men). Inclusion criteria were age >18 years, and ACS within 30 days, or age <55 years plus ≥2 major vascular risk factors, or age ≥55 years plus ≥1 vascular risk factors. Patients received standardized assessments at baseline and six-month follow-up for medical history, ankle-brachial index (ABI), and the Edinburgh Claudication Questionnaire (ECQ). ABI <0.8 was found in 10.5%, <0.9 in 22.5%, >1.3 in 4.8%, and >1.4 in 3.6%, without differences according to sex or selection criteria. Positive ECQ was found in 7.6%. ABI <0.9 was directly associated with age, diabetes, ACS, and chronic kidney disease, but inversely associated with BMI >27. The six-month case-fatality and atherothrombotic events rates were 1.6% and 3.6%, respectively. In patients with ABI <0.9 and ABI <0.8, the six-month case-fatality rates were 2.5% (p = 0.27) and 5.4% (p = 0.03), respectively. In a Cox proportional-hazards model, baseline factors associated with death were age ≥65, ABI <0.8, and ACS. Subclinical PAD is more common than symptomatic claudication in high-risk coronary outpatients. Low ABI is associated with reduced short-term survival in patients with recent ACS or at high coronary risk.

Effects of Far-Infrared Therapy on Foot Circulation Among Hemodialysis Patients With Diabetes Mellitus

Far-infrared radiation (FIR) therapy improves vessel dilation, circulation, vessel endothelial function, and angiogenesis and reduces atherosclerosis. However, evidence of FIR therapy's effects on foot circulation among diabetic patients undergoing hemodialysis is scarce. To determine whether FIR therapy improves foot circulation in diabetic patients undergoing hemodialysis. Quasi-experimental. In June to November 2017, diabetic patients undergoing hemodialysis (N = 58) at a hemodialysis center in northern Taiwan were divided into two groups: the experimental group (n = 31) received FIR therapy to the bilateral dorsalis pedis artery (40 min/session, 3 times/week for 6 months) and the control group (n = 27) received conventional dialysis care. Paired t test, independent samples t test, two-proportion Z test, and repeated-measures analysis of covariance were performed to compare changes from baseline to the end of the 6-month intervention between the groups. Significant positive effects of FIR therapy on temperature, pulse, and blood flow of the dorsalis pedis artery were observed. Sensitivity to pain, tactility, and pressure also improved significantly in the experimental group. The Edinburgh Claudication Questionnaire revealed that the experimental group had reductions in subjective experiences of soreness, tingling, and coldness in the feet. The findings of significant improvements to objective and subjective measures of blood flow and neural function in the experimental group indicate that FIR therapy improves blood circulation to the feet. This therapy thus has great potential to be an effective adjuvant treatment for patients with diabetes mellitus undergoing hemodialysis.

The prevalence of and risk factors for peripheral arterial occlusive disease in human immunodeficiency virus-infected omani patients: The first study in GCC

Aim: To assess the prevalence of peripheral arterial occlusive disease (PAOD) in human immunodeficiency virus (HIV)-infected Omani patients and to assess the potential risk factors in this group. Methodology: This was a single-center, cross-sectional study. All patients attending the infectious disease clinic between July 2017 and March 2018 were included in the study; their peripheral pulses were examined and pre- and postexercise ankle–brachial pressure index (ABPI) was measured. Normal ABPI was considered as being in the range of 1.0 ± 0.1, and a reduction of >15% postexercise ABPI was considered as a cutoff limit to define PAOD. The Edinburgh Claudication Questionnaire was answered by all patients, and CD4 count, viral load, albumin and Vitamin D (25-OH) levels, and glycated hemoglobin (HbA1c) were measured. The data were analyzed using IBM SPSS Statistics version 22. Results: Eighty-eight patients who were retroviral positive were enrolled in the study. Fifty-three (60.2%) patients were male and 35 (39.8%) were female, with a mean age of 43 years (24–71). The dorsalis pedis artery pulsation was absent bilaterally in 3 (3.4%) patients. None of the patients had a history of claudication; 1 (1.1%) had an abnormal ABPI; 17 (19.2%) had a reduction of >15% postexercise ABPI; 7 (8%) had CD4 count

Detection of peripheral arterial disease in patients with type 2 diabetes mellitus in family medicine clinic

&amp;lt;p&amp;gt;Introduction. Peripheral arterial disease (PAD) is a progressive, occlusive and atherosclerotic vascular disease and patients with type 2 diabetes mellitus (DM) are at increased risk of developing this disease. The aim of the study was to determine the frequency of PAD in patients with type 2 DM by measuring the ankle-brachial index (ABI) in the family medicine clinic. Methods. The cross-sectional study included the patients with type 2 DM, registered at the Family Medicine Department of Primary Healthcare Center Lakta&amp;amp;scaron;i. ABI measurement was carried out by means of the &amp;quot;Boso ABI Mess 100 Oscillometer&amp;quot; apparatus while patients were diagnosed with PAD if the ABI value was &amp;amp;lt;0.9 or &amp;amp;gt;1.3. Results. The study included 178 respondents with type 2 DM, aged &amp;amp;ge;50 years, whereby 90 of them (50.6%) were men. PAD was found in 26 (14.6%) respondents. There was a statistically significant difference in ABI (left/ right leg) between the patients with PAD and the ones without it (0.82/0.84 vs. 1.04/1.05; p&amp;amp;lt;0.01). The average duration of DM was longer in patients with PAD compared to those without PAD (12 vs. 8 years; p = 0.097) and the mean values of HbA1c were the same in both groups (7.7% vs. 7.9%; p = 0.634). There was no statistically significant difference in the frequency of hypertension, dyslipidaemia and obesity between the patients with and without PAD, respectively. Furthermore, the number of smokers among the patients with PAD was significantly higher (p &amp;amp;lt;0.01). Conclusion. In patients with type 2 DM, PAD prevalence was 14.6%. Diabetes lasted a bit longer in patients with PAD, and among them there were significantly more smokers compared to the group without PAD. The Edinburgh Claudication Questionnaire showed positive results in only a third of patients with PAD. Early PAD diagnosis could be established in considerably larger number of patients with type 2 DM by ABI measurement than by the use of the above-mentioned questionnaire.&amp;lt;/p&amp;gt;

Assessment of peripheral arterial disease in diabetic adults with foot ulcers in an African population

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Peripheral arterial disease (PAD) is a recognized risk factor for diabetic foot ulceration. It was thought that PAD is not common in Sub-Saharan Africa. Studies show otherwise. It becomes necessary to assess the prevalence of PAD among diabetic adults with foot ulcers in Nigeria. The objective of the study was to assess the prevalence of PAD in diabetic subjects with foot ulcers in Nigeria.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Diagnosis of PAD was made with the ankle-brachial index (ABI). Edinburgh claudication questionnaire was administered to the patients. An ABI of &amp;lt;0.9 is diagnostic of PAD. Risk factors for PAD were assessed. A control group of non-diabetic adults was used.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Sixty-seven per cent (67%) of the test group has PAD as compared to 18% of the control group. Smoking, duration of diabetes and systemic hypertension were strongly associated with PAD.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Diabetic adults with foot ulcers in Nigeria have a high prevalence of PAD.&lt;/p&gt;