Pedal Pulses Research Articles

False anastomotic femoral aneurysm associated with multi-aneurysmal disease

Anastomotic pseudoaneurysms and true femoral aneurysms are two infrequent arterial entities of low incidence, and together, they are even less common. We present the case of a 71-year-old patient with a history of arterial hypertension who has a history of multiple long-standing vascular interventions: abdominal aortic aneurysm with aortic-iliac anastomosis with subsequent femoral-femoral bypass crossed by occlusion of the left branch; and femoropopliteal bypass for left popliteal artery aneurysm. She presents a large pulsatile mass in the left inguinofemoral region without left popliteal and pedal pulses with the viable limbs. The tomographic study showed a pseudoaneurysm of the left common femoral artery with partial thrombosis, dependent on the distal anastomosis of the old femoral-femoral bridge, and a bilateral true fusiform aneurysm of the common and superficial femoral artery with extensive mural thrombosis. It was decided to perform surgery to resect the mixed aneurysmal lesions, perform a right iliac-femoral prosthetic bridge, and replace the crossed femoral-femoral bypass; both included shunts to the deep femoral arteries. With suspicion of thrombosis of the old femoropopliteal bypass, thromboembolectomy of the left leg is performed through the superficial femoral artery, the anastomosis is permeabilized with recovery of the distal pulses.

A case of a young man with secondary hypertension

Background: Secondary hypertension is characterized by an elevated blood pressure greater than 140/90 mmHg, which occurs as a consequence of other diseases. The common etiologies of secondary hypertension include renal parenchymal causes, endocrine disorders, and vascular pathologies like coarctation of the aorta (CoA). Case presentation: A 20-year-old patient was admitted to our hospital as he complained of headache and palpitations since one week. On examination, the blood pressure in his right upper limb was 180/100 mmHg. The volume of the femoral and the dorsalis pedis pulses was found to be reduced bilaterally. The patient was started on antihypertensive medication labetalol 10 mg injection intravenously immediately. After clinical suspicion and a series of investigations, the patient was diagnosed with severe CoA, distal to the origin of the left subclavian artery via computed tomography (CT) aortogram. The patient was managed by coarctoplasty with stenting. Discussion: The most striking examination findings indicative of CoA include decreased lower limb pulses and a blood pressure difference of >20 mmHg across both the lower and upper extremities. It is important to evaluate the blood pressure in both upper and lower limbs to diagnose obstructive vascular diseases. Conclusion: The presence of multiple well-developed collaterals can often mask symptoms and delay the detection of hypertension in patients with CoA. Patients with CoA require regular follow-up to monitor left ventricular outflow tract obstruction, and patients with severe CoA should be treated interventionally to prevent complications including aortic aneurysm and dissection. The patient was managed by coarctoplasty with stenting and recovered well post-surgery.

Total Contact Casting Remains an Effective Modality for Treatment of Diabetic Foot Ulcers.

Total contact casting (TCC) is used to promote wound closure in diabetic foot ulcers (DFUs); however, this technique is underused today. This study aims to further evaluate the efficacy of TCC in a large cohort, including patients with peripheral artery disease (PAD). This was a retrospective analysis of patients with DFUs who underwent TCC from 2017 to 2021. PAD was defined as absence of pedal pulse or ABI <0.9. Demographic data, DFU characteristics, and peripheral arterial intervention were evaluated. Outcomes included complete healing, healing time, and rate of major amputation. Subgroup analysis was performed on patients undergoing peripheral intervention. 152 patients underwent TCC. Mean age was 58.8 ± 12.1years, 79.6% were male, and 26.3% had PAD. Mean DFU size was 8.27 ± 9.9cm2, with mean depth 0.61 ± 0.49cm. 112 patients had palpable pedal pulses on the affected extremity (73.7%). Average ABI was 1.12 ± 0.22 (n = 90). Complete healing was observed in 122 (80.3%) patients, with average healing time of 81.5 ± 57.1days. Thirteen (8.6%) patients eventually required amputation (3 major). When compared to patients with healed DFUs, those without healing had higher rates of amputation (39.1% vs 3.1%, P < .001), intervention (43.4% vs 17.8%, P = .006), and noncompliance (39.1% vs 20.2%, P = .046). Thirty-three patients underwent revascularization, undergoing angioplasty (81.8%), atherectomy (63.6%), stent (15.2%), and/or bypass (9.1%). Interventions were performed in aortoiliac (3.0%), femoropopliteal (45.5%), and tibial (72.7%) segments. Twenty-two (66.7%) patients who underwent revascularization completely healed. Patients requiring revascularization were more likely to have previous intervention (57.6% vs 13.4%, P < .0001) and incompressible vessels (36.4% vs 7.6%, P < .00001), with lower ABIs (0.94 ± 0.25 vs 1.17 ± 0.18, P = .0008) compared to patients without intervention. TCC remains an effective option for treatment of DFUs, as most were completely healed. Patients with PAD may benefit from TCC and revascularization, however, healing rates are lower in this cohort, necessitating the need for close observation.

OA27 A Thrombus Tale

Abstract Introduction Non catheter related arterial thrombosis is very rare in children. Our patient had a peripheral arterial thrombus with no risk factors apart from a background of recurrent Henoch-Schönlein Purpura (HSP). He had no history of trauma. Thrombosis as a complication of HSP is extremely rare with onlyeight case reports so far in children and among those eight, there is only one resembling our case with an arterial thrombus. We considered other causes of thrombosis and screened our patient for thrombophilia, infection and malignancy. Case description Our patient, a 12-year-old boy with a background of recurrent HSP for the last two years, presented with a rash on the left 2nd toe followed by blackish discolouration of the distal part of the same toe, a few days later. His initial presentation with purpuric rash, arthralgia, and abdominal pain was diagnosed as HSP and he required no intervention required for this. He continued to have regular flares of his HSP every six weeks, and these were self-limiting. His last flare was in February 2024. In April 2024, his feet appeared dusky and mottled. He presented to his local hospital with a rash on the tip of his left 2nd toe which turned gangrenous. He was otherwise systemically well. He was initially treated with antibiotics and acyclovir as a swab from the lesions grew staphylococcus aureus and the rash was bullous initially. He was referred to our tertiary rheumatology and haematology teams at Nottingham due to worsening ischemia and an absent left dorsalis pedis pulse. His examination revealed normal blood pressure, mottled, dusky lower legs, warm left foot with a faint petechial rash near left malleolus, absent left Dorsalis pedis pulse and an ischemic tip of left 2nd toe. Bilateral femoral and upper limb pulses were well felt. His respiratory, cardiovascular, abdomen &amp; musculoskeletal examination were normal apart from an antalgic gait. His clotting and thrombophilia screen including antiphospholipid screen was normal. His D dimer was raised at 1894ug/l. A duplex scan of his left leg showed occlusions in the distal anterior and posterior tibial artery as well as in the dorsalis pedis artery with no emboli. His inflammatory markers and autoantibodies were normal. Infection screen including mycoplasma, CMV, EBV and ASOT titres were all negative. Echo was normal. A skin biopsy from the toe revealed IgA vasculitis. Discussion We had a multidisciplinary team (MDT) discussion with haematology, vascular surgery and dermatology. As per the MDT discussion, he was given a pulse of intravenous methylprednisolone after careful consideration weighing the risk versus benefit of steroids adding to the pro thrombotic state versus active vasculitis causing narrowing of the arteries. He was also commenced on Aspirin at 1 mg/kg/day. There was marked improvement in his symptoms with improvement in the discolouration and pain, his d-dimer reduced, and he was able to mobilise comfortably. We felt that active vasculitis could be causing the vascular event. As immunology screen was negative and the skin biopsy was confirmatory of HSP. There was no thrombus specifically mentioned in the duplex but with D-dimer being raised it was a reasonable assumption was that there was a thrombus occluding the peripheral arteries. As his HSP was recurring quite frequently and was bothersome, as well as the thought that the recurrences might contribute to further vascular events and complications, we started our patient on Azathioprine. We have also sent genetic tests and awaiting a catheter angiogram to complete the investigation process. Key learning points • Consider vasculitis as one of the differentials in a child with unexplained venous or arterial thrombosis. • In a child with recurrent HSP, keep an open mind for rare complications that may occur. • Recurrent HSP in an older child may need immunosuppression. • Treatment considerations in a case with vasculitis with a thrombus has to be in close connection with haematology to decide on anticoagulation and its implications on the young person and their lifestyle. • Should there be any other investigations done or alternative diagnosis though of at this point?

Studying the Diabetic Foot at Risk Using a 60-Second Foot Screening Tool and the Importance of the Categories of the Foot at Risk in Diabetes Patients at a Tertiary Care Center in East India.

Introduction The etiology of a diabetic foot ulcer (DFU) is multifactorial. The three main components that are implicated in DFUs are foot deformity, repeated minor trauma to the foot, and diabetic peripheral neuropathy. Aimand objectives The study aims to find the prevalence of diabetes patients having a foot at risk using the Simplified 60-Second Diabetic Foot Screen tool (SSDFST). The objective is to ascertain the dispersal of various categories of the foot at risk in patients with diabetes and to find out the association of neuropathy with the various risk factors for the evolution of DFUs. Materials and methods This was a cross-sectional study comprising 128 patients; a detailed history and examination including neurological and vascular assessment were performed attending a tertiary care hospital. Patients were screened for the risk of diabetic foot using the SSDFST. The detection of loss of protective sensation (LOPS) using a simple 10-g monofilament test (10g M) was highly predictive of subsequent ulceration, which had been reported by the Seattle Diabetic Foot Study. The foot at risk was correlated with demographic and clinical features. Data were analyzed using descriptive and inferential statistics, significant at p = 0.05. Results Out of 128 patients, 92 (72%) and 36 (28%) were male and female, respectively. The mean duration of diabetes was 7.42 ± 6.23years (range 1-27). The mean age and BMI of the study population were 53.13 ± 10.99years and 25.93 ± 4.46kg/m2, respectively. Out of 128 patients, 82 (64%) were normal without any risk factor for diabetic foot, and 46 (36%) patients had at least one risk factor for diabetic foot using the SSDFST. About 36% of patients were combinedly qualified for the foot at risk into (categories 1, 2, and 3), among which six (5%) were placed under category 1, 18 (14%) patients were classified under category 2 with LOPS + PAD, and 22 (17%) were placed under category 3 with a history of ulcer and/or amputation. The duration of diabetes, previous foot ulcer, deformity, absent pedal pulses, active ulcers, and neuropathy (p = 0.05) were significantly associated with neuropathy measured by 10g M. Conclusions Our study revealed that one-third of our patients had at least one risk factor for the diabetic foot using the SSDFST. About one-fifth of our patients had neuropathy detected by monofilaments. Meanwhile, two-fifth of the study population were aware of proper foot care practices.

Case Report: Delayed Diagnosis of Leprosy-Related Neuropathic Ulcer, Insights from a Case of Delay to Diagnose across Four Clinical Settings

Background Neuropathy is common in both Diabetes Mellitus (DM) and Leprosy, often resulting in neuropathic ulcers. Leprosy-related neuropathic ulcers are frequently misdiagnosed as DM-related, causing delays in appropriate care. This case report underscores the importance of timely recognition and a better understanding of Leprosy-related neuropathic ulcers to prevent misdiagnosis and improve patient outcomes. Methods The case report adopt the CARE Guidelines and was conducted at the Wound Care Specialist Clinic, Griya Afiat, Makassar, East Indonesia. Data were collected using a Minimum Data Sheet (MDS) to capture demographics, health history, and history of treatments. A head-to-toe assessment focused on the eyes, hands, and feet, with neuropathy, confirmed using the Semmes Weinstein Monofilament test, and angiopathy was assessed by palpating the dorsal pedis and posterior tibialis pulse. Wound care interventions consisted of cleansing, debridement, and dressing. Given the similarities between Leprosy-related neuropathic ulcers and DM-related neuropathic ulcers, the DMIST (depth, maceration, inflammation/infection, size, tissue type of the wound bed, type of wound edge, and tunnelling/undermining) tool was used to evaluate wound healing progress. Results Anamnesis indicated patient has no DM, with normal blood glucose; however, the patient had neuropathic wounds on her feet, asymmetrical eyebrow distribution, and rashes on her hands and calves, with neuropathy confirmed by a monofilament test—initial treatment involved Cadexomer Iodine powder to control bacterial growth and Honey-based gel to promote granulation. Over 62 days, 11 treatments were administered, with an average dressing change every 5.6 days, which improved the DMIST score from 12 to 4 by the end of observation day. Conclusions This case report highlights the significance of distinguishing leprosy-related neuropathic ulcers from those associated with DM to ensure accurate diagnosis and timely treatment. By employing comprehensive assessment tools and targeted wound care interventions, significant improvements in wound healing were achieved, emphasizing the need for greater awareness and clinical vigilance in managing Leprosy-related neuropathic ulcers.

Protocolo de exploración del pie diabético

The diabetic foot screening protocol recommends an annual assessment in all patients with diabetes starting at the time of diagnosis in those with type 2 diabetes mellitus (DM2). The examination focuses on three aspects: a visual inspection of the foot, a vascular evaluation by means of pedal pulses, and neurological examination using a 10g monofilament to detect sensory loss. It is essential to identify risk factors for ulcers, such as neuropathy, deformities, and peripheral arterial disease (PAD). If there are signs of risk, such as previous ulcers or sensory loss, patients should be referred to a diabetic foot specialist. Tests such as the ankle-brachial index (ABI) are used for vascular assessment and other tools such as a monofilament and tuning fork are used to measure neurological sensitivity. The patient's risk classification is used to plan follow-up and treatment.

Association between Mediterranean diet adherence and peripheral artery disease in type 2 diabetes mellitus: An observational study

IntroductionTo evaluate the relationship between adherence to the Mediterranean diet (MD) and periphereal artery disease (PAD) in patients with type 2 diabetes mellitus (T2DM). MethodsAn observational sectional study was conducted with 174 patients diagnosed with T2DM, of which 78 patients had PAD. A patient was considered to have PAD if they obtained an ankle-brachial index (ABI) < 0.9 and/or absence of both distal pulses in one of the two feet. Data on sociodemographic and anthropometric variables, physical activity, smoking habits, biochemical blood parameters, and comorbidities were recorded. Good adherence to the MD was considered with a score ≥ 9 in MEDAS-14. Vascular factors independently associated with adherence to the MD in patients with T2DM were identified through multivariate logistic regression analysis. ResultsABI, DFU, intermittent claudication and pedal pulse absence correlated with MD adherence. DFU, intermittent claudication and posterior tibial pulse absence were associated with the final score obtained in the MEDAS-14. Nut consumption, white meat preference and sautéed dish intake were associated with PAD presence. Multivariate analysis linked MD adherence to sex (OR = 0.044, 95 % CI 0.003–0619), age (OR = 0.139, 95 % CI 0.029–0.666), duration of T2DM (OR = 7.383, 95 % CI 1.523–35.779) and age at diagnosis of T2DM (OR = 6082, 95 % IC 1.415–26.136), as well as the presence of DFU (OR = 0.000, 95 % IC 0.000–0.370) and intermittent claudication (OR = 0.004, 95 % IC 0.000–0.534). ConclusionsAdherence to the MD is associated with a reduction in vascular complications in T2DM, highlighting its potential as a dietary intervention strategy.

Inflammatory Protein Panel: Exploring Diagnostic Insights for Peripheral Artery Disease Diagnosis in a Cross-Sectional Study.

Cytokine-induced neutrophil chemoattractant 1 (CINC-1), a cluster of differentiation 95 (CD95), fractalkine, and T-cell immunoglobulin and mucin domain 1 (TIM-1) are circulating proteins known to be involved in inflammation. While their roles have been studied in neurological conditions and cardiovascular diseases, their potential as peripheral artery disease (PAD) biomarkers remain unexplored. We conducted a cross-sectional diagnostic study using data from 476 recruited patients (164 without PAD and 312 with PAD). Plasma levels of CINC-1, CD95, fractalkine, and TIM-1 were measured at baseline. A PAD diagnosis was established at recruitment based on clinical exams and investigations, defined as an ankle-brachial index < 0.9 or toe-brachial index < 0.67 with absent/diminished pedal pulses. Using 10-fold cross-validation, we trained a random forest algorithm, incorporating clinical characteristics and biomarkers that showed differential expression in PAD versus non-PAD patients to predict a PAD diagnosis. Among the proteins tested, CINC-1, CD95, and fractalkine were elevated in PAD vs. non-PAD patients, forming a 3-biomarker panel. Our predictive model achieved an AUROC of 0.85 for a PAD diagnosis using clinical features and this 3-biomarker panel. By combining the clinical characteristics with these biomarkers, we developed an accurate predictive model for a PAD diagnosis. This algorithm can assist in PAD screening, risk stratification, and guiding clinical decisions regarding further vascular assessment, referrals, and medical/surgical management to potentially improve patient outcomes.

Early screening for foot problems in people with diabetes is the need of the hour: ‘Save the Feet and Keep Walking Campaign’ in India

IntroductionEvidence on the prevalence of foot problems among people with diabetes in India at a national level is lacking. Hence, this study was aimed to assess the burden of high-risk...

Popliteal artery aneurysm treated with endovascular technique and new device: case report and literature review

In this paper, we aimed to report an alternative endovascular treatment in a patient with an isolated popliteal artery aneurysm. A 69 year-old male patient, with hypertension and post-operative of gastric bypass surgery for obesity, was admitted with right limb pain, mainly in the calf, associated with a weakness and difficulty walking. The patient was submitted to a duplex ultrasound, that suggested a popliteal artery aneurysm, with 3,8 cm diameter, confirmed with CT angiogram. Furthermore, the patient had no proper saphenous vein diameter for a open surgery bypass evaluated by a Doppler ultrasound. Then, the patient was scheduled to undergo endovascular treatment of the popliteal artery aneurysm with two covered self-expandable 8x100 and 10x75 Merit Wrapsodyâ. The patient was discharged from the hospital two days after the surgery with no complications, palpable pedal pulses taking Rivaroxaban 20mg and Clopidogrel 75mg daily. At year follow-up the patient was asymptomatic and duplex showed patent stent without evidence of endoleak.

Clinical utility of diabetic ulcer severity score in patients with diabetic foot ulcers – A prospective study

Background: The most common reason for hospitalisation for diabetic people is diabetic foot ulcer (DFU). For diabetic foot ulcers, a variety of scoring systems and classifications are available with the goal of comparing treatment options and long-term results. Aim of the study was to evaluate the effectiveness of the diabetic ulcer severity score, a wound-based clinical scoring system for diabetic foot ulcers, in predicting clinical outcomes. Materials and method: A prospective study was conducted on 65 diabetic ulcer patients. DUSS was applied during the admission. The DUSS consists of four clinical variables: 1) pedal pulses, 2) bone probing, 3) ulcer site, and 4) ulcer number. These wounds were scored as 0, 1, 2, 3, or 4. All patients received standard care in accordance with a protocol. The outcome of treatment was recorded. Results: In this prospective study of 65 patients with diabetic foot ulcers, most common age group affected was between 51-70 years. Mean duration of diabetes was 8.13±4.28 years. Most commonly ulcers were of DUSS score 1. Of the 65 patients, 36 (55.38%) got conservative care, including wound debridement, 14 (21.54%) underwent skin grafting, and 15 (23.08%) underwent amputation. DFU with DUSS score 0 healed by 2 weeks, score 3 and 4 healed mostly only after surgical intervention. Comparison of amputation based on DUSS score showed statistical significance. The mean healing time was found to be 108.8±43.7 days. Conclusion: This study conclude that DUSS system is a wound based diagnostic procedure to predict healing, amputation or need for surgery by combining the four sign in a safe manner. Keywords: amputation; diabetes mellitus; duss scoring system; foot ulcer

Spontaneous Iliac Artery Dissection in a 66-Year Old Male Complicated By Hemorrhage, GI Bleeding, and Bilateral DVT/PE

Spontaneous iliac artery dissection (IAD) is a rare medical condition with only a few cases being reported in the medical literature. Dissections typically involve the aorta and are not localized to the iliac arteries. Patients with spontaneous IAD typically present with symptoms that resemble peripheral artery disease, and cases are typically associated with connective tissue diseases such as Marfan syndrome and Ehlers-Danlos syndrome or high-risk states such as pregnancy and extreme athletics. There are some case reports that showed an association with hyperlipidemia, hypertension, and tobacco use. The most frequent complication of spontaneous IAD is rupture, and cases are typically treated endovascularly but may be treated with classical surgery such as in the case of rupture. Some cases have reportedly been treated with conservative management alone. In this case, we discuss a 66-year-old male with a past medical history of hyperlipidemia, hypertension, and tobacco use with no known diagnosis of connective tissue disease, and not in a high-risk state, who was found to have a spontaneous iliac artery dissection. He initially presented with sudden onset back pain that he described as a shooting pain that radiated into his head. He was also having right lower extremity discomfort. Initial vital signs were significant for tachycardia and hypertension, and physical exam was significant for tachycardia and diminished right posterior tibial and dorsalis pedis pulses. Laboratory workup was significant for a leukocytosis of 10.06 and creatinine of 1.52, consistent with acute kidney injury. Labs were otherwise unremarkable. Computed tomography angiogram (CTA) of the head and neck was negative for acute pathology, but CTA chest/abdomen/pelvis demonstrated arterial dissection that began at the origin of the right common iliac artery extending down to the right common femoral artery and also demonstrated a left renal infarct. A bare metal stent was placed by Interventional Radiology and the patient was started on dual antiplatelet therapy (DAPT) with a heparin drip and clopidogrel. Connective tissue disease workup was later performed including antinuclear antibody, rheumatoid factor, cyclic citrullinated peptide, and extractable nuclear antigen antibodies panel, which were all negative. Hospital stay was complicated by development of subarachnoid hemorrhage, intraventricular hemorrhage, subdural hematoma, and intradural hematoma that required laminoplasty and evacuation by Neurosurgery. DAPT was discontinued and the patient was later restarted on aspirin only. The patient then developed a cecal bleed that required clipping by Gastroenterology. Aspirin was discontinued and he then developed bilateral lower extremity deep venous thromboses and pulmonary emboli. He was started on enoxaparin with the assistance of Hematology and was later transitioned to apixaban with no complications. This case supports comorbidities as risk factors for spontaneous IAD and raises the need for formal screening and surveillance guidelines for these patients, as there are currently no guidelines in place. This case also demonstrates the complications that can occur with DAPT and anticoagulants and provides a manner in which to cautiously initiate anticoagulation in patients with high risk of bleeding while also preventing the development of further thrombi.

THU388 Insulin Edema Associated With Glargine: A Case Report And Brief Review Of Literature

Abstract Disclosure: J. Wood: None. V. Samji: None. F.S. Celi: None. P. Majety: None. Introduction: Insulin edema is an uncommon and poorly understood complication of insulin therapy in patients with diabetes. We report a patient with type 1 diabetes (T1DM) who developed edema within days of initiating insulin glargine that resolved with discontinuation of this medication. Case Report: A 20-year-old man with no past medical history presented with nausea, vomiting, polydipsia, and a 15-pound weight loss and was noted to have a hemoglobin A1c greater than 14.0%. Diabetic ketoacidosis (DKA) was ruled out and was started on weight-based insulin therapy with glargine and lispro three units with meals. Additional diabetes workup was notable for positive Anti-IA2 antibodies. Blood glucose levels improved prior to discharge. A week after discharge, he complained of swelling of limbs. Patient denied any shortness of breath, cough, chest pain, orthopnea, or nocturnal dyspnea. He was found to have extensive 2+ pitting edema in bilateral feet extending up to his calves. Dorsalis Pedis pulses were 2+ bilaterally. No warmth or erythema of legs was noted. His weight in clinic was 70.2 kg (154.4 lbs), up 11.6 kg (25.5 lbs) ten days post discharge. Evaluation for bilateral pedal edema was performed. Labs were notable for normal liver enzymes, creatinine, glomerular filtration rate and urine albumin levels, ruling out hepatic and renal causes of edema. Thyroid function tests were normal. His presentation was discussed with cardiology and brain natriuretic peptide level was drawn which was also normal. No further cardiac workup was recommended at that time given the patient’s history and lack of other clinical signs or symptoms of heart failure. After ruling out other systemic causes of edema in our patient, a diagnosis of insulin edema was made. Based on prior case reports of glargine associated insulin edema, he was switched from insulin glargine to insulin degludec. He noted significant improvement within 24 hours of switching insulin with a 6.4-pound weight loss in just one day and complete resolution of edema within 3 days. He had no recurrence of edema once glargine was discontinued despite increasing insulin dosing for glycemic control. Conclusion: The pathophysiology of insulin edema is unclear. Insulin’s role in renal sodium handling, vasodilation, and increased vascular permeability, have been postulated as possible mechanisms. Risk factors for developing insulin edema include T1DM, high A1C, high dose of insulin, rapid correction of hyperglycemia, DKA on presentation and poor nutritional status. Additional risk factors for developing insulin edema include thiamine deficiency and an underlying genetic predisposition related to a mitochondrial mutation, although this seems to be rare. Insulin edema is a diagnosis of exclusion. Clinicians should be aware of this rare complication, and its occurrence should be documented and differentiated from other causes of edema. Presentation: Thursday, June 15, 2023

Diabetic Foot Risk Factors &amp; level in Diabetes People: A Cross-Sectional Study

Objective: Determining diabetic foot risk levels and risk factors and treating foot problems is one of the main components of the prevention of diabetic foot ulcers (DFU). This study aimed to determine diabetic foot risk levels and risk factors in diabetic people.&#x0D; Materials and Methods: This descriptive cross-sectional study included 278 participants during September 2020 to March 2021. The patients' general characteristics, peripheral sensory loss (10 g-Semmes-Weinstein monofilament), foot skin temperature (palpation method) and vascular evaluation (pedal pulses) were examined.&#x0D; Results: Among 278 patients, 83 cases had DFU. Of those without DFU, 33.3% had risk level “0”, 35.4% had risk level “1”, 23.6% had risk level “2” and 7.7% had risk level “3”. In the regression analysis, male gender [OR= 0.74, 95% CI (0.014-0.338), P= 0.002], education (literate) [OR= 0.38, 95% CI (0.002-0.630), P= 0.022], foot examination by health professional [OR= 0.013, 95% CI (0.001-0.183), P= 0.001], foot deformity [OR= 0.170, 95% CI (0.042-0.679), P&lt; 0.001], foot skin temperature (cold) [OR= 0.003, 95% CI (0.000– 0.026), P&lt; 0.001], and pedal pulse [OR= 8.146, 95% CI (1.505-44.081), P&lt; 0.015] were found to have a high effect on diabetic foot development.&#x0D; Conclusion: The annual DFU rate is 29.8%. Independent risk factors of DFU were gender, education, previous history foot examination, foot skin temperature, pedal pulse and foot deformity. These findings provide support for a multifactorial etiology for DFU.

Polycythemia as an Underlying Cause of Digital Gangrene: A Rare and Unusual Case Presentation

Digital gangrene is frequently encountered in patients who have diabetes with peripheral vascular compromise, with or without superimposed infection. Preoperative laboratory values and radiographic images are important to determine a proper course of action. Equally important is a thorough history taking to confirm or rule out systemic entities and preexisting conditions that can aggravate or predispose one to the development of digital gangrene. A patient with diabetes presented with a rare and unusual case of digital gangrene, as he clinically had strong pedal pulses. Preoperative workup revealed a suspicion of polycythemia, which was subsequently confirmed. The patient underwent several days of phlebotomy until his hemoglobin and hematocrit levels were brought down to optimized levels before a digital amputation was performed. He went on to heal uneventfully, and he is currently being closely followed by oncology/hematology colleagues with periodic phlebotomy.

Performance Analysis Smart-Shoes To Measure the Pulse in Dorsalis Pedis Artery

Wearable device has grown in popularity in recent years. This&#x0D; article presents the performance of smart shoes as a biomedical&#x0D; device that can be used to capture heart rate signals from the&#x0D; dorsalis pedis artery on the leg. In general, heart rate is measured&#x0D; from the arteries located in the chest, hands, fingertips, and ears or&#x0D; neck. Even though the pulse from the dorsalis pedis has a smaller&#x0D; amplitude compared to other arterial locations, the sensor is&#x0D; integrated on smart shoes can catch the signal from the dorsalis&#x0D; pedis pulse. Research is intended to analyze lifetime and accuracy&#x0D; smart shoes. The experiment was carried out by 30 healthy male&#x0D; and female volunteers aged 20-25 years. The results obtained&#x0D; indicate that the sensor smart shoes can measure the dorsalis pedis&#x0D; pulse and has an average error rate of 9.28% compared to a digital&#x0D; sphygmomanometer. Based on the results of energy consumption&#x0D; analysis,smart shoes in this study has a lifetime of up to 25.86 hours&#x0D; using a 1100 mAh battery.

ASSOCIATIONS OF INTER-ARM BLOOD PRESSURE DIFFERENCE WITH TREATMENT RESPONSE IN NEWLY TREATED HYPERTENSION

Objective: Inter-arm differences (IAD) in systolic blood pressure (SBP) predict future cardiovascular mortality and morbidity. IAD varies between measures and gets smaller with repeated measures. The relationship of IAD to response to antihypertensive treatment is unknown. We set out to examine associations of IAD with BP treatment response over 18 weeks in treatment-naïve adults with moderate to severe hypertension. Design and method: We previously reported that nurse-led accelerated stepwise management of treatment-naïve grade II/III hypertension is feasible, safe and effective, achieving control of SBP to &lt; 140 mmHg for 76% after 18 weeks. Using this cohort, univariable associations of IAD (mean of 8 simultaneous BP measurements) with vascular and clinical indices, and with BP change on treatment, were examined with mixed-effects linear regression models. Candidate univariable indices (p&lt;0.2) entered multivariable modelling. Regression modelling of change in IAD was undertaken. All analyses adjusted for age, sex and entry SBP. Results: For 52 participants (mean age 59; 42% female), mean (standard deviation: SD) entry SBP was 171 (13.9) mmHg falling, after protocol-led treatment intensification, to 131 (10.7) mmHg at 18 weeks; mean systolic IAD was 4.5 (4.2) mmHg at entry and 3.9 (4.3) mmHg at 18 weeks (p = 0.28). In final adjusted models, IAD at entry was associated with handedness, height, body mass index, smoking and absence of pedal pulses. Greater reduction of SBP from entry to 18 weeks was associated with lower entry IAD, greater SD of daytime ambulatory BP, smoking history and handedness. Adjusted change in IAD over 18 weeks was correlated with falls in SBP (Adjusted R2 = 0.56). Conclusions: These data associate greater systolic IAD with reduced response to intensive BP lowering, and correlate reduction in IAD with change in BP. Slower BP target achievement can carry prognostic implications, suggesting one possible mechanism whereby IAD might predict future mortality.

Explant of an Embolized Left Atrial Appendage Occlusion Device

This case highlights an open retroperitoneal approach to explant an embolized left atrial appendage occlusion device in the visceral aorta. Endovascular retrieval of the device was deemed to be an inferior alternative given the significant mural thrombus that extended toward the superior mesenteric artery and celiac artery from the device, as demonstrated on computed tomography angiogram, and the associated risk of embolizing the visceral vessels or the lower extremities. After explantation of the device and thrombectomy of the visceral aorta and vessels, the aorta was closed with a bovine pericardium patch and the patient had excellent flow in the visceral vessels on Doppler interrogation as well as palpable femoral and dorsalis pedis pulses bilaterally. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJkNTNlYmZhY2E0ZmY1Mzg1MmY5NzhlNDZjMTBjZThmNyIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjg0ODU3NjI1fQ.EwSKLOWw5WMOIFl-wvWWwpZ7pG3kMhvd-frnMY9vMsKkaG5adl1pnISOCa7EIYfupXtCwyig2ODvko3HhNvDcJ7kZjuJmGR33n7CmhdTq26386TMs8CE2nUTr4nk1KR-ETkO2MaC35h3oI9NIwT0WL9wxp8HUREcuc5Abtp_sXo1wMPlZvcn3hBHioZ2LDS1R3ujoBhwpG3-O5ALBXldrThyDOO_Gy9dS1se8d-PqiqlTGKAyZpLQhSUKjel8oc81EsIYQ-QfOh1uS3bHWlSzAL3j_LyBHK7drmWFixT0-01ztpO6MLn4fyj01wGEFBW6QFHSsetgmPmwayf3HyrmQ Download .mp4 (107.46 MB) Help with .mp4 files Watchman Case 1.8.23NoTitles.mp4

Risk Factors for Hospital Re-admission for Diabetes Related Foot Disease: A Prospective Cohort Study

Diabetes related foot disease (DFD) is a common reason for admission to hospital, but the predictive factors for repeat admission are poorly defined. The primary aim of this study was to identify rates and predictive factors for DFD related hospital re-admission. Patients admitted to hospital for treatment of DFD at a single regional centre were recruited prospectively between January 2020 and December 2020. Participants were followed for 12 months to evaluate the primary outcome of hospital re-admission. The relationship between predictive factors and re-admission were examined using non-parametric statistical tests and Cox proportional hazard analyses. The median age of the 190 participants was 64.9 (standard deviation 13.3) years and 68.4% were male. Forty-one participants (21.6%) identified themselves as Aboriginal or Torres Strait Islander people. One hundred participants (52.6%) were re-admitted to hospital at least once over 12 months. The commonest reason for re-admission was for treatment of foot infection (84.0% of first re-admission). Absent pedal pulses (unadjusted hazard ratio [HR] 1.90; 95% confidence interval [CI] 1.26 - 2.85), loss of protective sensation (LOPS) (unadjusted HR 1.98; 95% CI 1.08 - 3.62), and male sex (unadjusted HR 1.62; 95% CI 1.03 - 2.54) increased the risk of re-admission. After risk adjustment, only absence of pedal pulses (HR 1.92, 95% CI 1.27 - 2.91) and LOPS (HR 2.02, 95% CI 1.09 - 3.74) significantly increased the risk of re-admission. Over 50% of patients admitted to hospital for treatment of DFD are re-admitted within one year. Patients with absent pedal pulses and those with LOPS are twice as likely to be re-admitted.