Progression of asymptomatic peripheral artery disease over 1 year
|
|
- Prosper Russell
- 5 years ago
- Views:
Transcription
1 1106VMJ / X Vascular MedicineMohler ER III et al. Progression of asymptomatic peripheral artery disease over 1 year Vascular Medicine 17(1) The Author(s) 2012 Reprints and permission: sagepub. co.uk/journalspermissions.nav DOI: / X vmj.sagepub.com Emile R Mohler III 1, Warner Bundens 2, Julie Denenberg 2, Elizabeth Medenilla 1, William R Hiatt 3 and Michael H Criqui 2 Abstract The pathophysiology and time course of an individual converting from asymptomatic peripheral artery disease (PAD) to symptomatic claudication is unclear. The objectives of this study were: (1) to characterize the extent of atherosclerotic disease in individuals with an abnormal ankle brachial index (ABI), but without claudication; and over 1 year of followup to (2) evaluate the progression of PAD using ultrasound imaging, (3) determine changes in the ABI and leg pain symptoms, and (4) correlate PAD progression with changes in the ABI and leg symptoms. We hypothesized that PAD progression would be associated with the development of claudication and changes in the ABI, 6-minute walk distance (6-MWD), and walking quality of life. Individuals with a reduced ABI but without typical intermittent claudication noted on community screening were invited to undergo baseline and 1-year follow-up assessment, including duplex ultrasound. The initial and repeat evaluations included measurement of the ABI, lower extremity duplex arterial mapping, and assessment of leg pain and functional status. Of the 50 people studied, 44 (88%) had significant atherosclerotic lesions in the lower extremity arteries, affecting 80 legs. A total of 33 of 50 individuals (66%) returned for the 1-year follow-up visit. On ultrasound examination, two of 18 normal legs developed PAD, and in 48 legs with PAD at baseline, 17 legs (35%) developed new or progressive lesions. Thirteen legs developed new claudication. Overall, there was no significant worsening in the ABI, 6-MWD, or the Walking Impairment Questionnaire (WIQ). However, legs with new lesions or lesion progression were significantly more likely to develop claudication, and the 13 legs (seven subjects) developing claudication showed a significant decline in the 6-MWD. In conclusion, these data indicate that a significant number of people with asymptomatic PAD show progression over 1 year, that such individuals are more likely to develop claudication, and that those developing claudication have a significant decrease in their 6-MWD. Keywords ankle brachial index; claudication; peripheral artery disease; ultrasound Introduction The PARTNERS study showed that the prevalence of peripheral artery disease (PAD) in an at-risk population approached 30%. 1 In that study, using a hand-held Doppler device in the office setting, less than 10% of patients with PAD had typical claudication symptoms based on the San Diego Claudication Questionnaire (SDCQ), indicating that evaluating people with the ankle brachial index (ABI) provides additional diagnostic benefit beyond the history of claudication symptoms. 2 The natural history of patients with PAD is poorly understood. Epidemiological studies indicate that approximately 75% who have claudication remain stable, without progressive leg deterioration, throughout their lifetime. 3 However, one study indicated that functional decline was more common than originally thought, even though such individuals may not be cognizant of lifestyle impairment. 4 The pathophysiology leading to development of claudication and decline in functional status is thought to be due to progression of the underlying lower extremity atherosclerosis. 1 Cardiovascular risk factors such as smoking, diabetes mellitus, hypertension and dyslipidemia, along with genetic factors, 1 Department of Medicine, Cardiovascular Division, Section of Vascular Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA 2 Division of Preventive Medicine, Department of Family and Preventive Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA 3 University of Colorado School of Medicine and CPC Clinical Research, Aurora, CO, USA Corresponding author: Emile R Mohler III 6 Penn Tower Building Hospital of the University of Pennsylvania 3400 Spruce Street Philadelphia, PA USA mohlere@uphs.upenn.edu Dr Thom Rooke was the guest editor for this article.
2 Mohler ER III et al. 11 predispose to development of atherosclerosis in the leg arteries, with a sharp increase in prevalence with age. 5 Few patients go from being asymptomatic to symptoms of sudden acute arterial occlusion; rather, most have an insidious development of claudication. The natural history of atherosclerosis in the extremities involves plaque development in the intimal layer of the artery, typically in susceptible regions where turbulent blood flow occurs, such as the superficial femoral artery at Hunter s canal. 6 There are few published prospective studies evaluating the progression of disease using an imaging method such as ultrasound. Patients with a reduced ABI have occlusive disease present in their lower extremity, but may not have typical claudication symptoms and are therefore often considered asymptomatic. Lower extremity arterial duplex ultrasound mapping combined with ABI can assess the location and hemodynamic severity of PAD. Although still unclear, there is some evidence that atherosclerotic disease progression involves plaque hemorrhage or ulceration leading to vessel stenosis or occlusion, similar to that which occurs in the coronary arteries. 7 Duplex ultrasound may allow for tracking of PAD progression. The objectives of this study were: (1) to characterize the extent of PAD in individuals with an abnormal ABI > and < 0.90, but without claudication; and over 1 year of follow-up to (2) evaluate the progression of PAD using ultrasound imaging, (3) determine changes in the ABI, leg pain symptoms, 6-minute walk distance (6-MWD), and the Walking Impairment Questionnaire (WIQ), and (4) correlate PAD progression with changes in the ABI, leg pain, 6-MWD, and the WIQ. We hypothesized that individuals showing ultrasound PAD progression would be more likely to develop claudication, as well as changes in the ABI, 6-MWD, and WIQ. Methods Study design This was a two-site study with the aim of evaluating progression of PAD over a 1-year time period. The institutional review board of each of the respective institutions approved the study. Study subjects were recruited from university clinics and a community screening program when they were found to have an abnormal ABI. After signing an informed consent, patients previously found to have a reduced ABI were invited to undergo repeat ABI measurement and bilateral lower extremity arterial duplex ultrasound mapping, and the 6-MWD test. 8 Also, individuals were asked to complete the SDCQ and the WIQ. 2,9 These tests and questionnaires were repeated 1 year after enrollment. A 6-month visit or teleconference was also done to assess for any interim questions or problems and served to promote retention in the study. Inclusion and exclusion criteria The inclusion criteria were subjects with PAD defined as an abnormal ABI in any of four ABI measurements (right posterior tibial [PT], left PT, right dorsalis pedis [DP] or left DP), defined as > 0.60 and < 0.90, and subjects could not have complaints of typical claudication on the SDCQ. Also, subjects with an ABI > 1.30 had the toe brachial index (TBI) measured and were included if a TBI was < Three individuals had at least one ABI measurement which was > 1.30; in two of those individuals, there was also an ABI measurement that was < In the third person, the PT ratios were both above 1.3 and the DP pulse was not detected bilaterally, but both TBIs were < Other inclusion criteria included an ability to perform a 6-MWD test. An exclusion criterion was an inability to lay supine for the ultrasound study. Ankle brachial index measurement The ABI (and if necessary TBI) was measured using standardized methods. 10 Brachial and ankle (right PT, left PT, right DP and left DP) systolic pressures were measured with appropriately sized cuffs with attached sphygmomanometers. Return of flow was determined using a continuous wave Doppler. If an ABI was > 1.30, great toe pressures were measured using a 2.5 cm cuff and return of flow was determined using photoplethysmography IMEX 9000). Each ankle pressure (or the toe pressure) divided by the highest brachial pressure was used to calculate each ABI (or TBI). Thus, each participant had four ABIs, two left and two right, and a right and left TBI if necessary. The index ABI was defined as the lower of the two leg ABIs. Lower extremity ultrasound study All patients underwent a lower extremity duplex ultrasound evaluation of the arterial system and plaque was used as the measure of disease progression. The evaluation began at the inguinal ligament level and included evaluation of the common femoral, superficial femoral, popliteal, and posterior tibial arteries, as per the Inter-societal Commission for Accreditation of Vascular Laboratory guidelines. The peroneal arteries were not evaluated with ultrasound due to difficulty in visualizing these vessels in most individuals. Vessels were recorded as having no lesions, stenotic or occluded. A completely occluded artery was defined as having no blood flow on color and spectral imaging. A plaque was defined as a focal region that protruded into the lumen > 1.5 mm and was distinct from the adjacent boundary. In each artery, PAD progression at follow-up was conservatively defined as either a new stenosis or progression of a baseline stenosis to an occlusion. Six-minute walk test and functional questionnaires For the 6-MWD test, subjects were asked to walk in the hall for 6 minutes as per the previously published method. 8 They were asked to cover as much distance as possible during the 6 minutes and were also told to rest and resume walking or cease walking if needed. The primary unit of analysis was the total distance walked (in meters) regardless of whether the subjects stopped or not during the conduct of the test.
3 12 Vascular Medicine 17(1) Table 1. Demographics of the study population, n = 50 Variable Category n (%) Sex Male 22 (44) Female 28 (56) Ethnicity Non-Hispanic white 29 (58) African American 18 (36) Hispanic 2 (4) Native American 1 (2) The SDCQ 2 is a modification of the WHO claudication questionnaire, and yields five mutually exclusive leg pain categories: no pain, pain at rest, non-calf pain, atypical calf pain, and classic claudication. For leg-specific analyses, we collapsed the initial three categories into no claudication and the final two categories, both of which involve calf pain on exertion that does not begin at rest, into claudication. The WIQ is a validated measure, which has questions regarding walking distance, walking speed and stairclimbing. 9 The walking distance questions concern the degree of physical difficulty walking distances ranging from indoors around the home to 1500 feet (five blocks; 457 meters) without stopping to rest, with answers ranging from no difficulty to inability to walk that distance. The walking speed questions concern the degree of physical difficulty walking one city block without stopping at speeds ranging from slowly to running or jogging, with answers ranging from no difficulty to inability to move at that speed. The stair-climbing questions range from one to three flights without stopping to rest, with answers again ranging from no difficulty to inability to climb flights of stairs. Statistical analysis Mean Age (years) Weight (kg) Height (m) Body mass index Standard deviation Data were entered into a relational database created in Microsoft Access with screens that reflected the paper forms. The screens included range and validity checks. The data were converted into a file usable by SAS 9.2, which was used for all statistical analyses. Data were checked and edited. Descriptive analyses were conducted to characterize the subjects at baseline. The follow-up analyses were performed on available data from subjects completing the study and therefore excluded the baseline data from subjects not available at follow-up. Correlations among variables were examined to assist in assessing issues of co-linearity. Bivariate analyses compared mean and standard deviation for continuous variables sorted by binary or categorical variables, with t-test for difference in means. General linear models were used for analyses of change data. All p-values reflect two-tailed tests. Results Subject characteristics A total of 50 subjects with abnormal ABI on community screening underwent repeat ABI testing and duplex ultrasound in the vascular laboratory (Table 1). There were six subjects without PAD in the study population. Therefore, out of the 50 subjects, 44 had objective evidence of PAD defined as an abnormal ABI and atherosclerotic plaque on ultrasound. The population was an older age group with 58% of non-hispanic white ethnic origin. The comorbidities included hypertension (n = 36), hypercholesterolemia (n = 27), and diabetes (n = 15), with all defined as being on prescription medication(s) for the disease. Eight subjects had a previous myocardial infarction and three had a previous cerebrovascular accident. Three deaths occurred during the study: one secondary to spontaneous bacterial peritonitis, one due to cardiorespiratory arrest following a stroke, and one due to complications from ischemic cardiomyopathy in the setting of colon cancer. Ankle brachial index and SDCQ The ABI and SDCQ results are given in Table 2 and are depicted in sequential columns for all subjects at baseline, for study completers at baseline, for study completers at follow-up, and for the change over time study completers. The mean ABI in each leg was consistent with mild moderate PAD. Study completers had similar ABIs at baseline to the non-completers, with no significant differences in any ABI measurement between the two groups, and the ABI in completers actually increased slightly. When the original 50 subjects were evaluated by leg, 80 legs had PAD and 20 legs did not have PAD. Ten legs had claudication and 90 did not have claudication. After excluding the six subjects without PAD, there were 78 legs without claudication (Table 2). The 10 legs with claudication were included because the symptoms had changed from the initial eligibility screening, and four of these legs were studied at followup. Thirteen of 50 legs (seven subjects) developed claudication at follow-up as per SDCQ. 6-MWD and WIQ Table 3 uses the same format as Table 2. There were no significant differences between completers and non-completers at baseline (p-values for 6-MWD = 0.19; WIQ distance = 0.62; WIQ speed = 0.93; WIQ stairs = 0.55). Although walking distance declined about 20 meters overall, this change was not statistically significant (excluding the two non-walkers at the 1-year follow-up, the p-value was 0.21; including them with values of 0, the p-value was 0.06). At baseline the WIQ demonstrated that completing patients had moderate severity of functional limitations in walking distance (60%), speed (45%), and stair-climbing (56%) scores. None of the WIQ scores showed significant changes over 1 year (p-values were 0.89, 0.94 and 0.70, respectively).
4 Mohler ER III et al. 13 Table 2. Ankle brachial index (ABI) and leg pain category n Baseline n Baseline for study completers Follow-up Change Mean SD Mean SD Mean SD Mean SD ABI Left lower ABI Left higher ABI Right lower ABI a 0.13 Right higher ABI n n n n Claudication No claudication b 13 b Claudication a p-value < b Two legs were missing the San Diego Claudication Questionnaire (SDCQ) at follow-up. Table 3. Six-minute walk distance (6-MWD) and Walking Impairment Questionnaire (WIQ) Baseline (n = 44) Baseline for study completers (n = 27) Follow-up (n = 27) a Change (n = 27) a Mean SD Mean SD Mean SD Mean SD 6-MWD (meters) Everyone (n = 44) Non-quitters (n = 41) Non-resters (n = 38) WIQ (scores) Distance (%) Speed (%) Stairs (%) Non-quitters included those who had to rest during the walking time, whereas non-resters were those individuals who walked for the entire 6 minutes. a Two individuals were unable to perform the 6-minute walk at follow-up. Table 4. Lower extremity PAD progression according to anatomical site on ultrasound over 1 year Right leg Left leg Patient 1 Proximal PTA stenosis Patient 2 Proximal PTA stenosis Patient 3 POP occlusion Patient 4 PTA occlusion Distal POP stenosis Patient 5 Mid SFA stenosis Patient 6 Distal CFA stenosis Distal CFA stenosis Patient 7 Mid POP stenosis Mid POP stenosis Patient 8 Distal PTA stenosis Patient 9 Distal CFA stenosis Patient 10 Distal SFA stenosis Distal SFA stenosis Patient 11 Proximal SFA stenosis Patient 12 Mid SFA stenosis Patient 13 SFA occlusion; POP occlusion* Patient 14 Proximal POP stenosis Proximal CFA stenosis; proximal POP stenosis PTA, posterior tibial artery; POP, popliteal; SFA, superficial femoral artery; CFA, common femoral artery. a These two lesions were prior stenoses that progressed to occlusion. The remaining lesions were all new stenoses or new occlusions. Lower extremity artery lesions and PAD progression on ultrasound At baseline, atherosclerotic lesions that involved arteries of both lower extremities from the common femoral to posterior tibial level were identified by duplex ultrasound. Forty-four subjects had significant atherosclerotic lesions in the lower extremity arteries, with 80 affected legs. The majority of complete vessel occlusions were in the posterior tibial artery. Of the 13 individuals with occlusions in the posterior tibial arteries, nine had diabetes mellitus. Sixty percent of diabetics (9/15) had posterior tibial occlusions, in contrast with 11% of non-diabetics (4/35) (p = 0.009). All common femoral artery waveforms were triphasic, making significant more proximal disease unlikely. In study completers, PAD was present at baseline in 48 of the 66 legs. Over 1 year of follow-up, two of the 18 normal legs at baseline developed PAD, and of the 48 legs with PAD at baseline, 17 developed new or progressive lesions. Two legs developed two separate lesions. The leg-specific anatomical location of these 21 lesions in 19 legs of 14 subjects is shown in Table 4. Changes were observed for both above and below-knee vessels, with seven new lesions in the popliteal artery, six in the superficial femoral artery
5 14 Vascular Medicine 17(1) Table 5. Subject characteristics according to lesion progression Lesion progression n = 14 (SFA), four in the common femoral artery (CFA), and four in the posterior tibial artery (PTA). Table 5 shows the characteristics of subjects who had lesion progression compared to those who did not have lesion progression. Although the numbers are small in each group, those who progressed tended to be male, have a higher percentage of hypertension, diabetes and high cholesterol and had more smoking pack years. The cardiovascular disease co-morbidities were similar except for an excess of carotid occlusion. PAD progression on ultrasound and change in claudication, ABI, 6-MWD, and WIQ Non-lesion progression n = 19 Age, mean (SD) (7.20) (8.77) Male, n (%) 7 (50) 6 (32) High blood pressure, 12 (86) 11 (58) n (%) Diabetes, n (%) 6 (43) 3 (16) High cholesterol, n (%) 11 (79) 8 (42) Smoking status 5 never, 7 former, 8 never, 11 former 2 current Pack years (0.6 64) ( ) ever-smokers, mean (range) MI, n (%) 1 (7) 2 (11) Stroke, n (%) 1 (7) 0 Carotid occlusion, 4 (29) 0 n (%) CHF, n (%) 1 (7) 2 (11) Family history of CVD, n (%) 8 (57) 12 (63) MI, myocardial infarction; CHF, congestive heart failure; CVD, cardiovascular disease. Compared to the 47 legs without ultrasound changes, the 19 legs with PAD progression on duplex ultrasound showed a significantly higher rate of incident claudication: 43.8 versus 13.6%, p-value = (Table 6). Legs with PAD progression also showed a smaller increase in the PT and AT (anterior tibial) ABIs, a slightly greater decline in the 6-MWD, and decline rather than increase in the WIQ distance, speed, and stair-climbing scores. However, except for incident claudication, none of these differences was statistically significant. The DP change and the PT change were highly correlated (r = 0.58, p-value < ), but neither was significantly correlated with walking distance change (r = 0.05, p-value 0.73; r = 0.23, p-value = 0.10, respectively). Claudication change and 6-MWD change Legs of study completers could be grouped into three categories based on their SDCQ results at baseline and followup: Group 1 continued no claudication (n = 35 legs of 18 subjects); Group 2 no claudication converting to claudication (n = 13 legs of seven subjects); and Groups 3 continued claudication (n = four legs of two subjects). Figure 1 shows that change in distance on the 6-MWD was 5.3 meters for Group 1 (reference), 36.6 meters for Group 2 (p = 0.05 vs Group 1), and 99.1 meters for Group 3 (p = < vs Group 1 and p = 0.03 vs Group 2). Discussion This study demonstrated that patients without claudication but with atherosclerotic lesions on ultrasound had lesion progression over 1 year, and that progression occurred in a variety of vessels. Claudication was more likely to develop if there was concomitant lesion progression, and new claudicants had a significant decrease in the 6-MWD. However, overall there was minimal change in the ABI, 6-MWD, or WIQ over 1 year. Several studies, beginning as early as the 1940s, have reported the progression of claudication symptoms in patients with PAD who had classic symptoms of claudication at study initiation. 11,12 These early studies mainly focused on the development of need for surgery, foot ulceration, and gangrene but also asked patients if claudication symptoms had worsened over time. Clinical risk factors such as smoking and diabetes were correlated with increased risk for progression of disease. One study of 15 Table 6. One-year claudication, ABI, 6-MWD, and WIQ change by change in PAD progression status No PAD progression PAD progression p-value for difference n Development of claudication after baseline (%) Posterior tibial ABI change Anterior tibial ABI change MWD change (meters) WIQ distance change (%) WIQ speed change (%) WIQ stairs change (%) ABI, ankle brachial index; 6-MWD, 6-minute walk distance; WIQ, Walking Impairment Questionnaire. Excluded from claudication analyses were four legs with claudication at baseline (three of which had PAD progression) and two legs with a missing San Diego Claudication Questionnaire (SDCQ) at follow-up.
6 Mohler ER III et al Six Minute Walk Distance Change Change in Meters Walked Over One Year Ref. * = p-value=0.05 ** = p-value <0.001 No Claudica on, No Change (N=35) * No Claudica on Claudica on (N=13) ** Claudica on, No Change (N=4) Figure 1. Six-minute walk distance change according to claudication group at 1 year of follow-up (p-values are comparison against the no claudication, no change group). patients evaluating progression of disease on serial angiography in patients with claudication found over a 5-year period reported progression of claudication symptoms (patient s subjective report) in two patients and progression of disease in 14 legs. 13 A publication from the Edinburgh Artery Study, a large-scale cohort study of 695 subjects (5.1% with PAD) aged years, reported claudication developing in 179 cases over a 12-year follow-up. 14 The progression of atherosclerotic disease occurred more rapidly in the leg with the higher ABI than in the leg with the lower ABI. In a study evaluating the natural history of PAD using angiography and ultrasound, superficial femoral artery lesions progressed more rapidly among patients whose contralateral superficial femoral artery was occluded. 15 In our study, the conversion from no claudication to claudication was a bilateral phenomenon in six out of the seven patients with symptom progression. The ability of the ABI to predict disease progression in the lower extremity appears less sensitive than ultrasound in the present study, although the follow-up was limited to 12 months. A study by McLafferty et al. of 193 extremities in patients with prior lower-extremity revascularization, found that the ABI was relatively insensitive in identifying disease progression as demonstrated on angiography or duplex ultrasound scanning. 16 Similarly, despite PAD progression and development of claudication, overall neither the 6-MWD nor the WIQ changed significantly over 1 year. Limitations The aorto-iliac vascular territory was not evaluated directly in this study and thus proximal disease cannot be completely ruled out in subjects. However, the spectral Doppler waveform in all subjects was triphasic at the proximal common femoral artery, indicating no significant proximal disease in subjects. There was some attrition that occurred throughout the course of the study, including three subjects who died. This attrition may have introduced a type 2 statistical error for questionnaires. The baseline ABIs of non-completers was not statistically different from the ABIs of completers (Table 2). It is unclear how their non-participation might have affected the progression data. Mortality in this study most likely minimized disease progression, since disease progression has been independently related to mortality. 17 Another potential limitation is that there were some instances where the same ultrasound technician at the University of Pennsylvania site did not conduct the follow-up ultrasound study; theoretically that could introduce variability. Conclusions and clinical implications There is a population of subjects with no classic claudication symptoms who have both reduced ABI and significant atherosclerotic lesions in the lower extremity arteries. A significant number of legs (21%) developed claudication over 1 year. These data support the hypothesis that a significant number of asymptomatic patients with PAD and abnormal ABI progress relatively rapidly. Those progressing were more likely to develop claudication, and new claudicants had a decrease in 6-MWD. This population deserves more study to determine if risk factor modification inhibits atherosclerotic lesion progression and development of symptoms. Funding This study was supported by an unrestricted grant from Bristol- Myers Squibb and Sanofi-Aventis pharmaceutical companies. Conflict of interest A portion of Dr Mohler s salary was supported via NIH National Heart, Lung, and Blood Institute grant K12 HL Dr Mohler received an unrestricted research grant from the Bristol- Myers Squibb and Sanofi-Aventis partnership to conduct the study. The other authors do not report any relevant disclosures. References 1. Hirsch AT, Criqui MH, Treat-Jacobson D, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA 2001; 286:
7 16 Vascular Medicine 17(1) 2. Criqui MH, Denenberg JO, Bird CE, Fronek A, Klauber MR, Langer RD. The correlation between symptoms and noninvasive test results in patients referred for peripheral arterial disease testing. Vasc Med 1996; 1: Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation 2006; 113: e463 e McDermott MM, Criqui MH, Greenland P, et al. Leg strength in peripheral arterial disease: associations with disease severity and lower-extremity performance. J Vasc Surg 2004; 39: Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg 2007; 45 Suppl S: S Van der Feen C, Neijens FS, Kanters SD, Mali WP, Stolk RP, Banga JD. Angiographic distribution of lower extremity atherosclerosis in patients with and without diabetes. Diabet Med 2002; 19: Mohler ER, Jaff MR. Peripheral arterial disease. Philadelphia: American College of Physicians, Montgomery PS, Gardner AW. The clinical utility of a sixminute walk test in peripheral arterial occlusive disease patients. J Am Geriatr Soc 1998; 46: Regensteiner JG, Steiner JF, Panzer RJ, Hiatt WR. Evaluation of walking impairment by questionnaire in patients with peripheral arterial disease. J Vasc Med Biol 1990; 2: Gerhard-Herman M, Gardin JM, Jaff M, Mohler E, Roman M, Naqvi TZ. Guidelines for noninvasive vascular laboratory testing: a report from the American Society of Echocardiography and the Society of Vascular Medicine and Biology. J Am Soc Echocardiogr 2006; 19: Boyd AM. The natural course of arteriosclerosis of the lower extremities. Proc R Soc Med 1962; 55: Cronenwett JL, Warner KG, Zelenock GB, et al. Intermittent claudication. Current results of nonoperative management. Arch Surg 1984; 119: Coran AG, Warren R. Arteriographic changes in femoropopliteal arteriosclerosis obliterans. A five-year follow-up study. N Engl J Med 1966; 274: Smith FB, Lee AJ, Price JF, van Wijk MC, Fowkes FG. Changes in ankle brachial index in symptomatic and asymptomatic subjects in the general population. J Vasc Surg 2003; 38: Walsh DB, Gilbertson JJ, Zwolak RM, et al. The natural history of superficial femoral artery stenoses. J Vasc Surg 1991; 14: McLafferty RB, Moneta GL, Taylor LM Jr, Porter JM. Ability of ankle brachial index to detect lower-extremity atherosclerotic disease progression. Arch Surg 1997; 132: ; discussion Criqui MH, Ninomiya JK, Wingard DL, Ji M, Fronek A. Progression of peripheral arterial disease predicts cardiovascular disease morbidity and mortality. J Am Coll Cardiol 2008; 52:
USWR 23: Outcome Measure: Non Invasive Arterial Assessment of patients with lower extremity wounds or ulcers for determination of healing potential
USWR 23: Outcome Measure: Non Invasive Arterial Assessment of patients with lower extremity wounds or ulcers for determination of healing potential MEASURE STEWARD: The US Wound Registry [Note: This measure
More informationTABLE OF CONTENTS. 2. LOWER EXTREMITY PERIPHERAL ARTERIAL DISEASE 2.1. Epidemiology Risk Factors
LOWER EXTREMITY PAD The following is one of three extracted sections lower extremity, renal/mesenteric, and abdominal aortic of the ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral
More informationPerfusion Assessment in Chronic Wounds
Perfusion Assessment in Chronic Wounds American Society of Podiatric Surgeons Surgical Conference September 22, 2018 Michael Maier, DPM, FACCWS Cardiovascular Medicine Cleveland Clinic Disclosures Speaker,
More informationNational Clinical Conference 2018 Baltimore, MD
National Clinical Conference 2018 Baltimore, MD No relevant financial relationships to disclose Wound Care Referral The patient has been maximized from a vascular standpoint. She has no other options.
More informationNon-invasive examination
Non-invasive examination Segmental pressure and Ankle-Brachial Index (ABI) The segmental blood pressure (SBP) examination is a simple, noninvasive method for diagnosing and localizing arterial disease.
More informationLower Extremity Artery: Physiologic Testing
Master Title Ultrasound for Initial Evaluation of Lower Extremity Arterial Occlusive Disease: WHY? Gregory L. Moneta MD Professor and Chief Knight Cardiovascular Institute Division of Vascular Surgery
More informationPeripheral Arterial Disease: Who has it and what to do about it?
Peripheral Arterial Disease: Who has it and what to do about it? Seth Krauss, M.D. Alaska Annual Nurse Practitioner Conference September 16, 2011 Scope of the Problem Incidence: 20%
More informationDeclining Walking Impairment Questionnaire Scores Are Associated With Subsequent Increased Mortality in Peripheral Artery Disease
Journal of the American College of Cardiology Vol. 61, No. 17, 2013 2013 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jacc.2013.01.060
More informationPeripheral Arterial Disease: the growing role of endovascular management
Peripheral Arterial Disease: the growing role of endovascular management Poster No.: C-1931 Congress: ECR 2012 Type: Educational Exhibit Authors: E. M. C. Guedes Pinto, E. Rosado, D. Penha, P. Cabral,
More informationPrevalence, Progression and Associated Risk Factors of Asymptomatic Peripheral Arterial Disease
ORIGINAL PAPER ORIGINAL PAPER The ANNALS of AFRICAN SURGERY www.annalsofafricansurgery.com Prevalence, Progression and Associated Risk Factors of Asymptomatic Peripheral Arterial Disease Nikita Mehta 1,
More informationEarly Identification of PAD: Evidence to Refute USPSTF Position on Screening
Early Identification of PAD: Evidence to Refute USPSTF Position on Screening Mehdi H. Shishehbor, DO, MPH, PhD Director Endovascular Services Interventional Cardiology & Vascular Medicine Department of
More informationAnkle brachial index performance among internal medicine residents
Ankle brachial index performance among internal medicine residents Vascular Medicine 15(2) 99 105 The Author(s) 2010 Reprints and permission: http://www. sagepub.co.uk/journalspermission.nav DOI: 10.1177/1358863X09356015
More informationWhat s New in the Management of Peripheral Arterial Disease
What s New in the Management of Peripheral Arterial Disease Sibu P. Saha, MD, MBA Professor of Surgery Chairman, Directors Council Gill Heart Institute University of Kentucky Lexington, KY Disclosure My
More informationGarland Green, MD Interventional Cardiologist. Impact of PAD: Prevalence, Risk Factors, Testing, and Medical Management
Garland Green, MD Interventional Cardiologist Impact of PAD: Prevalence, Risk Factors, Testing, and Medical Management Peripheral Arterial Disease Affects over 8 million Americans Affects 12% of the general
More informationPeripheral Arterial Disease: Objectives. Disclosure. Definition: Peripheral Arterial Disease (PAD)
Geriatric Grand Rounds Tuesday, April 21, 2009 12:00 noon Dr. Bill Black Auditorium Glenrose Rehabilitation Hospital In keeping with Glenrose Rehabilitation Hospital policy, speakers participating in this
More informationGender and Peripheral Arterial Disease
Gender and Peripheral Arterial Disease Tracie C. Collins, MD, MPH, Maria Suarez-Almazor, MD, PhD, Ruth L. Bush, MD, and Nancy J. Petersen, PhD Objective: The aim of this study is to determine gender differences
More informationJohn E. Campbell, MD. Assistant Professor of Surgery and Medicine Department of Vascular Surgery West Virginia University, Charleston Division
John E. Campbell, MD Assistant Professor of Surgery and Medicine Department of Vascular Surgery West Virginia University, Charleston Division John Campbell, MD For the 12 months preceding this CME activity,
More informationCLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION
Donald L. Renfrew, MD Radiology Associates of the Fox Valley, 333 N. Commercial Street, Suite 100, Neenah, WI 54956 6/30/2012 Radiology Quiz of the Week # 79 Page 1 CLINICAL PRESENTATION AND RADIOLOGY
More informationPeripheral Arterial Disease Management A Practical Guide for Internists. EFIM Vascular Working Group
2 Peripheral Arterial Disease Management A Practical Guide for Internists EFIM Vascular Working Group 1 Peripheral arterial disease (PAD) is a growing concern among our aging population. More than 27 million
More informationIntroduction. Risk factors of PVD 5/8/2017
PATHOPHYSIOLOGY AND CLINICAL FEATURES OF PERIPHERAL VASCULAR DISEASE Dr. Muhamad Zabidi Ahmad Radiologist and Section Chief, Radiology, Oncology and Nuclear Medicine Section, Advanced Medical and Dental
More informationWhen to screen for PAD? Prof. Dr.Tine De Backer Prof. Dr. Jean-Claude Wautrecht
When to screen for PAD? Prof. Dr.Tine De Backer Prof. Dr. Jean-Claude Wautrecht How do we define asymptomatic PAD? A. ABI < 1 B. ABI < 0.9 C. ABI < 0.8 D. ABI > 1 How do we define asymptomatic PAD? A.
More informationJOURNAL OF VASCULAR SURGERY Volume 32, Number 6 McDermott et al 1165 METHODS
Lower ankle/brachial index, as calculated by averaging the dorsalis pedis and posterior tibial arterial pressures, and association with leg functioning in peripheral arterial disease Mary McGrae McDermott,
More informationPeripheral Arterial Disease Extremity
Peripheral Arterial Disease Lower Extremity 05 Contributor Dr Steven Chong Advisors Dr Ashish Anil Dr Tay Jam Chin Introduction Risk Factors Clinical Presentation Classification History PHYSICAL examination
More informationThe Walking Impairment Questionnaire stair-climbing score predicts mortality in men and women with peripheral arterial disease
The Walking Impairment Questionnaire stair-climbing score predicts mortality in men and women with peripheral arterial disease Atul Jain, MD, a Kiang Liu, PhD, a Luigi Ferrucci, MD, PhD, b Michael H. Criqui,
More informationRadiologic Evaluation of Peripheral Arterial Disease
January 2003 Radiologic Evaluation of Peripheral Arterial Disease Grace Tye, Harvard Medical School Year III Patient D.M. CC: 44 y/o male with pain in his buttocks Occurs after walking 2 blocks. Pain is
More informationImaging for Peripheral Vascular Disease
Imaging for Peripheral Vascular Disease James G. Jollis, MD Director, Rex Hospital Cardiovascular Imaging Imaging for Peripheral Vascular Disease 54 year old male with exertional calf pain in his right
More informationBaseline Functional Performance Predicts the Rate of Mobility Loss in Persons With Peripheral Arterial Disease
Journal of the American College of Cardiology Vol. 50, No. 10, 2007 2007 by the American College of Cardiology Foundation ISSN 0735-1097/07/$32.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2007.05.030
More informationThe Accuracy of a Volume Plethysmography System as Assessed by Contrast Angiography
Research imedpub Journals http://www.imedpub.com/ DOI: 10.21767/2572-5483.100036 Journal of Preventive Medicine The Accuracy of a Volume Plethysmography System as Assessed by Contrast Angiography Andrew
More informationPeripheral arterial disease (PAD) is a highly prevalent
Exertional Leg Pain in Patients With and Without Peripheral Arterial Disease Jimmy C. Wang, MD; Michael H. Criqui, MD, MPH; Julie O. Denenberg, MA; Mary M. McDermott, MD; Beatrice A. Golomb, MD, PhD; Arnost
More informationV.A. is a 62-year-old male who presents in referral
, LLC an HMP Communications Holdings Company Clinical Case Update Latest Trends in Critical Limb Ischemia Imaging Amit Srivastava, MD, FACC, FABVM Interventional Cardiologist Bay Area Heart Center St.
More informationThe Struggle to Manage Stroke, Aneurysm and PAD
The Struggle to Manage Stroke, Aneurysm and PAD In this article, Dr. Salvian examines the management of peripheral arterial disease, aortic aneurysmal disease and cerebrovascular disease from symptomatology
More informationSelf-reported symptoms on questionnaires and anatomic lesions on duplex ultrasound examinations in patients with peripheral arterial disease
Self-reported symptoms on questionnaires and anatomic lesions on duplex ultrasound examinations in patients with peripheral arterial disease Moniek van Zitteren, MD, MSc, a,b Patrick W. Vriens, MD, PhD,
More informationMaking the difference with Live Image Guidance
Live Image Guidance 2D Perfusion Making the difference with Live Image Guidance In Peripheral Arterial Disease Real-time results, instant assessment Severe foot complications the result of hampered blood
More informationLarry Diaz, MD, FSCAI Mehdi H. Shishehbor, DO, FSCAI
PAD Diagnosis Larry Diaz, MD, FSCAI Metro Health / University of Michigan Health, Wyoming, MI Mehdi H. Shishehbor, DO, FSCAI University Hospitals Harrington Heart & Vascular Institute, Cleveland, OH PAD:
More informationGoals of Screening Programs. What is Vascular Screening? Assumptions Regarding the Potential Benefits of Screening Programs PAD
Conflict of Interest Disclosure (Relationships with Industry) An Epidemic of : The Debate Over Population Screening Membership on an advisory board, consultant, or recipient of a research grant from the
More informationObjective assessment of CLI patients Hemodynamic parameters
Objective assessment of CLI patients Hemodynamic parameters Worth anything in end stage patients? Marianne Brodmann Angiology, Medical University Graz, Austria Disclosure Speaker name: Marianne Brodmann
More informationJohn E. Campbell, MD Assistant Professor of Surgery and Medicine Department of Vascular Surgery West Virginia University, Charleston Division
John E. Campbell, MD Assistant Professor of Surgery and Medicine Department of Vascular Surgery West Virginia University, Charleston Division John Campbell, MD For the 12 months preceding this CME activity,
More information- Lecture - Recommandations ESC : messages importants P. MEYER (Saint Laurent du Var) - Controverse - Qui doit faire l'angioplastie périphérique?
- Lecture - Recommandations ESC : messages importants P. MEYER (Saint Laurent du Var) - Controverse - Qui doit faire l'angioplastie périphérique? Un chirurgien E. DUCASSE (Bordeaux) Un interventionnel
More informationClinical Appropriateness Guidelines: Arterial Ultrasound
Clinical Appropriateness Guidelines: Arterial Ultrasound Appropriate Use Criteria Effective Date: January 2, 2018 Proprietary Date of Origin: 8/27/2015 Last revised: 11/02/2017 Last reviewed: 11/02/2017
More informationHypothesis: When compared to conventional balloon angioplasty, cryoplasty post-dilation decreases the risk of SFA nses in-stent restenosis
Cryoplasty or Conventional Balloon Post-dilation of Nitinol Stents For Revascularization of Peripheral Arterial Segments Background: Diabetes mellitus is associated with increased risk of in-stent restenosis
More informationClinical Features and Subtypes of Ischemic Stroke Associated with Peripheral Arterial Disease
Cronicon OPEN ACCESS EC NEUROLOGY Research Article Clinical Features and Subtypes of Ischemic Stroke Associated with Peripheral Arterial Disease Jin Ok Kim, Hyung-IL Kim, Jae Guk Kim, Hanna Choi, Sung-Yeon
More informationClinicians traditionally associate lower extremity peripheral
Leg Symptoms, the Ankle-Brachial Index, and Walking Ability in Patients With Peripheral Arterial Disease Mary McGrae McDermott, MD, Shruti Mehta, BA, Kiang Liu, PhD, Jack M. Guralnik, MD, PhD, Gary J.
More informationLimitation of the resting ankle brachial index in symptomatic patients with peripheral arterial disease
Limitation of the resting ankle brachial index in symptomatic patients with peripheral arterial disease Russell Stein a, Ingrid Hriljac a, Jonathan L Halperin a, Susan M Gustavson a, Victoria Teodorescu
More informationCase Study: Chris Arden. Peripheral Arterial Disease
Case Study: Chris Arden Peripheral Arterial Disease Patient Presentation Diane is a 65-year-old retired school teacher She complains of left calf pain when walking 50 metres; the pain goes away after she
More informationPeripheral Arterial Disease. Westley Smith MD Vascular Fellow
Peripheral Arterial Disease Westley Smith MD Vascular Fellow Background (per 10,000) Goodney P, et al. Regional intensity of vascular care and lower extremity amputation rates. JVS. 2013; 6: 1471-1480.
More informationRole of ABI in Detecting and Quantifying Peripheral Arterial Disease
Role of ABI in Detecting and Quantifying Peripheral Arterial Disease Difference in AAA size between US and Surgeon 2 1 0-1 -2-3 0 1 2 3 4 5 6 7 Mean AAA size between US and Surgeon Kathleen G. Raman MD,
More informationIntroduction to Peripheral Arterial Disease. Stacey Clegg, MD Interventional Cardiology August
Introduction to Peripheral Arterial Disease Stacey Clegg, MD Interventional Cardiology August 20 2014 Outline (and for the ABIM board exam * ** ***) Prevalence* Definitions Lower Extremity: Aorta*** Claudication***
More informationPractical Point in Diabetic Foot Care 3-4 July 2017
Diabetic Foot Ulcer : Role of Vascular Surgeon Practical Point in Diabetic Foot Care 3-4 July 2017 Supapong Arworn, MD Division of Vascular and Endovascular Surgery Department of Surgery, Chiang Mai University
More informationJoshua A. Beckman, MD. Brigham and Women s Hospital
Peripheral Vascular Disease: Overview, Peripheral Arterial Obstructive Disease, Carotid Artery Disease, and Renovascular Disease as a Surrogate for Coronary Artery Disease Joshua A. Beckman, MD Brigham
More informationPeripheral Arterial Occlusive Disease- The Challenge in patients with diabetes
Peripheral Arterial Occlusive Disease- The Challenge in patients with diabetes Ashok Handa Reader in Surgery and Consultant Surgeon Nuffield Department of Surgery University of Oxford Introduction Vascular
More informationSurveillance of Peripheral Arterial Disease Cases Using Natural Language Processing of Clinical Notes
Surveillance of Peripheral Arterial Disease Cases Using Natural Language Processing of Clinical Notes Naveed Afzal, Sunghwan Sohn, Christopher G. Scott, Hongfang Liu, Iftikhar J. Kullo, Adelaide M. Arruda-Olson
More informationHybrid surgical treatment of bilateral aorto-femoral occlusion: a clinical case
Hybrid surgical treatment of bilateral aorto-femoral occlusion: a clinical case Chernyavskiy M.,MD,PhD, Chernova D., Zherdev N., Chernov A. Almazov National Medical Research Centre, St.Petersburg, Russia
More informationPractical Point in Holistic Diabetic Foot Care 3 March 2016
Diabetic Foot Ulcer : Vascular Management Practical Point in Holistic Diabetic Foot Care 3 March 2016 Supapong Arworn, MD Division of Vascular and Endovascular Surgery Department of Surgery, Chiang Mai
More informationCath Lab Essentials : Peripheral Vascular Disease in Patients with CAD
Cath Lab Essentials : Peripheral Vascular Disease in Patients with CAD Pranav M. Patel, MD, FACC, FSCAI Interim Chief & Associate Professor of Medicine Director, Cardiac Catheterization Lab University
More informationClaudication Treatment Comparative Effectiveness: 6 Month Outcomes from the CLEVER Study
Claudication Treatment Comparative Effectiveness: 6 Month Outcomes from the CLEVER Study Authors: Murphy TP, Cutlip DE, Regensteiner JG, Mohler ER, Cohen DC, Reynolds MR, Lewis BA, Cerezo J, Oldenburg
More informationPERIPHERAL ARTERIAL DISEASE (PAD); Frequency in diabetics.
PERIPHERAL ARTERIAL DISEASE (PAD); Frequency in diabetics. ORIGINAL PROF-2084 Dr. Qaiser Mahmood, Dr. Nasreen Siddique, Dr. Affan Qaiser ABSTRACT Objectives: (1) To determine the frequency of PAD in diabetic
More informationThe Changing Landscape of Managing Patients with PAD- Update on the Evidence and Practice of Care in Patients with Peripheral Artery Disease
Interventional Cardiology and Cath Labs The Changing Landscape of Managing Patients with PAD- Update on the Evidence and Practice of Care in Patients with Peripheral Artery Disease Manesh R. Patel MD Chief,
More informationClinical and morphological features of patients who underwent endovascular interventions for lower extremity arterial occlusive diseases
Original paper Clinical and morphological features of patients who underwent endovascular interventions for lower extremity arterial occlusive diseases Sakir Arslan, Isa Oner Yuksel, Erkan Koklu, Goksel
More informationCritical Limb Ischemia A Collaborative Approach to Patient Care. Christopher LeSar, MD Vascular Institute of Chattanooga July 28, 2017
Critical Limb Ischemia A Collaborative Approach to Patient Care Christopher LeSar, MD Vascular Institute of Chattanooga July 28, 2017 Surgeons idea Surgeons idea represents the final stage of peripheral
More informationNADINE R. BARSOUM, M.D.; LAMIAA I.A. METWALLY, M.D. and IMAN M. HAMDY IBRAHIM, M.D.
Med. J. Cairo Univ., Vol. 84, No. 2, December: 175-183, 2016 www.medicaljournalofcairouniversity.net Peripheral Arterial Disease of the Lower Limbs: Is Doppler Examination as Efficient in its Diagnosis
More informationVASCULAR DISEASE: THREE THINGS YOU SHOULD KNOW JAMES A.M. SMITH, D.O. KANSAS VASCULAR MEDICINE, P.A. WICHITA, KANSAS
VASCULAR DISEASE: THREE THINGS YOU SHOULD KNOW JAMES A.M. SMITH, D.O. KANSAS VASCULAR MEDICINE, P.A. WICHITA, KANSAS KANSAS ASSOCIATION OF OSTEOPATHIC MEDICINE ANNUAL CME CONVENTION APRIL 13, 2018 THREE
More informationEndovascular intervention for patients with femoro-popliteal and aorto-iliac TASC D lesions
Endovascular intervention for patients with femoro-popliteal and aorto-iliac TASC D lesions Poster No.: C-2012 Congress: ECR 2014 Type: Educational Exhibit Authors: E. Thomee, W. C. Liong, D. R. Warakaulle;
More informationPAD Characterization Within A Healthcare System" RAPID Face-to-Face Meeting Schuyler Jones, MD September 14, 2016
PAD Characterization Within A Healthcare System" RAPID Face-to-Face Meeting Schuyler, MD September 14, 2016 Interventional Cardiology and Cath Labs Disclosures Research Grants: Agency for Healthcare Research
More informationSTATINS FOR PAD Long - term prognosis
STATINS FOR PAD Long - term prognosis Prof. Pavel Poredos, MD, PhD Department of Vascular Disease University Medical Centre Ljubljana Slovenia DECLARATION OF CONFLICT OF INTEREST No conflict of interest
More informationResearch Article. Sanjeev Agarwal 1 *, Ritu Mehta 2, C. P. Joshi 1. DOI:
International Surgery Journal Agarwal S et al. Int Surg J. 2016 May;3(2):537-542 http://www.ijsurgery.com pissn 2349-3305 eissn 2349-2902 Research Article DOI: http://dx.doi.org/10.18203/2349-2902.isj20160953
More informationThank you for the opportunity to provide expert advice on the Draft Research Plan on Screening for Peripheral Artery Disease.
January 12, 2012 Robert L. Cosby, Ph.D., MSW Senior Coordinator, USPSTF Department of Health and Human Services Agency for Healthcare Research and Quality Center for Primary Care, Prevention and Clinical
More informationImaging Strategy For Claudication
Who are the Debators? Imaging Strategy For Claudication Duplex Ultrasound Alone is Adequate to Select Patients for Endovascular Intervention - Pro: Dennis Bandyk MD No Disclosures PRO - Vascular Surgeon
More informationFollow this and additional works at: Part of the Biomechanics Commons
University of Nebraska Omaha DigitalCommons@UNO Journal Articles Biomechanics Research Building 3-2008 Claudication distances and the Walking Impairment Questionnaire best describe the ambulatory limitations
More informationSAFETY AND EFFECTIVENESS OF ENDOVASCULAR REVASCULARIZATION FOR PERIPHERAL ARTERIAL OCCLUSIONS
SAFETY AND EFFECTIVENESS OF ENDOVASCULAR REVASCULARIZATION FOR PERIPHERAL ARTERIAL OCCLUSIONS LIBBY WATCH, MD MIAMI VASCULAR SPECIALISTS MIAMI CARDIAC & VASCULAR INSTITUTE FINANCIAL DISCLOSURES None 2
More informationArterial Studies And The Diabetic Foot Patient
Arterial Studies And The Patient George L. Berdejo, BA, RVT, FSVU gberdejo@wphospital.org Disclosures I have nothing to disclose! Diabetes mellitus continues to grow in global prevalence and to consume
More informationThe Peripheral Vascular System
The Peripheral Vascular System Anatomy and Physiology Arteries Arteries contain 3 concentric layers of tissue: - the intima - the media - the adventitia The intima The endothelium of the intima has metabolic
More informationORIGINAL INVESTIGATION
ORIGINAL INVESTIGATION Pulse Oximetry as a Potential Screening Tool for Lower Extremity Arterial Disease in Asymptomatic Patients With Diabetes Mellitus G. Iyer Parameswaran, MD; Kathy Brand, RDMS, RVT;
More informationPAD and CRITICAL LIMB ISCHEMIA: EVALUATION AND TREATMENT 2014
PAD and CRITICAL LIMB ISCHEMIA: EVALUATION AND TREATMENT 2014 Van Crisco, MD, FACC, FSCAI First Coast Heart and Vascular Center, PLLC Jacksonville, FL 678-313-6695 Conflict of Interest Bayer Healthcare
More informationRadRx Your Prescription for Accurate Coding & Reimbursement Copyright All Rights Reserved.
Interventional Radiology Coding Case Studies Prepared by Stacie L. Buck, RHIA, CCS-P, RCC, CIRCC, AAPC Fellow President & Senior Consultant Week of November 19, 2018 Abdominal Aortogram, Bilateral Runoff
More informationMORTALITY AND MORBIDITY RISK FROM CAROTID ARTERY ATHEROSCLEROSIS. 73 year old NS right-handed male applicant for $1 Million life insurance
MORTALITY AND MORBIDITY RISK FROM CAROTID ARTERY ATHEROSCLEROSIS October 17, 2012 AAIM Triennial Conference, San Diego Robert Lund, MD What Is The Risk? 73 year old NS right-handed male applicant for $1
More informationCurrent Vascular and Endovascular Management in Diabetic Vasculopathy
Current Vascular and Endovascular Management in Diabetic Vasculopathy Yang-Jin Park Associate professor Vascular Surgery, Samsung Medical Center Sungkyunkwan University School of Medicine Peripheral artery
More informationIs the Ankle-Brachial Index a Useful Screening Test for Subclinical Atherosclerosis in Asymptomatic, Middle-Aged Adults?
Is the Ankle-Brachial Index a Useful Screening Test for Subclinical Atherosclerosis in Asymptomatic, Middle-Aged Adults? Rachael A. Wyman, MD; Jon G. Keevil, MD; Kjersten L. Busse, RN, MSN; Susan E. Aeschlimann,
More informationACCF/ACR/AIUM/ASE/ASN/ICAVL/SCAI/SCCT/SIR/SVM/SVS 2012 Appropriate Use Criteria. Indications A _ appropriate; I _ inappropriate; U _ uncertain
National Imaging Associates, Inc. Clinical guidelines ABDOMINAL, PELVIS, SCROTAL, RETROPERITONEAL ORGANS DUPLEX SCAN (US) CPT Codes: 93975 Bilateral or Complete 93976 - Unilateral or Limited Guideline
More informationA RTICLES. Key Articles and Guidelines in the Management of Peripheral Arterial Disease
K EY A RTICLES Key Articles and Guidelines in the Management of Peripheral Arterial Disease Zachary A. Stacy, Pharm.D., Paul P. Dobesh, Pharm.D., FCCP, toby C. trujillo, Pharm.D., William e. Dager, Pharm.D.,
More informationDetection of peripheral vascular disease in patients with type-2 DM using Ankle Brachial Index (ABI)
Original article: Detection of peripheral vascular disease in patients with type-2 DM using Ankle Brachial Index (ABI) 1DR Anu N Gaikwad, 2 Dr Vikrant V Rasal, 3 Dr S A Kanitkar, 4 Dr Meenakshi Kalyan
More informationAssessing Cardiac Risk in Noncardiac Surgery. Murali Sivarajan, M.D. Professor University of Washington Seattle, Washington
Assessing Cardiac Risk in Noncardiac Surgery Murali Sivarajan, M.D. Professor University of Washington Seattle, Washington Disclosure None. I have no conflicts of interest, financial or otherwise. CME
More informationOne-year effect of a supervised exercise programme on functional capacity and quality of life in peripheral arterial disease.
Royal College of Surgeons in Ireland e-publications@rcsi School of Physiotherapy Articles School of Physiotherapy --0 One-year effect of a supervised exercise programme on functional capacity and quality
More informationTreatment Strategies For Patients with Peripheral Artery Disease
Treatment Strategies For Patients with Peripheral Artery Disease Presented by Schuyler Jones, MD Duke University Medical Center & Duke Clinical Research Institute AHRQ Comparative Effectiveness Review
More informationEndovascular and Hybrid Treatment of TASC C & D Aortoiliac Occlusive Disease
Endovascular and Hybrid Treatment of TASC C & D Aortoiliac Occlusive Disease Arash Bornak, MD FACS Vascular & Endovascular Surgery University of Miami Miller School of Medicine No disclosure BACKGROUND
More informationLimb Salvage in Diabetic Ischemic Foot. Kritaya Kritayakirana, MD, FACS Assistant Professor Chulalongkorn University April 30, 2017
Limb Salvage in Diabetic Ischemic Foot Kritaya Kritayakirana, MD, FACS Assistant Professor Chulalongkorn University April 30, 2017 Case Male 67 years old Underlying DM, HTN, TVD Present with gangrene
More informationVascular claudication: How to individualize treatment
REVIEW BRUCE H. GRAY, DO Codirector, Peripheral Interventional Laboratory, Cleveland Clinic. TIMOTHY M. SULLIVAN, MD Codirector, Peripheral Interventional Laboratory, Cleveland Clinic. Vascular claudication:
More informationDue to Perimed s commitment to continuous improvement of our products, all specifications are subject to change without notice.
A summary Disclaimer The information contained in this document is intended to provide general information only. It is not intended to be, nor does it constitute, medical advice. Under no circumstances
More informationA study on diabetic foot and its association with peripheral artery disease
International Surgery Journal Muthiah A et al. Int Surg J. 2017 Apr;4(4):1217-1221 http://www.ijsurgery.com pissn 2349-3305 eissn 2349-2902 Original Research Article DOI: http://dx.doi.org/10.18203/2349-2902.isj20170937
More informationMORTALITY AND MORBIDITY RISK FROM CAROTID ARTERY ATHEROSCLEROSIS. 73 year old NS right-handed male applicant for $1 Million Life Insurance
MORTALITY AND MORBIDITY RISK FROM CAROTID ARTERY ATHEROSCLEROSIS October 17, 2012 AAIM Triennial Conference, San Diego Robert Lund, MD What Is The Risk? 73 year old NS right-handed male applicant for $1
More informationBangladesh Journal of Medical Science Vol. 15 No. 04 October 16
Bangladesh Journal of Medical Science Vol. 15 No. 04 October 16 Original article The prevalence of peripheral artery disease by using ankle brachial index in hypertensive patients Singal KK 1, Singal N
More informationIntroduction History Preceded by Arterial Doppler and ABI Indications
Elise Brady, RVT, RDMS Introduction History Preceded by Arterial Doppler and ABI Indications 1) Abnormal ABI (within 2weeks of duplex) 2) Abnormal Doppler waveforms 3) Claudication 4) History of PVD 5)
More informationPeripheral Artery Disease Role of Exercise, Endovascular and Surgical Options
Peripheral Artery Disease Role of Exercise, Endovascular and Surgical Options Jeffrey W. Olin, D.O., F.A.C.C., F.A.H.A. Professor of Medicine (Cardiology) Director of Vascular Medicine & the Vascular Diagnostic
More informationInternational Journal of Pharma and Bio Sciences
Research Article Nursing International Journal of Pharma and Bio Sciences ISSN 0975-6299 EFFECTIVENESS OF ALLEN BUERGER EXERCISE IN PREVENTING PERIPHERAL ARTERIAL DISEASE AMONG PEOPLE WITH TYPE II DIABETES
More informationObjectives. Abdominal Aortic Aneuryms 11/16/2017. The Vascular Patient: Diagnosis and Conservative Treatment
The Vascular Patient: Diagnosis and Conservative Treatment Ferrell-Duncan Clinic Zachary C. Schmittling, M.D., F.A.C.S. Vascular and General Surgery Ferrell-Duncan Clinic Cox Health Systems Objectives
More informationAccess strategy for chronic total occlusions (CTOs) is crucial
Learn How Access Strategy Impacts Complex CTO Crossing Arthur C. Lee, MD The Cardiac & Vascular Institute, Gainesville, Florida VASCULAR DISEASE MANAGEMENT 2018;15(3):E19-E23. Key words: chronic total
More informationGuidelines for Management of Peripheral Arterial Disease
Guidelines for Management of Peripheral Arterial Disease Subhash Banerjee, MD, FACC, FSCAI Professor of Medicine, Univ. of Texas Southwestern Medical Center Chief, Division of Cardiology, VA North Texas
More informationUtility of Exercise-Induced Zero TBI Sign in Patients on Maintenance Hemodialysis
2016 Annals of Vascular Diseases doi:10.3400/avd.oa.16-00074 Original Article Utility of Exercise-Induced Zero TBI Sign in Patients on Maintenance Hemodialysis Kazuo Tsuyuki, CVT, PhD, 1 Kenji Kohno, PhD,
More informationOUTPATIENT DEPARTMENT
1 This chapter outlines the main arterial and venous diseases that are likely to be seen within a vascular outpatient setting. It also highlights the role of the vascular nurse specialist wherever appropriate.
More informationDisclosures. Talking Points. An initial strategy of open bypass is better for some CLI patients, and we can define who they are
An initial strategy of open bypass is better for some CLI patients, and we can define who they are Fadi Saab, MD, FASE, FACC, FSCAI Metro Heart & Vascular Metro Health Hospital, Wyoming, MI Assistant Clinical
More information