Evidence Of Peripheral Vascular Disease Research Articles

A Review of Cardiovascular Effects of Marijuana Use.

Cannabinoids exert their effects on body tissues via cannabinoid 1 (CB1) and cannabinoid 2 (CB2) receptors. Receptors are present in brain, myocardium, vascular endothelium, platelets, and adipose tissues. Under normal physiologic conditions, endocannabinoid effects are minimal. The use of exogenous cannabis leads to endothelial dysfunction and increases vascular thrombosis via CB1 receptor stimulation. On the other hand, CB2 receptors may have a beneficial anti-inflammatory response. We reviewed reports of the effects of cannabis on the cardiovascular system utilizing PUBMED from the last 20years with emphasis on the most recent reports. Despite a plethora of reviews and some retrospective studies, there is a need for more definitive data regarding the effect of cannabis use on cardiovascular events (CVE). Marijuana does not appear to accelerate atherosclerosis. There is a suggestion that it may induce myocardial infarction in a small percentage of users, especially in male users, particularly during recent use. It has a possibility of increasing cerebrovascular events when combined with other risk factors such as tobacco use. There is an association between cannabis use and increased evidence of peripheral vascular disease. To have a definitive answer to the question of whether cannabis contributes to CVE, there is an urgent need for prospective controlled studies with patients presenting to academically oriented medical facilities with CVE following cannabis use for either medicinal or recreational use.

Stromal and Epithelial Architectural Alterations Mimicking Invasion (Pseudoinvasion) in Noninvasive Papillary Urothelial Carcinoma.

Retraction artifact, paradoxic maturation/differentiation, desmoplasia, and complex irregular growth are morphologic criteria of invasion in urothelial carcinoma. To describe changes mimicking invasion in noninvasive papillary urothelial carcinoma (NPUC). We reviewed 159 consecutive in-house patients with NPUC for either the presence of pseudoinvasion (irregular carcinoma nests within dense hyalinized stroma in the absence of other criteria of invasion) or precursor findings (stromal hyalinization not yet associated with epithelial architectural alteration). We assessed the correlation of these findings with age, sex, evidence of peripheral vascular disease, tumor grade, tumor infarction, and tumor size. We then followed up the patients clinically for tumor recurrence or progression. We identified 233 separate NPUCs (136 high grade and 97 low grade) in 125 men and 34 women. Of the 233 tumors, 26 (11.2%) had pseudoinvasion and 24 of 233 tumors (10.3%) had precursor findings. Except for complex irregular growth, no other criteria for invasion were seen. Pseudoinvasion and precursor findings were more common in men (47 of 183 [26%] versus 3 of 50 [6%]; P = .003), larger tumors (mean size, 2.6 versus 1.2 cm; P < .001), and tumors with infarction (33 of 50 [66%] versus 29 of 183 [15.8%]; P < .001). In multivariable analysis, tumor size (odds ratio, 1.49; P =.006), male sex (odds ratio, 6.48; P = .007), and the presence of infarction (odds ratio, 6.59; P < .001) were significant variables. Recurrence rates did not differ between patients with and those without pseudoinvasion (31% [5 of 16] versus 42% [45 of 107], respectively; P = .41). None of the tumors with pseudoinvasion progressed to invasive carcinoma. Given the correlation with size and presence of infarcted papillae, we suggest the possibility of tumor ischemia/infarction as a plausible etiology of pseudoinvasion. Awareness of this phenomenon is important for the accurate diagnosis of invasion in papillary urothelial carcinoma.

Implication of Peripheral Neuropathy on Unplanned Readmissions in Patients Hospitalized for Complicated Diabetic Foot Disease.

Introduction. Unplanned readmissions are common following discharge in patients after hospitalization for diabetic foot disease (DFD) complications. The aim of this study was to identify factors associated with readmissions in these high-risk patients, treated in a multidisciplinary setting and the implication of measures that could effectively reduce readmission rates. Methods. Patients presenting with DFDs admitted between 2015 and 2017 were studied retrospectively in a single-centre patient database. The demographics and clinical comorbidities were analyzed and comparison was made between 2 groups: patients readmitted within 30 days of discharge and those who did not require readmission. Multivariate analysis was performed to identify risk factors associated with readmissions. Results. In total, 340 patients were included. The unplanned readmission rate was 10.9%. More than half of readmissions (71%) were related to wound deterioration and infection. In the readmission group, the patients had lower body mass index, higher rate of osteomyelitis, lower rate of debridement, and evidence of peripheral vascular disease below the knee in the index admissions but these were not significant. In the multivariate analysis, peripheral neuropathy was the only significant risk associated with unplanned readmissions (odds ratio: 2.78, 95% confidence interval: 1.23-6.29, P = .014). Conclusion. This study demonstrates a significant association between peripheral neuropathy and unplanned readmissions. The implications of this nonmodifiable risk factor in reducing readmissions include all levels of patient care delivery such as adequate preparation for discharge and transition back into the community. Recognition and education in successful long-term offloading of insensate diabetic feet may help reduce rates of unplanned readmission.

Diabetes mellitus foot ulcer and associated factors among Type 2 diabetes patients in a Tertiary Institution in Southwest Nigeria.

This study aims to assess the proportion of diabetic foot ulcer (DMFU) and associated factors among patients with type 2 diabetes in a tertiary hospital in Southwest Nigeria. A pretested semi-structured interviewer-administered questionnaire adapted from the STEPwise Approach to Surveillance of Noncommunicable Disease Risk Factors of WHO.14 was used for data collection from a sample of 181 patients with type 2 diabetes mellitus. Sociodemographic, behavioral, clinical, and laboratory variables were collated from the participants. Chi-square test and logistic regression were used to identify the predictors of DMFU. A total of 166 patients had their questionnaires completed. The mean age (standard deviation) of the respondents was 62.6 (14.3) years. The proportion of DMFU was 18.7%. More than two-third (71.1%) of our respondents had clinical symptoms suggestive of peripheral neuropathy while 34.3% of the patients seen in the study had evidence of peripheral vascular disease on duplex Doppler ultrasound. Male patients were about five times more likely to have DMFU than female patients (adjusted odds ratio [AOR] =5.27; 95% confidence interval [CI] = 1.001-27.841). Those with duration of diabetes ≥10 years were more likely to have DMFU than those with disease duration <10 years (AOR = 15.47; 95% CI = 1.201-199.314). Patients with fasting blood glucose (FBG) of ≥ 7.2 mmol/L were about four times more likely to have DMFU than those with FBG of <7.2 mmol/L (AOR = 4.19; 95% CI = 1.618-18.463). The proportion of DMFU was 18.7%, and the predictors identified included sex, duration of disease, and FBG level.

Predictive parameters of arteriovenous fistula maturation in patients with end-stage renal disease.

BackgroundThe objevctive of the present study was to explore the potential influence of blood markers and patient factors such as risk factors, kidney function profile, coagulation profile, lipid profile, body mass index, blood pressure, and vein diameter on the maturation of arteriovenous fistula (AVF) in patients with end-stage renal disease.MethodsRetrospective data from 300 patients who had undergone AVF creation at the Royal Infirmary of Edinburgh were examined. A predictive logistic regression model was developed using a backward stepwise procedure. Model performance, discrimination, and calibration were assessed using the receiver operating characteristic (ROC) curve and Hosmer–Lemeshow goodness-of-fit test. The final model was externally validated by 100 prospective patients who received a new fistula at the Royal Infirmary of Edinburgh.ResultsA total of 400 (300 retrospective and 100 prospective) patients were recruited for this study, with a mean age of 60.14 ± 15.9 years (development set) and 58 ± 15 years (validation set), respectively (P = 0.208). Study results showed that males were twice as likely to undergo fistula maturation as females, while patients with no evidence of peripheral vascular disease (PVD) were three times more likely to mature their fistula and a preoperative vein diameter > 2.5 mm resulted in a fivefold increase in fistula maturation as compared with a vein size of less than 2.5 mm. The model for fistula maturation had fair discrimination, as indicated by the area under the ROC curve (0.68), but good calibration as indicated by the Hosmer–Lemeshow test (P = 0.79). The area under the receiver operating curve for the validation model in the validation set was 0.59. Similarly, in the validation set, the Hosmer–Lemeshow statistic indicated an agreement between the observed and predicted probabilities of maturation (P > 0.05).ConclusionGender, PVD, and vein size are independent predictors of AVF maturation. The clinical utility of these risk categories in the maturation of AVF requires further evaluation in longer follow-up.

Development of prognostic model for fistula maturation in patients with advanced renal failure

BackgroundThis study aimed to explore the role of patient’s characteristic and haematological factors as predictive on the maturation of arteriovenous fistulae in patients who underwent vascular access surgery at the Royal Infirmary of Edinburgh.MethodsRetrospective data from 300 patients who had undergone fistula creation between February 2007 and October 2010 was examined. A predictive logistic regression model was developed using the backward stepwise procedure. Model performance, discrimination and calibration, was assessed using the receiver operating characteristics (ROC) curve and Hosmer and Lemeshow goodness of fit test.ResultsThree variables were identified which independently influenced fistula maturation. Males were twice as likely to undergo fistula maturation, compared to that of females (odds ratio (OR) 0.514; 95% confidence interval (CI) 0.308–0.857), patients with no evidence of peripheral vascular disease (PVD) were three times more likely to mature their fistula (OR 3.140; 95% CI 1.596–6.177) and a pre-operative vein diameter > 2.5 mm resulted in a fivefold increase in fistula maturation compared to a vein size less than 2.5 mm (OR 4.532; 95% CI 2.063–9.958). The model for fistula maturation had fair discrimination as indicated by the area under the ROC curve (0.68; 95% CI 0.615–0.738) but good calibration indicated by Hosmer and Lemeshow test (p = 0.79).ConclusionGender, PVD and vein size are independent predictors of arteriovenous fistula maturation. The clinical utility of these risk equation in the maturation of arteriovenous fistulae requires further validation in the newly treated patients.

Extracorporeal Shock Wave Therapy in the Treatment of Non-Healing Diabetic Ulcer: A Pilot Study

15-20% of all diabetic patients develop a foot ulcer. Diabetic ulcer is the major cause of non-traumatic lower extremity amputation. Extracorporeal shock wave therapy (ESWT) has emerged as a promising therapy in the field of wound healing. In this study, Five patients with diabetic foot (mean age of 58.2 ± 19.63 years, mean ulcer duration: 1.6 years), received ESWT in 6-8 weekly sessions, at a flux density of 0.25 mJ/mm2, delivered as 500 shocks at wound margin and 1000 shocks distal to the wound. All patients had evidence of peripheral vascular disease and neuropathy before treatment. A significant reduction in ulcer surface area was observed in four patients (mean reduction: 1.21 ± 0.82 cm2, p value=0.03). All patients showed improvement in the ankle brachial index and monofilament test after treatment. In sum, ESWT may be a promising adjunct in the treatment of chronic, non-healing diabetic ulcers.

Clinical Profile and Practice Guidelines for Diabetic Foot Infections in Hilly Regions of Uttarakhand, India

The rising incidence of diabetes and its complications means that the number of patients presenting to surgical clinics with diabetic foot infections will continue to rise. A diabetic foot is defined as any infra malleolar infection in a person with diabetes mellitus. The morbidity of the condition has implications in the management and there are few surgical clinics where such patients find specialized treatment. It is imperative that such patients are managed by a team of a physician, a surgeon, a social care worker, a physiotherapist, a dietician and a podiatrist. We continue to see increasing numbers of patients at younger age with diabetic foot infections (DFI). This series of patients seen over a five year period includes 70 patients. More than 90 per cent of our patients were in the age group of 30 years or more. About 41% of them were PEDIS grade 1 or 2, i.e. they had mild or no infections. About 24% had PEDIS grade 4 infections. 33% of them had evidence of peripheral vascular disease, neurological features were seen in 27%, and renal compromise was seen in 20% of our patients. 67% of our patients had infra malleolar disease where as the rest had involvement of the leg or thigh. Bony involvement was seen in 4% of our patients. We isolated more than two micro organisms in 54% of our patients. Bacterial resistance was a problem more commonly seen in hospitalized patients. More than half of all patients needed debridement of our patients needed debridement. About 20% of patients were managed with partial thickness skin grafting for skin cover. One patient was treated with reverse sural flap for skin cover. About 30% of all patients needed amputations of toes/mid tarsal amputations or below knee amputations. Practice guidelines for the management of these patients are presented after an extensive review of the literature.

Evaluation of Shear Stress in the Popliteal Artery in Patients With Type 2 Diabetes Mellitus Using Vascular Sonography

The aim of this study was to use vascular sonography to evaluate the dynamic forces acting on the wall of the popliteal artery in patients with type 2 diabetes mellitus (T2DM) compared to a control group without diabetes. Forty patients with T2DM and 20 control subjects were enrolled in the study. Patients were divided according to their measured Ankle-Brachial Index (ABI) into two groups, those with evidence of peripheral vascular disease (PVD) based on an ABI &lt; 0.9 (n = 18) and those without peripheral vascular disease (N-PVD, ABI ≥ 0.9, n = 22). The systolic and diastolic internal diameter (IDs, IDd) and the end-diastolic intima media thickness (IMT) of the popliteal artery were measured. Hemodynamic parameters measured were the peak systolic velocity, end-diastolic velocity, and the mean velocity (Vs, Vd, Vm). The peak systolic and mean shear stress (Ts, Tm) were calculated using the Hagen-Poiseuille formula. The shear stress of the popliteal artery was significantly decreased in patients with diabetes in the PVD group compared to the N-PVD group ( P &lt; .05). Shear stress also was significantly decreased in both the N-PVD and the PVD patients compared to the control group ( P &lt; .05). The shear stress may be a reliable index for the assessment of lower extremity arterial disease status in patients with diabetes mellitus at an early stage when the vascular IMT remains normal.

Prevalence of erectile dysfunction and associated factors among diabetic men attending diabetic clinic at Muhimbili National Hospital in Dar-es-Salaam, Tanzania.

IntroductionThere has been an increase in the prevalence of erectile dysfunction (ED) in the general population especially among Diabetic patients. This seems to be neglected problem in low-income countries. This study aims at establishing the prevalence of ED and associated risk factors in diabetic patients attended at Diabetic Clinic at Muhimbili National Hospital.MethodsA cross-sectional hospital based study was conducted among 312 diabetic patients attending diabetic clinic at Muhimbili National Hospital between May and December 2011.ResultsMore than half (55.1%) of the patients were found to have some form of ED (12.8% had mild dysfunction, 11.5% moderate and 27.9% severe dysfunction). The severity of ED was correlated with increased age. Multivariate logistic regression revealed that ED was significantly predicted by old age (odds ratio (OR) = 7.1, 95% CI 1.2-40.7), evidence of peripheral neuropathy (OR) =5.9, 95% CI 1.6-21.3), and evidence of peripheral vascular disease (OR =2.5, 95% CI 1.2-5.3). Also longer duration of DM was marginally associated with ED (p=0.056). Patients with ED were also more likely to suffer other sexual domains (p<0.001). No lifestyle factor was associated with ED.ConclusionThe prevalence of ED is high among DM patients. Interventions aimed at prevention, early diagnosis and detection of DM and its complications, and adherence to treatment to prevent complications should be implemented. Further studies should emphasize on temporal variation to show true causality of DM on erectile dysfunction.

Chapter 8 - Diabetic neuropathy and foot complications

Foot ulceration and Charcot neuroarthropathy (CN) are well recognized and documented late sequelae of diabetic peripheral, somatic, and sympathetic autonomic neuropathy. The neuropathic foot, however, does not ulcerate spontaneously: it is a combination of loss of sensation due to neuropathy together with other factors such as foot deformity and external trauma that results in ulceration and indeed CN. The commonest trauma leading to foot ulcers in the neuropathic foot in Western countries is from inappropriate footwear. Much of the management of the insensate foot in diabetes has been learned from leprosy which similarly gives rise to insensitive foot ulceration. No expensive equipment is required to identify the high risk foot and recently developed tests such as the Ipswich Touch Test and the Vibratip have been shown to be useful in identifying the high risk foot. A comprehensive screening program, together with education of high risk patients, should help to reduce the all too high incidence of ulceration in diabetes. More recently another very high risk group has been identified, namely patients on dialysis, who are at extremely high risk of developing foot ulceration; this should be preventable. The most important feature in management of neuropathic foot ulceration is offloading as patients can easily walk on active foot ulcers due to the loss of pain sensation. Infection should be treated aggressively and if there is any evidence of peripheral vascular disease, arteriography and appropriate surgical management is also indicated. CN often presents with a unilateral hot, swollen foot and any patient presenting with these features known to have neuropathy should be treated as a Charcot until this is proven otherwise. Most important in the management of acute CN is offloading, often in a total contact cast.

Prevalence of Cardiovascular Events in Patients with Autosomal Dominant Polycystic Kidney Disease

Background: This study evaluates the prevalence of cardiovascular events in autosomal dominant polycystic kidney disease (ADPKD) patients. Methods: We distributed surveys to 1,439 subjects from our ADPKD research database. In total, 426 subjects completed and returned surveys; 7 of these were from children and were excluded from the study. Results: The patients who responded were female (63.2%), nonHispanic (88.1%) and white (93.6%). The mean age of the total group was 53.2 ± 13.7 years; 82.8% had a family history of ADPKD and 32.5% had reached end-stage renal disease (ESRD). With respect to cardiovascular risk factors, 86.6% were hypertensive with a mean age at diagnosis of 36.9 ± 12.9 years and hypertension was significantly more prevalent in males. In addition, 19.6% of the subjects were obese, 20.8% were smokers, 8.7% had diabetes, 45.7% had high cholesterol and 17.8% were sedentary. The most prevalent self-reported cardiovascular events were arrhythmias (25.9%), evidence of peripheral vascular disease (16.5%), heart valve problems (14.4%), cardiac enlargement (9.5%), stroke or cerebral bleeding (7.5%), myocardial infarction (6%) and brain aneurysm (5.0%). The most commonly used antihypertensive medications were renin-angiotensin inhibitors used by 75% of ADPKD patients. Older ADPKD patients and those at ESRD had a significantly higher incidence of cardiovascular events. Conclusion: These findings support the high prevalence of cardiovascular risk factors and events in ADPKD patients which contribute to a greater mortality risk. Due to the prevalence of cardiovascular risk factors in the ADPKD population, early diagnosis and clinical intervention are recommended.

Does a plain X-ray of the pelvis predict arterial complications in renal transplantation? A prospective study

It is unknown whether if a plain X-ray of the iliac arteries (pelvic X-ray) is a reliable tool to detect calcifications and predict vascular complications. In a prospective study, a pelvic X-ray was performed before transplantation in patients without evidence of peripheral vascular disease (n = 109) and vascular calcifications were scored. Vascular calcifications in the iliac arteries and complications were scored by the transplant surgeon during the operation (gold standard). Vascular calcifications were found on the pelvic X-ray in 33 patients (30.2%). The transplant surgeon identified vascular calcifications in 35%. Sensitivity and specificity of the pelvic X-ray for vascular calcifications in the iliac arteries were 48 and 82%, respectively. Technical problems with the arterial anastomosis due to vascular calcifications were observed in five patients. The negative predictive value and positive predictive value of a pelvic X-ray for complications with the arterial anastomosis were 99 and 14%, respectively. A pelvic X-ray is not a reliable tool to detect vascular calcifications. Technical problems with the arterial anastomosis due to calcifications are infrequent in the absence of vascular calcifications on the pelvic X-ray.

HYPERCAPNIA-INDUCED CEREBROVASCULAR RESERVE OF YOUNG HYPERTENSIVE PATIENTS: PP.4.150

Objectives: The aim of this study was evaluate state cerebrovascular reactivity in condition of hypercapnia-induced CO2 cerebrovascular reserve at young hypertensive patients. Methods: We used ultasonography of internal carotid artery (ICA) and transcranial Doppler‘s method in the study of middle cerebral arteries (MCA) from temporal window. We studied the changes of flow velocity mean (FVm) and diameter (D) starting, at the time of hypercapnia (inhalation 2 min 4% mixture of carbonic gas (MCG) with air) and FmV in period of recovery (rec) (air-inhalation 3 min) of 21 patients (1group) with essential hypertension with grade I-II and 20 healthy volunteers (2group) without cerebral stroke during of the life history (age 18–25years). Secondary hypertension were excluded by clinical and biochemical tests. At the time of vascular evaluation, none of the patients had a history or clinical evidence of peripheral vascular disease, coagulopathy, or any disease predisposing them to vasculitis. All participants of research have given the informed agreement. We used coefficient of FVm - CFVmCO2 = VmCO2/Vm0, index of D – IDCO2 = (DCO2-D0)/T and index of recovery IVmrecCO2 = Vm0/Vmrec; Vm0 and D0 is starting parameters. VmCO2, DCO2 and T -time is inhalation parameters. Statistical analysis: descriptive, t-test independent by groups. Results: Patients and healthy volunteers had not distinctions of anthropometrical parameters. Significant difference was found between 1 and 2 groups: FVm in ICA 68,3 ± 0,9 and 60,3 ± 1,9 ð < 0,05sm/s; CFVmCO2 - 1,24 ± 0,13 and 1,56 ± 0,21 ð < 0,05; IDCO2 - 0,31 ± 0,04 and 0,52 ± 0,15 ð < 0,05; IVmrecCO2 - 1,14 ± 0,08 and 0,98 ± 0,06 ð < 0,01 respectively. Conclusion: Young patients with a hypertension had higher blood velocity in ICA and inhibited cerebrovascular reactivity and decrease in adequacy of the answer of arterial blood circulation of a brain in condition of hypercapnia.

Factores de riesgo combinados para síndrome compartimental de la pierna después de una prostatectomía radical laparoscópica

Well leg compartment syndrome is rare after laparoscopic radical prostatectomy. We report a 68-year-old man that developed compartment syndrome after laparoscopic radical prostatectomy for prostate cancer. There are several circumstantial risk factors associated with LRP that, when combined, may potentially predispose to the development of compartment syndrome, including: obesity, evidence of peripheral vascular disease (advanced age, hypertension, hyperlipidemia, and diabetes mellitus), thromboembolism prophylaxis with compressive leg wraps together with intermittent pneumatic devices, combined general-spinal anesthesia, prolonged operative time in Trendelenburg position, and systemic hypotension due to intraoperative bleeding. The pathogenesis of this serious complication is discussed and preventive measures are highlighted.

Continuous Aortic Flow Augmentation in a Chronic Heart Failure Patient With Peripheral Arterial Disease

Continuous Aortic Flow Augmentation in a Chronic Heart Failure Patient With Peripheral Arterial Disease

Ischaemia of the hand after harvest of a radial forearm flap

The development of ischaemia in the hand after harvest of a radial forearm flap is extremely rare. Previous cases have been caused by anatomical anomalies or conditions that may have been detectable by ultrasonography. We report the development of ischaemia after harvest of a radial forearm flap despite a normal preoperative Allen's test and a normal Doppler ultrasound scan, in a non-smoker with no evidence of peripheral vascular disease. Angiographic appearances suggested that the ischaemia may have been secondary to an incomplete superficial palmar arch. This case highlights the potential for development of ischaemia despite normal preoperative investigations, with obvious ramifications for obtaining consent.

Peripheral Arterial Disease

SummaryPeripheral arterial disease (PAD) is a common disease. One in five of the middle-aged population of the United Kingdom has evidence of peripheral vascular disease on clinical examination, although only a quarter of these people have symptoms1. PAD is a distinct atherothrombotic syndrome that is associated with an elevated risk of cardiovascular and cerebrovascular events, including death, myocardial infarction (MI) and stroke2. In essence, PAD is an important manifestation of systemic atherosclerosis.

Microsurgical management of the diabetic foot.

Allthough there has been dramatic progress in limb salvage in recent decades, management of nonhealing wounds in diabetic patients continues to present a dilemma for the reconstructive surgeon. However, the acceptance of free-flap resurfacing of diabetic foot ulcers has increased in recent years. This study reviews 10 microvascular free muscle flaps in nine patients over a mean follow-up period of 44 months. Five patients had evidence of peripheral vascular disease. There was one flap loss, and nine flaps were transferred successfully. No perioperative mortality was encountered. The operations required a long, costly hospitalization (average hospital stay was 40 days). Seven of eight patients whose flaps survived had complications related to the free-flap recipient site. These seven patients underwent 20 secondary surgical procedures due to arterial and venous thrombosis, partial necrosis of the skin grafts, minor local infections, and gangrene or necrosis of the remaining toes. In three patients, progressive ischemic necrosis of the remaining toes, with total survival of the flap, was attributed to a microvascular steal phenomenon. However, all eight patients whose flaps survived subsequently ambulated on their flaps. The study demonstrates that microvascular surgery may result in functional lower-extremity salvage in diabetic patients with foot wounds that are not treatable by local flaps or skin grafts, and are destined for amputation.

The prevalence and associated risk factors of renal artery stenosis in patients undergoing cardiac catheterization.

Renal artery stenosis may be a cause of hypertension and a potential contributor to progressive renal insufficiency. However, the prevalence of renal artery disease in a general population is poorly defined. The purposes of this study were to evaluate the prevalence of angiographically-determined renal artery narrowing in a patient population undergoing routine cardiac catheterization, and to identify the risk factors for renal artery stenosis. After left ventriculography, abdominal aortography was performed to screen for the presence of renal artery stenosis. A total of 427 patients (274 males, 153 females) were studied and the mean age was 59 years. Renal artery narrowing was identified in 10.5% of patients. Significant (> or = 50% diameter narrowing) renal artery stenosis was found in 24 patients (5.6%) and insignificant stenosis was found in 21 patients (4.9%). Significant unilateral stenosis was present in 4.2% of patients and bilateral stenosis was present in 1.4%. The stem of the renal artery was a more common site of stenosis in 62.2% of patients than in the ostium (37.8%), but the severity of stenosis was not significantly different according to the site of stenosis. By univariate and multivariate logistic regression analysis, the association of clinical variables with renal artery stenosis was assessed. Multivariable predictors included age, hypertension and peripheral vascular disease (p < 0.05). The variables such as sex, smoking history, hyperlipidemia, renal insufficiency, as well as the presence of obesity, severity of coronary heart disease and D.M., were not associated. In conclusion, the prevalence of angiographically-determined renal artery narrowing in a patient population undergoing cardiac catheterization is 10.5%. Old age, hypertension and evidence of peripheral vascular disease represent the predictors of renal artery stenosis.