References 1. Diehm C, et al. Mortality and vascular morbidity in older adults with asymptomatic versus symptomatic peripheral artery disease. Circulation. 2009;120:2053-2061. 2. Perlstein TS, Creager MA. The Ankle-Brachial Index as a Biomarker of Cardiovascular Risk: It’s Not Just About the Legs. Circulation. 2009;120: 2033-2035. 3. Doobay AV, Anand SS. Sensitivity and specificity of the ankle-brachial index to predict future cardiovascular outcomes: a systematic review. Arterioscler Thromb Vasc Biol
Tímea Varga-Fekete, Katalin Felvinczi, Emese Kun-Bálint, A Puskás, E Nagy and Z Brassai
Tomasz Grzela, Arkadiusz Migdalski, Arkadiusz Jawień, Radosław Piotrowicz and Artur Szotkiewicz
DJ: The validity, reliability, reproducibility and Extended utility of ankle to brachial pressure index in current vascular surgical practice. Eur J Vasc Endovasc Surg 2005; 29: 443-51. Meru AV Mittra S, Thyagarajan B et al.: Intermittent claudication: An overview. Atherosclerosis 2006;187: 221-37. Zierler RE Sumner DS: Physiologic Assesment of Peripheral Arterial Occlusive Disease. W: Rutherford: Vascular Surgery, 6th ed., Copyright 2005 Elsevier: 197-208. McDermott M, Liu K
Saso Gelev, Goce Spasovski, Sonja Dzikova, Slavcho Tosev, Marjan Bosevski, Gjulsen Selim, Pavlina Dzekova, Arben Asani, Vili Amitov and Aleksandar Sikole
Different Ankle Brachial Index Levels in Asymptomatic Hemodialysis Patients
Resting ankle brachial systolic pressure index (ABI) level of 0.90 is 95% sensitive in detecting angiogram-positive peripheral arterial disease (PAD) and that falsely elevated pressures or incompressible arteries at the ankle level and ABI > 1.30 is caused by mediosclerosis. We evaluated 94 hemodialysis (HD) patients for the presence of PAD and mediosclerosis using ABI measurement, and the presence of atherosclerotic lesions using high resolution B-mode ultrasonography of the common carotid (CCA) and femoral arteries (FA). Asymptomatic HD patients with high ABI (mediosclerosis) and low ABI (PAD) levels were common. Patients with normal and high ABI levels had high percentage of atherosclerotic lesions. Older age, diabetes and low serum albumin, and higher doses of prescribed calcium carbonate were associated (p<0.05) with low levels of ABI in our HD patients. Male gender, higher blood pressure and presence of diabetes were associated (p<0.05) with high ABI levels. Low and high ABI levels were not associated with the specific risks such as elevated serum phosphate, calcium phosphate product and intact parathyroid hormone levels. Arterial disease in asymptomatic HD patients is frequent. Screening for atherosclerotic lesions in HD patients should be recommended even if they had no symptoms.
Lyudmila Vladimirova-Kitova, Tania Deneva-Koicheva, Fedya Nikolov and Varban Ganev
, Gilbeau JP, Leysen X, et al. Impact of genetic defect on atherosclerosis in patients suspected of familial hypercholesterolemia. Eur J Clin Inv 2008;31(11):958-65. Management of peripheral arterial disease (PAD). Trans-Atlantic Inter-Society Consensus (TASC). Int Angiol 2000;19 (Suppl 1):1-304. Doobay AV, Anand SS. Sensitivity and specificity of the ankle-brachial index to predict FUTURE cardiovascular outcomes. A systematic review. Arterioscler Thromb Vasc Biol 2005;25:1463. Duprez D. HOPE
Ljiljana Popović, Katarina Lalić, Olga Vasović, Danijela Drašković Radojković, Nataša Rajković, Sandra Singh, Ljubica Stošić, Miodrag Čivčić, Ljiljana Škorić Hinić and Tatjana Petrović Vujić
References 1. Willerson J T, Cohn JN, Wellens HJJ, Holmes DR Jr, eds. Cardiovascular Medicine 2. London: Springer 2007; 1681–703. 2. Marso S P, Hiatt WR. Peripheral arterial disease in patients with diabetes. J Am Coll Cardiol 2006; 47(5): 921–9. 3. Leng GC, Lee AJ, Fowkes FG, et al. Incidence, natural history and cardiovascular events in symptomatic and asymptomatic peripheral arterial disease in general population. Int J Epidemiol 1996; 25: 1172–81. 4. Diehm C, Allenberg JR, Pittrow D, et al; German Epidemiological Trial on Ankle Brachial Index
Mohammad-Reza Zafarghandi, Iraj Nazari, Morteza Taghavi, Abbas Rashidi, Sanaz Karimi Dardashti, Donya Sadid, Leyli Esmaili, Seyed Mostafa Mahmoodi and Masood Mousavi
Despite significant advances in the treatment of diabetic foot ulcers and below-the-knee critical ischemia, there are ongoing efforts to achieve a method with low complication, high success rate and persistence of long-term effects.
The aim of the study was to examine the outcome of angioplasty in patients with below-the-knee critical ischemia referred to Hospital.
Material and methods. This semi-experimental study conducted on diabetics patients treated with PTA (Percutaneous transluminal angioplasty) with critical ischemia of lower limbs referred to Sina Hospital. After discharge, the patients were followed weekly for the first month and then monthly up to 12 months. The procedure short-term effects were examined through evaluation of wound healing as well as patients' recovery and pain relief, after one month. Given the distribution type, parametric and non-parametric test were used to compare the results before and after treatment. Pearson's correlation coefficient was used to determine the correlation between variables.
Results. Twenty four patients participated in this study. The mean ankle-brachial index (ABI) at baseline was 0.55±0.17. A month after angioplasty, the index increased statistically significant to 0.93±0.16. The mean health score expressed by the patients at baseline was 5.48±1.39. A month after angioplasty, it was significantly increased (6.32±1.24). The mean pain score before enrollment was 6.68±2.52 (according to VAS scale). There was a significant decrease over time (3.45±1.13). The overall mean score of all patients at Rutherford Classification was 3.88±0.63 at baseline. During the 1st month and 6th month follow-up, it was changed to Class 0 that was statistically significant in the first month.
Conclusions. This study represents the mid-term outcomes of PTA. Although PTA treatment was associated with improved pain scores, satisfaction with health, classification of limb ischemia and diabetic foot ulcers, the effects only remain short-term and mid-term. However, long-term efficacy of PTA needs to be investigated further.
Anna-Boróka Tusa, Annamária Magdás, Réka-Júlia Tusa and Al. Incze
Objective. In lower limb peripheral artery disease the most commonly used method for the assessment of the main arterial system is represented by the determination of ankle-brachial index (ABI). The post-occlusive reactive hyperaemia (PORH) is a controversial method used for the evaluation of primary collateral circulation. The follow-up of these patients has an underestimated part, their quality of life. The aim of this study is to evaluate this and highlight the importance of the PORH in the sight of optimal treatment.
Method. 34 patients diagnosed with lower extremity artery disease, receiving conservative treatment, the ankle-brachial index was defined with a Doppler Bistos BT-200, 8 MHz device, the PORH was evaluated with a Bidop ES-100V, an instrument which sends information for a Smart-V-Link software. To assess the quality of life we used the VascuQol-6 test.
Results. The age (mean ± SD) of the patients was 67.24±9.51, 52.92% were active smokers. A significant positive correlation was found between PORH and the results of VascuQol-6 test (p=0.02, r=0.38) and an inverse correlation between ABI <0.5 and VascuQol-6 >12. We noticed a significant difference between the VascuQol-6 result at smokers and non-smokers (p=0.02).
Conclusions. The quality of life can be acceptable at patients with significant stenosis on the main artery and decreased ankle-brachial index due to presence of the collateral artery system with a maintained ability of vasodilatation represented by PORH. The efficiency of the treatmet is based on quitting smoking, starting programs which are helping patients to quit smoking would be useful.
Raminderjit Kaur, Manpreet Kaur, Rohit Kapoor and Jatinder Singh
diabetes mellitus. Cardiovasc. Diabetol 12: 94, 2013. 31. Han JY, Choi DH., Choi SW et al. Predictive value of brachial-ankle pulse wave velocity for cardiovascular events. AJMS 346: 92–97, 2013. 32. Snehalatha C, Viswanathan V, Ramachandran A . Cutoff values for normal anthropometric variables in Asian Indian adults. Diabetes Care 26: 1380-1384, 2003. 33. WHO expert consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363: 157–163, 2004. 34. Perusse L, Rice T
Ovidiu Mitu, Florin Mitu, Maria-Magdalena Leon, Mihai Roca, Andreea Gherasim and Mariana Graur
cardiovascular disease prevention in clinical practice (version 2012). Eur Heart J 33: 1635-1701, 2012. 8. Touboul PJ, Hennerici MG, Meairs S et al. Mannheim carotid intima-media thickness and plaque consensus (2004-2006-2011). Cerebrovasc Dis 34: 290-296, 2012. 9. Ko SH, Bandyk DF. Interpretation and significance of ankle-brachial systolic pressure index. Semin Vasc Surg 26: 86-94, 2013. 10. Mancia G, Fagard R, Narkiewicz K et al. 2013 ESH/ESC guidelines for the management of arterial hypertension. Eur Heart J 34: 2159-2219, 2013. 11. Van
Elod Nagy, Imre Zoltan Kun and Piroska Kelemen
, peripheral arterial disease, and change in ankle-brachial index: findings from the Framingham Heart Study. J Clin Endocrinol Metab. 2011,96(12):3724-32. 7. Kiechl S, Willeit J, Bonora E, Schwarz S, Xu Q. No Association Between Dehydroepiandrosterone Sulfate and Development Atherosclerosis in a Prospective Population Study (Bruneck Study). Arterioscler Thromb Vasc Biol. 2000;20:1094-1100. 8. Price JF, Lee AJ, Fowkes FG. Steroid sex hormones and peripheral arterial disease in the Edinburgh Artery Study. Steroids. 1997;62(12):789-94. 9. Yeap BB, Alfonso H