Diagnosis Of Peripheral Arterial Disease Research Articles

Sex-Based Differences in Clinical Characteristics and Outcomes among Patients with Peripheral Artery Disease: A Retrospective Analysis.

Peripheral arterial disease (PAD) is a prevalent medical condition associated with high mortality and morbidity rates. Despite the high clinical burden, sex-based differences among PAD patients are not well defined yet, in contrast to other atherosclerotic diseases. This study aimed to describe sex-based differences in clinical characteristics and outcomes among hospitalized patients affected by PAD. This was a retrospective study evaluating all patients with a diagnosis of PAD admitted to the Emergency Department from 1 December 2013 to 31 December 2021. The primary endpoint of the study was the difference between male and female PAD patients in cumulative occurrence of Major Adverse Cardiovascular Events (MACEs) and Major Adverse Limb Events. A total of 1640 patients were enrolled. Among them, 1103 (67.3%) were males while females were significantly older (median age of 75 years vs. 71 years; p =< 0.001). Females underwent more angioplasty treatments for revascularization than men (29.8% vs. 25.6%; p = 0.04); males were treated with more amputations (19.9% vs. 15.3%; p = 0.012). A trend toward more MALEs and MACEs reported in the male group did not reach statistical significance (OR 1.27 [0.99-1.64]; p = 0.059) (OR 0.75 [0.50-1.11]; p = 0.153). However, despite lower extremity PAD severity seeming similar between the two sexes, among these patients males had a higher probability of undergoing lower limb amputations, of cardiovascular death and of myocardial infarction. Among hospitalized patients affected by PAD, even if there was not a sex-based significant difference in the incidence of MALEs and MACEs, adverse clinical outcomes were more common in males.

Longitudinal Pathways Between Physical Activity, Depression, and Perceived Stress in Peripheral Artery Disease.

One-fifth of the patients with peripheral artery disease (PAD) experience depression and stress. Depression and stress may impact patients' abilities to be physically active, a key recommendation for supporting overall PAD management to improve symptoms and reduce the risk of cardiovascular events. We aimed to study interrelationships between 1-year longitudinal trajectories of depression, stress, and physical activity following a PAD diagnosis. Patients with new or worsening PAD symptoms enrolled at 10 US PORTRAIT study (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) vascular specialty clinics (CT, LA, MI, MO, NC, OH, and RI) were assessed at baseline, 3, 6, and 12 months between June 2, 2011 and December 3, 2015. Depressive symptoms were measured with the 8-item Patient Health Questionnaire, perceived stress with the 4-item Perceived Stress Scale and physical activity with items from the INTERHEART study. Path analysis was used to examine the longitudinal relationship between depression and physical activity and perceived stress and physical activity. A total of 766 patients were included (mean age of 68.2 [±9.4] years; 57.7% male). Overall, 17.8% reported significant depressive symptoms, 36.0% experienced increased perceived stress, and 44.1% were sedentary upon PAD diagnosis. A decrease in physical activity preceded a rise in subsequent depressive symptoms (β ranges -0.45 [95% CI, -0.80 to -0.09]; -0.81 [95% CI, -1.19 to 0.42]) over the course of 1 year. Low physical activity scores at the initial presentation were followed by high perceived stress at 3 months (β=-0.44 [95% CI, -0.80 to -0.07]). In symptomatic PAD, a decrease in physical activity was followed by an increased risk of depressive symptoms and perceived stress at subsequent intervals over the course of 1 year following PAD diagnosis and treatment. Integrated behavioral health approaches for PAD, addressing physical activity and managing depression or distress, are indicated as collective PAD treatment goals.

The Value of Concomitant Measurement of miR 323b-5p and miR 486-5p with Ankle Brachial Index in Diagnosis of Peripheral Arterial Disease

The Value of Concomitant Measurement of miR 323b-5p and miR 486-5p with Ankle Brachial Index in Diagnosis of Peripheral Arterial Disease

Contrast-free ultrasound imaging for blood flow assessment of the lower limb in patients with peripheral arterial disease: a feasibility study

While being a relatively prevalent condition particularly among aging patients, peripheral arterial disease (PAD) of lower extremities commonly goes undetected or misdiagnosed due to its symptoms being nonspecific. Additionally, progression of PAD in the absence of timely intervention can lead to dire consequences. Therefore, development of non-invasive and affordable diagnostic approaches can be highly beneficial in detection and treatment planning for PAD patients. In this study, we present a contrast-free ultrasound-based quantitative blood flow imaging technique for PAD diagnosis. The method involves monitoring the variations of blood flow in the calf muscle in response to thigh-pressure-cuff-induced occlusion. Four quantitative metrics are introduced for analysis of these variations. These metrics include post-occlusion to baseline flow intensity variation (PBFIV), total response region (TRR), Lag0 response region (L0RR), and Lag4 (and more) response region (L4 + RR). We examine the feasibility of this method through an in vivo study consisting of 14 PAD patients with abnormal ankle-brachial index (ABI) and 8 healthy volunteers. Ultrasound data acquired from 13 legs in the patient group and 13 legs in the healthy group are analyzed. Out of the four utilized metrics, three exhibited significantly different distributions between the two groups (p-value < 0.05). More specifically, p-values of 0.0015 for PBFIV, 0.0183 for TRR, and 0.0048 for L0RR were obtained. The results of this feasibility study indicate the diagnostic potential of the proposed method for the detection of PAD.

Assessing Automatic Plethysmographic Ankle-Brachial Index Devices in Peripheral Artery Disease Detection: A Comparative Study with Doppler Ankle-Brachial Index Measurements.

BACKGROUND The ankle-brachial index (ABI) is a critical diagnostic test for peripheral artery disease (PAD), albeit requiring technical expertise and dedicated resources. The advent of automatic ABI devices proposes a more accessible approach, necessitating fewer resources and less expertise. This study was conducted to gather data on PAD prevalence and to evaluate the correlation and efficacy of automatic ABI measurements vs traditional Doppler ABI measurements to understand their potential role in primary care settings. MATERIAL AND METHODS ABI measurements were obtained using both the Doppler method and an automatic plethysmographic device (Dopplex ABility, Huntleigh Healthcare). RESULTS Of the 290 participants (mean age 67.6±7.4 years), Doppler ABI method identified 16.8% with abnormal results (<0.9), while the automatic method identified only 5.9%. The mean Doppler ABI was 1.05±0.15, and the mean automatic ABI was 1.12±0.13. The sensitivity of the automatic ABI measurements was 22.2%, and the specificity was 96.8%, with a positive predictive value of 57.1%, and a negative predictive value of 86.9%. Adjustments in the automatic assessment and inclusion of pulse wave velocity enhanced the diagnostic capabilities of the automatic ABI device. CONCLUSIONS While the automatic plethysmographic ABI device may lack the necessary diagnostic capabilities to replace the traditional Doppler ABI device as a standalone test in PAD diagnosis, it could still offer significant value in primary care settings if integrated with adjusted cut-off points and pulse wave velocity analysis.

Assessment and Diagnosis of Peripheral Artery Disease in Patients with Diabetes

Peripheral artery disease (PAD) is a chronic circulatory condition that occurs when the arteries that supply blood to the legs and feet are narrowed or blocked, leading to reduced blood flow to these areas. PAD is a common complication of type 2 diabetes, affecting up to 1 in 3 individuals with the condition. Assessment of PAD in individuals with diabetes typically involves a physical exam, ankle-brachial index (ABI) measurement, and imaging tests such as Doppler ultrasound or angiography. The ABI is a noninvasive measure that compares the blood pressure in the ankles and arms, with a lower ABI indicating a higher risk of PAD. Management of PAD in type 2 diabetes involves a multifaceted approach, including lifestyle modifications, medication, and revascularization procedures. Lifestyle changes such as smoking cessation and regular exercise can improve PAD symptoms and reduce the risk of disease progression. Medications such as antiplatelet agents, statins, and blood pressure-lowering drugs help to manage PAD and its associated risk factors. Revascularization procedures such as angioplasty or bypass surgery may be necessary in severe cases of PAD to restore blood flow to the affected limbs. In addition, these procedures should be considered in the feet of patients with diabetes if there is evidence of ischemia. Early detection and management of PAD in type 2 diabetes are critical to preventing complications such as non-healing wounds, infections, and amputations. Individuals with type 2 diabetes should undergo regular screening for PAD and work with their healthcare providers to develop a personalized treatment plan.

Low and High Ankle-Brachial Index Are Both Associated with Mortality in German Nursing Home Residents-The Five-Year Follow-Up of the "Allo-Study" Cohort.

Peripheral arterial disease (PAD) is associated with high cardiovascular morbidity and mortality. We aimed to examine this relation in a population that tends to be under-represented in research on the topic. In a prospective observational cohort study, residents of 45 nursing homes in Germany were screened for pathological ankle-brachial index (ABI) and observed for five years. Of 1333 participants (median age 84 years), 55.5% had a pathological ABI (≤0.9 or >1.4) on one or both legs. 84.7% of the probands with a low ABI (indicating PAD) had no previously known PAD diagnosis. The five-year mortality was 73.0%. Mortality was higher in individuals with a pathological ABI (76.5%) than in those with a normal ABI (68.7%, p = 0.003). An ABI > 1.4 was associated with a higher mortality (79.4%) than a reduced (74.7%) or normal ABI (68.7%, p = 0.011). Pathological ABI values were associated with an increase in mortality after correction for age, sex and all recorded comorbidities, including cardiac disease. Although PAD is highly prevalent in nursing home residents, it is underdiagnosed and undertreated. In the study cohort, both high and low ABI were important predictors of mortality. PAD deserves more attention in this high-risk population.

False Normalization of Ankle Brachial Index: A Case of Lower Extremity Peripheral Arterial Disease with Normal Ankle-Brachial Index

Screening for lower extremity peripheral arterial disease (PAD) is essential in assessing a patient’s risk of cerebrovascular disorders. The ankle-brachial index (ABI) is widely used as a screening tool for PAD, but it can produce falsely normalized results due to factors like artery calcification and collateral vessels. We report a patient with normal ABI but confirmed lower extremity PAD through ultrasound and computed tomography (CT). This case shows the limitation of ABI for PAD diagnosis. Additional tests, such as CT or ultrasound, should be considered when PAD is suspected, even if the ABI is normal.

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

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

A novel, microvascular evaluation method and device for early diagnosis of peripheral artery disease and chronic limb-threatening ischemia in individuals with diabetes.

A novel transdermal arterial gasotransmitter sensor (TAGS) has been tested as a diagnostic tool for lower limb microvascular disease in individuals with and without diabetes mellitus (DM). The TAGS system noninvasively measures hydrogen sulfide (H2S) emitted from the skin. Measurements were made on the forearm and lower limbs of individuals from three cohorts, including subjects with DM and chronic limb-threatening ischemia, to evaluate skin microvascular integrity. These measurements were compared with diagnosis of peripheral artery disease (PAD) using the standard approach of the toe brachial index. Other measures of vascular health were made in some subjects including fasting blood glucose, hemoglobin A1c, plasma lipids, blood pressure, estimated glomerular filtration, and body mass index. The leg:arm ratio of H2S emissions correlated with risk factors for microvascular disease (ie, high-density lipoprotein levels, estimated glomerular filtration rate, systolic blood pressure, and hemoglobin A1c). The ratios were significantly lower in symptomatic DM subjects being treated for chronic limb-threatening ischemia (n= 8, 0.48± 0.21) compared with healthy controls (n= 5, 1.08± 0.30; P= .0001) and with asymptomatic DM subjects (n= 4, 0.79± 0.08; P= .0086). The asymptomatic DM group ratios were also significantly lower than the healthy controls (P= .0194). Using ratios of leg:arm transdermal H2S measurement (17 subjects, 34 ratios), the overall accuracy to identify limbs with severe PAD had an area under the curve of the receiver operating curve of 0.93. Ratios of transdermal H2S measurements are lower in legs with impaired microvascular function, and the decrease in ratio precedes clinically apparent severe microvascular disease and diabetic ulcers. The TAGS instrument is a novel, sensitive tool that may aid in the early detection and monitoring of PAD complications and efforts for limb salvage.

Performance of systolic pressure index for lower limb peripheral arterial disease in a group of elderly in sub-Saharan Africa

BackgroundThe automatic measurement of the ankle-brachial index (ABI) constitutes a reliable, simple, safe, rapid, and inexpensive alternative diagnostic screening test compared with the Doppler method for peripheral arterial disease (PAD). We aimed to compare the diagnostic performance of automatic ABI measurement tests to Doppler ultrasound for PAD in a group of patients aged 65 years and above, in Sub-Saharan Africa. MethodsThis was an experimental comparative study of the performance of Doppler ultrasound to the automated ABI test in the diagnosis of PAD in patients aged ≥ 65 years followed-up at the Yaoundé Central Hospital, Cameroon between January to June 2018. An ABI threshold < 0.90 is defined as a PAD. We compare the sensitivity, and specificity of the high ankle-brachial index (ABI-HIGH), low ankle-brachial index (ABI-LOW), and the mean ankle-brachial index (ABI-MEAN) for both tests. ResultsWe included 137 subjects with an average age of 71.7 ± 6.8 years. In the ABI-HIGH mode, the automatic device had a sensitivity of 55% and a specificity of 98.35% with a difference between the two techniques of d = 0.024 (p = 0.016). In the ABI-MEAN mode, it had a sensitivity of 40.63% and a specificity of 99.15%; d = 0.071 (p < 0.0001). In the ABI-LOW mode, it had a sensitivity of 30.95% and a specificity of 99.11%; d = 0.119 (p < 0.0001). ConclusionThe Automatic measurement of systolic pressure index has a better diagnostic performance in the detection of Peripheral Arterial Disease compared to the reference method by continuous Doppler in sub-Saharan African subjects aged ≥ 65 years.

(297) Evaluation of Endothelial Function and Metabolic Profile in Patients with Prostate Cancer Undergoing Androgen Deprivation Therapy

Abstract Introduction Androgen deprivation therapy (ADT) has been the cornerstone of prostate cancer treatment. ADT delays cancer progression, alleviates cancer-related symptoms, and is associated with survival gains. Despite these established benefits, the therapy comes with known side effects, such as increased cardiovascular adverse events and metabolic changes. Despite the well-established association between the level of circulating testosterone and endothelial integrity, the direct effects of ADT on endothelial function remain controversial. Objective The aim of the present study was to investigate the impact of ADT on endothelial function, through the analysis of vascular parameters of the brachial artery, and the measurement of serum inflammatory markers. It was also our goal to evaluate early impact of ADT on anthropometric and metabolic parameters Methods We prospectively evaluated men with moderate to high-risk prostate cancer treated with ADT from January to July 2022 at our institution. Patients with decompensated diabetes mellitus (HbA1c &amp;gt;9%), active smokers or smokers who have ceased for less than 5 years and those with confirmed diagnosis of peripheral artery disease, coronary artery disease, angina, congestive heart failure, myocardial infarction, coronary revascularization or stroke, were excluded. Brachial artery assessment included vascular diameter and flow-mediated (endothelium-dependent) vasodilation (FMD) using high-resolution B-mode ultrasound. Our metabolic and inflammatory profile included serum measurement of total cholesterol and fractions, triglycerides, fasting glucose, glycated hemoglobin, basal insulin, C-reactive protein, and bioimpedance assessment of body fat distribution. All measurements were performed at baseline and after 3 months of ADT initiation with goserelin acetate 10.80mg. Results A total of 14 men with mean age of 67.9 ± 6.9 years were included. The prevalence of diabetes in the present cohort was 21.4%. FMD demonstrated a slight increase following ADT, which did not reach statistical significance after 3 months (median 2.2% vs. 5.0%; p = 0.8224 – Figure 1). Baseline brachial artery diameter significantly decreased with ADT compared to baseline (median diameter 0.43cm vs 0.40cm; p = 0.006). With regard to the metabolic profile, ADT significantly increased insulin resistance: fasting insulin levels (mean 9.67 ± 6.09 vs 13.19 ± 7.47; p = 0.002), glycated hemoglobin (mean 5.79% ± 0.47 vs 6.22% ± 0.75; p = 0.009) and homeostatic model assessment insulin resistance increased significantly after 3 months (p = 0.006). Low-density lipoprotein cholesterol (mean 112.00 ± 27.35 vs 128.90 ± 29.00; p = 0.01) and triglycerides (mean 145.40 ± 78.52 vs 168.20 ± 105.80; p = 0.03) concentrations were higher after 3 months of ADT. No significant differences were found in body fat distribution. Conclusions Although the present study has not demonstrated a significant change in brachial artery FMD, we verified an important and surprisingly early worsening of the metabolic profile with ADT, especially increased insulin resistance and dyslipidemia, which represent well-established risk factors for cardiovascular events. Disclosure No

Effects of lower limb heating on the ankle-brachial index

Background: Peripheral artery disease (PAD) is an atherosclerotic disease with luminal narrowing of blood vessels, leading to an obstruction of blood flow. It most commonly affects blood vessels of the lower extremities. The ankle-brachial index (ABI, the ratio of ankle pressure over brachial pressure) is a primary index in the diagnosis (ABI &lt; 0.9) of PAD. However, resting ABI may not be sensitive enough to detect mild/moderate PAD in some patients. The ABI after a 5 -min exercise stress test is currently used to confirm a diagnosis of PAD in patients with classical symptoms of PAD, but with normal resting ABIs. However, not all of the patients can tolerate the treadmill test. The purpose of this study was to examine the effects of lower limb heating on the ABI measurement, since lower limb heating can also induce lower limb vasodilation as walking does. Hypothesis: We hypothesized that lower limb heating would specifically decrease ABI in PAD patients. Methods: In 10 PAD patients and 12 healthy control subjects, resting ABI was measured at first. Then, both feet and lower legs were immersed in warm water (~ 40 ºC) for 30 min. Thereafter, ABI was measured again. This study is associated with a registered clinical trial (NCT03900832). Data and a summary of the results: Lower limb heating did not significantly alter the hemodynamic variables in both groups. Lower limb heating significantly decreased the ABI of both legs in PAD patients (0.75 ± 0.03 to 0.67 ± 0.04, P = 0.003), and did not alter the ABI in healthy controls (1.01 ± 0.01 to 1.03 ± 0.01, P = 0.103). Discussion and Conclusion: The presented data show that lower limb heating decreases ABI in PAD patients, while it does not alter ABI in healthy individuals. The results suggest that lower limb heating can increase the sensitivity of the ABI measurement in PAD patients. Many patients with PAD can have comorbidities that are either absolute or relative contraindications to exercise treadmill testing. Moreover, many patients with intermittent claudication may not tolerate exercise treadmill testing. We speculate that the lower limb heating approach can be applied in these patients. Further studies on the mechanisms are warranted. This study was supported by National Institutes of Health Grants R01 HL141198 and R01 HL164571. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Abstract 374: Sexual Dimorphism And Elabela Expression In Peripheral Artery Disease

Introduction: Elabela is a component of the apelinergic system known to regulate immune responses and has a cardiovascular protection role, including atherosclerosis. Peripheral artery disease (PAD) is the narrowing or blockage of larger arteries in the legs. Patients with PAD suffer from poor perfusion to their lower extremities, in addition to increased rates of cardiovascular complications. The role of sexual dimorphism in the immune system in the PAD is poorly understood. Our previous research suggests that Elabela may hold a gender-dependent protective role that can be used as immunotherapeutic. We hypothesized that in patients with PAD, expression of Elabela will be different between males and females, implicating in sexual dimorphism of the immune response, the disease outcome, and treatment. Methods: Blood samples were collected from PAD patients (n=8) and risk factor closely matched controls (n=8). PBMCs were isolated by gradient centrifugation. By flow cytometry, gating strategy on Elabela, and Elabela expressing leukocytes, using FlowJow software for analysis. Results: The results showed that there is a sexual difference in the expression of Elabela in both controls and patients with PAD. In general, males showed a high level of Elabela than females. PAD decreases Elabela expression in both males and females. Regarding Elabela expressing leukocytes, in female controls, there was no significant difference in leukocyte expression of Elabela as compared to PAD patients, while male controls demonstrated increased leukocyte expression of Elabela. Conclusions: Our findings suggest a potential role for Elabela in PAD. Importantly, these results also indicate a difference in Elabela expression based on sex dimorphism. Such differences could potentially be used as a biomarker in the diagnosis and prognosis of PAD along with therapeutic values.

Peripheral arterial disease in hemodialysis patients 10 years later

Background and objectivePatients with chronic kidney disease (CKD) on hemodialysis present high cardiovascular comorbidity. Peripheral arterial disease (PAD) is associated with higher mortality and the interest in its early detection and treatment is increasing. The objective of this study is to determine the frequency and severity of symptomatic PAD, and to establish its relationship with mortality in HD patients that have received treated early and compare them with a cohort of our center already reported. Material and methodsRetrospective study on a cohort of incident patients since 2014 and followed up until December 2019. Demographic data, cardiovascular risk, the presence of symptomatic PAD at baseline and during follow-up were collected. Trophic lesions were graded using the Rutherford scale. ResultsInitially, there were 91 patients and 7 cases that were not included in the study were lost to follow-up. Age 64 ± 16 years, men 51.6% (47/91). The percentage of baseline PAD was 10.7% (9/84). During a median follow-up of 35 months (20−57), the diagnosis of PAD increased to 25% (21/84). Half of the patients with PAD 52.38% (11/21) obtained a score greater than 3 in the Rutherford Clinical Classification, which corresponds to severe disease. 13/21 patients required reoperation due to recurrence of symptoms (61.9% of cases with PAD).The development of PAD was significantly associated with: an elevated index of Charlson (3.9±2.1 vs. 7.7 ± 3.5; P = 0.001),being male (19 vs. 2; P = 0.001), diabetic (no: 7; yes: 15; P = 0.001) and with a history of chronic ischemic heart disease (no: 13; yes: 8; P = 0.001), 38.1% (8/21) had ischemic heart disease in patients who developed PAD, while in the absence of PAD the presence of ischemic heart disease was 9.5% (6/63). Furthermore, more than half (66.7% [14/21]) of those who developed PAD were diabetic.Univariate analysis showed that age, C reactive protein, albumin, and number of surgical interventions, but not PAD, were associated with mortality. In the multivariate analysis adjusted for other factors, only C reactive protein was related to overall survival Exp β: 2.17; P = 0.011; CI (1.19–3.97). Regarding cardiovascular mortality, in the multivariate Cox analysis, only PAD was related to mortality of cardiovascular origin Exp β: 1.73; P = 0.006; CI (1.17–2.56). ConclusionsA significant number of patients on hemodialysis develop PAD requiring peripheral vascular surgery. PAD was not associated with overall mortality in our cohort, but it did show an association with cardiovascular mortality. Prospective studies with a larger sample size are necessary. New surgical treatments and Follow-up by vascular surgeons could improve the severity of PAD and the long-term prognosis.

The impact of gender on differences in the diagnosis of peripheral arterial disease: the staggering effects of social determinants seen highest in women

Peripheral arterial disease (PAD) is a clinical manifestation of atherosclerosis, affecting primarily the peripheral vasculature in the lower extremities. In its terminal form, PAD can result in critical limb ischemia with subsequent amputation if inappropriately managed. As the prevalence of PAD continues to rise in the United States, disparities in its incidence and treatment have become a major focus point of cardiovascular research. However, most research efforts thus far have focused on the presentation and treatment of PAD in men. Given that women appear to be just as affected by PAD as men, more emphasis is needed on understanding the disparities and challenges affecting women with PAD. This paper aims to identify disparities in the treatment of PAD between males and females, with a closer look at gender disparities between Hispanic and non-Hispanic patients.&#x0D; &#x0D; Keywords: Peripheral arterial disease, women, Hispanics, disparities

Peripheral artery disease (PAD) in primary care-educational experiences for PAD primary care in England-a mixed-method study.

Peripheral artery disease (PAD), the pathophysiologic narrowing of arterial blood vessels of the lower leg due to atherosclerosis, is a highly prevalent disease, with sharp increases in prevalence with age. Primary care is ideally located to identify and manage PAD. This study aims to identify the educational experiences, opinions, and confidence of primary care clinicians (PCCs) regarding PAD. This mixed-method study was conducted within primary care in England. An online survey was completed with follow-on semistructured interviews, between January and September 2021, with PCCs, namely GPs, practice nurses, and allied professionals (survey n = 874, interviews n = 50). PCCs report variation in PAD education received, where the content could not often be recalled. Patient-focussed experiential and self-directed learning, formed the largest method to gain PAD education. All PCCs recognized that they have an important role in recognizing PAD yet confidence in recognizing and diagnosing PAD was lacking. PCCs acknowledged that late or missed PAD diagnosis resulted in significant patient morbidity and mortality. Yet many did not recognize PAD as a common disease. As "specialist-generalists" with finite resources, education provided to primary care needs to be applicable for the multimorbid patient presentations often seen, utilizing resources available in primary care, with consideration to the time constraints endured.

Interruption of Insurance Coverage and the Risk of Amputation in Patients with Pre-Existing Commercial Health Insurance and Peripheral Artery Disease

Peripheral artery disease (PAD) is linked with an increased risk of lower extremity amputation and multiple socioeconomic factors attenuate this risk. Prior studies have demonstrated increased rates of amputation in PAD patients with suboptimal or no insurance coverage. However, the impact of insurance loss in PAD patients with pre-existing commercial insurance coverage is unclear. In this study, we evaluated the outcomes of PAD patients who lose commercial insurance coverage. The Pearl Diver all-payor insurance claims database was used to identify adult patients (>18years) with a PAD diagnosis from 2010 to 2019. The study cohort included patients with pre-existing commercial insurance and at least 3years continuous enrollment after diagnosis of PAD. Patients were stratified based on whether they had an interruption of commercial insurance coverage over time. Patients who transitioned from commercial insurance to Medicare and other government-sponsored insurance during follow up were excluded. Adjusted comparison (1:1 ratio) was performed using propensity matching for age, gender, the Charlson Comorbidity Index (CCI), and relevant comorbidities. The main outcomes were major amputation and minor amputation. Cox proportional hazards ratios and Kaplan-Meier estimate were used to examine the association between loss of insurance and outcomes. Among the 214,386 patients included, 43.3% (n=92,772) had continuous commercial insurance coverage and 56.7% (n=121,614) had interruption of coverage (transition to uninsured or Medicaid coverage) during follow up. In the crude cohort and matched cohort, interruption of coverage was associated with lower major amputation-free survival on Kaplan Meier estimate (P<0.001). In the crude cohort, interruption of coverage was associated with 77% increased risk of major amputation (OR 1.77, 95% CI 1.49-2.12) and a 41% high risk of minor amputation (OR 1.41, 95% CI 1.31-1.53). In the matched cohort, interruption of coverage was associated with 87% increased risk of major amputation (OR 1.87, 95% CI 1.57-2.25) and a 104% increased risk of minor amputation (OR 1.47, 95% CI 1.36-1.60). Interruption of insurance coverage in PAD patients with pre-existing commercial health insurance was associated with increased risks of lower extremity amputation.

ROLE OF DUPLEX ULTRASONOGRAPHY IN DIAGNOSIS OF PERIPHERAL VASCULAR DISEASE IN WESTERN INDIAN POPULATION: A CROSS-SECTIONAL STUDY OF 100 PATIENTS

Peripheral arterial disease (PAD) is a common vascular condition that affects the lower extremities, and its prevalence is increasing worldwide. We studied 100 patients over a period of 9 months to understand the role of duplex ultrasound in peripheral arterial disease and assess the spectrum of vascular disease in western Gujarat population. Duplex ultrasound is a non-invasive imaging modality that plays a crucial role in the diagnosis, evaluation, and management of PAD. This technique combines two types of ultrasound, B-mode and Doppler, to visualize the arterial anatomy and assess blood ow velocities. Duplex ultrasound provides accurate information about the presence and severity of stenosis or occlusion, as well as the hemodynamic signicance of the disease. It can classify PAD based on various parameters, including the ankle-brachial index (ABI) and pulse wave velocity (PWV). Duplex ultrasound is also useful in monitoring disease progression and treatment response. The technique has several advantages over other imaging modalities, including its non-invasive nature, lower cost, portability, and ability to provide real-time imaging during interventions. However, interpreting duplex ultrasound results requires expertise in vascular anatomy and hemodynamics. Overall, duplex ultrasound is a versatile and valuable tool in the diagnosis and management of PAD

Peripheral artery disease and extracorporeal membrane oxygenation: Examining a high-risk cohort over time.

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a resource-intensive approach for the management of refractory cardiogenic shock. Within this population exists a substantial cohort of patients with peripheral artery disease (PAD), which independently increases the risk of complications and all-cause mortality. We studied 10-year national trends of the impact of PAD among VA-ECMO recipients to better understand the prevalence of PAD and implications on outcomes in this vulnerable population. This 10-year retrospective, propensity score-matched study identified all adult patients (≥18) who underwent VA-ECMO between 2009 and 2018, from a large US database (National Inpatient Sample). Patients with an ICD diagnosis of PAD were identified. The primary endpoints of in-hospital mortality, bleeding complications and major limb loss (above- or below-knee amputation) were compared between patients with PAD to those without. A total of 6768 patients were identified, of which 342 (5.3%) had PAD. The median age at admission was significantly higher in PAD patients [64years vs. 55years; p < .01], as was male gender [71% vs. 64%; p < .01]. Patients with PAD had higher rates of smoking (38.9% vs. 23.3%), hypertension (71.1% vs. 50%), diabetes (37.4% vs. 27.0%), chronic kidney disease (30.1% vs. 18.0%), coronary artery disease (76.0% vs. 35.0%) and dyslipidemia (76.0% vs. 35.0); all p < .01. After propensity-matching 2:1 for comorbidities, PAD patients were found to have significantly greater overall complications, including in-hospital mortality, bleeding, surgical wound infections, pseudoaneurysms, and major adverse limb events [71.9% vs. 63.9%; p < .01]. Subgroup analysis revealed greater in-hospital mortality [62.2% vs. 55.3%; p < .05], major amputations [4.1% vs. 0.3%; p < .01] and blood transfusions [32.2% vs. 26.2%; p < .05] in PAD patients. Over 2014-2018, the non-PAD group demonstrated statistically discernable trends in a 51.1% decrease in overall complications and a 28.1% increase in survival to discharge (all p < .01). Over the same time period the PAD cohort experienced a modest, nonsignificant, decrease in complications [7.0%, p = .40] and a decrease in those surviving to discharge [47.1% vs. 40.5%, p = .91]. Patients with PAD on VA-ECMO are sicker at baseline and experience significantly greater major amputations and higher in-hospital mortality. They have not benefitted from the considerable decrease in complication rates and increase in survival to discharge over time as compared to their non-PAD counterparts. These findings demonstrate the substantial frailty of the PAD population within an already high-risk cohort, and highlight the need for better procedural approaches and innovative technologies.