Scourge of Peripheral Artery Disease in a Low-Income-Setting: The Role of VascularSurgery

Background: Peripheral artery disease (PAD) is a progressive disorder characterized by stenosis and/or occlusion of large and medium-sized arteries, other than those that supply the heart (coronary artery disease, CAD) or the brain (cerebrovascular disease). It is increasingly becoming a challenge in developing countries owing to poverty and ignorance. Objective: To review the scourge of peripheral artery diseases in our institution in a low-income setting with a view to determining the role of a vascular surgeon. Materials and method: Over a period of 15 years (2006 to 2021), patients with documented PAD were reviewed. Data of the patients were retrieved from the record department and such data included demography, aetiology/risk factors, clinical features and investigative parameters as well as modes of treatment especially vascular surgery. Results: There were 35 patients which comprised 20 males and 15 females with male to female ratio of 4:3. Age range affected most was 71-80 years. Aetiologically, artherosclerosis was dominant. Leriche Fontaine classification used in clinical evaluation showed that type III was dominant. 6 Ps (pain, pulselessness, paralysis, paraesthesie, pallor and poikilothermia) of vascular ischemia were evident. Doppler/duplex ultrasound and computer angiography were used in diagnosis. Medical and or surgical treatments were used in patients' management. Vascular and or orthopedic surgery played significant role. Conclusion: PAD affects the lower extremities more commonly than the upper extremity vessels especially in the elderly leading to intermittent claudicationn which is the most recognized symptomatic subset of lower extremity PAD. Morbidity and mortality emanating from inadequate revascularization are burden to emerging economy like ours.

Profil pharmaco-doppler pénien des patients coronariens souffrant de dysfonction érectile à l'Institut de Cardiologie d'Abidjan une série de 30 cas / Penile pharmaco doppler profile of coronary patients with erectile dysfunction at the Abidjan Cardiology Institute: a series of 30 cases

Contexte et objectif. La maladie athéromateuse dont la coronaropathie étant une pathologie diffuse peut être prévenue par le contrôle des facteurs de risqué cardiovasculaire. Le but de cette étude était de décrire les caractéristiques pharmaco doppler pénien des patients coronariens souffrant de dysfonction érectile. Méthodes. Il s'agissait d'une série analytique des cas suivie entre juin 2020 et février 2021. Elle concernait des patients ayant des lésions athéromateuses significatives à la coronographie et souffrant de dysfonction érectile. Nous avons évalué les caractéristiques pharmaco doppler pénien. La qualité d'érection était appréciée par le score de rigidité Erectile Hardness Score (EHS). Résultats. Trente-six patients étaient inclus. L'âge moyen était de 56 ± 8,4 ans. le pic de Vitesse systolique au repos (PSVr) moyen des patients était de 13,7 cm/s ± 5,9. Le pic de vitesse systolique post injection (PSV pi) moyen des patients était de 23,9 cm/s ± 5,4. Les causes étaient principalement artérielles de 75%. La qualité d'érection était appréciée selon le score EHS : E1 (83%), E2 (22%), E3 (5%) et E4 (3%). Conclusion. La dysfunction érectile est associée aux facteurs de risque cardiovasculaire selon plusieurs études. L'echodoppler pénien avait occupé une place importante dans le diagnostic étiologique. Les causes retrouvées étaient principalement artérielles avec une baisse de PSVpi<25 cm/s.

Kawasaki disease; rare; or misdiagnosed: A case report in a tertiary hospital in Nigeria

Kawasaki disease (KD) is a self-limiting, acute febrile vasculitis with predilection for children under-5 years. Most reports have emanated from Japan with only a few cases reported in Africa. KD presents a diagnostic dilemma and a high index of suspicion is critical as early treatment reduces the incidence of complications. We describe a 5-month-old male infant who presented with classical clinical features though with delayed diagnosis. Received moderate dose aspirin with limitation of access to intravenous immunoglobulin and who did not develop coronary artery complication. The case report highlights the diagnostic challenges faced by practitioners, made worse by the low index of suspicion inherent in our setting. The fatal complications that may be associated with KD can, therefore, be avoided. It is hoped that pediatricians in particular would become conversant with the diagnostic criteria to facilitate early diagnosis and intervention in children

Invasive and Anticoagulant Treatment for Coronary Ectasia : a Single Operator's Experience in a Tertiary Hospital in South Africa : Cardiovascular Topics

Introduction: Coronary artery ectasia (CAE) is a rare but well-recognised condition involving dilatation of a coronary artery to more than 1.5 times the diameter of the adjacent portion of the artery. As far as we are aware; the disease has not been described in any local literature and no other research has been conducted in Africa. We carried out this research in order to establish the incidence of the condition in South Africa; as well as the possible preferred method of treatment. Methods: Cases were identified from the database of the practice. The study involved only patients who were classified to have Markis type I; II and III disease. From a total of approximately 2 000 angiographies performed during the study period; CAE types I; II and III were diagnosed in 20 patients. Patients with type IV CAE were excluded from the group. Nineteen patients were male and were in their fourth or fifth decade of life; and one was female. Three of the patients were Indian; one was black; and the rest were white. Results: Four patients in the group had diabetes; 13 were smokers and eight had hypertension. Dyslipidaemia was observed in seven patients. The most commonly affected area of the coronary artery was the RCA-19 (isolated; or in combination). Patients were treated mainly with anticoagulation and; when necessary; with angioplasty and stent implantation. Morbidity was seen in 5of the patients and no mortality was observed. Conclusion: Most of the patients were male; and the occlusion involved mostly the right coronary artery. The cause of occlusion is still unknown; but it is thought to be due to slow blood flow; damaged endothelium; or a combination of the two. The best therapeutic approach is not known as yet

In-Hospital and Mid-Term Adverse Clinical Outcomes of a Direct Stenting Strategy Versus Stenting after Predilatation for the Treatment of Coronary Artery Lesions : Cardiovascular Topic

Background : Direct stenting without balloon dilatation may reduce procedural costs and duration; and hypothetically; the restenosis rate. This study was designed to compare the in-hospital and long-term outcomes of direct stenting (DS) versus stenting after pre-dilatation (PS) in our routine clinical practice. Methods : The 1 603 patients treated with stenting for single coronary lesions were enrolled into a prospective registry. Patients with acute myocardial infarction (MI) within the preceding 48 hours; and those with highly calcified lesions; total occlusions; or a lesion in a saphenous graft were excluded. The baseline; angiographic and procedural data; in-hospital outcomes and follow-up data were recorded in our database and analysed with appropriate statistical methods. Results : Eight hundred and fifty-seven patients (53.5) were treated with DS and 746 (46.5) underwent PS. In the DS group; lesions were shorter in length; larger in diameter and had lower pre-procedural diameter stenosis. Type C and diffuse lesions and drug-eluting stents were found less often (p 0.001). With univariate analysis; dissection and non-Q-wave MI occurred less frequently in this group (0.2 and 0.6vs 3.9 and 2.1; p 0.001 and p ; p = 0.79). With multivariate analysis; direct stenting reduced the risk of dissection (OR = 0.07; 95CI: 0.01-0.33; but neither the cumulative endpoint of MACE (OR = 1.1; 95CI = 0.58-2.11; p = 0.7) nor its constructing components were different between the groups. Conclusions : Direct stenting in the real world has at least similar long-term outcomes in patients treated with stenting after pre-dilatation; and is associated with lower dissection rates

Patients with Coronary Artery Disease : Maintaining Planned Lifestyle Adaptations

The purpose of this study was to describe how patients with coronary artery disease; who have had one or more cardiac interventions; were maintaining their planned lifestyle adaptations at four months after the intervention. Furthermore; the study aimed to develop guidelines to further assist patients in maintaining lifestyle adaptations. A descriptive study was undertaken using the survey method. The population consisted of 65 participants (42 males; 23 females) from five private hospitals in Gauteng. The questions for a questionnaire were derived from a conceptual framework. The participants first completed the questionnaire immediately before they were discharged; and again over the telephone four months after the intervention. Descriptive statistics were used to analyse the data obtained. The results showed that patients suffering from coronary artery disease do adapt their lifestyle after interventions; but most patients find it problematic to stop smoking. It is essential for patients with coronary artery disease to maintain lifestyle adaptations to ensure further health and prevention of recurrence of the same problems. These adaptations should be a lifelong commitment

Culture et caracterisation des cellules endotheliales d'artere coronaire de porc

Introduction : Les proprietes biologiques de l'endothelium vasculaire lui conferent un role majeur dans le controle de la permeabilite; du tonus vasculaire et l'angiogenese; des fonctions physiologiques cruciales a l'homeostasie vasculaire. La comprehension du ou des mecanisme(s) d'action sous-jacent(s) a ces multiples proprietes a longtemps ete retardee par la difficulte technique d'obtenir des quantites suffisantes de ce tissu permettant de realiser les etudes in vitro. Ce travail a pour objectif de proceder a la mise en culture et a la caracterisation des cellules endotheliales d'artere coronaire de porc. Materiels et Methodes : La couche de cellules endotheliales a ete prelevee par passage de la solution de collagenase a travers la lumiere du vaisseau. Les cellules ont ete ensuite ensemencees dans des flacons de culture; prealablement recouverts de collagene de queue de rat dans un milieu de culture RPMI1640/M199 auquel a ete rajoute 15de serum de veau fotal; des antibiotiques et de la fungizone. Les cultures ont ete maintenues a 37oC dans un incubateur. La sonde fluorescente constituee de lipoproteines acetylees de faible densite (Dil-Ac-LDL) a ete utilisee comme marqueur biologique specifique par recapture par les cellules endotheliales. Les cellules confluentes ont ete repiquees dans des chambres de culture LAB-TEK puis examinees au microscope photonique et confocal. Resultats : Apres 24 heures de mise en culture; les cellules endotheliales adherent au collagene et forment des rosettes. En se multipliant; elles colonisent peu a peu l'ensemble de la surface de la boite de culture pour former a confluence un tapis pavimenteux relativement homogene. A confluence; la proliferation des cellules endotheliales est inhibee par le contact et elle presente un aspect polygonal. Nos resultats montrent que les cellules cultivees presentent un intense marquage au Dil-Ac-LDL. Conclusion : Les cellules endotheliales de l'artere coronaire de porc en culture constituent un bon outil pour l'etude des fonctions endotheliales dans des conditions physiologiques et pathologiques.Introduction : Les proprietes biologiques de l'endothelium vasculaire lui conferent un role majeur dans le controle de la permeabilite; du tonus vasculaire et l'angiogenese; des fonctions physiologiques cruciales a l'homeostasie vasculaire. La comprehension du ou des mecanisme(s) d'action sous-jacent(s) a ces multiples proprietes a longtemps ete retardee par la difficulte technique d'obtenir des quantites suffisantes de ce tissu permettant de realiser les etudes in vitro. Ce travail a pour objectif de proceder a la mise en culture et a la caracterisation des cellules endotheliales d'artere coronaire de porc. Materiels et Methodes : La couche de cellules endotheliales a ete prelevee par passage de la solution de collagenase a travers la lumiere du vaisseau. Les cellules ont ete ensuite ensemencees dans des flacons de culture; prealablement recouverts de collagene de queue de rat dans un milieu de culture RPMI1640/M199 auquel a ete rajoute 15de serum de veau fotal; des antibiotiques et de la fungizone. Les cultures ont ete maintenues a 37oC dans un incubateur. La sonde fluorescente constituee de lipoproteines acetylees de faible densite (Dil-Ac-LDL) a ete utilisee comme marqueur biologique specifique par recapture par les cellules endotheliales. Les cellules confluentes ont ete repiquees dans des chambres de culture LAB-TEK puis examinees au microscope photonique et confocal. Resultats : Apres 24 heures de mise en culture; les cellules endotheliales adherent au collagene et forment des rosettes. En se multipliant; elles colonisent peu a peu l'ensemble de la surface de la boite de culture pour former a confluence un tapis pavimenteux relativement homogene. A confluence; la proliferation des cellules endotheliales est inhibee par le contact et elle presente un aspect polygonal. Nos resultats montrent que les cellules cultivees presentent un intense marquage au Dil-Ac-LDL. Conclusion : Les cellules endotheliales de l'artere coronaire de porc en culture constituent un bon outil pour l'etude des fonctions endotheliales dans des conditions physiologiques et pathologiques

Are statins effective in preventing coronary artery disease?

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