Peripheral Vascular Disease Patients Research Articles

Evaluation of left ventricular systolic function in type 2 diabetes mellitus patients with and without peripheral vascular disease

BACKGROUND Peripheral vascular disease (PVD) is a common complication of type 2 diabetes mellitus (T2DM). Patients with T2DM have twice the risk of PVD as nondiabetic patients. AIM To evaluate left ventricular (LV) systolic function by layer-specific global longitudinal strain (GLS) and peak strain dispersion (PSD) in T2DM patients with and without PVD. METHODS Sixty-five T2DM patients without PVD, 57 T2DM patients with PVD and 63 normal controls were enrolled in the study. Layer-specific GLS [GLS of the epimyocardium (GLSepi), GLS of the middle myocardium (GLSmid) and GLS of the endocardium (GLSendo)] and PSD were calculated. Receiver operating characteristic (ROC) analysis was performed to calculate the sensitivity and specificity of LV systolic dysfunction in T2DM patients with PVD. We calculated Pearson’s correlation coefficients between biochemical data, echocardiographic characteristics, and layer-specific GLS and PSD. RESULTS There were significant differences in GLSepi, GLSmid and GLSendo between normal controls, T2DM patients without PVD and T2DM patients with PVD (P < 0.001). Trend tests revealed a ranking of normal controls > T2DM patients without PVD > T2DM patients with PVD in the absolute value of GLS (P < 0.001). PSD differed significantly between the three groups, and the trend ranking was as follows: normal controls < T2DM patients without PVD < T2DM patients with PVD (P < 0.001). ROC analysis revealed that the combination of layer-specific GLS and PSD had high diagnostic efficiency for detecting LV systolic dysfunction in T2DM patients with PVD. Low-density lipoprotein cholesterol was positively correlated with GLSepi, GLSmid and PSD (P < 0.05), while LV ejection fraction was negatively correlated with GLSepi, GLSmid and GLSendo in T2DM patients with PVD (P < 0.01). CONCLUSION PVD may aggravate the deterioration of LV systolic dysfunction in T2DM patients. Layer-specific GLS and PSD can be used to detect LV systolic dysfunction accurately and conveniently in T2DM patients with or without PVD.

Characteristics of motor evoked potentials in patients with peripheral vascular disease.

With an aging population, it is common to encounter people diagnosed with peripheral vascular disease (PVD). Some will undergo surgeries during which the spinal cord may be compromised and intraoperative neuromonitoring with motor evoked potentials (MEPs) is employed to help mitigate paralysis. No data exist on characteristics of MEPs in older, PVD patients, which would be valuable for patients undergoing spinal cord at-risk surgery or participating in neurophysiological research. Transcranial magnetic stimulation, which can be delivered to the awake patient, was used to stimulate the motor cortex of 20 patients (mean (±SD)) age 63.2yrs (±11.5) with confirmed PVD, every 10 minutes for one hour with MEPs recorded from selected upper and lower limb muscles. Data were compared to that from 20 healthy volunteers recruited for a protocol development study (28yrs (±7.6)). MEPs did not differ between patient's symptomatic and asymptomatic legs. MEP amplitudes were not different for a given muscle between patients and healthy participants. Except for vastus lateralis, disease severity did not correlate with MEP amplitude. There were no differences over time in the coefficient of variation of MEP amplitude at each time point for any muscle in patients or in healthy participants. Although latencies of MEPs were not different between patients and healthy participants for a given muscle, they were longer in older participants. The results obtained suggest PVD alone does not impact MEPs; there were no differences between more symptomatic and less symptomatic legs. Further, in general, disease severity did not corelate with MEP characteristics. With an aging population, more patients with PVD and cardiovascular risk factors will be participating in neurophysiological studies or undergoing surgery where spinal cord integrity is monitored. Our data show that MEPs from these patients can be easily evoked and interpreted.

Assessing the Prevalence Rate of Gangrene Among Patients With Peripheral Vascular Disease in a Tertiary Care Hospital in Central India.

Background Peripheral vascular disease (PVD) includes peripheral arterial disease (PAD) and venous disease. PAD is a chronic progressive atherosclerotic disease leading to partial or total peripheral vascular occlusion. PAD typically affects the abdominal aorta, iliac arteries, lower limbs,andoccasionally theupper extremities. Assessing the prevalence of gangrene among PVD patients is crucial for understanding the burden of this condition and informing clinical management strategies. This study aimed to estimate the prevalence rate of gangrene among patients diagnosed with peripheral vascular disease. Methods This case-control study was conducted at the General Surgery department of Jawaharlal Nehru Medical College and Acharya Vinoba Bhave Rural Hospital, Wardha, India. Patients diagnosed with PVD who presented with gangrene of the lower limb were included. Detailed demographic data were collected, and clinical examinationsand diagnostic tests were performed to assess the severity and extent of gangrene. Statistical analysis was conducted to estimate the prevalence of gangrene among PVD patients. Results Among the 100 participants, the age distribution ranged from 21 to over 70 years, with a mean age of 52.89. Gender distribution showed that 30% of the participants were female and 70% were male. The prevalence of gangrene among PVD patients was found to be 35%, with 65% patients not presenting with gangrene. Conclusion The findings of this study highlight the significant prevalence of gangrene among patients diagnosed with peripheral vascular disease. The implications of these findings for clinical practice and management strategies are discussed further, along with potential avenues for further research. The study provides valuable insights into the burden of gangrene among PVD patients. Early detection and appropriate management of PVD are crucial for preventing the development of gangrene and improving patient outcomes.

Impact of Care Fragmentation after Major Lower Extremity Amputation

Care fragmentation (CF) is a known risk factor for unplanned readmission, morbidity, and mortality after surgery. The goal of this study was to evaluate the impact of CF on outcomes of major lower extremity amputation for peripheral vascular disease. Health-care Cost and Utilization Project Database for NY (2016) and MD/FL (2016-2017) were queried using International Classification of Diseases 10thedition to identify patients who underwent above the knee-, through the knee-, and below the knee-amputation for peripheral vascular disease. Patients with CF were identified as those with admissions to ≥2 hospitals during the study period. We compared the postamputation outcomes of mortality, readmission rate, length of stay (LOS) and hospital charges. We identified a total of 13,749 encounters of 2,742 patients who underwent major lower extremity amputations. There were 1,624 (59.2%) patients with CF. Patients with CF were younger (68.4years old vs. 69.7years old, P=0.005), with higher Charlson Comorbidity Indices (4.4 vs. 4.1, P<0.001), and required more hospital resources on index admission ($113,699 vs. $91,854, P<0.001). These patients were prevalent for higher 30-, and 90-day readmission rates (34.7% vs. 24.5%, P<0.001 and 54.7% vs. 42.0%, P<0.001, respectively). On their first postamputation readmission, LOS (16.3days vs. 14.7days, P=0.004) and hospital charge ($48,964 vs. $44,388, P=0.002) were significantly higher. Multivariate regression analysis demonstrated that the CF was an independent predictor for 30-day (hazard ratio (HR) 1.65, 95% confidence interval (CI) 1.39-1.96, P<0.001) and 90-day (HR 1.66, 95% CI 1.42-1.95, P<0.001) readmission after the major lower extremity amputation, but not for mortality (HR 0.83, 95% CI 0.56-1.23, P=0.36). CF after major lower extremity amputation is associated with higher readmission rate, LOS, and hospital charge. Collaboration of care providers to maintain continuity of care for peripheral vascular disease patients may enhance quality of care and reduce health care cost.

Peripheral vascular emergencies-clinicopathological co- relation with outcome in a tertiary care centre

Background: Peripheral arterial disease represents a major caseload in emergency department and also is major cause of distress and socio-economic burden to patient and his/her family due to risk of complications. It has a multifactorial etilogy and requires prompt treatment to salvage the limb and prevent complications. This study is a clinic-pathological correlation between various factors and surgical outcome. Methods: It is a prospective study involving 75 patients who had presented with peripheral vascular disease with different mode of presentations. All patients underwent surgical procedure and were given inj. heparin and tab. Aspirin in post operative period. Their surgical outcome was studied and co-related with etiological factors and clinical presentation. Result: Time from onset till presentation was one of the most important factors in deciding outcome. COVID-19 also emerged as one of the important risk factors in 12 cases. Patients who had been given prior anticoagulation therapy had better outcomes. Conclusions: Outcome in peripheral vascular disease patient depends on variable factors, however starting patients prior on anticoagulants has shown more possibility of salvaging the limb.

Peroxisome proliferator-activated receptor gamma and osteoprotegerin levels as an indicator and diagnostic predictor of endothelial dysfunction

Abstract Objectives Peroxisome proliferator-activated receptor gamma (PPAR-γ) modifies many cellular processes that contribute to atherosclerosis. The increased concentrations of osteoprotegerin (OPG) are related with coronary artery disease, calcification in vascular tissue, advanced atherosclerosis, and diabetic complications has been informed. The aim of our study was to define the relation among PPAR-γ Pro12Ala and, OPG and PPAR-γ in Peripheral Vascular Disease (PVD) and hypertension (HT). Also, it was aim to investigate the relationship between flow-mediated dilatation (FMD) in HT and ankle brachial index (ABI) in PVD in terms of endothelial dysfunction (ED). Methods Fifty-four patients with HT, 47 with PVD, and 52 healthy for the controls were included. Blood samples were used for analyzing PPAR-γ and OPG by Enzyme-Linked Immunosorbent Assay (ELISA), and biochemical assays. The PPAR-γ Pro12Ala was examined using TaqMan with PrimerProbMix. p value less than 0.05 was accepted as the limit of significance. Results The PPAR-γ was significantly decreased in both HT and PVD (p&lt;0.001). The serum concentrations of OPG were higher in HT (p&lt;0.001) and increased in diabetic ones (p&lt;0.05). CG genotype of PPAR-γ Pro12Ala was more frequent in HT patients (p&lt;0.001). In the HT patients, increased OPG and decreased PPAR-γ were found in CC (p&lt;0.001). In the PVD patients, PPAR-γ levels decreased in carrying with CC (p&lt;0.05). Conclusions It may be significant that increased OPG, as a marker of endothelial dysfunction, is found in HT. Moreover, decreased PPAR-γ in those who have to carry CC may be protective in both HT and PVD.

Study to Evaluate Serum Homocysteine Levels as Marker of Peripheral Arterial Disease in a Tertiary Care Hospital in India

Background: The study is aimed to evaluate the association between raised serum Homocysteine levels and severity of Peripheral Vascular Disease (PVD) and its role as a prognostic marker in PVD. Thereby, Vitamin K therapy can be instituted for lowering Homocysteine levels as prophylaxis against cerebral and coronary events in PVD patients. Methods: The serum homocysteine levels was measured in all patients admitted for peripheral vascular disease of upper and/or lower limb and to correlate the abovevalues with Doppler ultrasonography (USG) in the duration between 2020-2022(18 months) Results: The comparison of homocysteine levels with Doppler shows corresponding significant increase in Serum homocysteine levels only in cases of moderate PVD. Statistical analysis with binary logistic regression does show a significant association with moderate severity of PVD and serum homocysteine levels with 80% predictability. Conclusions: There was significant association of homocysteinemia only in Moderate PVD with no statistically significant correlation with mild, severe cases of peripheral arterial disease (PAD) and radiological normal cases, further large randomized trials are required to elucidate its clinical relevance in PAD as a prognostic marker of Severity.

Burden and predictors of major adverse cardiac and cerebrovascular events in premature [18-49 years] peripheral vascular disease patients: A nationwide analysis

Burden and predictors of major adverse cardiac and cerebrovascular events in premature [18-49 years] peripheral vascular disease patients: A nationwide analysis

O012 Elevated sGP130 characterises dysregulated chronic inflammation in diabetic peripheral vascular disease

Abstract Introduction Chronic systemic inflammation is integral to the pathophysiology of cardiovascular disease and diabetes mellitus. Interleukin 6 (IL-6) is a cytokine which may stimulate either pro- or anti-inflammatory activity depending cell population. Classical IL-6 signalling only occurs in cells expressing membrane-bound IL-6 receptor, and results in anti-inflammatory JAK/STAT3 pathway activation. Trans-signalling, by contrast, involves soluble IL-6 receptor α and soluble glycoprotein 130 (sGP130), and therefore may affect any cell regardless of membrane receptor expression. We designed a study to characterise Interleukin-6 (IL-6) trans-signalling in a diabetic cohort receiving treatment for symptomatic peripheral vascular disease and identify whether IL-6 signalling is correlated to outcomes in this patient group. Methods A single-centre, prospective cohort study of patients with DM undergoing infra-inguinal revascularization was conducted. Pre-operative serum was obtained from patients, who were then followed and observed for major amputation, death, and need for re-intervention as primary outcomes. Quantitative serum assays for IL-6, sIL-6rα, and sGP130 were performed. Results 40 patients (20 controls) were included in the study. Diabetic peripheral vascular disease patients had significantly higher serum IL-6 (p=0.0038), as well as higher serum sGP130 (p=0.0119) at baseline. Significant correlation was found between serum IL-6 and C-reactive Protein (p= 0.02), and serum IL-6 and sGP130 (p=0.02) in the disease group, but not in controls. sGP130 was higher in patients who reached primary outcomes (p=0.0196). Conclusion Systemic IL-6 trans-signalling is dysregulated in diabetic peripheral vascular disease and may be a future therapeutic target or adjunct to surgical management. Elevated sGP130 may be a prognostically-relevant biomarker in this population.

Arterialized Vein Bypass Graft Recipient Vessel in Free Tissue Transfer Covering Diabetic Foot Ulcers Complicated by Critical Limb Ischemia.

Limb salvage options are limited in diabetic patients with critical limb ischemia. Soft tissue coverage remains technically demanding with limited recipient vessels for free tissue transfer. These factors make revascularization alone challenging. When open bypass revascularization is possible, venous bypass graft is optimal and functions as a recipient vessel for staged free tissue transfer.The authors present 2 cases using a combination approach of staged venous bypass graft revascularization followed by free tissue transfer with anastomosis to the venous bypass graft resulting in successful limb preservation.Free tissue transfer to a native vessel has limited application in severe peripheral vascular disease patients because early vascular compromise threatens flap survival. In both presented cases, venous bypass graft alone was insufficient to treat their nonhealing wounds, and preoperative angiogram revealed dismal options for free tissue transfer reconstruction. However, previous venous bypass graft provided an operable vessel for free tissue transfer anastomosis. The combination of venous bypass graft and free tissue transfer proved to be ideal for successful limb preservation by providing vascularized tissue to previously ischemic angiosomes, ensuring optimal wound healing capacity. Venous bypass graft is advantageous to native arterial grafts, and its combination with free tissue transfer likely increases graft patency and flap survival. We demonstrate that end-to-side anastomosis to a venous bypass graft is a viable option in these highly comorbid patients with favorable flap outcomes.

A comparative analysis of fasciocutaneous versus muscle free flaps in peripheral vascular disease patients.

Chronic lower extremity (LE) wounds are common in patients with peripheral vascular disease (PVD). Free tissue transfer (FTT) provides healthy soft tissue for wound coverage and additional blood supply to promote wound healing. Given previous studies demonstrate increased complications in LE fasciocutaneous flaps, it was hypothesized that low vascular resistance in muscle flaps may be more advantageous for wound healing in PVD patients. Therefore, this study compared outcomes in PVD patients undergoing LE reconstruction with fasciocutaneous versus muscle free flaps. Retrospectively reviewed PVD patients undergoing FTT between 2011 and 2021. Patients were stratified into fasciocutaneous and muscle free flap groups. Primary outcomes included complications, flap success, post-reconstruction vascular interventions, limb salvage, and ambulatory status. One hundred thirteen patients with PVD were identified, of which 60.2% received fasciocutaneous (n= 68) and 39.8% received muscle flaps (n= 45). Forty-two patients (37.2%) underwent pre-flap endovascular interventions. Flap success rate was 98.2% (n= 111). Overall complication rate was 41.2% following fasciocutaneous flaps compared to 24.4% in muscle flaps (p= 0.067). Fasciocutaneous flaps had higher odds of ulceration requiring repeat angiogram within 1 year of reconstruction compared to muscle flaps (OR 3.4, 95% CI: 1.07-10.95, p= 0.047), and higher odds of requiring repeat angiogram overall (OR 3.4, 95% CI: 1.07-10.95, p= 0.047). No difference in requiring procedures in the operated limb within 1 year was observed (p= 0.155). At mean follow-up, there was no difference in limb salvage, ambulatory, and mortality rate between groups. This study demonstrates that fasciocutaneous flaps had higher postoperative complication rates and more commonly required repeat arteriograms following LE FTT reconstruction due to recurrent ulcerations, suggesting greater utility of muscle flaps for FTT reconstruction in PVD patients.

Abstract 13841: Prevalence and Impact of Recreational Cannabis Use on Acute Ischemic Stroke and Related Mortality in Elderly (≥65 Yrs) Peripheral Vascular Disease Patients: A Population-Based Analysis in the US (2016-2019)

Background: Considering preliminary reports suggesting associations between peripheral atherosclerotic disease (cannabis arteritis) and acute ischemic stroke (AIS) with cannabis use disorder (CUD), we sought to study the burden and impact of CUD on AIS risk and outcomes in the elderly with PVD. Methods: The National Inpatient Sample (2016-2019) was used to identify geriatric PVD admissions with vs. without CUD . We compared the burden and risk of AIS admissions with vs. without CUD and subsequent in-hospital mortality using adjusted multivariable regression analyses. Results: Of 5,115,824 total geriatric admissions with PVD (50.6% males, 77.5% white), 21,405 had CUD. The prevalence of DM was lower in the CUD cohort (19.7% vs 33.7%) with comparable rates of HTN and smoking between groups [Table 1]. Concomitant drug use was higher in CUD vs non-CUD cohort. There was AIS period prevalence of 5.2% in CUD vs 4.0% in non-CUD cohorts (p&lt;0.001). Among geriatric PVD patients, CUD was associated with higher odds of AIS hospitalizations aOR 1.34 (95%CI 1.18-1.52, p&lt;0.001) without a statistically significant difference in subsequent all-cause in-hospital mortality (aOR 0.71, 95%CI 0.36-1.37, p=0.302). Elderly PVD patients with HTN (aOR 1 .73) predicted higher risk of AIS, however, interestingly, concomitant tobacco use disorder revealed a paradox protective effect while assessing the predictors of AIS in elderly PVD patients with CUD (aOR 0.58 95CI 0.42-0.79, p&lt;0.001). Conclusions: There is a 34% risk of AIS in Geriatric PVD patients with CUD even after controlling for CVD risk factors and drug abuse. Future studies are warranted to explore and confirm the observed smoker’s paradox.

Continuous sciatic nerve block as preoperative care for lower-limb revascularization surgery

Background The prevalence of peripheral arterial disease increases with age and it is highly prevalent (15–20%) over 70 years. Surgery can be the best option to resolve the disabling pain. The Anesthesiology and Acute Pain Service routinely adopts continuous popliteal nerve-analgesic block as preoperative care. Patients and methods This case series analyzes the medical records of patients under continuous ultrasound-guided sciatic block, during 2 years (2017–2018) before lower-limb revascularization surgery. From a total number of 25 records identified, 15 were selected for analysis. The primary outcome was pain relief from basal line to 24 h postcatheter placement, measured by the Numerical Rating Pain Scale, and the secondary outcomes were reduction of Numerical Pain Rating Scale after 72 h, complications, and possible technical difficulties. Results We found pain reduction in the first 24 h of catheter placement, with median Numerical Rating Pain Scale reduction from 10 [interquartile range (IIQ) 10–10] to 0 (IIQ 0–2) (P&lt;0.001); and from 0 to 72 h of catheter placement, with Numerical Rating Pain Scale decreasing median from 10 (IIQ 10–9) to 2 (IIQ 0–2) (P&lt;0.0001). Four (26.7%) patients had their catheters displaced, and in another four (26.7%) patients, hyperemia was observed around the catheter’s introduction ostium on the skin. Conclusion Preoperative continuous sciatic nerve block seems to be an effective and safe approach for pain management of peripheral vascular occlusive disease patients waiting for surgery.

Increased cold injuries and the effect of body mass index in patients with peripheral vascular disease

BackgroundExposure to extremely or moderate low temperatures is associated with increased morbidity and mortality risk. Peripheral vascular disease (PVD) is a slow and progressive circulation disorder. Given that cold temperature causes constriction of the small arteries and veins in the skin, patients who suffer from peripheral circulation problems, like PVD, may be vulnerable to cold injuries. This study aimed to investigate the association between PVD and cold-induced injuries in the winter among Korean adults. We further analyzed the association stratified by body mass index (BMI) classification.MethodsWe used the 2002–2015 National Health Insurance Service-National Sample Cohort data and included a total of 535,186 adults as the study population. Patients with underlying PVD were identified by ICD-10 code I73. Cold-related illnesses were defined by ICD-10 codes (T690, T691, T698, T699, T330 ~ T339, T340 ~ T349, and T350 ~ T357). Body mass index (BMI) was categorized into underweight, normal weight, overweight, and obese.ResultsA total of 23.21% (n = 124,224) were PVD patients, and 0.59% (n = 3154) had cold-induced injuries. PVD patients were more likely to be diagnosed with cold injuries, but it was valid only in the underweight or normal weight groups. After adjusting for age, sex, income, cigarette smoking, alcohol consumption, regular exercise, high blood pressure, and hyperglycemia, PVD patients had a significantly increased odds ratio (OR) for cold injuries [adjusted OR = 1.11; 95% confidence intervals (95% CI): 1.01–1.21]. Increased OR for cold injuries in PVD patients was also observed in adults (adjusted OR = 1.14; 95% CI: 1.03–1.25 in Model 2), but not in the elderly. When we classified study subjects into the four BMI groups, the adjusted OR of cold injuries in PVD patients was significant in the underweight group (OR = 1.83; 95% CI, 1.26–2.66) and normal weight group (OR = 1.15; 95% CI, 1.03–1.27), not in those with overweight and obese. In adults, a consistent result was found in adults in the underweight group (OR = 1.63; 95% CI, 1.08–2.47 in Model 2) and normal weight group (OR = 1.19; 95% CI, 1.07–1.33 in Model 2). In the elderly, the adjusted OR for cold injuries was only significant in the underweight group (OR = 3.37; 95% CI, 1.08–10.53 in Model 2).ConclusionsWe found a significant association between PVD and cold-induced injuries in the general population. BMI modified the association. Thus, the association observed appears to be clinically applicable to PVD patients being low to normal BMI.

Covid-19 és perifériás verőérbetegség

[Patients with peripheral vascular disease (PAD) are negatively affected by the coronavirus epidemic in several ways. Fewer-than-usual doctor-patient encounters make it more difficult to detect disease or disease progression. Outbreaks due to the epidemic reinforce a sedentary lifestyle that can mask the symptoms of PAD through lack of exercise. Another risk is that patients with cardiovascular disease are at risk for severe Covid-19 disease, and have a significantly increased risk of mortality. In the case of home treatment of Covid-19 infection in a patient with PAD, close observation is required to make a timely decision on the need for hospitalization. Vaccination, which is gradually available to all PAD patients, could be the solution to prevent the disease.]

Outcome of Transcatheter Aortic Valve Implantation in Patients with Peripheral Vascular Disease

Peripheral vascular disease (PVD) is common in patients referred for transcatheter aortic valve implantation (TAVI). We sought to investigate the impact of PVD on patients who underwent TAVI. Using data from the National Inpatient Sample database 2011 and 2014, we identified patients who had undergone TAVI. We studied the clinical characteristics and procedural outcomes in patients with PVD who underwent TAVI compared with those patients without PVD using propensity score matching score matching. Results: A total of 42,215 patients underwent TAVI; of which 1,388 patients were matched using propensity score matched scores to 694 in each (PVD vs no PVD) patients. The population had a mean age of 81 years old and 55.8% were of female gender. African-Americans constituted 4.3%. PVD patients who underwent TAVI were found to have higher rates of vascular complications (11.8% vs 5.9 % p <0.001) compared with non-PVD patients and tended to have higher mortality (5.5% vs 3.6%, p = 0.121) and post-TAVI bleeding (13.5% vs 12% p = 0.143). In conclusion, PVD patients have higher in-hospital mortality and higher incidence of in-hospital overall complications compared with patients who have no PVD.

Outcomes in patients with peripheral vascular disease following percutaneous coronary intervention

To evaluate the clinical characteristics and outcomes of patients with peripheral vascular disease (PVD) undergoing percutaneous coronary intervention (PCI) in a contemporary setting, and to determine whether use of drug-eluting stents (DESs) improves outcomes. PVD was an independent risk factor for adverse outcomes following PCI in the bare-metal stent (BMS) era. It is not known whether outcomes in these patients have improved with advances in interventional techniques and stent technology, as they have for the general population. Eighteen thousand three hundred and eighty patients undergoing PCI from an Australian registry between 2005 and 2013 were studied. Clinical and procedural data, 30-day and 12-month outcomes were compared in those with and without a reported history of PVD. Outcomes were also compared between patients with PVD who received DES and those who received BMS. Long-term mortality was compared using Australian National Death Index (NDI) linkage. Patients with PVD (n = 1,251, 6.8%) were older and had more prevalent diabetes, hypertension, cerebrovascular disease, heart failure, renal impairment, ostial lesions, left main, and multi-vessel disease (p < 0.001). Patients with PVD had significantly higher rates of major adverse cardiovascular events (MACEs) compared with those without PVD, in-hospital (5.7% vs. 4.1%, p < 0.008), at 30-days (8.6% vs. 5.8%, p < 0.001) and at 12-months (24.6% vs. 13.2%, p < 0.001). At 4.9 ± 2.6 years follow-up, there was significantly greater mortality in the PVD group. PVD patients who received DES experienced significantly less MACE than PVD patients treated with BMS at 30-days (4.8 vs. 10.1%, p < 0.001) and 12-months (19.4 vs. 26.4%, p < 0.005). PVD is an independent predictor of adverse outcomes in patients undergoing PCI. PVD patient who received DES had improved outcomes compared with those receiving BMS.

Are two internal thoracic grafts better than one in patients with peripheral vascular disease?

The use of two bilateral internal thoracic artery grafting (BITA) was shown to lead to survival benefit. However, operators are reluctant to use BITA with peripheral vascular disease (PVD) because of concerns of increased rates of sternal wound infection and lack of studies supporting survival benefit compared with single internal thoracic artery (SITA) grafting. The aim of this study is to compare outcome BITA grafting versus of SITA and vein grafts in PVD patients. Six hundred and twenty-one PVD patients who underwent BITA between 1996 and 2011 were compared with 372 patients who underwent SITA. SITA patients were older and more likely more likely to have comorbidities (female, insulin-dependent diabetes, chronic obstructive lung disease, congestive heart failure, previous coronary artery bypass grafting, renal insufficiency, cerebrovascular disease, and emergency operation). Operative mortality (5.1 vs. 4.5%, in the SITA and BITA, respectively, P=0.758), rate of sternal wound infection (5.1 vs. 3.9%, P=0.421), and strokes (4.8 vs. 7.4%, P=0.141) were not significantly different between groups. BITA patients did not have significantly better 10-year survival (52.6 vs. 45.9%, P=0.087) and after propensity score matching (302 well-matched pairs), BITA was not associated with improved survival (hazard ratio: 0.902; 95% confidence interval: 0.742-1.283; P=0.784) (Cox model). The routine use of BITA versus SITA in PVD patients does not improve long-term survival. Selective use of BITA in lower risk patients might unmask the benefits of BITA.

Clinical Features and Outcomes of Peripheral Vascular Disease Patients Receiving Red Blood Cell Transfusions.

BackgroundPeripheral vascular disease (PVD) patients are commonly transfused with red blood cells (RBC) due to their inability to compensate for anemia and blood loss. Anemias, as well as allogeneic transfusions, have been demonstrated as independent risk factors for increased mortality and morbidity following cardiovascular procedures. The relationships between anemia, transfusion, and adverse outcomes in PVD patients remain unascertained and understudied.MethodsA retrospective cohort study was conducted to determine mortality at 30-day, one-year, and three-year markers among 330 randomly selected PVD patients. The clinical features of patients receiving transfusions were examined, and the mortality rates were compared between patients who received an RBC transfusion and those who did not. Cox regression analysis was employed to identify independent variables predicting mortality.ResultsTransfusions were found to have increased mortality rates over non-transfused patients at 30 days (6.1% vs. 1.8%, p = 0.05), one year (21.8% vs 12.1%, p = 0.02), and three years (41.2% vs. 23.0%, p = 0.001). Using a multivariate regression model, it was determined that the transfusion itself was not a significant cause of this decrease in survival, while the propensity to transfuse was a predictor for both short (30 days, 36.73 [1.85-728.06], p = 0.04) and long-term mortality (one year (8.83 [2.62-29.77], p < 0.001; three years (7.07 [1.46-8.07], p <0.01). Anti-coagulation therapy using intravenous (IV) heparin and the chronic comorbidities of coronary artery disease and diabetes mellitus were also robust independent predictors of decreased survival.ConclusionThis study was able to find an association between RBC transfusion and reduction in short-term (three months) and long-term (three years) survival. Those requiring IV heparin during the hospital stay were at an increased risk of requiring blood transfusion, and patients receiving IV heparin were also found to have a significant increase in mortality rates.

Can Transcranial Magnetic Stimulation be used to detect potential spinal cord injury following thoracic endovascular aortic repair (TEVAR)? A preliminary study to characterise baseline motor evoked potentials in vascular disease patients

Background: Spinal cord injury (SCI) following TEVAR is a devastating complication. Transcranial Magnetic Stimulation (TMS) is a simple, safe and painless alternative to electrical neuromonitoring of the spinal cord and could be used post-operatively. The study aim was to determine the reliability of TMS motor evoked potentials (MEPs) in peripheral vascular disease (PVD) patients. The data is essential for the development of a late SCI TMS management protocol. Methods: 20 healthy controls (mean(±SD) age 28±7.7yrs) and 6 PVD patients (59±14.5yrs, mean VascuQol 4.0) were recruited. Twelve TMS stimuli were given every 10 minutes for one hour. MEPs were measured from two upper limb (left brachioradialis (LBR), abductor pollicis brevis (LAPB)) and three lower limb muscles (left vastus lateralis (LVL), tibialis anterior (LTA), adductor hallucis (LAH)). MEP amplitude, latency and variability were calculated and compared using one-way ANOVA. Results: MEP amplitudes in controls were not, in general, significantly different from those in patients, except for those in LBR - 0.42 vs 0.26mV (control vs patient) (p=0.04); LAPB - 1.91 vs 0.48mV, LVL - 0.31 vs 0.21mV, LTA - 0.67 vs 0.52mV, LAH - 1.07 vs 0.94mV (p>0.05). There were no differences in MEP latencies and variability; a combined muscles coefficient of variation was 0.29 vs 0.44 (p=0.06). Conclusion: The preliminary data show TMS-induced MEPs appear similar in size, latency and variability in healthy subjects and PVD patients, although data collection is ongoing. They provide evidence that TMS may be a reliable tool with which to monitor for SCI development following TEVAR.