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These data suggest that even though ICA occlusion may occur without cerebral damage, collateral blood supply is not enough to maintain normal hemispheric perfusion. The ACoA may be a key collateral pathway as a non-functioning ACoA is associated with an increased risk of developing low-flow infarcts.

Tinzaparin was more effective than AVK in achieving re-canalisation of leg thrombi. Long-term tinzaparin was at least as efficacious and safe as AVK for preventing recurrent VTE, especially in patients with cancer.

These results suggest that the PSV in the renal artery is the best predicting Doppler parameter to detect RAS greater than 60%. A PSV greater than 198 cm/sec may be an appropriate cutoff point to diagnose this group of stenosis. The RAR did not add any predicting utility in this series. An absent Doppler signal in the renal parenchyma and a kidney length less than 8.5 cm were the best predictors of renal artery occlusion.

Both decreased GFR and albuminuria are associated with an elevated prevalence of peripheral artery disease. However, the combined effects of these alterations previously were not evaluated. Patients with hypertension and with no known vascular disease (n ‫؍‬ 955; mean age 66 yr; 56% male) were selected from internal medicine outpatient clinics throughout Spain. Cardiovascular risk factors, urinary albumin excretion, and the ankle-brachial index (ABI) were assessed in all participants. GFR was estimated according to the Cockroft-Gault equation. Of the study population, 62% had diabetes, 23.8% had a GFR <60 ml/min per 1.73 m 2 , and 43.8% had albuminuria. The prevalence of ABI <0.9 was greater in patients with a GFR <60 ml/min per 1.73 m 2 (37.4 versus 24.3%; P < 0.0001) and in those who had albuminuria (32.2 versus 23.3%; P ‫؍‬ 0.001). In patients with both alterations, the prevalence of ABI <0.9 was 45.7%. Multivariate analysis indicated that the factors that were associated independently with low ABI were age (odds ratio P atients with peripheral artery disease (PAD) of the lower limbs, whether symptomatic or not, have an elevated risk for cardiovascular disease and premature death (1,2). Early detection of PAD identifies a group of patients who would benefit from aggressive cardiovascular risk factor modification and from antiplatelet therapy. Several factors have been associated with the development of PAD, among which are age, gender, diabetes, smoking habit, dyslipidemia, and hypertension. High BP is an important risk factor in the progressive deterioration of renal function and in the development of albuminuria, particularly in patients of advanced age. Although both a decreased GFR (3-7) and the presence of albuminuria (8,9) have been associated independently with an elevated prevalence of PAD, their combined effects were not evaluated previously. This is of considerable importance given that not only PAD but also chronic renal disease is additive, and both are independent risk factors for the development of cardiovascular disease (10,11). Their simultaneous presence characterizes a subgroup of patients who have very high risk for cardiovascular disease and could benefit from early diagnosis and treatment (12). The objective of the present study was to determine the association between the GFR and albuminuria with the presence of subclinical PAD of the lower limbs in a large population of hypertensive patients with no known cardiovascular disease.[ Materials and Methods PatientsParticipants in the Modificacion de le Estratificació n del Riesgo con el Indice Tobillo-brazo (MERITO) study were of both genders, were between the ages of 50 and 85 yr, and attended internal medicine outpatient clinics in hospitals throughout Spain. Each investigator was required to measure the ankle-brachial index (ABI) in 20 consecutive patients who attended the clinic; 10 had type 2 diabetes, and 10 did not have diabetes but had a risk for death from cardiovascular disease Ն3% over the next 10 yr, calculated according to the e...

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