Femoral Pulse Research Articles

The long-term effect of surgical aortic valve replacement on arterial stiffness and wave reflections

Abstract Background Assessing arterial properties in patients with aortic valve stenosis undergoing surgical aortic valve replacement (SAVR) is difficult, and the results to date have been inconclusive. Purpose We sought to investigate how SAVR affects vascular stiffness in the short and long term. Methods We included 69 patients (mean age 70.8±8.4 years, 62% men) with severe symptomatic aortic stenosis who underwent SAVR. Arterial stiffness was assessed using the carotid femoral pulse wave velocity (cfPWV) and brachial-ankle pulse wave velocity (baPWV). Measurements in patients with an ankle-brachial index (ABI) <0.9 were excluded from the analysis for baPWV measurments because a low ABI can affect the accuracy of baPWV. Augmentation index corrected for heart rate (Alx@75), central pressures and subendocardial viability ratio (SEVR) were assessed with arterial tonometry. Measurements were conducted at baseline, in the acute phase and 1 year after the operation. Results Immediately after SAVR there was an increase in cfPWV (8.04±1.3 m/s vs 8.54±1.6 m/s, p=0.02) that was sustained at 1 year (8.04±1.3 m/s vs 9.42±2.4 m/s, p≤0.001). Similarly, baPWV (n=55) increased in the acute phase (1633±429 cm/s vs 2014±606 cm/s, p<0.001) and persisted 1 year postoperatively (1633±429 cm/s vs 1867±408 cm/s, p<0.001). Post-SAVR we also observed a decrease in Alx@75 (31.02±10% vs 22.73±12%, p≤0.001) that was attenuated 1 year later (31.02±10% vs 26.65±8%, p≤0.001), and an increase in SEVR (136.1±30.4% vs 149.2±37.7%, p=0.01) which remained improved at 1 year (136.1±30.4% vs 147.5±30.4%, p=0.01). Conclusions After SAVR the arterial system shows an increase of stiffness in response to the acute relief of the obstruction, which is retained in the long term. Funding Acknowledgement Type of funding sources: None.

Lp(a) is not associated with arterial stiffness: a Mendelian randomization study

Abstract Background Deeper understanding of the potential causal relationship between Lp(a) and vascular injury will provide further insight to related pathways to be monitored and targeted by emerging treatments. Accumulating evidence supports the causal association of lipoprotein(a) [Lp(a)] with cardiovascular disease and calcific aortic valve disease (AVD). Arterial stiffening is mechanistically linked with cardiovascular disease and AVD severity. We hypothesized that Lp(a) may be causally associated with pulse-wave velocity (PWV) as the gold-standard marker of arterial stiffness. Aim To investigate the potential causal association of Lp(a) levels with PWV. Methods We performed a two sample Mendelian randomization (MR) analysis of LP(a) on PWV by combining the summary data of two independent Genetic-Wide Association Study (GWASs). Genetic variants associated with Lp(a) were retrieved from the UK Biobank (N=220,497). A GWAS based on a cohort in Germany (N=7,000) was used to obtain genetic associations for PWV index (outcome). We assessed two different measures of arterial stiffness, brachial ankle (baPWV) and carotid femoral pulse (cfPWV) wave velocity. In total, we used 170 SNPs as Instrument Variables (IV's) and applied a two sample MR with the main technique of Inverse Variance Weighting method (IVW). We conducted sensitivity analyses (MR-Egger and Median based) to detect pleiotropy of the causal variants and to test for robustness of our findings. Results Our analyses based on all 170 SNP's did not find evidence for causal relationship between Lp(a) and PWV for neither measurement [bivw (baPWV) = −0.0005, CI (−0.0043, 0.0034), P=0.8 and bivw (cfPWV) = −0.006, CI (−0.013, 0.002), P=0.16 for brachial ankle and carotid-femoral PWV, respectively]. Sensitivity analyses, including weighted median and mode-based estimation, did not show significant association of Lp (a) with neither baPWV nor cfPWV. Conclusions Lp(a) is not causally associated with arterial stiffness. These findings suggest that arterial stiffening is not involved Lp(a)-mediated cardiovascular and aortic valve disease. Funding Acknowledgement Type of funding sources: None.

Valsartan reduces arterial stiffness along with level of soluble ST2 independently of blood pressure changes

Abstract Introduction Arterial stiffness is one of end-organ damage signs in patients with arterial hypertension. Carotid femoral pulse wave velocity (cfPWV) is a clinical measure of arterial stiffness and its values above 10 m/sec are associated with increased cardiovascular risk. Soluble ST2 is a cytokine involved in fibrotic processes. There is paucity of data on the association between sST2, arterial stiffness, and effect of valsartan on these parameters. Objectives The aim of the study was to assess the effect of valsartan on arterial stiffness and level of soluble ST2 over a 12-month long treatment. Methods This was a randomized, blinded, placebo controlled single center study. There was a 24-hour-long wash-out period from angiotensin converting enzyme inhibitors (ACEI) and other than valsartan, angiotensin receptor blockers ARB (previous use of valsartan was an exclusion criterion). Drugs other than ACEI and ARB were allowed in follow-up to control blood pressure. CfPWV was assessed at baseline and at 12 months using applanation tonometry. Soluble ST2 was measured with lateral flow cassette-based immunofluorescent assay. We present the data for 28 placebo patients (Plac) and 60 valsartan patients (Vals). Results Patients from both groups have had comparable peripheral and central blood pressures. CfPWV has risen in Plac by 6.2% and has fallen by 6.2% in Vals (P=0.01) over 12 months. Soluble ST2 has risen in Plac by 9.4% and has fallen by 43.3% in Vals (P=0.001) over 12 months. Conclusion Valsartan has positive effect on improvement of arterial stiffness. Decrease in soluble ST2 concentration may help explain the alternative mechanism for protective role of valsartan. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Medical University of Silesia

Determining Underlying Mechanisms of Early Vascular Ageing by Clustered Analysis: The African-PREDICT Study.

Identifying individuals at increased risk of early vascular ageing (EVA) is paramount to inform intervention and prevention strategies and curb the increasing burden of cardiovascular disease. We stratified and phenotyped pre-screened young apparently healthy South African adults (20-30 yrs) (n=1,041) into vascular ageing profile groups based on carotid femoral pulse wave velocity (cfPWV) percentiles (healthy vascular ageing [HVA]; average vascular ageing [AVA] and EVA). We further compared various anthropometric, cardiovascular (CV), oxidative stress and lifestyle risk factors and determined factor scores to explore associations between CV measures and factor clusters to explore associations in those at risk of EVA. Young adults in the EVA group displayed marked phenotypic characteristics in terms of anthropometry, CV, and lifestyle risk factors, even though cfPWV were within healthy ranges. Blood pressure (brachial and central) and cfPWV were all incrementally higher across all three vascular ageing groups (p-trend ≤0.011). Hypertension, lifestyle risk factors such as self-reported smoking and alcohol consumption were all highest in the EVA group (p-trend ≤0.046). Additionally, in the EVA group only, cfPWV (adj. R2=0.028; β=0.171; p=0.042) associated positively with Factor 2 (oxidative stress and antioxidant capacity). No associations existed between Factor 1 (basic lipids) and any anthropometric or CV measures (p>0.050). Young adults with higher cfPWV presented with a less favourable vascular profile and more unhealthy lifestyle behaviours compared to groups with lower cfPWV. In the EVA group, cfPWV positively associated with a cluster of oxidative stress and antioxidant capacity. Early lifestyle behaviours may have the ability to modify the balance between oxidants and antioxidants, potentially contributing to early onset arterial stiffness.

Circulating microparticles are increased amongst people presenting with HIV and advanced immune suppression in Malawi and correlate closely with arterial stiffness: a nested case control study

Background: We aim to investigate whether circulating microparticle (CMPs) subsets were raised amongst people presenting with a new diagnosis of HIV and advanced immune suppression in Malawi, and whether they associated with arterial stiffness. Methods: Microparticle characterisation and carotid femoral Pulse Wave Velocity (cfPWV) were carried out in a cohort of adults with a new HIV diagnosis and CD4 <100 cells/µL at 2 weeks post ART initiation. HIV uninfected controls were matched on age, systolic BP and diastolic BP in a 1:1 ratio. Circulating microparticles were identified from platelet poor plasma and stained for endothelial, leucocyte, monocyte and platelet markers. Results: The median (IQ) total CMP count for 71 participants was 1 log higher in HIV compared to those without (p<0.0001) and was associated with arterial stiffness (spearman rho 0.47, p<0.001). In adjusted analysis, every log increase in circulating particles showed a 20% increase in cfPWV (95% CI 4 – 40%, p=0.02). In terms of subsets, endothelial and platelet derived microparticles were most strongly associated with HIV. Endothelial derived E-selectin+ CMPs were 1.3log-fold higher and platelet derived CD42a+ CMPs were 1.4log-fold higher (both p<0.0001). Endothelial and platelet derived CMPs also correlated most closely with arterial stiffness [spearman rho: E-selectin+ 0.57 and CD42a 0.56, both p<0.0001). Conclusions: Circulating microparticles associate strongly with arterial stiffness among PLWH in Malawi. Endothelial and platelet microparticles are the predominant cell origin types, indicating that platelet driven endothelial dysfunction pathways warrant further investigation in HIV associated arterial stiffness.

Surgical Approach of an Infected Saphenofemoral Looped PTFE Graft Arteriovenous Fistula and Arterial Reconstruction with Cryopreserved Allograft

Introduction: Autologous arteriovenous fistula is still the most popular vascular access for hemodialysis [1]. There have been few reports of saphenofemoral arteriovenous fistulas over the last 10 to 20 years because of suggestions of high morbidity, poor patencies and needling difficulties [2]. Some disadvantages of using this access are the necessity for a more extensive and deeper dissection using larger vessels and greater susceptibility to infection and steal syndrome [3, 4]. Attention should be paid to the patient's vasculature before surgery, through the "maturation" phase and chronic use [5]. Case report: A 72-year-old female with a history of arterial hypertension, diabetes mellitus and chronic renal failure requiring three-weekly hemodialysis, with a 4-day history of a painful and hot mass in the right thigh, fever, and hemoglobin decline. Physical examination: hematoma at the right inguinal region, presence of a tourniquet, femoral pulse 2/2 and not assessable distal pulses due to edema; coldness, and increased capillary refill. Aortoiliac and lower limb angiotomography showed: ruptured pseudoaneurysm of the right common femoral artery, ipsilateral superficial femoral artery injury and prosthetic femoral arteriovenous fistula infection. Open emergency approach through an infra-inguinal longitudinal incision was performed, draining a large hematoma and pus, finding an infected prosthetic PTFE graft from a saphenofemoral loop fistula with injury of the right superficial femoral artery and active bleeding at the site, plus dehiscence of saphenous anastomosis. Thrombectomy of the superficial and common femoral artery, en bloc arteriotomy of the right superficial femoral artery and arterial reconstruction with a cryopreserved arterial allograft with end-to-end anastomosis was performed. A Vacuum Assisted Therapy (VAC® ) system was created to cover the surgical site. Patient deceased from hypovolemic shock. Conclusions Unusual site AVFs (i.e., saphenofemoral loop graft AVFs) should be carefully followed-up to reduce the risk of complications and raise the awareness to diminish associated morbidity and mortality. An arterial cryopreserved allograft may be used for arterial reconstruction in the setting of an infected wound. The goal must be to spread more knowledge in this critical area of medicine that is importantly affecting medical costs of renal replacement therapies and patients' quality of life and survival rates.

An investigation into the detection of the pulse in conscious and anaesthetized dogs

ObjectivesTo record the success rate of veterinary professionals and students at identifying the pulse in conscious and anaesthetized dogs. To explore the influence of clinical experience, pulse location, anaesthesia and likely confounding variables on the success of pulse palpation. Study designProspective, observational, randomized study. AnimalsA total of 54 client-owned dogs scheduled for general anaesthesia. MethodsFor each dog, three participants (senior anaesthetist, anaesthesia resident/nurse, veterinary student/animal care assistant) attempted pulse palpation at three locations (femoral, radial and dorsal pedal pulse) in conscious and anaesthetized dogs. The time to pulse palpation was measured with a stopwatch for each attempt and data were modelled using a multivariate Cox regression survival analysis (significance p < 0.05). ResultsThe overall success rate of pulse palpation was 77%, with a median time of 10.91 seconds (interquartile range 9.09 seconds). Success rate was lower in conscious dogs (67%) than in anaesthetized dogs (87%). There was a 77% lower likelihood of success at the radial than at the femoral pulse [hazard ratio (HR) 0.23, 95% confidence interval (CI) 0.38–0.69, p < 0.001]. Veterinary students/animal care assistants had a 71% lower likelihood of success than senior anaesthetists (HR 0.29, 95% CI 0.22–0.39, p < 0.001). Age, weight and American Society of Anesthesiologists physical status had no significant influence. Premedication/anaesthetic drugs, heart rate or mean arterial pressure had no significant influence on the time to pulse palpation in anaesthetized dogs. The median time to palpation was less than 10 seconds for all experience groups at the femoral location. ConclusionsPalpation of the femoral location had the greatest likelihood of success with the least amount of time. Monitoring the femoral pulse during induction of anaesthesia is suggested as a method for confirming spontaneous circulation. Pulse palpation improves with clinical experience.

Estimated Pulse Wave Velocity and All-Cause Mortality: Findings From the Health and Retirement Study.

Background and ObjectivesThe gold standard method for the assessment of vascular aging is carotid–femoral pulse wave velocity (cfPWV). cfPWV can be estimated from 2 commonly assessed clinical variables—age and blood pressure. This analysis uses data from the Health and Retirement Study to examine the relationship between estimated pulse wave velocity (ePWV) and mortality among 9,293 middle age and older adults.Research Design and MethodsCox proportional hazard models were used to predict mortality occurring over a 10- to 12-year period. Controls were included for sociodemographic characteristics (age, gender, race, ethnicity, wealth, income, and education), health status (history of cardiovascular disease [CVD], diabetes, and stroke and related medication use), health behaviors (smoking, physical activity, and body mass index), and CVD-related biomarkers (systolic and diastolic blood pressure, C-reactive protein, cystatin c, hemoglobin A1c, total cholesterol, and high-density lipoprotein cholesterol).ResultsBy 2018, 26.19% of the weighted analytic sample were reported as deceased. In the fully specified models that control for age, age-squared, systolic and diastolic blood pressure, sociodemographic variables, health status and behaviors, and biomarkers, ePWV was associated with a greater likelihood of mortality.Discussion and ImplicationsAn estimate of PWV derived from age and blood pressure is independently associated with an increased likelihood of death in a representative sample of middle age and older adults in the United States.

Diabetes Affects the Relationship between Heart Rate Variability and Arterial Stiffness in a Gender-Specific Manner.

Background and Aims: Heart rate variability (HRV), i.e., the beat-by-beat fluctuations in heart rate (HR) reflecting the autonomic nervous system balance, is altered in patients with diabetes. This has been associated with arterial aging (stiffer arteries) and differs in men and women. The present study hypothesized that the impact of HRV on arterial aging, indexed as carotid–femoral pulse wave velocity (PWV), differs in a gender-specific manner and is affected by diabetes mellitus. Method: A total of 422 outpatients (187 women and 235 men) were studied. PWV was measured using the validated SphygmoCor device (AtCor Medical). Time-domain and frequency-domain parameters were measured to assess HRV. Results: The prevalence of diabetes was 30.8% with a slight, but nonsignificant, greater prevalence in men. Both age and SBP were independent determinants of PWV in each of the four groups (men and women with or without diabetes). Low-frequency activity was inversely correlated with PWV. It was greater in women without diabetes, but it was not significant in men regardless of the presence of diabetes. Conclusions: Beyond age, blood pressure, and diabetes, impaired cardiac autonomic function assessed by determination of HRV was significantly associated with arterial aging. The association between lower sympathetic and parasympathetic activity and stiffer arteries was significant in women, but not in men.

Femoral Pulse Pressure Variation Is Not Interchangeable with Radial Pulse Pressure Variation during Living Donor Liver Transplantation.

The radial artery is commonly used as the site measuring pulse pressure variation (PPV) during surgery. Accurate measurement of circulating blood volume and timely interventions to maintain optimal circulating blood volume is important to deliver sufficient oxygen to tissues and organs. It has not rather than never studied in patients undergoing liver transplantation whether PPV measured at peripheral sites, such as the radial artery, do represent central PPV for evaluating blood volume. In this retrospective study, 51 liver transplant recipients were enrolled. The two PPVs had been automatically recorded every minute in electrical medical records. A total 1878 pairs of the two PPVs were collected. The interchangeability of PPV measured at the radial and the femoral artery was analyzed by using the Bland–Altman plot, four-quadrant plot, Cohen’s kappa (k), and receiver operating curve. The bias and limits of agreement of the two PPVs were −1.3% and −8.8% to 6.2%, respectively. The percentage error was 75%. The concordance rate was 65%. The Kappa of PPV-radial determining whether PPV-femoral was >13% or ≤13% was 0.64. We found that PPV-radial is not interchangeable with PPV-femoral during liver transplantation. Additionally, PPV-radial failed to reliably track changes of PPV-femoral. Lastly, the clinical decision regarding blood volume status (depletion or not) is significantly different between the two PPVs. Therefore, PPV-femoral may help maintain blood volume circulating to major organs including the newly transplanted liver graft for liver transplant recipients.

No Symptoms for Over 70 Years! Incidentally Discovered Congenital Dysplasia of Infrarenal Aorta

A 75 year old female with a past history of pulmonary embolism was admitted with dyspnoea. Computed tomography angiography unexpectedly revealed a significantly narrowed and completely occluded abdominal aorta at the infrarenal level. She did not have any intestinal or lower limb problems, but she had had resistant hypertension for 40 years. Bilateral femoral, popliteal, and pedal pulses were palpable. The superior mesenteric artery (violet arrow), the arc of Riolan (white arrows), and the inferior mesenteric artery (red arrow) were dilated, providing adequate blood flow to the abdomen, pelvis, and lower limbs.

A Ten Year Retrospective Study on Cor Triatriatum Sinister Associated Heart Failure in Dogs

Background: Although cortriatriatumsinister (CTs) represents a well-known and widely described cardiac malformation in humans, its description in the canine population is rare. The aim of this ten-year study is to place on record about the most unusual congenital cardiac malformation, cortriatriatum sinister that was sporadically reported among veterinary patients. Methods: The dogs were examined clinically, physically and later subjected for chest radiograph and echocardiography to confirm CTs. All were showing regular femoral pulse that was strong and synchronous to the heart beat, pale mucosa, mean systolic arterial blood pressure of 145 mm Hg and with normal hemato-biochemical parameters. Cardiomegaly with increased sternal contact, elevated trachea, pulmonary congestion and engorged caudal vena cava were radiographic findings. 2d-echocardiography revealed a left atrium that was subdivided by a transverse membrane into two distinct compartments, one proximal and one distal, thus confirming the cortriatriatum sinister. Result: Cor triatriatum sinister (CTs) was diagnosed in 4 dogs with a prevalence of 4.59% amongst those suffering from congenital heart anomalies, that were aged between 5y-7y and the breeds include Boxer, Doberman and Cocker spaniel. All these dogs were presented with similar signs suggestive of heart failure viz., exercise intolerance, dyspnoea at rest, cough that was dry nocturnal type, generalised weakness and syncope. All of these patients were successfully managed with frusemide, benazapril and pimobendan. Hence, it may be concluded that the CTS, a rare congenital cardiac anomaly in dogs should also be included in the differential diagnosis of heart failure, particularly if presented at early life, which also helps to prevent further breeding from such stock.

Spontaneous Resolution of Lower Extremity Hypoperfusion in Type B Aortic Dissection: A Case Report

Lower extremity hypoperfusion occurs in 5.7-30% of Stanford type B aortic dissection cases. A 53-year-old male patient presented with type B aortic dissection. His left femoral pulse was not palpable. The proximal left common iliac artery was nearly occluded in computed tomography angiography. There was no extremitythreatening rest pain, but there was intermittent claudication at 100 meters. Cross femoral bypass was planned for the patient under elective conditions. After two months, the left femoral pulse was palpable, and the patient no longer had intermittent claudication. In this study, we report that lower extremity hypoperfusion, which developed after acute type B aortic dissection resolved without open and endovascular surgery.

Early Ambulation of Patients with Post Transfemoral Arteriography with Vascular Closure Device (VCD): A Quality Improvement Project

<h3>Introduction</h3> Post Transfemoral Arteriogram (PTFA) is a minimally invasive diagnostic interventional procedure using venous closure device (VCD) to achieve hemostasis. Post procedure patient discomfort arises due to restrictions in position and prolonged bedrest. The postanesthesia care unit (PACU) nurses conducted an evidence-based practice (EBP) project that recommended early ambulation for PTFA with VCD between May 1, 2021 and December 1, 2021. <h3>Identification of the problem</h3> IR PACU patients' 120 minute supine positioning and 180 minute total bedrest time causes patient discomfort and PACU to go on hold – not allowing the operating room patients to be transferred. <h3>QI question/Purpose of the study</h3> Can supine positioning be reduced from 120 minutes to 60 minutes and total bedrest time be reduced from 180 minutes to 120 minutes without incidence of bleeding or trauma after PTFA with VCD? <h3>Methods</h3> This project compared current practice of IR patients that requires three-hour bedrest while maintaining supine head of bed (HOB) in flat position for two hours then elevating the HOB to 30 degrees for one additional hour vs implementing two-hour bedrest while maintaining supine HOB in flat position for one hour then elevating the HOB to 30 degrees for an additional hour. Data collection involved monitoring BP, HR, RR, femoral pulse check, femoral groin site check, pain score and patient satisfaction. <h3>Outcomes/Results</h3> Data showed reducing the total supination time from 120 minutes to to 69.95 minutes and total bedrest time from 180 minutes to to 108 minutes showed no increased risk for bleeding or trauma in the patient and overwhelmingly increased patient satisfaction related to decrease in back discomfort while supine and ability to void out-of-bed and/or without assistive devices. <h3>Discussion</h3> Cardiac Prep/PACU nurses recover interventional cardiac patients with the early ambulation protocol for one hour and progressively elevate HOB every thirty minutes. These patients safely ambulate after two hours. Further evaluation of this protocol could be cost effective due to decreased utilization of resources, manpower, and length of hospital stay. <h3>Conclusion</h3> PTFA with VCD patients can safely reduce their flat bedrest and ambulation time frames by one hour after PTFA with VCD. <h3>Implications for perianesthesia nurses and future research</h3> The science revealed ten years of research recommending safe ambulation within 120 minutes PTFA with VCD. Dissemination of these findings will advance the IR recovery process and improve patient satisfaction.

A Cross-Sectional Comparison of Arterial Stiffness and Cognitive Performances in Physically Active Late Pre- and Early Post-Menopausal Females.

Menopause accelerates increases in arterial stiffness and decreases cognitive performances. The objective of this study was to compare cognitive performances in physically active pre- and post-menopausal females and their relationship with arterial stiffness. We performed a cross-sectional comparison of blood pressure, carotid–femoral pulse wave velocity (cf-PWV) and cognitive performances between physically active late pre- and early post-menopausal females. Systolic (post-menopause—pre-menopause: +6 mmHg [95% CI −1; +13], p = 0.27; ŋ2 = 0.04) and diastolic (+6 mmHg [95% CI +2; +11], p = 0.06; ŋ2 = 0.12) blood pressures, and cf-PWV (+0.29 m/s [95% CI −1.03; 1.62], p = 0.48; ŋ2 = 0.02) did not differ between groups. Post-menopausal females performed as well as pre-menopausal females on tests evaluating executive functions, episodic memory and processing speed. Group differences were observed on the computerized working memory task. Post-menopausal females had lower accuracy (p = 0.02; ŋ2 = 0.25) but similar reaction time (p = 0.70; ŋ2 < 0.01). Moreover, this performance was inversely associated with the severity of menopausal symptoms (r = −0.38; p = 0.05). These results suggest that arterial stiffness and performance on tests assessing episodic memory and processing speed and executive functions assessing inhibition and switching abilities did not differ between physically active pre- and post-menopausal females. However, post-menopausal females had lower performance on a challenging condition of a working memory task, and this difference in working memory between groups cannot be explained by increased arterial stiffness.

Role of duplex-guided infragenicular angioplasty in saving limbs

Background/aim Critical limb ischemia (CLI) is known as ischemic rest pain at rest or tissue loss with peripheral arterial disease. Endovascular intervention has many advantages than surgical bypasses and it is used frequently with fragile patients, at the same time, it has many adverse effects for both surgeon and patient such as radiation effect for both and renal-induced nephropathy for the patient. Worldwide duplex-guided infragenicular angioplasty is a new method that has been started to emerge and to be a common technique in such patients, That is why the present study aims to assess the feasibility and efficacy of duplex-guided infragenicular angioplasty to save limbs and to detect if it is applicable or not. Patients and methods Twenty CLI patients were admitted to the vascular unit from 2015 to 2017 in Al-Zahraa University Hospital, Al-Azhar University, Cairo, Egypt. We included patients with good femoral pulse and significant infragenicular lesions. We excluded those with proximal outflow lesions and with acute embolic or thrombotic insults. Percutanous transluminal angioplasty was done to all the patients through ipsilateral femoral access by using 0.014 and 0.018 wires 4 F catheters and low-profile balloons, then we followed them clinically and with duplex ultrasound at 1, 3, 6, and 12 months with calculating the hemodynamic studies. Results The present study enrolled 20 patients, six (30%) of them are females and 14 (70%) males, with mean age of 59.2. The clinical history of smokers, cardiac, diabetics, renal, and hypertensive were 65, 60, 50, 85, and 80%, respectively. Technical success was 90%. Groin hematoma, distal thrombosis, and vessel perforation were technical complications, with 5% for each. Optimal procedural success was achieved in 70%, of suboptimal in 20%, and then we failed in 10%. Rest paint completely disappeared from 75% of patients. Sixteen limbs were saved postintervention, Kaplan–Meier curve showed 70% survival rate at 6 months, while at 9 months, the drop occurred to be 28%, which was still to be the percent at 12 months. Conclusion Modern duplex ultrasound can be used to map the arterial disease and to show guide wires, sheaths, balloons, and stents for the treatment of infragenicular arterial lesions. Also, it seems to be safe, easy and effective technique, a bedside procedure, and cost-effective as well. It has a crucial role in saving limbs for CLI patients.

Estimation of Aortic Stiffness with Bramwell–Hill Equation: A Comparative Analysis with Carotid–Femoral Pulse Wave Velocity

Aortic stiffness is an important clinical parameter for predicting cardiovascular events. Carotid–femoral pulse wave velocity (cf-PWV) has been proposed for performing this evaluation non-invasively; however, it requires dedicated equipment and experienced operators. We explored the possibility of measuring aortic stiffness using ultrasound scans of the abdominal aorta coupled with the Bramwell–Hill equation. Healthy subjects were investigated; measurements of cf-PWV were taken by arterial tonometry and aortic systo-diastolic pressure difference was estimated using a validated model. Pulsatility of an abdominal tract of aorta was assessed by automated processing of ultrasound scans. Through a Bland–Altmann analysis, we found large biases when estimating each parameter by applying the Bramwell–Hill equation to the measured values of the other two paramters (bias, ± 1.96 SD; PWV, about 2.1 ± 2.5 m/s; pulsatility, 12 ± 14%; pressure jump, 47 ± 55 mmHg). These results indicate that the two measures are not interchangeable, and that a large part of the bias is attributable to blood pressure estimation. Further studies are needed to identify the possible sources of bias between cf-PWV and aortic pulsatility.

Endothelial Dysfunction and Arterial Stiffness in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis.

Population-based studies have suggested that patients with inflammatory bowel disease (IBD) might be at an increased risk for cardiovascular diseases. A meta-analysis was performed on clinical studies to evaluate endothelial function, arterial stiffness, and carotid intima-media thickness (cIMT) in patients with IBD, after searching PubMed, Embase, Cochrane library, and Web of Science databases. A random-effects model was used to allow for the pooling of studies and for determination of the overall effect. After exclusion, a total of 41 eligible studies with 2330 patients with IBD and 2032 matched controls were identified and included for the analysis. It was found that cIMT was significantly increased in patients with IBD as compared with that in matched controls (Cohen’s d: 0.63; 95% CI: 0.34, 0.93; I2 = 91.84%). The carotid–femoral pulse wave velocity was significantly higher in patients with IBD compared to that in matched controls (Cohen’s d: 0.76; 95% CI: 0.54, 0.98; I2 = 70.03%). The augmentation index was also significantly increased in patients with IBD compared to matched control subjects (Cohen’s d: 0.35; 95% CI: 0.08, 0.63; I2 = 61.37%). Brachial artery flow-mediated dilatation was significantly decreased in patients with IBD than that in matched controls (Cohen’s d: −0.73; 95% CI: −1.10, −0.36; I2 = 81.02%). Based on the meta-analysis, it was found that patients with IBD exhibit significant endothelial dysfunction, increased arterial stiffness, and cIMT. Thus, patients with IBD may benefit from aggressive risk stratification for cardiovascular diseases.

Correlation among Waist Circumference and Central Measures of Blood Pressure.

ResumoFundamento:A rigidez arterial é um forte preditor de doença cardiovascular (DCV). Medidas de gordura corporal, como a circunferência da cintura (CC), têm sido associadas à DCV na idade adulta.Objetivos:O objetivo deste estudo foi avaliar a associação da rigidez arterial, medida por tonometria de aplanação-Sphygmocor, com a CC.Métodos:Estudo observacional com 240 participantes que fazem consultas de rotina no ambulatório de clínica médica de um hospital universitário. Os participantes foram entrevistados e tiveram as medidas centrais da pressão arterial (MCPA), parâmetros antropométricos, gordura abdominal e gordura visceral mensurados. Foram u tilizados os testes t pareado e não pareado e qui-quadrado. Foi a dotado nível de significância de 5%.Resultados:Dos 240 participantes, 51,82% era do sexo masculino com idade média de 59,71(±14,81) anos e CC média de 99,87 (±11,54) cm. Os valores médios das MCPA foram: Pressão arterial central (PAC) = 130,23 (91-223) mmHg, velocidade de onda de pulso (VOP) = 9,8 (5,28-19,6)m/s e Augmentation Index [Índice de amplificação (AI)] = 29,45 (-14-60). A VOP e a PAC foram altamente correlacionadas com uma CC com p<0,001 e p=0,02, respectivamente; porém, a mesma correlação positiva não foi encontrada entre a CC e o AI (p=0,06).Conclusão:O presente estudo mostrou uma associação positiva entre a CC e a rigidez arterial, através da velocidade de onda de pulso carotídeo femoral (VOP-cf) e o AI, sendo mais forte com a VOP-cf, sugerindo a avaliação do efeito da CC na saúde vascular como método de auxílio no tratamento precoce das DCV e na prevenção de desfechos clínicos.

P247 ARTERIAL STIFFNESS, SUBENDOCARDIAL PERFUSION AND 30–DAYS READMISSION IN ELDERLY INDIVIDUALS WITH HEART FAILURE

Abstract Arterial stiffness and subendocardial perfusion impairment significantly affect cardiovascular morbidity and mortality, playing a relevant role in heart failure. The aim of the present study was to describe the trend of hemodynamical parameters, arterial stiffness indexes and subendocardial viability ratio (SEVR) in geriatric patients, hospitalized with hearth failure, and to define the main predictors of 30–days readmission. A cohort of 41 patients, admitted to the Geriatric ward of Verona University Hospital, affected by heart failure, was included in the study. Each subject underwent clinical evaluation, geriatric comprehensive assessment, routine laboratory testing, and cardiac ultrasound. At the time of admission, after achievement of clinical stability (defined as switching from intravenous to oral diuretic therapy) and at the time of discharge, blood pressure measurement and applanation arterial tonometry (with evaluation of carotid–femoral pulse wave velocity –PWVcf– and SEVR) were also performed. SEVR was corrected for hemoglobin concentration and oxygen saturation. Through the three evaluations, a progressive decrease in PWVcf was described (17.79±4.49 m/s, 13.54±4.54 m/s, 9.94±3.73 m/s respectively, p &amp;lt; 0.001); the trend remained significant even after adjustment for age, gender, mean arterial pressure (MAP) variation and left ventricular ejection fraction (LVEF) (p &amp;lt; 0.001). A significant improvement was registered for both SEVR (83.48±24.43, 97.94±26.84, 113.29±38.02 respectively) and corrected SEVR (12.74±4.69, 15.71±5.30, 18.55±6.66 respectively) values (p &amp;lt; 0.001 for both), and it was still significant when adjusted for age, gender, MAP variation and LVEF (p &amp;lt; 0.001). After discharge, 26.8% of patients was readmitted within 30 days. In a multivariate binary logistic regression analysis, considering 30–days readmission as dependent variable, PWVcf at discharge was the only predictor of readmission (OR 2.004, CI 1.154–3.481, p = 0.014) In conclusion, medical therapy seems to improve arterial stiffness and subendocardial perfusion in geriatric patients hospitalized with hearth failure. Furthermore, PWVcf is a valid predictor of 30–days readmission. Its feasibility and reproducibility in clinical practice, may provide an instrument to detect heart failure patients at high risk of rehospitalization.