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[PMID]:27771811
[Au] Autor:Kamenskiy A; Seas A; Deegan P; Poulson W; Anttila E; Sim S; Desyatova A; MacTaggart J
[Ad] Endereço:Department of Surgery, 987690 Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE, 68198-7690, USA. Alexey.Kamenskiy@unmc.edu.
[Ti] Título:Constitutive description of human femoropopliteal artery aging.
[So] Source:Biomech Model Mechanobiol;16(2):681-692, 2017 04.
[Is] ISSN:1617-7940
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:Femoropopliteal artery (FPA) mechanics play a paramount role in pathophysiology and the artery's response to therapeutic interventions, but data on FPA mechanical properties are scarce. Our goal was to characterize human FPAs over a wide population to derive a constitutive description of FPA aging to be used for computational modeling. Fresh human FPA specimens ([Formula: see text]) were obtained from [Formula: see text] predominantly male (80 %) donors 54±15 years old (range 13-82 years). Morphometric characteristics including radius, wall thickness, opening angle, and longitudinal pre-stretch were recorded. Arteries were subjected to multi-ratio planar biaxial extension to determine constitutive parameters for an invariant-based model accounting for the passive contributions of ground substance, elastin, collagen, and smooth muscle. Nonparametric bootstrapping was used to determine unique sets of material parameters that were used to derive age-group-specific characteristics. Physiologic stress-stretch state was calculated to capture changes with aging. Morphometric and constitutive parameters were derived for seven age groups. Vessel radius, wall thickness, and circumferential opening angle increased with aging, while longitudinal pre-stretch decreased ([Formula: see text]). Age-group-specific constitutive parameters portrayed orthotropic FPA stiffening, especially in the longitudinal direction. Structural changes in artery wall elastin were associated with reduction of physiologic longitudinal and circumferential stretches and stresses with age. These data and the constitutive description of FPA aging shed new light on our understanding of peripheral arterial disease pathophysiology and arterial aging. Application of this knowledge might improve patient selection for specific treatment modalities in personalized, precision medicine algorithms and could assist in device development for treatment of peripheral artery disease.
[Mh] Termos MeSH primário: Envelhecimento
Artérias/fisiologia
Modelos Biológicos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Fenômenos Biomecânicos
Colágeno/metabolismo
Elastina/metabolismo
Feminino
Seres Humanos
Masculino
Meia-Idade
Doença Arterial Periférica/fisiopatologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
9007-34-5 (Collagen); 9007-58-3 (Elastin)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM; S
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE
[do] DOI:10.1007/s10237-016-0845-7


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[PMID]:27770498
[Au] Autor:Zietzer A; Buschmann EE; Janke D; Li L; Brix M; Meyborg H; Stawowy P; Jungk C; Buschmann I; Hillmeister P
[Ad] Endereço:Experimental and Clinical Research Center (ECRC), Richard-Thoma-Laboratories for Arteriogenesis, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Campus Mitte (CCM), Berlin, Germany.
[Ti] Título:Acute physical exercise and long-term individual shear rate therapy increase telomerase activity in human peripheral blood mononuclear cells.
[So] Source:Acta Physiol (Oxf);220(2):251-262, 2017 Jun.
[Is] ISSN:1748-1716
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIM: Physical activity is a potent way to impede vascular ageing. However, patients who suffer from peripheral artery disease (PAD) are often unable to exercise adequately. For those patients, we have developed individual shear rate therapy (ISRT), which is an adaptation of external counterpulsation and enhances endovascular fluid shear stress to increase collateral growth (arteriogenesis). To evaluate the effects of physical exercise and ISRT on the telomere biology of peripheral blood mononuclear cells (PBMCs), we conducted two clinical trials. METHODS: In the ISRT-1 study, we assessed PBMC telomerase activity in 26 young healthy volunteers upon a single (short-term) ISRT session and a single treadmill running session. In the ISRT-2 study, we investigated PBMC telomere biology of 14 elderly patients with PAD, who underwent 30 h of (long-term) ISRT within a 5-week period. RESULTS: We demonstrate that telomerase activity significantly increased from 39.84 Total Product Generated (TPG) Units ± 6.15 to 58.10 TPG ± 10.46 upon a single treadmill running session in healthy volunteers. In the ISRT-2 trial, PBMC telomerase activity and the mRNA expression of the telomere-protective factor TRF2 increased from 40.87 TPG ± 4.45 to 60.98 TPG ± 6.83 and 2.10-fold ± 0.40, respectively, upon long-term ISRT in elderly patients with PAD. CONCLUSION: In summary, we show that acute exercise and long-term ISRT positively affect PBMC telomerase activity, which is indicative for an improved regenerative potential of immune cells and vascular tissues. Long-term ISRT also enhances the gene expression of the telomere-protective factor TRF2.
[Mh] Termos MeSH primário: Contrapulsação/métodos
Exercício/fisiologia
Leucócitos Mononucleares/enzimologia
Doença Arterial Periférica/terapia
Telomerase/metabolismo
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Estudos Cross-Over
Feminino
Seres Humanos
Masculino
Meia-Idade
Adulto Jovem
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE
[Nm] Nome de substância:
EC 2.7.7.49 (Telomerase)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161023
[St] Status:MEDLINE
[do] DOI:10.1111/apha.12820


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[PMID]:28468784
[Au] Autor:Kalbaugh CA; Kucharska-Newton A; Wruck L; Lund JL; Selvin E; Matsushita K; Bengtson LGS; Heiss G; Loehr L
[Ad] Endereço:Department of Surgery, School of Medicine, The University of North Carolina at Chapel Hill, NC corey_kalbaugh@med.unc.edu.
[Ti] Título:Peripheral Artery Disease Prevalence and Incidence Estimated From Both Outpatient and Inpatient Settings Among Medicare Fee-for-Service Beneficiaries in the Atherosclerosis Risk in Communities (ARIC) Study.
[So] Source:J Am Heart Assoc;6(5), 2017 May 03.
[Is] ISSN:2047-9980
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Outpatient ascertainment of peripheral artery disease (PAD) is rarely considered in the measurement of PAD clinical burden; therefore, the clinical burden of PAD likely has been underestimated while contributing to a decreased awareness of PAD in comparison to other circulatory system disorders. METHODS AND RESULTS: The purpose of this study was to estimate the age-standardized annual period prevalence and incidence of PAD in the outpatient and inpatient settings using data from the Atherosclerosis Risk in Communities (ARIC) study linked with Centers for Medicare and Medicaid Services claims. The majority (>70%) of all PAD encounters occurred in the outpatient setting. The weighted mean age-standardized prevalence and incidence of outpatient PAD was 11.8% (95% CI 11.5-12.1) and 22.4 per 1000 person-years (95% CI 20.8-24.0), respectively. Black patients had higher weighted mean age-standardized prevalence (15.6%; 95% CI 14.6-16.4) compared with white patients (11.4%; 95% CI 11.1-11.7). Black women had the highest weighted mean age-standardized prevalence (16.9%; 95% CI 16.0-17.8). Black patients also had a higher incidence rate of PAD (31.3 per 1000 person-years; 95% CI 27.3-35.4) compared with white patients (25.4 per 1000 person-years; 95% CI 23.5-27.3). PAD prevalence and incidence did not differ by sex alone. CONCLUSIONS: This study provides comprehensive estimates of PAD in the inpatient and outpatient settings where the majority of PAD burden was found. PAD is an important circulatory system disorder similar in prevalence to stroke and coronary heart disease.
[Mh] Termos MeSH primário: Assistência Ambulatorial
Planos de Pagamento por Serviço Prestado
Medicare
Admissão do Paciente
Doença Arterial Periférica/epidemiologia
[Mh] Termos MeSH secundário: Demandas Administrativas em Assistência à Saúde
Afroamericanos
Distribuição por Idade
Idoso
Assistência Ambulatorial/economia
Comorbidade
Grupo com Ancestrais do Continente Europeu
Planos de Pagamento por Serviço Prestado/economia
Feminino
Custos Hospitalares
Seres Humanos
Incidência
Masculino
Medicare/economia
Admissão do Paciente/economia
Doença Arterial Periférica/diagnóstico
Doença Arterial Periférica/economia
Doença Arterial Periférica/etnologia
Prevalência
Fatores de Risco
Distribuição por Sexo
Fatores de Tempo
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE


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[PMID]:29419394
[Au] Autor:Morley RL; Sharma A; Horsch AD; Hinchliffe RJ
[Ad] Endereço:North Bristol NHS Trust, Bristol, Bristol, UK.
[Ti] Título:Peripheral artery disease.
[So] Source:BMJ;360:j5842, 2018 02 01.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Aterosclerose/complicações
Transtornos Cerebrovasculares/complicações
Isquemia Miocárdica/complicações
Doença Arterial Periférica/diagnóstico
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Aterosclerose/patologia
Transtornos Cerebrovasculares/epidemiologia
Complicações do Diabetes
Diagnóstico Diferencial
Inglaterra/epidemiologia
Seres Humanos
Meia-Idade
Isquemia Miocárdica/epidemiologia
Doença Arterial Periférica/complicações
Doença Arterial Periférica/epidemiologia
Doença Arterial Periférica/fisiopatologia
Guias de Prática Clínica como Assunto
Atenção Primária à Saúde/normas
Medição de Risco
Fatores de Risco
Fumar/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180209
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j5842


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[PMID]:29386181
[Au] Autor:Adelborg K; Szépligeti SK; Holland-Bill L; Ehrenstein V; Horváth-Puhó E; Henderson VW; Sørensen HT
[Ad] Endereço:Department of Clinical Epidemiology, Aarhus University Hospital, Denmark kade@clin.au.dk.
[Ti] Título:Migraine and risk of cardiovascular diseases: Danish population based matched cohort study.
[So] Source:BMJ;360:k96, 2018 01 31.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To examine the risks of myocardial infarction, stroke (ischaemic and haemorrhagic), peripheral artery disease, venous thromboembolism, atrial fibrillation or atrial flutter, and heart failure in patients with migraine and in a general population comparison cohort. DESIGN: Nationwide, population based cohort study. SETTING: All Danish hospitals and hospital outpatient clinics from 1995 to 2013. PARTICIPANTS: 51 032 patients with migraine and 510 320 people from the general population matched on age, sex, and calendar year. MAIN OUTCOME MEASURES: Comorbidity adjusted hazard ratios of cardiovascular outcomes based on Cox regression analysis. RESULTS: Higher absolute risks were observed among patients with incident migraine than in the general population across most outcomes and follow-up periods. After 19 years of follow-up, the cumulative incidences per 1000 people for the migraine cohort compared with the general population were 25 17 for myocardial infarction, 45 25 for ischaemic stroke, 11 6 for haemorrhagic stroke, 13 11 for peripheral artery disease, 27 18 for venous thromboembolism, 47 34 for atrial fibrillation or atrial flutter, and 19 18 for heart failure. Correspondingly, migraine was positively associated with myocardial infarction (adjusted hazard ratio 1.49, 95% confidence interval 1.36 to 1.64), ischaemic stroke (2.26, 2.11 to 2.41), and haemorrhagic stroke (1.94, 1.68 to 2.23), as well as venous thromboembolism (1.59, 1.45 to 1.74) and atrial fibrillation or atrial flutter (1.25, 1.16 to 1.36). No meaningful association was found with peripheral artery disease (adjusted hazard ratio 1.12, 0.96 to 1.30) or heart failure (1.04, 0.93 to 1.16). The associations, particularly for stroke outcomes, were stronger during the short term (0-1 years) after diagnosis than the long term (up to 19 years), in patients with aura than in those without aura, and in women than in men. In a subcohort of patients, the associations persisted after additional multivariable adjustment for body mass index and smoking. CONCLUSIONS: Migraine was associated with increased risks of myocardial infarction, ischaemic stroke, haemorrhagic stroke, venous thromboembolism, and atrial fibrillation or atrial flutter. Migraine may be an important risk factor for most cardiovascular diseases.
[Mh] Termos MeSH primário: Doenças Cardiovasculares/etiologia
Transtornos de Enxaqueca/complicações
Infarto do Miocárdio/etiologia
Acidente Vascular Cerebral/etiologia
[Mh] Termos MeSH secundário: Adulto
Fibrilação Atrial/epidemiologia
Fibrilação Atrial/etiologia
Índice de Massa Corporal
Doenças Cardiovasculares/epidemiologia
Estudos de Coortes
Comorbidade
Dinamarca/epidemiologia
Feminino
Insuficiência Cardíaca/epidemiologia
Insuficiência Cardíaca/etiologia
Seres Humanos
Incidência
Hemorragias Intracranianas/epidemiologia
Hemorragias Intracranianas/etiologia
Masculino
Meia-Idade
Transtornos de Enxaqueca/diagnóstico
Transtornos de Enxaqueca/epidemiologia
Infarto do Miocárdio/epidemiologia
Avaliação de Resultados (Cuidados de Saúde)
Doença Arterial Periférica/epidemiologia
Doença Arterial Periférica/etiologia
Estudos Prospectivos
Fatores de Risco
Fumar/epidemiologia
Acidente Vascular Cerebral/epidemiologia
Tromboembolia Venosa/epidemiologia
Tromboembolia Venosa/etiologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180202
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.k96


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[PMID]:29240654
[Au] Autor:Henni S; Gabory G; Abraham P
[Ad] Endereço:Samir Henni, MD, University Hospital Center of Angers and Mitovasc, France. Gaétane Gabory, RN, MSc, Candé, Erdre et Loire Hospital Center, France. Pierre Abraham, PhD, MD, University Hospital Center of Angers and Mitovasc, France.
[Ti] Título:Peripheral Artery Disease Symptomatology and Ischemia.
[So] Source:Nurs Res;67(1):3-5, 2018 Jan/Feb.
[Is] ISSN:1538-9847
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Isquemia
Doença Arterial Periférica
[Mh] Termos MeSH secundário: Seres Humanos
Fatores de Risco
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM; N
[Da] Data de entrada para processamento:171215
[St] Status:MEDLINE
[do] DOI:10.1097/NNR.0000000000000257


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[PMID]:29326105
[Au] Autor:Barraclough K; Bradbury A
[Ad] Endereço:Hoyland House, Painswick, UK k.barraclough@btinternet.com.
[Ti] Título:Chronic limb threatening ischaemia.
[So] Source:BMJ;360:j5460, 2018 01 11.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: /irrigação sanguínea
Isquemia/diagnóstico
Doença Arterial Periférica/diagnóstico
[Mh] Termos MeSH secundário: Idoso
Doença Crônica
Diagnóstico Diferencial
Seres Humanos
Masculino
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180113
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j5460


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[PMID]:29237359
[Au] Autor:Cragg J; Lowry D; Hopkins J; Parker D; Kay M; Duddy M; Tiwari A
[Ad] Endereço:1 Department of Vascular Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
[Ti] Título:Safety and Outcomes of Ipsilateral Antegrade Angioplasty for Femoropopliteal Disease.
[So] Source:Vasc Endovascular Surg;52(2):93-97, 2018 Feb.
[Is] ISSN:1938-9116
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Previous reports have suggested higher periprocedural complications after ipsilateral antegrade femoral arterial access (AA). We looked at a contemporary series comparing complication rates between AA and contralateral retrograde femoral arterial access (RA) for femoropopliteal angioplasty. METHOD: A prospective review of all cases between 2010 and 2015 in a United Kingdom tertiary vascular center. Demographical and procedural data were obtained for those undergoing percutaneous femoropopliteal angioplasty. The primary outcome looked at periprocedural complications including retroperitoneal hematoma, pseudoaneurysm, hematoma requiring transfusion, arteriovenous fistulation, and surgical intervention. Secondary outcomes included contrast and radiation doses in addition to procedural failure leading to major amputation. RESULTS: A total of 556 (66% male) patients underwent femoropopliteal angioplasty, 461 (82%) via AA. Groups were of comparable age, sex, comorbidity, and symptomatology. AA patients had a lower body mass index, 26 versus 29 ( P = .005). No significant difference was seen in periprocedural (15.8% AA vs 11.6% RA; P = 0.292) or access site complications (3.7% AA vs 1.1% RA; P = 0.186). There was less need for a closure device, 40.3% AA vs 73% RA ( P < .01), less contrast, 94 mL AA: 114 mL RA ( P < .001), and less radiation, 3487 cGy cm AA: 9697 cGy cm RA ( P < .001). Arterial access was also associated with greater technical success of 83.8%: 73.3% RA ( P = .002). CONCLUSIONS: Arterial access is associated with higher technical success and reduced contrast/radiation doses with no significant difference in complications compared to RA contrary to previous reports.
[Mh] Termos MeSH primário: Angioplastia/métodos
Artéria Femoral
Doença Arterial Periférica/terapia
Artéria Poplítea/fisiopatologia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Angiografia
Angioplastia/efeitos adversos
Bases de Dados Factuais
Inglaterra
Feminino
Artéria Femoral/diagnóstico por imagem
Artéria Femoral/fisiopatologia
Seres Humanos
Masculino
Meia-Idade
Doença Arterial Periférica/diagnóstico por imagem
Doença Arterial Periférica/fisiopatologia
Artéria Poplítea/diagnóstico por imagem
Dose de Radiação
Exposição à Radiação/efeitos adversos
Exposição à Radiação/prevenção & controle
Estudos Retrospectivos
Fatores de Risco
Centros de Atenção Terciária
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171215
[St] Status:MEDLINE
[do] DOI:10.1177/1538574417739762


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[PMID]:29179651
[Au] Autor:Hanna EB; Ababneh BA; Amin AN
[Ad] Endereço:1 Department of Medicine, Cardiovascular Section, Louisiana State University, New Orleans, LA, USA.
[Ti] Título:Endovascular Therapy of the Superficial Femoral Artery Via a Stand-Alone Transradial Access: A Single-Center Experience.
[So] Source:Vasc Endovascular Surg;52(2):107-114, 2018 Feb.
[Is] ISSN:1938-9116
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: We describe our experience in transradial recanalization of the superficial femoral artery (SFA), and we provide a stepwise approach accounting for the patient's height and optimizing the yield of currently available devices. METHODS AND RESULTS: Fifteen patients with simple SFA disease, including 4 patients with total SFA occlusions <15 cm, were selected for stand-alone transradial recanalization. A 6F, 125-cm multipurpose guiding catheter was used to cannulate the limb of interest and support device delivery. The procedure was successful in all patients and consisted of balloon angioplasty (using 0.014″, 200-cm shaft monorail balloons) in all patients, and orbital atherectomy in 6 patients. We illustrate the steps and challenges of the transradial approach, namely the limited support in complex disease and the limited reach of current equipment. CONCLUSION: In patients with simple SFA disease, transradial recanalization appears feasible and safe but currently limited to balloon angioplasty ± orbital atherectomy. Proximal SFA stenting may be feasible in patients <160 cm in height.
[Mh] Termos MeSH primário: Angioplastia com Balão/métodos
Aterectomia/métodos
Doença Arterial Periférica/terapia
Artéria Radial
[Mh] Termos MeSH secundário: Angioplastia com Balão/efeitos adversos
Angioplastia com Balão/instrumentação
Aterectomia/efeitos adversos
Aterectomia/instrumentação
Constrição Patológica
Estudos de Viabilidade
Feminino
Artéria Femoral/diagnóstico por imagem
Artéria Femoral/fisiopatologia
Seres Humanos
Masculino
Meia-Idade
Nova Orleans
Doença Arterial Periférica/diagnóstico por imagem
Doença Arterial Periférica/fisiopatologia
Punções
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE
[do] DOI:10.1177/1538574417742239


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[PMID]:28468953
[Au] Autor:Randhawa MS; Reed GW; Grafmiller K; Gornik HL; Shishehbor MH
[Ad] Endereço:From the Department of Cardiovascular Medicine, Cleveland Clinic, OH; and School of Medicine, Case Western Reserve University, Cleveland, OH.
[Ti] Título:Prevalence of Tibial Artery and Pedal Arch Patency by Angiography in Patients With Critical Limb Ischemia and Noncompressible Ankle Brachial Index.
[So] Source:Circ Cardiovasc Interv;10(5), 2017 May.
[Is] ISSN:1941-7632
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Approximately 20% of patients undergoing ankle brachial index testing for critical limb ischemia have noncompressible vessels because of tibial artery calcification. This represents a clinical challenge in determining tibial artery patency. We sought to identify the prevalence of tibial artery and pedal arch patency by angiography in these patients. METHODS AND RESULTS: One hundred twenty-five limbs (of 89 patients) with critical limb ischemia and ankle brachial index ≥1.4 who underwent lower extremity angiograms within 1 year were included. Reviewers of angiography were blinded to results of physiological testing. Tibial artery vessels were classified as completely occluded, significantly stenosed (≥50%), or patent (<50% stenosis). The sensitivity of toe brachial index and pulse volume recording to predict tibial artery disease was also determined. Of 125 limbs with noncompressible ankle brachial index, 72 (57.6%) anterior tibial and 80 (64%) posterior tibial arteries were occluded. Another 23 (18.4%) anterior tibial and 13 (10.4%) posterior tibial arteries had ≥50% stenosis. Pulse volume recording was moderate to severely dampened in 54 of 119 (45.4%) limbs. Toe brachial index <0.7 was found in 75 of 83 (90.4%) limbs. Moderate to severe pulse volume recording dampening was 43.6% sensitive, whereas toe brachial index <0.7 was 89.7% sensitive in diagnosing occluded or significantly stenotic tibial artery disease. The pedal arch was absent or incomplete in 86 of 103 (83.5%) limbs. CONCLUSIONS: Among patients with critical limb ischemia and noncompressible ankle brachial index results, the prevalence of occlusive tibial and pedal arch disease is very high. Toe brachial index <0.7 is more sensitive in diagnosing occluded and significantly stenotic tibial artery disease in these patients compared with ankle pulse volume recording.
[Mh] Termos MeSH primário: Angiografia
Índice Tornozelo-Braço
Isquemia/diagnóstico
Doença Arterial Periférica/diagnóstico
Artérias da Tíbia/diagnóstico por imagem
Calcificação Vascular/diagnóstico
Grau de Desobstrução Vascular
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Constrição Patológica
Estado Terminal
Feminino
Seres Humanos
Isquemia/diagnóstico por imagem
Isquemia/epidemiologia
Isquemia/fisiopatologia
Masculino
Meia-Idade
Ohio/epidemiologia
Doença Arterial Periférica/diagnóstico por imagem
Doença Arterial Periférica/epidemiologia
Doença Arterial Periférica/fisiopatologia
Valor Preditivo dos Testes
Prevalência
Estudos Retrospectivos
Índice de Gravidade de Doença
Artérias da Tíbia/fisiopatologia
Ultrassonografia Doppler
Calcificação Vascular/diagnóstico por imagem
Calcificação Vascular/epidemiologia
Calcificação Vascular/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE



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