Health and lifestyle parameters in peripheral artery disease at two periods of the COVID-19 pandemic: comparison between men and women

ABSTRACT Objective: This study analyzed the impact of sex on self-reported health and lifestyle parameters in peripheral artery disease patients at two periods of the COVID-19 pandemic. Methods: In this longitudinal study, 99 patients with peripheral artery disease (53 men and 46 women) were evaluated during two periods of the COVID-19 pandemic ( i.e ., at onset: May to August 2020, and on follow-up: May to August 2021). Patients were interviewed via telephone, and information regarding lifestyle and health parameters was obtained. Results: At the onset of the COVID-19 pandemic, health and habit parameters were similar between women and men, with 63.0% and 45.3% indicating frequent fatigue, 73.9% and 84.9% reporting increased sitting time, and 23.9% and 39.6% practicing physical activity, respectively. At follow-up, difficulties in physical mobility (women: from 26.1% to 73.9%, p<0.001; men: from 39.6% to 71.7%, p=0.001) and the frequency of hospitalization for reasons other than COVID-19 increased similarly in women and men (women: from 4.3% to 21.7%, p=0.013; men: from 9.4% to 24.5%, p=0.038). The other parameters were similar between the periods. Conclusion: Self-reported physical mobility difficulties and hospitalization frequency increased in women and men with peripheral artery disease.

Relação entre o índice de resistência vascular e o sucesso hemodinâmico de revascularizações distais dos membros inferiores / Vascular resistance index and the immediate hemodynamic success of lower limb distal artery revascularization

Resumo Contexto A cirurgia de revascularização é proposta para restaurar o fluxo sanguíneo para o pé nos casos de isquemia crítica (IC) devido a doença arterial obstrutiva periférica dos membros inferiores (MMII). O uso de ultrassonografia com Doppler (USD) vem despontando nos últimos anos como um método de grande valor para o planejamento cirúrgico dessa intervenção. Objetivos Avaliar a relação entre o índice de resistência (IR), mensurado por meio de USD, e o sucesso hemodinâmico imediato da cirurgia de revascularização dos MMII em pacientes com IC. Métodos O tipo de estudo empregado foi a coorte prospectiva, na qual foram avaliados 46 pacientes portadores de IC dos MMII submetidos à operação de revascularização infrainguinal por angioplastia ou em ponte de agosto de 2019 a fevereiro de 2022. Todos os pacientes foram submetidos à avaliação clínica vascular, à USD com medida do IR das artérias distais dos MMII, à arteriografia dos MMII e à aferição do índice tornozelo-braquial (ITB) no período pré-operatório. No pós-operatório imediato, todos os pacientes foram submetidos à nova aferição do ITB. Resultados Entre os 46 pacientes avaliados, 25 (54,3%) eram do sexo masculino. A idade variou de 32 a 89 anos (média de 67,83). Quanto ao sucesso hemodinâmico, avaliado pela comparação do ITB pré e pós-operatório, constatou-se que 31 (67,4%) pacientes apresentaram sucesso hemodinâmico após cirurgia de revascularização (aumento do ITB em 0,15 ou mais). Foi observada correlação positiva (p ≤ 0,05) entre o IR da artéria distal revascularizada do MMII e o sucesso hemodinâmico imediato avaliado pela aferição do ITB (IR menor e sucesso hemodinâmico). Conclusões Na presente pesquisa foi observada uma correlação positiva entre o índice de resistência arterial distal e o sucesso hemodinâmico nas revascularizações dos membros inferiores, avaliada através do índice tornozelobraquial, de forma que, quanto menor foi o IR, maior o sucesso hemodinâmico obtido.

Abstract Background Revascularization surgery is used to attempt to restore blood flow to the foot in patients with critical ischemia (CI) caused by peripheral arterial occlusive disease of the lower limbs (LL). Ultrasonography with Doppler (USD) SAH emerged in recent years as a highly valuable method for planning this surgical intervention. Objectives To evaluate the relationship between the resistance index (RI), measured with USD, and immediate hemodynamic success of LL revascularization surgery in patients with CI. Methods The study design was a prospective cohort assessing 46 patients with LL CLI who underwent operations to perform infrainguinal revascularization by angioplasty or bypass from August 2019 to February 2022. All patients underwent preoperative clinical vascular assessment with USD including measurement of the RI of distal LL arteries, LL arteriography, and measurement of the ankle-brachial index (ABI). All patients had their ABI measured again in the immediate postoperative period. Results Forty-six patients were assessed, 25 (54.3%) of whom were male. Age varied from 32 to 89 years (mean: 67.83). Hemodynamic success was assessed by comparison of preoperative and postoperative ABI, showing that hemodynamic success was achieved in 31 (67.4%) patients after revascularization surgery (ABI increased by 0.15 or more). A positive correlation (p ≤ 0.05) was observed between the RI of the distal revascularized LL artery and immediate hemodynamic success assessed by ABI (lower RI and hemodynamic success). Conclusions This study observed a positive correlation between the resistance index of the distal artery and immediate hemodynamic success of lower limb revascularizations, as assessed by the ankle-brachial index, so that the lower the RI the greater the hemodynamic success achieved.

Correlação entre o índice de resistência vascular e a arteriografia na avaliação do leito arterial distal na isquemia crítica dos membros inferiores / Correlation between the vascular resistance index and arteriography for assessment of the distal arterial bed in chronic limb threatening ischemia

Resumo Contexto Pacientes com isquemia crítica (IC) dos membros inferiores (MMII) precisam de arteriografia para o planejamento da cirurgia de revascularização. A ultrassonografia Doppler (UD) não é invasiva e, através da aferição do índice de resistência (IR), pode fornecer informações sobre as artérias distais. Objetivos Correlacionar a Classificação Angiográfica de Rutherford com o IR na avaliação do leito arterial distal dos MMII. Métodos Estudo transversal, realizado em hospital público terciário, com 120 pacientes portadores de IC dos MMII, entre setembro de 2019 a abril de 2022. Foi comparado o IR das artérias da perna passíveis de serem receptoras de revascularização com a imagem obtida através da arteriografia dessas artérias em acordo com a Classificação Angiográfica de leito distal de Rutherford. Resultados Foram avaliados 120 MMII em 120 pacientes com idade média de 68,6 anos. A amostra foi composta de 50,0% de pacientes do sexo masculino. Na amostra, 90,0% pacientes encontravam-se na classe cinco de Rutherford. Os valores do IR encontrados para as artérias de perna apresentaram uma correlação positiva, estatisticamente significativa, quando comparados com a Classificação de Rutherford (tibial anterior, p< 0,01; tibial posterior, p = 0,012 e fibular, p = 0,034 e artéria dorsal do pé, p < 0,001). Conclusões Neste estudo, os IRs das artérias da perna obtidos através da ultrassonografia Doppler apresentaram uma correlação positiva quando comparados à classificação de Rutherford. Em pacientes com isquemia crítica, esse índice pode ser útil na avaliação do leito arterial distal dos membros inferiores.

Abstract Background Patients with chronic limb threatening ischemia (CLTI) of the lower limbs (LL) undergo arteriography for revascularization surgery planning. Doppler ultrasound (DU) is non-invasive and can provide information about the distal arteries through measurement of the resistance index (RI). Objectives To correlate the Rutherford Angiographic Classification with the RI for assessment of the distal arterial bed of the LL. Methods A cross-sectional study, conducted at a public tertiary hospital with 120 patients with LL CLTI, from September 2019 to April 2022. The RI of arteries that were candidates for revascularization was compared with the images of the same arteries obtained using arteriography, using the Rutherford Angiographic Classification of the distal bed. Results A total of 120 LL were assessed in 120 patients with a mean age of 68.6 years. The sample was 50.0% male and 90.0% of the patients in the sample were classified as Rutherford category five. The RI values found for the arteries of the leg exhibited a statistically significant positive correlation with the Rutherford Classification (anterior tibial, p< 0.01; posterior tibial, p = 0.012 fibular, p = 0.034; and dorsalis pedis, p < 0.001). Conclusions In this study, RIs for the arteries of the leg measured using Doppler ultrasound exhibited a positive correlation with the Rutherford Classification. This index could be useful for assessment of the distal arterial bed of the lower limbs of patients with chronic limb threatening ischemia.

Duplex ultrasound and pedal acceleration time as tools to evaluate foot perfusion: a literature review / Ultrassonografia dúplex e tempo de aceleração plantar como ferramentas para avaliar a perfusão do pé: uma revisão da literatura

Abstract Currently, the standard non-invasive test for diagnosing Peripheral Arterial Disease is the Ankle-Brachial Index. However, this test becomes unfeasible in a certain population. New evidence proposes the pedal acceleration time, an ultrasound index, as an alternative test. An integrative bibliographic review was carried out between June 3, 2022 and January 8, 2023, to investigate this new index as a tool to assess foot perfusion. Papers published in English, Portuguese, or Spanish between 2012 and 2022 were searched on PubMed, Google Scholar, and Scielo, using the keywords "Peripheral Arterial Disease" AND "Acceleration Time" AND (Pedal OR Plantar). Research that didn't assess foot perfusion using the methods of interest or did not present human data and also case series or reports were excluded. Seven out of the sixty-six articles identified in the searches were selected for the review, all of which had notable methodological limitations. Pedal acceleration time seems to be able to diagnose and stratify and may reflect prognosis.

Resumo Atualmente, o teste não invasivo padrão para diagnosticar a doença arterial periférica é o índice tornozelo-braquial, porém, em uma determinada população, este torna-se inviável. Novas evidências propõem o tempo de aceleração plantar, que é um índice ultrassonográfico, como alternativa. Para investigá-lo no contexto do estudo da perfusão do pé, uma revisão bibliográfica integrativa foi realizada entre 03/06/2022 e 08/01/2023. Artigos em inglês, português ou espanhol, publicados entre 2012 e 2022 foram pesquisados através das ferramentas PubMed, Google Scholar e SciELO, com as palavras-chave "Peripheral Arterial Disease" AND "Acceleration Time" AND (Pedal OR Plantar). Pesquisas que não avaliaram a perfusão do pé pelos métodos de interesse, sem dados em humanos e relatos ou séries de casos, foram excluídos. Dos 66 artigos, 7 foram selecionados; todos com notáveis limitações metodológicas. O tempo de aceleração plantar aparenta ser capaz de diagnosticar, estratificar e prognosticar os doentes.

Enfermedad arterial periférica en población trabajadora: factores de riesgo y estilo de vida

Introducción: La Enfermedad Arterial Periférica (EAP) es definida como la oclusión de las arterias de las extremidades, se reconoce como la tercera causa de morbilidad vascular aterosclerótica, después del infarto agudo de miocardio y el accidente cerebrovascular. Aunque las enfermedades cardiovasculares se han relacionado con la ocupación, la información sobre la relación entre el trabajo con la EAP es escasa. Objetivo: Identificar la prevalencia de EAP en población laboralmente activa y su relación con variables sociodemográficas, clínicas y estilo de vida. Metodología: Se realizó un estudio analítico de tipo transversal, en 203 sujetos de 40 años o más, laboralmente activos de Popayán. Tras la firma del consentimiento, se realizó una entrevista, y se registraron las variables sociodemográficas y clínicas. Para el tamizaje de EAP se evaluó el índice tobillo brazo (ITB). Los participantes se clasificaron en categorías basadas en el ITB de la siguiente manera: EAP ≤ 0,90; 0,91 a 0,99 normal; y no compresible > 1,40. Los datos fueron analizados con el programa SPSS versión 26.0, se aplicó la prueba de Kolmogorov-Smirnov como prueba de normalidad, la t Student para evaluar diferencias de medias entre los grupos de estudio y la prueba de Chi-cuadrado. Resultados y discusión: La prevalencia fue del 2,5 % para EAP, siendo el primer estudio reportado para población trabajadora en Colombia. La EAP fue más prevalente en empleados manuales (2,8 %) e ingresos bajos (30 %); además, fueron obesos y fumadores. El riesgo encontrado para edad fue OR 1,5; IC95 % 1,17 a 2,14, género OR 1,2; IC95 % 1,20 a 3,28 y DM2 OR 1,5; IC95 % 1,23 a 6,68. Conclusión: Se estableció por primera vez la prevalencia de EAP (2,5 %) en una población laboralmente activa de Popayán, siendo más prevalente en los individuos con ingresos bajos, expuestos a factores de riesgo cardiovascular y con antecedente familiar de DM2.

Introduction: The Peripheral Arterial Disease (PAD) is defined as the occlusion of the extremities' arteries, and it is known to be the third vascular atherosclerotic cause of death after acute myocardial infarction and brain stroke. Even though cardiovascular diseases had been linked to occupation, information about the relation between PAD and labor activity runs short. Objective: To identify the PAD prevalence in the working population and its relationship with sociodemographic, clinical and lifestyle variables. Methodology: A cross-sectional analytical study was conducted in 203 people of >40 years, actively working in the city of Popayán. After consent signing, interviews were completed to record such variables. PAD testing was evaluated through Ankle-Brachial Index (ABI). Participants were grouped into categories based on ABI as follows: PAD ≤0.90; normal 0.91 to 0.99; and non-compressible >1.40. Collected data was analyzed in SPSS version 26.0, applying Kolmogorov-Smirnov test as the normal; t Student test to evaluate mean differences between study groups and Chi-square. Results and discussion: PAD prevalence was 2.5 % being the very first report done for Colombia's working class. PAD was prevalent for manual-labor employees (2.8 %), low-income people (30 %), adding obesity and smoking to their profile. Age risk found was (OR 1.5; IC 95 % 1.17 to 2.14), by gender (OR 1.2; IC 95 % 1.20 to 3.28); DM2 (OR 1.5; IC 95 % 1.23 to 6.68). Conclusion: It was determined for the first time a prevalence of (2.5 °%) PAD for a population actively working in Popayán, being more frequent with individuals with low income, people exposed to higher cardiovascular risks, and for people with family DM2 records.

Factores asociados al éxito de la cirugía revascularizadora en diabéticos con isquemia crítica crónica de las extremidades / Factors associated with the success of revascularization surgery in diabetic patients with chronic critical limb ischemia

Introducción: La cirugía revascularizadora es una de las estrategias fundamentales para el tratamiento de la isquemia crítica crónica de los miembros inferiores. Objetivo: Identificar los factores asociados al éxito de la cirugía revascularizadora de los miembros inferiores en diabéticos con isquemia crítica crónica. Métodos: Se realizó un estudio descriptivo, prospectivo y de tipo cohorte en pacientes diabéticos sometidos a una cirugía revascularizadora, por presentar isquemia crítica crónica de la extremidad. Estos fueron seguidos durante seis meses en el Instituto Nacional de Angiología y Cirugía Vascular entre septiembre de 2019 y enero de 2021. La variable principal de salida resultó los factores pronosticadores del éxito de la cirugía, la cual se consideró exitosa cuando el paciente permaneció vivo y sin una amputación mayor. Resultados: Se incluyeron 50 pacientes con una edad promedio de 64 ± 10,21 años y un 24 por ciento de mujeres. El 88 por ciento fueron fumadores; y el 78 por ciento, hipertensos. La efectividad global de la cirugía resultó del 64 por ciento (IC al 95 por ciento 50 por ciento-78 por ciento). Solamente el sexo femenino, con una probabilidad de 0,053 y un Odds Ratio de 4,23; el antecedente de enfermedad cerebrovascular (p: 0,13 y OR: 6,98); y la infección (p: 0,18 y OR: 2,7) mostraron una tendencia a asociarse de forma estadísticamente significativa con el éxito de la cirugía. Conclusiones: El sexo femenino, el antecedente de enfermedad cerebrovascular y la presencia de infección fueron los principales candidatos para estudiarse como variables pronosticadoras del éxito de la cirugía revascularizadora(AU)

Introduction: Revascularizing surgery is one of the fundamental strategies for the treatment of chronic critical ischemia of the lower limbs. Objective: To identify the factors associated with the success of lower limb revascularization surgery in diabetics with chronic critical ischemia. Methods: A descriptive, prospective, cohort-type study was conducted in diabetic patients undergoing revascularization surgery due to chronic critical limb ischemia. The patients were followed for six months at the National Institute of Angiology and Vascular Surgery from September 2019 to January 2021. The primary endpoint variable was the predictor of the success of surgery, which was considered successful when the patient remained alive and without major amputations. Results: 50 patients with an average age of 64 ± 10.21 years and 24 percent women were included. 88 percent of the patients were smokers; and 78 percent hypertensive ones. The overall effectiveness of surgery was 64 percent (95 percent CI 50 percent-78 percent). Only the female sex, with a probability of 0.053 and an Odds Ratio of 4.23, history of cerebrovascular disease (p: 0.13 and OR: 6.98); and infection (p: 0.18 and OR: 2.7) showed a tendency to be statistically, significantly associated with the success of surgery. Conclusions: Female sex, history of cerebrovascular disease and presence of infection were the main candidates as prognostic variables of the success of revascularizing surgery(AU)

Características sociodemográficas y clínicas de pacientes con hipertensión arterial en un área de salud de Niquero / Sociodemographic and clinical characteristics of patients with hypertension in a health area of Niquero

Introducción: La hipertensión arterial es la enfermedad crónica de mayor morbilidad a escala mundial, la cual representa un problema de salud por su multicausalidad y sus consecuencias. Objetivo: Describir las principales características sociodemográficas y clínicas de pacientes con hipertensión arterial, pertenecientes a un área de salud de Niquero. Métodos: Se realizó un estudio observacional, descriptivo y transversal de 370 pacientes con hipertensión arterial, quienes pertenecían al Consultorio Médico de la Familia No. 4 de Niquero, provincia de Granma, desde junio de 2021 hasta igual mes de 2022. Se estudiaron las variables edad, sexo, color de la piel, clasificación según cifras tensionales y evolución, así como estado del paciente y complicaciones. Resultados: Predominaron los grupos etarios de 40-59 (37,6 %) y 60-79 años (36,5 %), el sexo femenino (58,4 %), así como el color de la piel mestizo (55,9 %). Resultaron mayoría los pacientes con hipertensión arterial de grado II en fase 1 (44,3 %) y los parcialmente compensados (55,9 %). La enfermedad arterial periférica fue la principal complicación (21,1 %). Conclusiones: La descripción de las características sociodemográficas y clínicas de los pacientes con hipertensión arterial constituye un elemento a tener en cuenta para el adecuado control de los afectados en las áreas de salud.

Introduction: Hypertension is the chronic disease of more morbidity worldwide, which represents a health problem due to its multicausality and consequences. Objective: To describe the main sociodemographic and clinical characteristics of patients with hypertension, belonging to a health area of Niquero. Methods: An observational, descriptive and cross-sectional study of 370 patients with hypertension who belonged to the Family Doctor Office No. 4 of Niquero, Granma province, was carried out from June, 2021 to the same month in 2022. The variables age, sex, color of the skin, classification according to tension figures and evolution were studied, as well as patient state and complications. Results: There was a prevalence of the 40-59 (37.6 %) and 60-79 (36.5 %) age groups, female sex (58.4 %), as well as the mixed race color of the skin (55.9 %). The patients with grade II hypertension in phase 1 (44.3 %) and partially compensated (55.9 %) were the majority. Peripheral arterial disease was the main complication (21.1 %). Conclusions: The description of the sociodemographic and clinical characteristics of patients with hypertension constitutes an element to take into account for the appropriate control of those affected in the health areas.

MTHFR 677C>T (rsRS1801133) variant is associated with hyperhomocysteinemia but not with clinical severity in patients with peripheral arterial disease / A variante MTHFR 677C>T (RS1801133) está associada a hiperhomocisteinemia, mas não a gravidade clínica em pacientes com doença arterial periférica

Abstract Background The MTHFR 677C>T variant's involvement with hyperhomocysteinemia and peripheral arterial disease (PAD) is still unclear. Objectives To evaluate associations between the MTHFR 677C>T (rs1801133) variant and susceptibility to and severity of PAD and homocysteine (Hcy) levels. Methods The study enrolled 157 PAD patients and 113 unrelated controls. PAD severity and anatomoradiological categories were assessed using the Fontaine classification and the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC), respectively. The variant was genotyped using real-time polymerase chain reaction and Hcy levels were determined using chemiluminescence microparticle assay. Results The sample of PAD patients comprised 60 (38.2%) females and 97 (61.8%) males. Patients were older and had higher Hcy than controls (median age of 69 vs. 45 years, p<0.001; and 13.66 µmol/L vs. 9.91 µmol/L, p=0.020, respectively). Hcy levels and the MTHFR 677C>T variant did not differ according to Fontaine or TASC categories. However, Hcy was higher in patients with the CT+TT genotypes than in those with the CC genotype (14.60 µmol/L vs. 12.94 µmol/L, p=0.008). Moreover, patients with the TT genotype had higher Hcy than those with the CC+CT genotypes (16.40 µmol/L vs. 13.22 µmol/L, p=0.019), independently of the major confounding variables. Conclusions The T allele of MTHFR 677C>T variant was associated with higher Hcy levels in PAD patients, but not in controls, suggesting a possible interaction between the MTHFR 677C>T variant and other genetic, epigenetic, or environmental factors associated with PAD, affecting modulation of Hcy metabolism.

Resumo Contexto O envolvimento da variante MTHFR 677C>T na hiperhomocisteinemia e na doença arterial periférica (DAP) ainda não está claro. Objetivos Avaliar a associação da variante MTHFR 677C>T (rs1801133) com suscetibilidade e gravidade da DAP e valores séricos de homocisteína (Hcy). Métodos Este estudo caso-controle envolveu 157 pacientes com DAP e 113 controles não relacionados. A gravidade e as categorias anatomorradiológicas da DAP foram avaliadas pela classificação de Fontaine e pelo Inter-Society Consensus for the Management of Peripheral Arterial Disease, respectivamente. A genotipagem foi realizada por meio de reação em cadeia da polimerase em tempo real, e os valores de Hcy foram determinados por ensaio de micropartículas de quimioluminescência. Resultados Entre os pacientes com DAP, 97 (61,8%) eram homens e 60 (38,2%) eram mulheres, com mediana de idade de 69 anos. Os pacientes com DAP eram mais velhos e apresentaram valores mais elevados de Hcy do que os controles (mediana de 69 vs. 45 anos de idade, p < 0,001; 13,66 µmol/L vs. 9,91 µmol/L, p = 0,020, respectivamente). Os valores de Hcy foram mais elevados em pacientes com os genótipos CT+TT do que aqueles com o genótipo CC (14,60 µmol/L vs. 12,94 µmol/L, p = 0,008). Além disso, os pacientes com o genótipo TT apresentaram valores mais elevados de Hcy do que aqueles com os genótipos CC+CT (16,40 µmol/L vs. 13,22 µmol/L, p = 0,019, respectivamente), independentemente das principais variáveis confundidoras. Conclusões O alelo T da variante MTHFR 677C>T foi associado a valores mais elevados de Hcy nos pacientes com DAP, mas não em controles, sugerindo uma possível interação entre a variante genética MTHFR 677C>T e outros fatores genéticos, epigenéticos ou ambientais associados com a DAP na modulação do metabolismo da Hcy.

Physiological responses during walking in men and women with intermittent claudication

ABSTRACT Objective Peak oxygen consumption (VO2peak), anaerobic threshold, walking economy, and cardiovascular responses during walking are used to guide and monitor walking training in patients with peripheral artery disease and intermittent claudication. Women with peripheral artery disease and intermittent claudication present greater impairments than men, and evaluating training markers according to sex for decisions regarding walking prescription in this population is important. This study aimed to compare VO2peak, walking economy, anaerobic threshold, and cardiovascular responses during walking in men and women with peripheral artery disease and intermittent claudication. Methods Forty patients (20 men and 20 women with similar baseline characteristics) underwent a cardiopulmonary treadmill test (3.2km/h and 2% increase in slope every 2 minutes until maximal leg pain). The VO2 and rate-pressure product were assessed. Data from men and women were compared using t-tests. Results There were no significant differences between men and women (VO2peak: 15.0±4.8 versus 13.9±2.9mL∙kg-1∙min-1, p=0.38; walking economy: 9.6±2.7 versus 8.4±1.6mL∙kg-1∙min-1, p=0.09; anaerobic threshold: 10.5±3.2 versus 10.5±2.2mL∙kg-1∙min-1, p=0.98; rate pressure product at 1st stage: 13,465± 2,910 versus 14,445±4,379bpm∙mmHg, p=0.41; and rate pressure product at anaerobic threshold:13,673±3,100 versus 16,390±5,870bpm∙mmHg, p=0.08 and rate pressure product at peak exercise: 21,253±6,141 versus 21,923±7,414bpm∙mmHg, p=0.76, respectively). Conclusion Men and women with peripheral artery disease and similar baseline characteristics presented similar responses to walking, suggesting that decisions regarding walking prescription and monitoring can be made regardless of sex in this specific population.

Correlação das medidas ultrassonográficas, tomográficas e intraoperatórias da veia safena interna utilizada como enxerto arterial / Correlations between ultrasound, tomographic, and intraoperative measurements of the great saphenous vein used as an arterial graft

Resumo Contexto A veia safena interna é a principal veia superficial do membro inferior, sendo também a mais utilizada para cirurgias de enxerto arterial para revascularização de membros inferiores. O conhecimento prévio da qualidade da veia pode orientar a mudança da estratégia terapêutica, evitando cirurgias fadadas ao insucesso. Observou- se, com frequência, a discrepância entre achados intraoperatórios e exames de imagem. Objetivos Avaliar e comparar o calibre da veia safena interna através de dois métodos de imagem [ultrassonografia (USG) dúplex e angiotomografia computadorizada (angio TC)] e do padrão-ouro (medida no intraoperatório). Métodos Tratou-se de estudo prospectivo observacional. Os dados coletados foram obtidos dos procedimentos médicos de rotina realizados pela equipe de Cirurgia Vascular. Resultados Foram avaliados 41 pacientes, seguidos clinicamente por 12 meses, sendo 27 (65,8%) do sexo masculino, com média de idade de 65,37 anos. Dezenove (46,3%) pacientes foram submetidos a enxerto fêmoro-poplíteo, e 22 (53,7%) a enxertos distais. Os diâmetros da veia safena foram em média 16,4% menores na TC e 33,8% menores na USG, quando medidos em decúbito dorsal no pré-operatório, comparados ao diâmetro externo após dilatação hidrostática no intraoperatório. Não houve diferença estatística das medidas da cirurgia quando se comparou sexo, peso e altura. Conclusões A avaliação do calibre da veia safena foi subestimada pelos exames de USG e TC pré-operatórias com o paciente em decúbito dorsal, em relação à medida intraoperatória. Em pacientes em programação de enxerto para revascularização, a escolha do conduto deve levar esse dado em consideração para que não ocorra exclusão precipitada do uso da veia safena no planejamento.

Abstract Background The great saphenous vein is the major superficial vein of the lower limb, and also the most often used as arterial graft material for lower limb revascularization. Prior knowledge of the quality of the vein can guide choice of therapeutic strategy, avoiding surgery that is doomed to failure. Discrepancies between intraoperative findings of the quality of the great saphenous vein and imaging tests are also frequently observed. Objectives To evaluate the diameter of the great saphenous vein using two imaging methods (Duplex Ultrasound and Computed Tomography) and the gold-standard (intraoperative direct measurement of the vein), comparing the results. Methods Prospective, observational study of data obtained during routine medical procedures performed by the Vascular Surgery team. Results 41 patients were evaluated, with a 12-month follow-up. 27 (65.85%) were male and mean age was 65.37 years. 19 (46.34%) patients had femoropopliteal grafts and 22 (53.66%) had distal grafts. Preoperative saphenous vein internal diameters measured with the patient supine were on average 16.4% smaller on CT and 33.8% smaller on US than the external diameters measured after intraoperative hydrostatic dilatation. There were no statistical differences in measurements when sex, weight, and height were considered. Conclusions Saphenous vein diameters were underestimated by preoperative US and CT scans when compared to intraoperative measurements. Thus, in patients undergoing graft planning for revascularization, the choice of conduit should take this data into consideration, so that use of the saphenous vein is not ruled out unnecessarily during planning.

Foot-at-Risk among adult outpatients with diabetes mellitus in Bowen University Teaching Hospital, Ogbomoso, Nigeria

Introduction: the rising prevalence of diabetes mellitus (DM) around the world has dramatically increased the number of people bearing the complications of this potentially incapacitating disease. One of these complications is foot ulcers that may result in amputation. This study sets out to determine the profiles of the "foot-at-risk" for ulceration and the associated socio-medical factors in DM patients. Methods: this study was conducted at Bowen University Teaching Hospital, Ogbomoso, Southwest, Nigeria. This was a descriptive cross-sectional study comprising 299 outpatient adults aged 18 years and above with diabetes mellitus of at least 6 months in duration. Comprehensive Foot Examination and Risk Assessment tool was used to identify the foot-at-risk categories of the participants. Data analysis was done using Statistical Package for Social Sciences (SPSS) version 20. Results: the prevalence of foot-at-risk among the participants was 64.9% (194). Among the 194 participants with foot-at-risk, 35.1% (105) belonged to the foot-at-risk categories 0, 37.8% (113) in category 1, 16.1% (48) in category 2, and 11.0% (33) in category 3. Other factors that had a statistically significant association with foot-at-risk included; age, religion, level of education, duration of diabetes, history of smoking, and glycemic control. Conclusion: foot-at-risk was found to have an alarming prevalence among the participants. In addition, the level of glycemic control in this group was unacceptably poor. Clinicians need to intensify preventive measures like foot screening and health education to prevent foot ulcerations, which may result in limb amputation in DM patients.

Ultrasound findings and related factors of lower extremity arterial disease in patients with type 2 diabetes mellitus / 中国基层医药

Objective:To investigate the value of ultrasound findings in the diagnosis of lower extremity arterial disease in patients with type 2 diabetes mellitus and correlate it with clinical factors.Methods:A total of 535 patients with type 2 diabetes mellitus who received treatment in Taiyuan Second People's Hospital from January 2016 to June 2019 underwent color Doppler ultrasound examination (T2DM group). Vascular inner diameter, intima-media thickness, atherosclerotic plaque formation, lumen stenosis or occlusion, and hemodynamic characteristics were determined in patients with type2 diabetes mellitus compared with those in 107 patients with non-type 2 diabetes mellitus (non-T2DM group). These parameters were correlated with the course of the disease, blood glucose level, concomitant hypertension or not, and clinical Wagner grade.Results:The incidences of intima-media thickening, atherosclerotic plaque, stenosis, and occlusion of lower extremity arteries were 69.9%, 89.0%, 77.0% and 11.6% respectively, in the T2DM group, which were significantly higher than 41.1%, 78.5%, 72.0%, and 1.9% respectively in the non-T2DM group ( χ2 = 32.52, P < 0.001; χ2 = 8.76, P = 0.003; χ2 = 27.77, P < 0.001). With the prolongation of the course of T2DM, the incidence of arterial lesions in the lower extremities increased ( P < 0.001). The incidences of intima-media thickening, atherosclerotic plaque, stenosis, and occlusion of lower extremity arteries were significantly greater in the poor blood glucose control group and non-hypertension group compared with the good blood glucose control group and hypertension group (all P < 0.05). The degree of lower extremity arterial stenosis in T2DM patients was related to Wagner's grade. As the degree of stenosis increased, Wagner's grade increased correspondingly and significantly ( P < 0.001). Conclusion:Color Doppler ultrasound examination has an important value in evaluating lower extremity arterial lesions in patients with T2DM. The degree of arterial lesions in the lower extremities of T2DM patients is correlated with the course of the disease, blood glucose levels, concomitant hypertension, and clinical Wagner grade. Color Doppler ultrasound examination has an important clinical significance in evaluating the degree of vascular lesions and guiding early interventions in the clinic.

The Influence of Primary Atherosclerotic Diseases on the Occurrence of Secondary Disease

Abstract Background Atherosclerosis is a condition in which fats, cholesterol, fibrin, and other substances accumulate into plaque on the arterial walls. Plaque can harden and narrow the arteries, in turn limiting the blood flow and resulting in diseases, such as acute myocardial infarction (AMI), ischemic stroke (IS), or peripheral arterial disease (PAD). There is a fairly high risk of a secondary atherosclerotic event if patients are not treated after the primary episode. Objective To calculate the statistical probability of developing AMI, IS, or PAD after treating the primary disease. Methods Data for statistical probability studies included 507,690 patients with primary atherosclerotic disease, who were in treatment during the study period and who did or did not develop a secondary atherosclerotic disease event. Result Statistical probability data indicate that few AMI patients can develop IS (2.99%) or PAD (2.86%) as a secondary disease. Patients with primary diagnoses of IS showed a 5.07% risk of developing PAD and a 0.95% risk of developing AMI; however, PAD patients showed a higher probability for both AMI (9.17%) and IS (8.79%). Conclusion Secondary atherosclerotic disease episodes after IS, AMI, and PAD were confirmed by statistical probability and are consistent with data from the literature. The study revealed that a primary PAD event leads to high rates of secondary episodes, and special attention should be given to the diagnosis and treatment of PAD in order to decrease the occurrence of secondary events.

Smoking cessation for peripheral arterial disease: systematic review protocol / Cessação do tabagismo para doença arterial periférica: protocolo de revisão sistemática

ABSTRACT Background: peripheral arterial disease has smoking as its main avoidable vascular risk factor. However, most studies do not focus on smoking as the main exposure variable. Objectives: to assess the impact of smoking cessation interventions versus active comparator, placebo or no intervention, on peripheral arterial disease outcomes. Methods: we will use the Cochrane Handbook for Systematic Reviews of Interventions to guide whole this review process. We will consider parallel or cluster-randomised controlled trials (RCTs), quasi-RCTs, and cohort studies. We will search CENTRAL, MEDLINE, Embase, PsycINFO, LILACS and IBECS. We will also conduct a search of ClinicalTrials.gov and the ICTRP for ongoing or unpublished trials. Each research step will involve at least two independent reviewers. We will create a table, using GRADE pro GDT software, reporting the pooled effect estimates for the following outcomes: all-cause mortality, lower limb amputation, adverse events, walking distance, clinical severity, vessel or graft secondary patency, and QoL. Conclusions: we will assess these outcomes according to the five GRADE considerations to assess the certainty of the body of evidence for these outcomes, and to draw conclusions about the certainty of the evidence within the review.

RESUMO Introdução: a doença arterial periférica tem o tabagismo como principal fator de risco vascular evitável. Entretanto, a maioria dos estudos não destaca o tabagismo como principal variável de exposição. Objetivos: avaliar o impacto das intervenções de cessação do tabagismo versus comparador ativo, placebo ou nenhuma intervenção, nos desfechos da doença arterial periférica. Métodos: usaremos o Cochrane Handbook for Systematic Review of Interventions para orientar todo este processo de revisão. Consideraremos ensaios controlados paralelos ou randomizados por cluster (ECRs), quase-ECRs e estudos de coorte. Buscaremos no CENTRAL, MEDLINE, Embase, PsycINFO, LILACS e IBECS. ClinicalTrials.gov e ICTRP serão consultados para ensaios em andamento ou não publicados. Criaremos uma tabela, usando o software GRADE pro GDT, relatando as estimativas de efeito agrupado para os seguintes desfechos: mortalidade por todas as causas, amputação de membro inferior, eventos adversos, distância percorrida, gravidade clínica, permeabilidade secundária do vaso ou enxerto e qualidade de vida. Avaliaremos esses resultados de acordo com as cinco considerações GRADE para avaliar a certeza do corpo de evidências para esses resultados e tirar conclusões sobre a certeza das evidências na revisão.

Proposed public policies to improve outcomes in vascular surgery: an experts' forum

ABSTRACT Objective To evaluate outcomes of vascular surgeries and identify strategies to improve public vascular care. Methods This was a descriptive, qualitative, and cross-sectional survey involving 30 specialists of the Hospital Israelita Albert Einstein via Zoom. The outcomes of vascular procedures performed in the Public Health System extracted through Big Data analysis were discussed, and 53 potential strategies to improve public vascular care to improve public vascular care. Results There was a consensus on mandatory reporting of some key complications after complex arterial surgeries, such as stroke after carotid revascularization and amputations after lower limb revascularization. Participants agreed on the recommendation of screening for diabetic feet and infrarenal abdominal aortic aneurysms. The use of Telemedicine as a tool for patient follow-up, auditing of centers for major arterial surgeries, and the concentration of complex arterial surgeries in reference centers were also points of consensus, as well as the need to reduce the values of endovascular materials. Regarding venous surgery, it was suggested that there should be incentives for simultaneous treatment of both limbs in cases of varicose veins of the lower limbs, in addition to the promotion of ultrasound-guided foam sclerotherapy in the public system. Conclusion After discussing the data from the Brazilian Public System, proposals were defined for standardizing measures in population health care in the area of vascular surgery.

Influência dos fatores de risco para aterosclerose na distribuição anatômica da doença arterial periférica em pacientes com isquemia crônica crítica de membros: um estudo transversal / Influence of atherosclerosis risk factors on the anatomical distribution of peripheral arterial disease in patients with chronic limb-threatening ischemia: a cross-sectional study

Resumo Contexto Os fatores de risco para aterosclerose podem ter influência distinta nas doenças cardiovasculares, impactando também no território da doença arterial periférica (DAP). Objetivos Estudar a influência dos diferentes fatores de risco para a aterosclerose na distribuição anatômica da DAP em pacientes com isquemia crítica crônica de membros (ICCM). Métodos Foi realizado um estudo observacional, transversal e analítico, incluindo 476 doentes internados devido à ICCM por DAP. Foram estudados, comparativamente, os pacientes com DAP dos três distintos territórios anatômicos (aortoilíaco, femoropoplíteo e infragenicular) em relação à presença dos fatores de risco para a aterosclerose (idade, gênero, diabetes mellitus, tabagismo e hipertensão arterial). A análise multivariada foi realizada para testar a associação entre os fatores de risco e a distribuição anatômica da DAP. Resultados A média de idade dos pacientes foi de 69 anos, 249 (52%) eram homens, e 273 (57%), diabéticos. Predominaram os pacientes na Categoria 5 da Classificação de Rutherford (353/74%). Na análise multivariada, as mulheres tiveram chance 2,7 (IC: 1,75-4,26) vezes maior de doença do território femoropoplíteo. Os doentes tabagistas tiveram 3,6 (IC: 1,54-8,30) vezes maior risco de doença do território aortoilíaco. Diabéticos apresentaram 1,8 (IC: 1,04-3,19) vezes maior chance de obstrução apenas do território infragenicular. Conclusões O estudo mostrou que gênero, diabetes mellitus e tabagismo influenciam no padrão de distribuição da DAP em pacientes com ICCM. Os doentes diabéticos apresentaram maior chance de doença isolada do território infragenicular, as mulheres tiveram maior risco de DAP do território femoropoplíteo e os tabagistas possuem maior chance comprometimento aortoilíaco.

Abstract Background Atherosclerosis risk factors can have different impacts on cardiovascular diseases and on the anatomical distribution of Peripheral Arterial Disease (PAD). Objectives To study the influence of atherosclerosis risk factors on the anatomical distribution of PAD in patients with chronic limb-threatening ischemia (CLTI). Methods We performed an observational, cross-sectional, and analytical study that included 476 hospitalized patients with CLTI due to PAD. We compared the presence of atherosclerosis risk factors (age, gender, diabetes mellitus, smoking, and hypertension) in patients with PAD involving three different anatomic areas (aortoiliac, femoropopliteal, and infrapopliteal). Multivariate analysis was performed to identify associations between atherosclerosis risk factors and PAD distribution. Results The mean age of the 476 patients was 69 years, 249 (52%) were men, and 273 (57%) had diabetes. Seventy-four percent (353) had minor tissue loss. Multivariate analysis identified three risk factors associated with PAD anatomical distribution (gender, smoking, and DM). Women had a 2.7 (CI: 1.75-4.26) times greater chance of having femoropopliteal disease. Smokers had a 3.6-fold (CI: 1.54-8.30) greater risk of aortoiliac disease. Diabetic patients were 1.8 (CI: 1.04-3.19) times more likely to have isolated infrapopliteal occlusive disease. Conclusions The study showed that gender, DM, and smoking impact on the anatomical distribution of PAD in patients with CLTI. Diabetic patients were more likely to have only infrapopliteal disease, women had a greater risk of femoropopliteal PAD, and smokers had a greater risk of aortoiliac occlusive disease.

Buerger's disease with cerebral involvement in a middle-aged woman with diabetes mellitus. a case report

Introduction: Buerger's disease (BD) generally affects men, young people, and smokers, but it can also affect women. Its incidence is rare in Latin America. Case report: A 40-year-old Colombian woman, active smoker and user of psychoactive substances, attended the emergency department of a tertiary care center due to symptoms of 3 days consisting of retraction of the corner of the mouth, drooling, and involuntary tongue movements. The patient, who had a history of uncontrolled diabetes and recent acute ischemia of the right upper limb due to acute thrombosis, required surgical management and subsequent use of oral anticoagulation. She later developed necrotic changes in the distal phalanges of the right hand that required ablative therapy. Since age, sex and limb involvement were not typical for BD, collagenosis, vasculitis or thrombophilia were ruled out, but after excluding these disorders, BD with atypical features was considered. The patient was discharged with oral anticoagulation, aspirin, combined analgesia, physiotherapy, and recommendation for smoking cessation. Conclusions: Age, sex, smoking and comorbidities such as diabetes are risk factors for BD. Imaging and histopathology are the gold standard for the definitive diagnosis of this entity. Multidisciplinary management, lifestyle changes, smoking cessation, pain control, good wound healing and social support are key aspects for better clinical outcomes in patients with BD.

Introducción. La enfermedad de Buerger (EB) afecta generalmente a hombres, jóvenes y fumadores, y aunque también puede afectar a mujeres, su incidencia es rara en Latinoamérica. Presentación del caso. Mujer colombiana de 40 años, fumadora activa y consumidora de sustancias psicoactivas, quien acudió al servicio de urgencias de una institución de tercer nivel por síntomas de 3 días de evolución consistentes en retracción de la comisura bucal, babeo y movimientos involuntarios de la lengua. La paciente, que tenía antecedente de diabetes no controlada y reciente isquemia aguda de miembro superior derecho por trombosis aguda, requirió manejo intervencionista y subsecuente uso de anticoagulación oral. Posteriormente, desarrolló cambios necróticos en falanges distales de mano derecha y requirió terapia ablativa. Dado que la edad, el género y la afectación de las extremidades no eran típicos para EB, se procedió a descartar colagenosis, vasculitis o trombofilia, pero tras excluir estas patologías se consideró EB con características atípicas. La paciente fue dada de alta con anticoagulación oral, aspirina, analgesia combinada, fisioterapia y recomendación de suspender el consumo de tabaco. Conclusiones. La edad, el género, el tabaquismo y las comorbilidades como diabetes son factores de riesgo para EB. La imagenología e histopatología son estándar de oro en el diagnóstico definitivo de esta entidad. El manejo multidisciplinario, los cambios en el estilo de vida, la cesación del tabaquismo, el control del dolor, la buena cicatrización de heridas y el apoyo social son aspectos importantes para obtener mejores resultados clínicos en pacientes con EB.

Relationship between peripheral arterial disease severity determined by the Glass classification and triglyceride-glucose index; novel association and novel classification system / Relación entre la gravedad de la enfermedad arterial periférica determinada por la clasificación GLASS y el índice de triglicéridos-glucosa; nueva asociación y nuevo sistema de clasificación

Abstract Peripheral arterial disease is a serious clinical manifestation caused by atherosclerosis. It is one common cause of morbidity and mortality worldwide. It is commonly seen in males, and its (prevelance) increases with age. It is most prevalent with smoking, hypertension, diabetes mellitus and hyperlipidemia. Novel studies investigate the relationship between triglyceride-glucose index (TyG) and cardiovascular diseases. Studies investigating the association of this index and peripheral arterial disease and disease severity are generally done by using The Trans-Atlantic Inter-Society Consensus (TASC) classification. We aimed to study this association by using the new Global Limb Anatomic Staging System (GLASS) classification. Two hundred patients between 25 to 90 years old diagnosed with peripheral arterial disease and admitted to the hospital for peripheral arterial angiography between July 2021 and December 2021, were evaluated retrospectively with blood parameters and angiographic images. Patients were divided into two groups: moderate (group 1; n=58) and severe (group 2; n=142) according to the GLASS classification. No statistical differences were observed for comorbidities and repeated interventional procedure rates (p=0.164). Triglyceride values were found to be statistically different between groups (p=0.040). TyG was found higher in group 2 (p= 0.04). According to the binary logistic regression model, only TyG was found to have a significant effect as a diagnostic factor (p=0.011). TyG was also significantly correlated with the Rutherford (p=0.012) and GLASS classification severity (p<0.001). Peripheral arterial disease and disease severity could be easily monitored with simple calculable TyG. In this way, precautions could be taken, and morbidities could be prevented.

Resumen La enfermedad arterial periférica es una manifestación clínica importante causada por la aterosclerosis. Es una causa común de morbilidad y mortalidad en todo el mundo. Se ve comúnmente en hombres y la prevalencia aumenta con la edad. Es más común con el tabaquismo, la hipertensión, la diabetes mellitus y la hiperlipidemia. Nuevos estudios investigan la relación entre el índice de triglicéridos-glucosa (TyG) y las enfermedades cardiovasculares. Los estudios que investigan la asociación de este índice y la enfermedad arterial periférica generalmente se realizan utilizando la clasificación de TASC. Nuestro objetivo fue estudiar esta asociación utilizando la nueva clasificación de GLASS (sistema global de estadificación anatómica de extremidades). Doscientos pacientes entre 25 a 90 años con diagnóstico de enfermedad arterial periférica e ingresados al hospital para angiografía arterial periférica entre julio de 2021 y diciembre de 2021, fueron evaluados retrospectivamente con parámetros sanguíneos e imágenes angiográficas. Los pacientes se dividieron en dos grupos: leves (grupo 1; n=58) y graves (grupo 2; n=142) según la clasificación de GLASS. No se observaron diferencias estadísticas para las comorbilidades y las tasas de procedimientos intervencionistas repetidos (p = 0,164). Los valores de triglicéridos se encontraron significativamente diferentes entre los grupos (p= 0,04). El índice de triglicéridos-glucosa se encontró más alto en el grupo 2 (p= 0,04). Según el modelo de regresión logística binaria, solo el índice de triglicéridos-glucosa resultó tener un efecto significativo como factor diagnóstico (p=0,011). El índice de triglicéridos-glucosa también se correlacionó significativamente con la gravedad de la clasificación de Rutherford (p=0,012) y la clasificación de GLASS (p<0,001). La enfermedad arterial periférica y la gravedad de la enfermedad podrían controlarse fácilmente con TyG calculable simple. De esta manera, se podrían tomar precauciones y prevenir morbilidades.

Perfusión 2D por angiografía en oclusión arterial periférica. Método de evaluación inmediato posproceder / 2D perfusion by angiography in peripheral arterial occlusion. Post-procedural immediate evaluation method

La enfermedad arterial periférica se considera la mayor causa de hospitalización, con riesgo de amputación de la extremidad afectada y muerte debido a la enfermedad per se o sus complicaciones. Se reporta la experiencia del tratamiento a un paciente con macroangiopatía diabética, estenosis del 64 por ciento de la arteria ilíaca izquierda y afectación de los segmentos fémoro-poplíteos bilaterales, al cual, a través de un acceso percutáneo vía arteria braquial izquierda, se le realizó revascularización mediante la implantación de stent de cromo-cobalto liberado por balón catéter. El objetivo de este estudio fue describir la utilidad del 2D-ASD y su valor como herramienta para determinar el transproceder y la repercusión en el flujo sanguíneo de la revascularización realizada, y establecer un pronóstico funcional para el paciente. Se utilizó la angiografía por perfusión bidimensional como herramienta para evaluar el éxito técnico del proceder y la repercusión inmediata en la perfusión distal de la extremidad afecta, y describir la utilidad de la escala paramétrica de colores y las curvas de densidad en función del tiempo obtenidos en el estudio(AU)

Peripheral artery disease is considered the leading cause of hospitalization, with risk of amputation of the affected limb and death due to the disease per se or its complications. It is reported the experience of treatment in a patient with diabetic macroangiopathy, stenosis of 64 percent of the left iliac artery and involvement of the bilateral femoro-popliteal segments, to which, through a percutaneous access via the left brachial artery, revascularization was performed through the implantation of cobalt-chromium stent released by balloon catheter. The objective of this study was to describe the usefulness of 2D-ASD and its value as a tool to determine the trans-procedure and the impact on blood flow of the revascularization performed, and to establish a functional prognosis for the patient. Two-dimensional perfusion angiography was used as a tool to evaluate the technical success of the procedure and the immediate impact on distal perfusion of the affected limb, and to describe the usefulness of the parametric color scale and density curves as a function of the time obtained in the study(AU)

Perfusión 2D por angiografía en oclusión arterial periférica. Método de evaluación inmediato posproceder / 2D perfusion by angiography in peripheral arterial occlusion. Post-procedural immediate evaluation method

La enfermedad arterial periférica se considera la mayor causa de hospitalización, con riesgo de amputación de la extremidad afectada y muerte debido a la enfermedad per se o sus complicaciones. Se reporta la experiencia del tratamiento a un paciente con macroangiopatía diabética, estenosis del 64 por ciento de la arteria ilíaca izquierda y afectación de los segmentos fémoro-poplíteos bilaterales, al cual, a través de un acceso percutáneo vía arteria braquial izquierda, se le realizó revascularización mediante la implantación de stent de cromo-cobalto liberado por balón catéter. El objetivo de este estudio fue describir la utilidad del 2D-ASD y su valor como herramienta para determinar el transproceder y la repercusión en el flujo sanguíneo de la revascularización realizada, y establecer un pronóstico funcional para el paciente. Se utilizó la angiografía por perfusión bidimensional como herramienta para evaluar el éxito técnico del proceder y la repercusión inmediata en la perfusión distal de la extremidad afecta, y describir la utilidad de la escala paramétrica de colores y las curvas de densidad en función del tiempo obtenidos en el estudio(AU)

Peripheral artery disease is considered the leading cause of hospitalization, with risk of amputation of the affected limb and death due to the disease per se or its complications. It is reported the experience of treatment in a patient with diabetic macroangiopathy, stenosis of 64 precent of the left iliac artery and involvement of the bilateral femoro-popliteal segments, to which, through a percutaneous access via the left brachial artery, revascularization was performed through the implantation of cobalt-chromium stent released by balloon catheter. The objective of this study was to describe the usefulness of 2D-ASD and its value as a tool to determine the trans-procedure and the impact on blood flow of the revascularization performed, and to establish a functional prognosis for the patient. Two-dimensional perfusion angiography was used as a tool to evaluate the technical success of the procedure and the immediate impact on distal perfusion of the affected limb, and to describe the usefulness of the parametric color scale and density curves as a function of the time obtained in the study(AU)