Peripheral Arterial Disease: Current Perspectives and New Trends in Management

Aslam, Farhan; Haque, Attiya; Foody, JoAnne M.; Lee, L Veronica

doi:10.1097/smj.0b013e3181bb9ab8

Cited by 31 publications

(20 citation statements)

References 57 publications

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“…Ten consecutive non-diabetic patients (mean age ± SD: 66.5±9.9 years; 8 males and 2 females) with clinical symptoms of PAD (Fontaine stage II; intermittent claudication with no signs of critical ischemia [23]) with suspected arterial lesions of the superficial femoral artery (SFA) by duplex ultrasonography (peak systolic velocity (PSV) ratio >2.0 [24]) were included, as well as 10 healthy control subjects with no known PAD symptoms (age 24.1±2.2 years; 3 males and 7 females). Exclusion criteria were hemodynamic instability, contraindications for MRI (i.e.…”

Section: Methodsmentioning

confidence: 99%

MRI of Arterial Flow Reserve in Patients with Intermittent Claudication: Feasibility and Initial Experience

et al. 2012

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ObjectivesThe aim of this work was to develop a MRI method to determine arterial flow reserve in patients with intermittent claudication and to investigate whether this method can discriminate between patients and healthy control subjects.MethodsTen consecutive patients with intermittent claudication and 10 healthy control subjects were included. All subjects underwent vector cardiography triggered quantitative 2D cine MR phase-contrast imaging to obtain flow waveforms of the popliteal artery at rest and during reactive hyperemia. Resting flow, maximum hyperemic flow and absolute flow reserve were determined and compared between the two groups by two independent MRI readers. Also, interreader reproducibility of flow measures was reported.ResultsResting flow was lower in patients compared to controls (4.9±1.6 and 11.1±3.2 mL/s in patients and controls, respectively (p<0.01)). Maximum hyperemic flow was 7.3±2.9 and 16.4±3.2 mL/s (p<0.01) and the absolute flow reserve was 2.4±1.6 and 5.3±1.3 mL/s (p<0.01), respectively in patients and controls. The interreader coefficient of variation was below 10% for all measures in both patients and controls.ConclusionsQuantitative 2D MR cine phase-contrast imaging is a promising method to determine flow reserve measures in patients with peripheral arterial disease and can be helpful to discriminate patients with intermittent claudication from healthy controls.

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Section: Methodsmentioning

confidence: 99%

MRI of Arterial Flow Reserve in Patients with Intermittent Claudication: Feasibility and Initial Experience

et al. 2012

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“…Ten patients (age mean ± SD: 66.5±9.9 years; 8 males and 2 females) with proven PAD (intermittent claudication, Fontaine stage II, [5]), diagnosed by the vascular surgeon, and 10 healthy control subjects without signs and symptoms of PAD (age 24.1±2.2 years; 3 males and 7 females) were included in this study. Exclusion criteria were diabetes mellitus, hemodynamic instability, contra-indications for MRI (i.e.…”

Section: Methodsmentioning

confidence: 99%

“…Among these functional measurements, the ankle brachial index (ABI) is the most recognized and widely applied test for diagnosis and therapy monitoring in PAD [1], [2], [3], [4], [5], [6], [7], [8], [9]. ABI measurements only represent macrovascular functionality, whereas PAD is known to affect the microcirculation as well, particularly in patients with diabetes [10], [11].…”

Section: Introductionmentioning

confidence: 99%

Dynamic Contrast-Enhanced MRI Assessment of Hyperemic Fractional Microvascular Blood Plasma Volume in Peripheral Arterial Disease: Initial Findings

et al. 2012

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ObjectivesThe aim of the current study was to describe a method that assesses the hyperemic microvascular blood plasma volume of the calf musculature. The reversibly albumin binding contrast agent gadofosveset was used in dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) to assess the microvascular status in patients with peripheral arterial disease (PAD) and healthy controls. In addition, the reproducibility of this method in healthy controls was determined.Materials and MethodsTen PAD patients with intermittent claudication and 10 healthy control subjects were included. Patients underwent contrast-enhanced MR angiography of the peripheral arteries, followed by one DCE MRI examination of the musculature of the calf. Healthy control subjects were examined twice on different days to determine normative values and the interreader and interscan reproducibility of the technique. The MRI protocol comprised dynamic imaging of contrast agent wash-in under reactive hyperemia conditions of the calf musculature. Using pharmacokinetic modeling the hyperemic fractional microvascular blood plasma volume (Vp, unit: %) of the anterior tibial, gastrocnemius and soleus muscles was calculated.Results Vp was significantly lower for all muscle groups in PAD patients (4.3±1.6%, 5.0±3.3% and 6.1±3.6% for anterior tibial, gastrocnemius and soleus muscles, respectively) compared to healthy control subjects (9.1±2.0%, 8.9±1.9% and 9.3±2.1%). Differences in Vp between muscle groups were not significant. The coefficient of variation of Vp varied from 10–14% and 11–16% at interscan and interreader level, respectively.ConclusionsUsing DCE MRI after contrast-enhanced MR angiography with gadofosveset enables reproducible assessment of hyperemic fractional microvascular blood plasma volume of the calf musculature. Vp was lower in PAD patients than in healthy controls, which reflects a promising functional (hemodynamic) biomarker for the microvascular impairment of macrovascular lesions.

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“…Atherosclerotic heart disease is one of the most important causes of morbidity and mortality, 1 and its prevalence is escalating much more rapidly in developing countries. 2 In contrast to trends in Northern Europe and the United States, 1999 data showed that mortality from cardiovascular disease (CVD) is increasing in Iran.…”

Section: Introductionmentioning

confidence: 99%

Trends in Risk Factors for Cardiovascular Disease Among Iranian Adolescents: The Tehran Lipid and Glucose Study, 1999–2008

Hosseini-Esfahani

Khameneh

Mirmiran

et al. 2011

Journal of Epidemiology

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ObjectivesData on secular trends in adolescent obesity and dyslipidemia are limited. Data on obesity status collected during 3 surveys were used to evaluate these trends in obesity and dyslipidemia among Tehranian adolescents and to assess the likelihood of risk factors for cardiovascular disease.MethodsWe analyzed data for adolescents (age 10 to 19 years) from 3 cross-sectional surveys of the Tehran Lipid and Glucose Study: 1999–2001 (n = 3010, 47.2% males), 2002–2005 (n = 1107, 48.4% males), and 2006–2008 (n = 1090, 46.6% males). Overweight and abdominal obesity were defined using Iranian body mass index (BMI) percentiles, International Obesity Task Force (IOTF) criteria, and Iranian waist circumference (WC) charts. Hypertension was defined by using the National Heart, Lung, and Blood Institute’s recommended cut points, and dyslipidemia was defined according to the recent recommendations of the American Heart Association.ResultsThe overall adjusted prevalences of “at risk for overweight” and overweight changed from 13% and 8% (using Iranian cutoffs), respectively, and 14.8% and 4.7% (using IOTF criteria) in 1999–2001 to 19% and 15% (Iranian cutoffs) and 23.0% and 9.2% (IOTF criteria) in 2006–2008 (P < 0.01 for all comparisons). The prevalence of abdominal obesity increased in males from 14.5% in 1999–2001 to 33.3% in 2006–2008 (P < 0.001). Almost half the adolescents had low high-density lipoprotein cholesterol (HDL-C) in the 3 surveys. In all surveys, as BMI and WC increased, multivariate age- and sex-adjusted odds ratios of low HDL-C and high triglyceride levels significantly increased. Overweight was associated with a greater likelihood of these risk factors, as compared with increased WC.ConclusionsOverweight and abdominal obesity are increasing in Tehranian adolescents, and these increases are accompanied by abnormalities in levels of serum triglyceride and HDL-C.

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Peripheral Arterial Disease: Current Perspectives and New Trends in Management

Cited by 31 publications

References 57 publications

MRI of Arterial Flow Reserve in Patients with Intermittent Claudication: Feasibility and Initial Experience

MRI of Arterial Flow Reserve in Patients with Intermittent Claudication: Feasibility and Initial Experience

Dynamic Contrast-Enhanced MRI Assessment of Hyperemic Fractional Microvascular Blood Plasma Volume in Peripheral Arterial Disease: Initial Findings

Trends in Risk Factors for Cardiovascular Disease Among Iranian Adolescents: The Tehran Lipid and Glucose Study, 1999–2008

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