Peripheral arterial disease evaluation

MN is a 48-year-old man with a history of hypertension and smoking who presents to the clinic for evaluation of his cholesterol. He denies having chest pain or history of myocardial infarction, stroke, or peripheral artery disease. He has no siblings and both parents are alive with no history of CHD. MN says that he smokes about 1 pack of cigarettes per day. He does not exercise on a regular basis. He has been fasting for approximately 11 hours. 

Cardiovascular evaluation and rehabilitation may permit reclassification as low risk Noncardiac atherosclerotic sequelae (peripheral arterial disease, history of stroke, or transient ischemic attacks)... 

WAVE investigators. The effects of oral anticoagulants in patients witii peripheral arterial disease rationale, design, and baseline characteristics of tiie Warfarin and Antiplatelet Vascular Evaluation (WA ) trial, including a meta-analysis of trials. Am Heart J (2006) 151, 1-9. 

Criqui MH, Frouek A, Klauber MR, Barrett-Connor E, Gabriel S. The sensitivity, specificity and predictive value of traditional clinical evaluation of peripheral arterial disease results for non-invasive testing in a defined population. Circulation m5 l 5l6-522. 

Noninvasive Diagnostic Evaluation of Peripheral Arterial Disease... 

Clearly, diabetics who have peripheral arterial disease have higher mortality rates than those who do not have arterial disease. A recent study by Vogt et al. (15) evaluated the relationship between peripheral arterial disease and mortality in a population of close to 2000 individuals over a 13-year period. All patients 50 years of age and older with no history of lower extremity surgery were evaluated for the presence of peripheral arterial disease. Analysis of the data stratified by populations and comorbid conditions showed that a low ankle-brachial index is an independent predictor of all causes of mortality in both men and women with peripheral arterial disease. This increase is a relative risk and is unchanged after exclusions of all patients with a clinical history of cardiovascular disease or diabetes. Thus, a low ankle-brachial index is an important measurement to obtain to assess the risk of mortality among those who smoke and have either angina or diabetes. 

Novo S, Avellon G, Di Garbo V, et al. Prevalence of risk factors in patients with peripheral arterial disease. A clinical and epidemiological evaluation. Int Angiol 1992 11 218-229. 

Swartbol et al. (10) studied 450 consecutive patients with peripheral vascular disease to evaluate risk factors associated with renal artery stenosis. Of 221 patients who had peripheral arterial disease and a renal artery lesion detected by angiography, 44 were normotensive and 177 were hypertensive. The authors concluded that hypertension secondary to renal artery stenosis was significantly correlated with peripheral vascular disease. They also noted an association with age over 70 years, smoking history, and an abnormal baseline ECG. 

In the Peripheral Arterial Disease Detection, Awareness, Risk and Treatment New Resources for Survival (PARTNERS) study (64), 6979 patients age 70 years or older or age 50-69 years with diabetes mellitus or history of smoking were evaluated by history and ABI. LEAD cases were classified as such, if the ABI was <0.9 or if there was a history of limb revascularization. A main outcome measure evaluated the treatment of LEAD patients compared with other forms of arterial disease. 

Regensteiner JG, Steiner JF, Panzer RJ, Hiatt WR. Evaluation of walking impairment by questionnaire in patients with peripheral arterial disease. J Vase Med Biol 1990 2 142-152. 

Rutherford RB, Becker GJ. Standards for evaluating and reporting the results of surgical and percutaneous therapy for peripheral arterial disease. JVIR 1991 83 169-174. 

Cover Illustration Figure 3D from Chapter 2, Noninvastve Diagnostic Evaluation of Peripheral Arterial Disease," by Nicos Labropoulos and Apostolos K. Tassiopoulos. 

Cardiovascular Effects Analysis of NHANES 1999-2000 survey data from participants aged 40 years or more identified a positive association of urinary antimony levels and peripheral arterial disease (Navas-Acien et al. 2005). The authors cautioned that this should be considered a preliminary exploratory finding, and more research is needed to explore and define this possible association. Other analyses of NHANES data (1999-2006) have examined whether metals may affect the risk of cardiovascular disease (Agarwal et al. 2011). In this study, urinary antimony levels were significantly positively associated with cardiovascular and cerebrovascular disease adjusted Odds Ratio (OR) 2.15 (95 % Cl 1.45-3.18). This OR was the second highest (highest was for urinary cadmium) of the 13 metals evaluated. 

Abbreviations. CAD. coronary artery diseases CVA, cerebrovascular accident HOPE, heart outcomes prevention evaluation LTA. light transmittance aggregometry MI. myocardial infarction PCI. percutaneous coronary intervention PVD. peripheral vascular diseases RPFA, rapid platelet function analyzer TxB2, thromboxane B2. 

An even more chemically and biologically stable derivative of PCI is beraprosi, which is being evaluated in an oral formulation for the treatment of early-stage pulmonaiv arterial hypertensiun and peripheral vo.scular disease. This prostacyelin has been approved for use in Japan but not yet in the United States. 

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