Prevalence Of Peripheral Vascular Disease Research Articles

Audit of diabetes-related lower extremity amputations in the Northern Region of New Zealand 2013-2016.

To characterise diabetes-related lower extremity amputations (DRLEA) and prior contact with specialist podiatrists in Northern New Zealand. Using administrative data, DRLEA ≥35 years were identified for the Northern Region (July 2013 to June 2016). For those domiciled in Metro Auckland (July 2015 to June 2016), additional clinical data described amputation cause, diabetes-related comorbidities and podiatry contact. There were 862 DRLEA for 488 people, including 25% (n=214) major amputations. Age-standardised amputation rates were three times higher for males than females (41.1 vs 13.6 per 100,000 population [95% confidence interval (CI): 37.3-44.9 vs 11.6-15.6 per 100,000] respectively). Amputation rates varied by ethnicity, being 2.8 and 1.5 times higher respectively for Māori and Pacific people than non-Māori, non-Pacific people. Mortality was high at 1-, 3- and 6-months post-admission (7.9%, 12.4 % and 18.3% respectively). There was high prevalence of peripheral vascular disease (78.8%), neuropathy (75.6%), retinopathy (73.6%) and nephropathy (58%). In the 3 months prior to first DRLEA admission, 65% were not seen by specialist podiatry. Our study confirms higher DRLEA admission rates for Māori and males. We identified elevated rates among Pacific populations and observed suboptimal utilisation of specialist podiatry services.

Prognostic Factors in Necrotizing Fasciitis: Insights from a Two-Decade, Two-Center Study Involving 209 Cases.

Necrotizing fasciitis (NF) is a critical disease with high morbidity and mortality rates that poses significant challenges in diagnosis and treatment. Prognostic factors for the clinical course of NF remain unclear and are currently under research. This study aims to identify such factors in a large cohort of patients which represents a major comprehensive investigation of prognostic factors for NF. Retrospective analysis was conducted on necrotizing fasciitis cases from 2003 to 2023 at two German hospitals. Data included demographics, comorbidities, laboratory findings, infection site, causative microorganisms and outcomes. Statistical analysis involved t-tests, chi-square tests, and ROC analysis. A total of 209 patients were included, with a mortality rate of 18%. Patients were categorized into survivors (n = 171) and non-survivors (n = 38). Non-survivors were significantly older (68.9 ± 13.9 years vs. 55.9 ± 14.3 years; p < 0.01) and exhibited a higher prevalence of peripheral vascular diseases, cancer, and heart, liver, or renal insufficiency. Laboratory findings and scoring results also varied significantly between the two groups. The ROC curve analysis identified age as a predictor of mortality, with an optimal cut-off value of 68.5 years (sensitivity: 60.5%, specificity: 81.9%). Higher age was associated with increased mortality risk. The patient's age stands out as the primary predictive element for mortality in necrotizing fasciitis. Additionally, we advocate for employing the Laboratory and Anamnestic Risk Indicator for Necrotizing Fasciitis (LARINF-score), which holds substantial prognostic significance and is straightforward to calculate. Considering our findings, crafting a clinical algorithm or scoring mechanism to forecast mortality in NF would be a promising target for future research.

Outcomes of Septuagenarians and Octogenarians with Monoclonal Gammopathy of Undetermined Significance Admitted for Acute Pulmonary Embolism

Introduction: Monoclonal gammopathy of undetermined significance (MGUS) is clinically defined with a serum monoclonal immunoglobulin of less than 3 g/dL and the presence of less than 10% of plasma cells in the bone marrow, in the absence of any end-organ damage that is typically seen in patients with multiple myeloma. The incidence of MGUS mostly involves the elderly, with a median age estimated at 70 years. While some studies have linked MGUS with a hypercoagulable state, there are no large studies investigating the impact and outcomes of MGUS in the elderly with pulmonary embolism(PE). We thus propose a national analysis to investigate. Methods: Our retrospective study via the National Inpatient Sample (NIS) focused on adults admitted with a primary diagnosis of Acute Pulmonary Embolism. We excluded all cases of ages &amp;lt;70 years and &amp;gt;90 years. Patient characteristics in acute PE cases with and without MGUS such as age, sex, race, and presence of various comorbidities such as diabetes, hypertension, obesity, among many, were explored via Chi-Square tests, t-tests, and Mann-Whitney U tests as appropriate. Differences in outcomes for PE in MGUS and non-MGUS patients were estimated via logistic regression models on SPSS 29.0. A p-value of &amp;lt;0.05 was considered as statistically significant. To comply with the database provider's (HCUP) guidelines, we did not report values &amp;lt;11. Results: Among the 327090 septuagenarians and octogenarians admitted primarily for acute PE in our study, there were 1095 (0.3%) patients with a diagnosis for MGUS that also reported a higher mean Charlson Comorbidity Index (CCI) score (4.26 vs. 2.90, p&amp;lt;0.01) (Table 1). While 51.1% of MGUS cases with acute PE were males, the non-MGUS group mainly consisted of females (56.1%, p&amp;lt;0.01). Medicare covered 91.3% and 90.8% of all MGUS and non-MGUS cases in our study, and 68.9% and 66.3% of all admissions involved Urban-teaching centers, respectively. Around 11.0% of MGUS cases also had a history of prior pulmonary embolism, while it was 8.0% in the non-MGUS cohort (p&amp;lt;0.01). The MGUS cohort also showed a lower prevalence of hypertension (41.1% vs.46.7%, p&amp;lt;0.01) while having a higher prevalence of peripheral vascular disease (11.4% vs. 5.1%, p&amp;lt;0.01), smoking status (40.6% vs. 37.8%, p=0.049), lipid disorders (56.6% vs. 50.6%, p&amp;lt;0.01), and chronic kidney disease (35.6% vs. 20.0%, p&amp;lt;0.01) than the non-MGUS group. MGUS patients showed lower odds of experiencing in-patient events such as myocardial infarction (aOR 0.345, 95% CI 0.221-0.538, p&amp;lt;0.01), acute kidney injury (aOR 0.843, 95% CI 0.719-0.990, p=0.037), and respiratory compromise (aOR 0.749, 95% CI 0.652-0.860, p&amp;lt;0.01). While a higher odds of cardiogenic shock (aOR 1.903, 95% CI 1.316-2.753, p&amp;lt;0.01) was also noted, patients with and without MGUS had no differences related to in-hospital mortality (aOR0.721, 95% CI 0.513-1.013, p=0.060) or the need for IVC filters (aOR 1.156, 95% CI 0.924-1.446, p=0.206). MGUS patients also experienced a longer stay (mean length of stay 4.91 vs. 4.62 days, p&amp;lt;0.01). Conclusion: This nationwide data analysis suggests a higher prevalence of a history of previous PE in MGUS cases admitted for PE than those without MGUS. Furthermore, while odds of events involving in-patient myocardial infarction, acute kidney injury, or respiratory compromise in MGUS patients were lower, they had a higher risk of cardiogenic shock. It is thus vital for physicians to be on the watch-out of such complications and provide adequate testing and care in a timely manner to improve their prognosis and outcomes.

UNOS Decisions Impact Data Integrity of the OPTN Data Registry.

The Organ Procurement Transplant Network (OPTN)/United Network for Organ Sharing (UNOS) registry is an important national registry in the field of solid organ transplantation. Data collected are mission critical, given its role in organ allocation prioritization, program performance monitoring by both the OPTN and the Centers for Medicare & Medicaid Services, and countless observational analyses that helped to move the field forward. Despite the multifaceted importance of the OPTN/UNOS database, there are clear indications that investments in the database to ensure the quality and reliability of the data have been lacking. This analysis outlines 2 examples: (1) primary diagnosis for patients who are receiving a second transplant and (2) reporting peripheral vascular disease in kidney transplantation to illustrate the extensive challenges facing the veracity and integrity of the OPTN/UNOS database today. Despite guidance that repeat kidney transplant patients should be coded as "retransplant/graft failure" rather than their native kidney disease, only 59% of new incident patients are coded in this manner. Peripheral vascular disease prevalence more than doubled in a 20-y span when the variable became associated with risk adjustment. This article summarizes critical gaps in the OPTN/UNOS database, and we bring forward ideas and proposals for consideration as a path toward improvement.

The Prevalence of Peripheral Vascular Disease (PVD) and Its Correlation with Biochemical Parameters in Type 2 Diabetes Mellitus (T2DM) - A Tertiary Care Hospital Based Study in Eastern India

INTRODUCTION PVD, one of the major macrovascular complications of T2DM, usually begins at an earlier age and remains subclinical for a long duration. So early detection of PVD will help to assess its true prevalence and hence prevention of overt manifestation. OBJECTIVES To assess the true prevalence of PVD in T2 DM from Eastern India and its correlation with clinical and biochemical parameters METHODS It was a cross sectional study with consecutive diabetes patients attending OPD from 2015 January to 2016 July. Each was subjected to meticulous history, measurement of ABPI by handheld Doppler and various laboratory parameters. Patients having known vascular disease due to other causes were excluded. RESULTS Out of 103 patients, PVD was present in around 25% cases with positive association with age, male gender, and high body weight. Hypertension, hyperglycemic state (PPBS, HbA1C), total cholesterol, triglyceride and LDL independently increases the risk of PVD. Though low levels of HDL are a well-recognized risk factor for PVD, this was not reflected in study. CONCLUSION The true prevalence of PVD is higher in DM and ABPI can detect subclinical PVD much before its progression and overt manifestations

#5443 ASSOCIATION OF SERUM CALCIUM-TO-MAGNESIUM RATIO WITH CARDIOVASCULAR AND CEREBRAL VASCULAR DISEASES IN DIALYSIS PATIENTS

Abstract Background and Aims Cardiovascular disease (CVD) and cerebral vascular accident (CVA) are the important complications and the leading causes of death in dialysis patients. High serum calcium (Ca) level promotes the clotting cascades and vascular calcification, which leads to CVD and CVA. Magnesium (Mg) is a well-known Ca blocker, inhibiting the formation of thrombin. An imbalance between serum Ca and Mg levels has been reported as an associated factor with CVD and mortality. This study investigated the associations of serum Ca-Mg ratio with CVD and CVA in dialysis patients. Method We conducted a cross-sectional analysis using baseline data from a multicenter prospective cohort for dialysis patients in South Korea. A total of 860 patients were divided into tertile groups according to serum Ca-Mg ratio levels. Patients with serum Ca-Mg ratio less than 3.28 were classified as the low group, and patients with serum Ca-Mg ratio more than 3.87 were classified as the high group, and the rest were classified as the middle group. Serum Ca level was calculated and applied as corrected Ca level considering serum albumin level. The associations of serum Ca-Mg ratio with prevalence of acute coronary syndrome (ACS), congestive heart failure, aortic artery calcification, and CVA were assessed. Results The average age of all patients was 59.1±12.1 years, and the average duration of dialysis was 7.9±5.9 years, and the duration of the low group was shorter than those of other groups. The high group had higher prevalence of peripheral vascular disease (P = 0.004). Serum albumin, phosphorus and Mg levels in the high group were lower than other groups (P&amp;lt;0.001). The prevalence of ACS showed higher in the high group than in other groups (P = 0.017). The prevalence of cerebral infarction showed higher in the high group than the low group (P = 0.016). In multivariable logistic regression analysis, higher Ca-Mg ratio was independently associated with the prevalence of ACS (Odds ratio 1.321, 95% confidential interval 1.009-1.728, P = 0.043) and cerebral infarction (Odds ratio 1.392, 95% confidential interval 1.002-1.896, P = 0.036). Conclusion A high Ca-Mg ratio was associated with the development of ACS and cerebral infarction. If the optimal cut-off of Ca-Mg ratio is determined, it can be used as a predictive marker for ACS and cerebral infarction.

Prevalence and risk of type 2 myocardial infarction (T2MI) in adults with depression and its impact on in-hospital outcomes: a nationwide population-based analysis in the USA (2019)

Abstract Funding Acknowledgements Type of funding sources: None. Background Type 2 myocardial infarction (T2MI) is an ischaemic myocardial injury in the context of oxygen supply/demand mismatch in the absence of a primary coronary event. However, though there is a rising prevalence of depression and its potential association with T1MI, data remains non-existent to evaluate the association with T2MI. Therefore, we aim to identify the prevalence and risk of T2MI in adults with depression and its impact on the in-hospital outcomes. Methods We queried the National Inpatient Sample (2019) to identify T2MI hospitalizations using ICD-10 codes in hospitalized adults ( ≥18 years). In addition, we compared sociodemographics and comorbidities in the T2MI cohort with vs. without comorbid depression. Finally, we used multivariate regression analysis to study the odds of T2MI hospitalizations with vs. without depression and in-hospital outcomes (all-cause mortality, cardiogenic shock, cardiac arrest, and stroke); adjusting for confounders. Statistical significance was achieved with p-value of &amp;lt;0.05. Results There were 331,145 adult T2MI hospitalizations after excluding T1MI (median age 73 years, 52.8% male, 69.9% white); 41,405 (12.5%) had depression, the remainder; 289,740 did not have depression. Multivariate analysis revealed lower odds of T2MI in patients with depression vs without (aOR 0.88, 95% CI 0.86-0.90, p= 0.001).There was equal prevalence of prior MI with any revascularization and similar prevalence of peripheral vascular disease in cohort with depression vs without depression. There is a greater prevalence of stroke in patients with depression 10.1% vs those without 8.6 %. There was a slightly higher prevalence of hyperlipidaemia in patients with depression vs without depression; (56.5% vs 48.9%), as well as obesity (21.3% vs 17.9%) There was generally equal prevalence of HTN and T2DM in both cohorts. There was no significant difference in the frequency of elective and non-elective admissions between cohorts. Patients with depression vs without depression also showed a lower risk of all-cause mortality (aOR 0.75, 95%CI 0.67-0.83, p= 0.001), Cardiogenic shock (aOR 0.65, 95%CI 0.56-0.76, p= 0.001), Cardiac arrest (aOR 0.77, 95%CI 0.67-0.89, p= 0.001) as well as Stroke (aOR 0.79, 95%CI 0.70-0.89, p= 0.001). Conclusions This study revealed a significantly lower risk of T2MI in patients with depression vs. without depression. The data also showed a significant decrease in adverse in-hospital outcomes such as all-cause mortality, cardiogenic shock, cardiac arrest and stroke in patients with depression vs. without depression. Further prospective studies are warranted to assess the impact of depression on other in-hospital outcomes as well as the impact of medication, its duration and serotonin levels on T2MI.

Enterococci in Diabetic Foot Infections: Prevalence, Clinical Characteristics, and Outcomes.

Diabetic foot infections (DFIs) are frequently polymicrobial, yet the relevance of each isolated pathogen, remains ill-defined. Specifically, the prevalence and pathogenicity of enterococcal DFIs and the impact of targeted antienterococcal treatment remain elusive. We collected demographic, clinical, and outcome-related data on patients admitted with DFIs to the Hadassah Medical Center diabetic foot unit between 2014 and 2019. The primary outcome was a composite of in-hospital death or major amputation. Secondary outcomes included any amputation, major amputation, length of stay (LOS), and 1-year major amputation or mortality rate. Enterococci were isolated in 35% of 537 eligible DFI case patients, who were notable for a higher prevalence of peripheral vascular disease, increased levels of C-reactive protein, and higher Wagner scores. Infection in enterococci-positive individuals was mostly polymicrobial (96.8% vs 61.0% in non-enterococci-infected patients; P < .001). Enterococci-infected patients were more likely to undergo amputation (72.3% vs 50.1%; P < .001) and had longer hospital stays (median LOS, 22.5 vs 17 days; P < .001), but the primary end point of major amputation or in-hospital death did not differ between groups (25.5% vs 21.0%; P = .26). Appropriate antienterococcal antibiotics were used in 78.1% of enterococci-infected patients and, compared with results in untreated patients, were associated with a trend toward a lower rate of major amputations (20.4% vs 34.1%; P = .06) but longer hospitalization (median LOS, 24 vs 18 days; P = .07). Enterococci are common in DFIs and associated with higher rates of amputation and longer hospitalization. A reduction in major amputation rates with appropriate enterococci treatment is suggested retrospectively, meriting validation by future prospective studies.

Prevalence and Predictors of Peripheral Vascular Disease Amongst Predialysis Hypertensive Chronic Kidney Disease Patients in Southern Nigeria.

Peripheral vascular disease (PVD) is an atherosclerotic disease associated with increased morbidity and mortality among chronic kidney disease (CKD) patients. However, despite the substantial burden of PVD in CKD, local data are lacking. To determine the prevalence and predictors of PVD in predialysis CKD patients. The study was cross-sectional. One hundred fifty hypertensive CKD patients and age- and sex-matched hypertensive non-CKD subjects were consecutively enrolled at the renal unit of Delta State University Teaching Hospital (DELSUTH), Oghara. Structured questionnaires were used to obtain information on participants' demographic data and health status. PVD was defined by an ankle-brachial index of < 0.9 or > 1.4 in either lower extremity. eGFR was calculated from serum creatinine using the MDRD equation. The mean ages of the study and control groups were 48±14 and 51±15years, respectively. The sex ratio was 3:2 in favour of males for both the study and control groups. The majority of the study group was in CKD stage 4 (44%). The prevalence of PVD was higher among the CKD group compared with controls (24.0% vs. 14.7%).Of the CKD patients with PVD, 11.1% were symptomatic. Predictors of PVD in the study group were eGFR (B=0.010, 95%CI: 0.007-0.013), diastolic BP (B=-0.005, 95%CI: -0.007- -0.002), MAP (B=-0.018, 95%CI: -0.027- -0.008), urinary ACR (B=-0.0036, 95%CI: -0.040- -0.024) and smoking history (p<0.001, OR=14.71). PVD is common and largely asymptomatic in CKD patients. The predictors of PVD in this study were eGFR, diastolic BP, mean arterial pressure (MAP), urinary albumin to creatinine ratio (ACR), and smoking. A proactive assessment of PVD and early intervention in CKD patients is needed.

A Study of the Peripheral Vessels in Patients With Type 2 Diabetes Mellitus With or Without Foot Involvement.

Peripheral vascular disease (PVD) is chronic limb ischemia caused by atherosclerosis of the peripheral arteries. Diabetes mellitus (DM) is a risk factor for this disease. The probability of a diabetic foot ulcer (DFU) is higher in a patient with DM and PVD than in a patient without DM. Ankle-brachial-pressure index (ABPI) allows the measurement of blood flow towards the distal extremities, which could help timely diagnosis, initiate brief therapy, and minimize the risk of critical limb ischemia and loss. This study aims to determine the prevalence of peripheral vascular disease and assess its association with intima-media thickness (IMT) in diabetic patients with and without foot ulcers in India. In the present study, we included all type 2 DM patients. The assessment was conducted clinically by measuring Ankle Brachial Pressure Index (ABPI) radiologically by Duplex Ultrasonography (Samsung HS 70A machine), and Doppler (Linear probe- LA3 - 12A) and IMT were detected. In healthy adults, IMT ranges from 0.25 to 1.5mm, and values above 1.0mm are often considered abnormal and linked with atherosclerosis and significantly increased cardiovascular disease (CVD). In this study, 72 patients with DM were enrolled over the study period; 52 patients presented with DFU, and 20 presented without DFU. The prevalence of PVD was higher in males compared to females; 40% of the patient population in the age range of 40-49 years was with PVD, and 62.5% of patients with PVD showed an IMT value more than 1.0mm, whereas only 5% patients without PVD shows IMT value more than 1.0mm. In conclusion, among type 2 diabetic subjects, the prevalence of PVD is 72.2%, and IMT is strongly associated with PVD.

Risk Factors of Peripheral Vascular Disease in Diabetes Mellitus in Abbottabad, Pakistan: A Cross-Sectional Study.

IntroductionDiabetes mellitus (DM) is a significant and common risk factor for the development of peripheral vascular disease (PVD). Peripheral vascular disease is the atherosclerotic narrowing of peripheral arteries and has a high prevalence among patients with diabetes.Material and methodsA cross-sectional study was conducted in the Department of Medicine of Ayub Teaching Hospital, Abbottabad. A total of 271 diagnosed diabetic patients aged 40 years or above were included in the study. Ankle-brachial pressure index (ABPI) was measured using a hand-held Doppler device and sphygmomanometer. An ABPI < 0.9 was taken to be abnormal. The risk factors were noted through history taking, physical examination, and appropriate investigations. ResultsOur study sample included 271 patients. A hundred and forty-five (53.5%) of them were males, and 126 (46.5%) were females. Fifty-three (19.9%) out of 271 patients had peripheral vascular disease. The prevalence of peripheral vascular disease was stratified among smoking (p=0.00), hypertension (p=0.00), obesity (p=0.004), and hypercholesterolemia (p=0.005) to determine if there was any association between these and peripheral vascular disease. A p-value less than 0.05 was taken to be significant.ConclusionThis study showed a significant association between PVD and smoking, hypertension, hypercholesterolemia, and obesity.

Length of Stay, Hospital Costs and Mortality Associated With Comorbidity According to the Charlson Comorbidity Index in Immobile Patients After Ischemic Stroke in China: A National Study.

In this study, we examined the length of stay (LoS)-predictive comorbidities, hospital costs-predictive comorbidities, and mortality-predictive comorbidities in immobile ischemic stroke (IS) patients; second, we used the Charlson Comorbidity Index (CCI) to assess the association between comorbidity and the LoS and hospitalization costs of stroke; third, we assessed the magnitude of excess IS mortality related to comorbidities. Between November 2015 and July 2017, 5114 patients hospitalized for IS in 25 general hospitals from six provinces in eastern, western, and central China were evaluated. LoS was the period from the date of admission to the date of discharge or date of death. Costs were collected from the hospital information system (HIS) after the enrolled patients were discharged or died in hospital. The HIS belongs to the hospital's financial system, which records all the expenses of the patient during the hospital stay. Cause of death was recorded in the HIS for 90 days after admission regardless of whether death occurred before or after discharge. Using the CCI, a comorbidity index was categorized as zero, one, two, and three or more CCI diseases. A generalized linear model with a gamma distribution and a log link was used to assess the association of LoS and hospital costs with the comorbidity index. Kaplan-Meier survival curves was used to examine overall survival rates. We found that 55.2% of IS patients had a comorbidity. Prevalence of peripheral vascular disease (21.7%) and diabetes without end-organ damage (18.8%) were the major comorbidities. A high CCI=3+ score was an effective predictor of a high risk of longer LoS and death compared with a low CCI score; and CCI=2 score and CCI=3+ score were efficient predictors of a high risk of elevated hospital costs. Specifically, the most notable LoS-specific comorbidities, and cost-specific comorbidities was dementia, while the most notable mortality-specific comorbidities was moderate or severe renal disease. CCI has significant predictive value for clinical outcomes in IS. Due to population aging, the CCI should be used to identify, monitor and manage chronic comorbidities among immobile IS populations.

Nationwide analysis on the impact of peripheral vascular disease following primary total knee arthroplasty: A matched-control analysis

BackgroundAs the prevalence of peripheral vascular disease (PVD) continues to increase nationwide, studies demonstrating its effects following primary total knee arthroplasty (TKA) are limited. Therefore, the purpose of this study was to evaluate whether patients with PVD have higher rates of: 1) in-hospital lengths of stay (LOS); 2) readmissions; 3) medical complications; 4) implant-related complications; and 5) costs of care. MethodsUsing a nationwide database, patients with PVD undergoing primary TKA were identified and matched to controls in a 1:5 ratio by age, sex, and medical comorbidities. The query yielded 1,547,092 between the cohorts. Outcomes analyzed included: in-hospital LOS, readmission rates, complications, and costs of care. A p-value less than 0.004 was considered statistically significant. ResultsPVD patients had significantly longer in-hospital LOS (4-days vs. 3-days, p < 0.0001). Additionally, the study cohort had a higher incidence and odds (OR) of readmissions (20.5 vs. 15.2%; OR: 1.43, 95% CI: 1.42–1.45, p < 0.0001), medical complications (2.46 vs. 1.32%; OR: 1.88, CI: 1.83–1.94, p < 0.0001), and implant-related complications (3.82 vs. 2.18%; OR: 1.78, CI: 1.26–1.58, p < 0.0001). Additionally, the study found patients with PVD had higher day of surgery (p < 0.0001) and 90-day costs of care (p < 0.0001). ConclusionsAfter adjusting for confounding variables the results of the study show patients with PVD undergoing primary TKA have longer in-hospital LOS; in addition to higher rates of complications, readmissions, and costs of care. The study can be utilized by orthopaedists to adequately counsel patients of the potential complications following their procedure.

A meta-analysis of transcarotid versus transfemoral transcatheter aortic valve replacement.

Carotid access has shown promise as an excellent delivery route for transcatheter aortic valve replacement (TAVR). We aimed to compare outcomes of transcarotid (TC) and transfemoral (TF) TAVR by conducting a search and analysis of the best evidence in the literature to shed light on its safety and effectiveness. The PubMed/MEDLINE, Embase, and Cochrane library from inception to July 2020 were searched to identify articles reporting comparative data on TC versus TF approaches for TAVR. Patients' baseline characteristics and clinical outcomes were extracted from the articles and pooled for analysis. Five studies, including a total of 2470 patients, were included in the study with 1859 patients in the TF group and 611 patients in the TC group. The TC group had higher prevalence of peripheral vascular disease, while the patients in the TF group was older. Meta-analysis revealed that there was no significant differences between the two groups with regard to 30-day mortality (p=0.09), stroke (p=0.28), new dialysis (p=0.58), major bleeding (p=0.69), or pacemaker implantation (p=0.44). The TF group had a higher incidence of vascular complications (3.9% vs. 2.3%; OR 2.22; 95% CI [1.13, 4.38]; p=0.02). Compared with the TF approach, TC-TAVR is associated with comparable procedural and clinical outcomes. Our analysis found a lower rate of vascular complication in TC access compared with TF access. This supports consideration of such an alternative access when there are concerns over the feasibility of TF access.

Axillary artery cannulation for veno-arterial extracorporeal membrane oxygenation support in cardiogenic shock.

ObjectiveTo review the outcomes of axillary artery (AX) and femoral artery (FA) cannulation for veno-arterial extracorporeal membraneous oxygenation (VA-ECMO).MethodsFrom 2009 to 2019, 371 patients who were supported with VA-ECMO for cardiogenic shock were compared based on the arterial cannulation site: AX (n = 218) versus FA (n = 153).ResultsPatients in the AX group were older (61 years vs 58 years, P = .011), had a greater prevalence of peripheral vascular disease (13.8% vs 5.2%, P = .008), and were less likely to have undergone cardiopulmonary resuscitation preoperatively (18.8% vs 36.6%, P < .001). Other characteristics were similar between groups, as were in-hospital outcomes, including survival to discharge (60.6% vs 56.9%), cerebrovascular accidents (12.4% vs 10.5%), cannulation-related bleeding (15.1% vs 17%), and length of VA-ECMO support (6 days). The incidence of leg ischemia (6.9% vs 15.7%, P = .006), limb ischemia related to VA-ECMO cannulation (0% vs 10.5%), the need to switch the cannulation site (4.6% vs 14.7%), and wound complications (WCs; 2.8% vs 15%) including infection and additional procedure were significantly greater in the FA group (P < .001). In multiple logistic regression analysis, FA cannulation and primary graft failure after heart transplantation were independent risk factors for cannulation-related WC. In subgroup analysis among patients with primary graft failure, WCs were more prevalent in FA cannulation (3.6% vs 39.1%, P = .001).ConclusionsAX cannulation for VA-ECMO is a safe and effective alternative to FA cannulation. It can be considered especially for patients with limited groin access, peripheral vascular disease, or for primary graft failure after heart transplant.

S0661 The Prevalence of Peripheral Vascular Disease Is Increased in Inflammatory Bowel Disease, but Decreased After Anti-TNF Treatment: A Population-Based Study

INTRODUCTION: Patients with inflammatory bowel disease (IBD) might be at increased risk of peripheral vascular disease (PVD) due to the similarities in the ongoing paradigm of inflammation. Anti-tumor necrosis factor (anti-TNF) has been shown to decrease the endothelial function responsible for atherosclerotic vascular disease in rheumatoid arthritis. However, in IBD this relation is not clear. We sought to investigate the prevalence of PVD in IBD patients with and without anti-TNF. METHODS: We used a commercial database (Explorys Inc, Cleveland, OH) which includes electronic health record data from 26 major integrated US healthcare systems. Based on Systematized Nomenclature Of Medicine—Clinical Terms (SNOMED-CT), we identified all patients (age >18 years) who were diagnosed with either CD or UC between 2015 and 2020 who were treated with any type of anti-TNFs. We investigated the prevalence of PVD in IBD patients compared to patients with no IBD. Also, we compared the prevalence between IBD patients with and without anti-TNF therapy. RESULTS: Of the 32, 411,600 individuals in the database from 2015 to present, we identified 139,710 (0.43%) patients with CD and 114,770 (0.35%) patients with UC, of whom 24,160 (17.3%) and 8,080 (7%) patients received anti-TNFs, respectively. The prevalence of PVD was 20.5% and 21.8% for CD and UC, respectively, compared to 9.6% in individuals without IBD, P < 0.001 to all. The prevalence of PVD was significantly lower in anti-TNF treated CD patients (7.8%) compared to those who did not receive anti-TNF (22.1%). Similarly, anti-TNF treated UC patients were significantly less likely to have PVD (7.5%) compared to UC patients who did not receive anti-TNF therapy (22.3%), (P < 0.001 to all). CONCLUSION: This is the largest individual study investigating prevalence of PVD in patients with IBD with and without anti-TNF therapy. We found that IBD patients who were treated with anti-TNF were significantly less likely to have PVD when compared to IBD individuals who were never treated with anti-TNF.Figure 1.: The prevalence of Peripheral Vascular Disease in patients with inflammatory bowel disease with and without anti-TNF therapy.Table 1.: Type of Anti-TNF therapy in inflammatory bowel disease patients with Peripheral Vascular Disease

A Study on Carotid Intima-Media Thickness and Ankle Brachial Index In Patients with Various Stages of Chronic Kidney Disease

The presence of peripheral vascular disease in chronic kidney disease portends a dismal prognosis due to the increased morbidity and mortality from cardiovascular events. Peripheral vascular disease is asymptomatic in about 40%. The study was designed to identify the prevalence of the peripheral vascular disease in chronic kidney disease, which is a state of accelerated atherosclerosis. A sample of 90 patients of chronic kidney disease attending the outpatient department in medicine and nephrology were assessed for the prevalence of peripheral vascular disease by measuring the Ankle-brachial index and Carotid intima-media thickness. Gender, smoking, hypertension, diabetes and ischemic heart disease profiles of the sample were analyzed for association with peripheral vascular disease. Majority of the patients belonged to the age group 40-50 years. 82 were males, of these 47 were smokers. 6 patients in the sample had symptoms suggestive of peripheral vascular disease. While 21%(n=19) of patients in the sample were diabetics and 21%(n=19) had evidence of ischemic heart disease, hypertension was present in 41%(n=37) of the patients. 50% of the patients belonged to CRF stage 4. The prevalence of the peripheral vascular disease, as determined by ABI&lt;0.9, was 31.1%. CIMT thickness &gt; 0.9mm has a positive correlation with CKD stages and has a statistically significant P value of &lt;0.05. In conclusion, this study revealed that there is an increased prevalence of PVD in smokers, diabetics and in ischemic heart disease compared to those with hypertension.

Efficacy of Manual Hemostasis for Percutaneous Axillary Artery Intra-Aortic Balloon Pump Removal.

Background The prevalence of peripheral vascular disease has led to the re-emergence of percutaneous axillary vascular access as a suitable alternative access site to femoral artery. We sought to investigate the efficacy and safety of manual hemostasis in the axillary artery. Methods Data were collected from a prospective internal registry of patients who had a Maquet® (Rastatt, Germany) Mega 50 cc intra-aortic balloon pumps (IABP) placed in the axillary artery position. They were anticoagulated with weight-based intravenous heparin to maintain an activated partial thromboplastin time (aPTT) of 50–80 seconds. Anticoagulation was discontinued 2 hours prior to the device explantation. Manual compression was used to achieve the hemostasis of the axillary artery. Vascular and bleeding complications attributable to manual hemostasis were classified based on the Valve Academic Research Consortium-2 (VARC-2) and Bleeding Academic Research Consortium-2 (BARC-2) classifications, respectively. Results 29 of 46 patients (63%) achieved axillary artery homeostasis via manual compression. The median duration of IABP implantation was 12 days (range 1–54 days). Median compression time was 20 minutes (range 5–60 minutes). There were no major vascular or bleeding complications as defined by the VARC-2 and BARC-2 criteria, respectively. Conclusion Manual compression of the axillary artery appears to be an effective and safe method for achieving hemostasis. Large prospective randomized control trials may be needed to corroborate these findings.

Prevalence and Awareness of Stroke and Other Comorbidities Associated with Diabetes in Northwest India.

Objectives The main purpose of this study is to investigate the prevalence of comorbid conditions in diabetic, prediabetic, and nondiabetic individuals. Additionally, the current study examines the levels of awareness of those comorbidities among North Indian population. Methods As a part of a national study (Niyantrit Madhumeh Bharat [NMB] screening program), different comorbidity parameters were screened in the northern part of India between April and September 2017. There were 1,215 participants recruited in this study. Biochemical analyses of hemoglobin A1c (HbA1c) were conducted on the study subjects. Subsequently, the study subjects were divided into diabetic, prediabetic, and nondiabetic groups based on their HbA1c results. Results The study analysis reveals a higher prevalence of peripheral vascular disease (21.2%), ocular diseases (18%), and hypertension (13.4%) in diabetics with other comorbidities. Furthermore, the study found that a vast majority of the participants were unaware of the presence of hypertension (67.2%), dyslipidemia (84.5%), kidney disease (95.2%), peripheral vascular disease (34.5%), and stroke (95.1%). Conclusion The study concluded that in the northern India, the prevalence of multiple comorbid conditions, such as peripheral vascular disease and hypertension, is higher among diabetic population. Also, the level of awareness of diabetic comorbidities is surprisingly low, which has implications for policymakers, health practitioners, and educators of alternate medicine to increase awareness about diabetes, comorbid conditions, health risk, and possible solution at community and rural level, such as periodic screening programs in this population.

P1514PERIPHERIAL VASCULAR DISEASE IN DIABETIC PATIENTS ON HEMODIALYSIS - RISK OF HOSPITALIZATION AND MORTALITY IN A LARGE EUROPEAN COHORT

Abstract Background and Aims Patients with diabetes mellitus on hemodialysis (HD) are at increased risk of development and progression of vascular calcification, atherosclerosis and peripheral vascular disease (PVD). Presence of PVD constitute a major risk factor for the development of cardiovascular events, such as myocardial infarction, stroke, hospitalization or cardiovascular death. The presence of PVD is also associated with a reduced quality of life and disability. A significant proportion of patients with PVD are asymptomatic with no or few classical symptoms and early detection to prevent progressive disease is therefore very important. Both the ACC/AHA and KDIGO guidelines recommend screening of individuals who are at risk. Method We analyzed the frequency of foot complications following implementation of a standardized foot examination in 345 prevalent diabetic hemodialysis patients in 12 DaVita centers; 8 in Poland (n=177 patients) and 4 in Portugal (n=168 patients). The protocol includes: history of ulcers, amputation and examination of the pedal pulses (a dorsalis pedis and a tibialis posterior). Foot complications were classified according to Wagner (grade 0-5). PVD was classified by clinical pulse measurement (normal vs weak or missing). We analyzed associations between foot complications and peripheral pulses with risk of hospitalization and mortality using Cox proportional hazard models. Results The mean age in all diabetic HD patients (58% men) was 70.4 (14 SD) yrs. Charlson comorbidity index (CCI) was 8.8 (2.4), Kt/V 1.8 (0.4), s-albumin 39 (4) g/L, Hb 11.1 (1.3) g/dL. A normal pulse in both a dorsalis pedis and both a tibialis posterior was found in 18% and 10% of patients. All other patients had weak or absent pulses. The Wagner classification score was 0 in 79% of patients, 1-3 in 16 % patients and 4-5 in 5 %. All-cause mortality was 31% during the 2 year follow up and 71% of patients had at least one hospital stay In patients hospitalized during follow up, a dors ped was normal/abnormal in 12% and 88% respectively (p&amp;lt;0.05); a tib post was normal/abnormal in 8% and 92%, respectively (p&amp;lt;0.05). There were no associations between Wagner score 0-5 and hospitalization or mortality. In unadjusted Cox models presence of weak or absent pulses in a dorsalis pedis was significantly associated with all-cause mortality RR 2.1 (CI 1.1-4.3; p&amp;lt;0.05). In adjusted analyses including age, sex, Hb, albumin, Kt/V, vascular access, phosphorus, PTH and CCI, only albumin was associated with mortality (RR 0.89, CI 0.84-0.94; p&amp;lt;0.001) and risk of hospitalization (RR 0.92, CI 0.89-0.96; p&amp;lt;0.001). Conclusion Diabetic patients on HD have a high prevalence of PVD that warrant close clinical attention. Documentation of peripheral foot pulses for early detection of PVD is simple and suitable to identify patients at high risk of future complications and mortality. This standardized protocol could be the basis of a program to improve overall health outcomes in this vulnerable group of patients.