Comparação das alterações angiográficas entre pacientes diabéticos e não diabéticos com doença arterial periférica / Comparative study of angiographic changes in diabetic and non-diabetic patients with peripheral arterial disease

Resumo Contexto Os diabéticos possuem risco de 5 a 15 vezes maior para o desenvolvimento de doença arterial periférica (DAP), e poucos estudos compararam fatores de risco e a distribuição e gravidade de alterações arteriais angiográficas entre diabéticos e não diabéticos. Objetivos Comparar alterações angiográficas entre pacientes diabéticos e não diabéticos com DAP avançada, correlacionando-as com demais fatores de risco. Métodos Trata-se de um estudo transversal retrospectivo de pacientes consecutivos submetidos a arteriografia de membros inferiores por DAP (Rutherford de 3 a 6), usando os escores angiográficos TASC II e de Bollinger et al. Os critérios de exclusão incluíram arteriografias de membros superiores, exames incompletos ou sem nitidez e cirurgias prévias. A análise estatística incluiu o teste do qui-quadrado ou exato de Fisher para variáveis discretas e o teste t para variáveis contínuas (significância: p < 0,05). Resultados Foram estudados 153 pacientes com idade média de 67 anos, sendo 50,9% do sexo feminino e 58,2% diabéticos. Um total de 91 pacientes (59%) tinha lesão trófica (Rutherford 5 ou 6), enquanto 62 (41%) tinham dor em repouso ou claudicação limitante (Rutherford 3 e 4). Entre os diabéticos, 81,7% eram hipertensos, 29,4% nunca fumaram e 14% tinham antecedente de infarto do miocárdio. Pelo escore de Bollinger et al., as artérias infrapoplíteas foram as mais comprometidas, em especial a tibial anterior (p = 0,005) nos diabéticos, enquanto a femoral superficial foi mais acometida nos não diabéticos (p = 0,008). Pelo TASC II, as alterações arteriográficas mais graves ocorreram no segmento fêmoro-poplíteo nos pacientes não diabéticos (p = 0,019). Conclusões Os setores infrapoplíteos foram os mais comprometidos nos diabéticos, enquanto o setor femoral foi o mais acometido nos não diabéticos.

Abstract Background Diabetics are at 5-15 times greater risk of developing peripheral arterial disease (PAD) and few studies have compared risk factors and distribution and severity of arterial changes in diabetics compared with non-diabetics. Objectives To compare angiographic changes between diabetic and non-diabetic patients with advanced PAD and correlate them with risk factors. Methods A retrospective cross-sectional study was conducted of consecutive patients undergoing lower limb arteriography for PAD (Rutherford 3-6) using TASC II and Bollinger et al. angiographic scores. Exclusion criteria were upper limb angiographies, unclear images, incomplete laboratory test results, and previous arterial surgeries. Statistical analyses included chi-square tests, Fisher's test for discrete data, and Student's t test for continuous data (significance level: p < 0.05). Results We studied 153 patients with a mean age of 67 years, 50.9% female and 58.2% diabetics. A total of 91 patients (59%) had trophic lesions (Rutherford 5 or 6) and 62 (41%) had resting pain or limiting claudication (Rutherford 3 and 4). Among diabetics, 81.7% were hypertensive, 29.4% had never smoked, and 14% had a history of acute myocardial infarction. According to the Bollinger et al. score, infra-popliteal arteries were more affected in diabetics, especially the anterior tibial artery (p = 0.005), while the superficial femoral artery was more affected in non-diabetics (p = 0.008). According to TASC II, the most severe angiographic changes in the femoral-popliteal segment occurred in non-diabetic patients (p = 0.019). Conclusions The most frequently affected sectors were the infra-popliteal sectors in diabetics and the femoral sector in non-diabetics.

Programa de superación profesional para angiólogos sobre tratamiento de enfermedades vasculares periféricas con técnicas novedosas

Introducción: La superación profesional es un conjunto de acciones de carácter educativo vinculadas con la actualización de conocimientos y el desarrollo de habilidades y actitudes profesionales en correspondencia con la identificación de problemas profesionales. En Ciego de Ávila, Cuba, los especialistas de Angiología y Cirugía Vascular carecen de actividades de superación profesional de forma general, sistemática y de participación colectiva, dirigidas u orientadas desde la Universidad de Ciencias Médicas. Objetivo: Elaborar un programa de superación profesional del especialista en Angiología y Cirugía Vascular para el tratamiento de las enfermedades vasculares periféricas con técnicas novedosas, a partir de insuficiencias identificadas. Método: Se realizó una investigación cualitativa con un estudio descriptivo en especialistas de Angiología y Cirugía Vascular de la provincia de Ciego de Ávila, vinculada directamente con la atención a pacientes, en el año 2020. Se trabajó con toda la población compuesta por 19 especialistas. Fue aplicada una encuesta y se utilizó la estadística descriptiva para organizar y clasificar los indicadores cuantitativos obtenidos. Resultados: La preparación para la aplicación de tratamiento con técnicas novedosas en las enfermedades vasculares periféricas se encontró como insuficiencia en nivel de Poco adecuado y No adecuado en más del 90 % de los especialistas. Conclusiones: Se aporta un programa de superación profesional como sistema abierto, de carácter flexible, que facilita su rediseño constante para adaptarse a condiciones específicas de los contextos de aplicación.

Introduction: Professional development is a set of educational actions linked to update knowledge and professional skills and attitudes in correspondence with the professional problems met. In Ciego de Avila, Cuba, specialists in Angiology and Vascular Surgery lack professional improvement activities in general, systematic and collective participation way, straightly performed or oriented from the University of Medical Sciences. Objective: To design a professional development program for specialists in Angiology and Vascular Surgery on the treatment of peripheral vascular diseases with the use of novel techniques based on the professional problems met. Method: A qualitative research with descriptive study was carried out in Angiology and Vascular Surgery specialists linked directly to the patient care service in 2020. It worked with the whole population comprised of 19 specialists. A survey was applied and descriptive statistics were used to organize and classify the quantitative indicators obtained. Results: Knowledge on how to use the novel techniques in peripheral vascular diseases treatment proved to be inadequate at a pointed level of Less adequate and Inadequate in more than 90% of studied specialists. Conclusions: The professional development program is provided with characteristics of an open system and flexibility, which facilitates its constant redesign to adapt to the specific conditions of the contexts required.

Introdução: O aperfeiçoamento profissional é um conjunto de ações educativas vinculadas à atualização de conhecimentos e desenvolvimento de habilidades e atitudes profissionais em correspondência com a identificação de problemas profissionais. No Ciego de Ávila, Cuba, os especialistas em Angiologia e Cirurgia Vascular carecem de atividades de aperfeiçoamento profissional de forma geral, sistemática e de participação coletiva, dirigidas ou orientadas pela Universidade de Ciências Médicas. Objetivo: Desenvolver um programa de aperfeiçoamento profissional do especialista em Angiologia e Cirurgia Vascular para tratamento de doenças vasculares periféricas com técnicas inovadoras, a partir das insuficiências identificadas. Método: Foi realizada uma investigação qualitativa com estudo descritivo em especialistas de Angiologia e Cirurgia Vascular na província de Ciego de Ávila, diretamente vinculados ao atendimento ao paciente, no ano de 2020. Trabalhamos com toda a população composta por 19 especialistas. Aplicou-se um survey e utilizou-se estatística descritiva para organizar e classificar os indicadores quantitativos obtidos. Resultados: A preparação para a aplicação do tratamento com novas técnicas nas doenças vasculares periféricas revelou-se insuficiente ao nível de Pouco adequado e Pouco adequado em mais de 90% dos especialistas. Conclusões: Um programa de aperfeiçoamento profissional é fornecido como um sistema aberto, de natureza flexível, o que facilita seu redesenho constante para se adaptar às condições específicas dos contextos de aplicação.

Vascular complications in 305 severely ill patients with COVID-19: a cohort study

ABSTRACT BACKGROUND: Although an association has been made between coronavirus disease 2019 (COVID-19) and microvascular disease, data on vascular complications (other than venous thromboembolism) are sparse. OBJECTIVE: To investigate the vascular complications in severely ill patients hospitalized with COVID-19 and their association with all-cause mortality. DESIGN AND SETTING: This cohort study was conducted at the Universidade Federal de São Paulo, Brazil. METHODS: All 305 consecutive patients diagnosed with COVID-19 and hospitalized in the intensive care unit (ICU) of a tertiary university hospital from April 2 to July 17, 2021, were included and followed up for 30 days. RESULTS: Of these, 193 (63.3%) were male, and the mean age was 59.9 years (standard deviation = 14.34). The mortality rate was 56.3% (172 patients), and 72 (23.6%) patients developed at least one vascular complication during the follow-up period. Vascular complications were more prevalent in the non-survivors (28.5%) than in the survivors (17.3%) group and included disseminated intravascular coagulation (DIC, 10.8%), deep vein thrombosis (8.2%), acrocyanosis (7.5%), and necrosis of the extremities (2%). DIC (adjusted odds ratio (aOR) 2.30, 95% confidence interval (CI) 1.01-5.24, P = 0.046) and acrocyanosis (aOR 5.21, 95% CI 1.48-18.27, P = 0.009) were significantly more prevalent in the non-survivors than in the survivors group. CONCLUSION: Vascular complications in critically ill COVID-19 patients are common (23.6%) and can be closely related to the mortality rate (56.3%) until 30 days after ICU admission. Macrovascular complications have direct implications for mortality, which is the main outcome of the management of COVID-19. REGISTRATION: RBR-4qjzh7 (https://ensaiosclinicos.gov.br/rg/RBR-4qjzh7).

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.

Estrategias para enseñar sobre autocuidado a personas con úlceras vasculares venosas: una revisión integrativ / Strategies for Teaching Self-care to People with Venous Ulcers: An Integrative Review / Estratégias para o ensino do autocuidado a pessoas com úlceras vasculares venosas: uma revisão integrativa

Introducción: las úlceras vasculares son lesiones que se desarrollan principalmente en miembros inferiores, se acompañan de dolor continuo e incapacitante, dificultan la movilidad, alteran la propia imagen corporal y pueden interferir en las actividades de la vida diaria. Las úlceras venosas son graves, ocasionadas por insuficiencia venosa crónica e hipertensión venosa permanente, y la persona que las padece debe recibir cuidados de enfermería integrales, que contribuyan al autocuidado. Objetivo:describir las estrategias que debe tener en cuenta el profesional de enfermería para la promoción del autocuidado en personas con úlceras vasculares venosas. Metodología: revisión integrativa de la literatura. Se realizó búsqueda en bases de datos y recursos electrónicos: Medline a través de PubMed Health, Epistemonikos y SciELO. Se incluyeron artículos de investigación y de revisión relacionados con el problema en estudio, publicados en inglés, portugués o español en el periodo 2010-2020. Estudio sin riesgo, se respetan los derechos de autor. Resultados: se analizó una muestra constituida por 41 publicaciones. Los temas principales producto del análisis fueron: proceso de atención de enfermería y autocuidado, familiarizándose con la úlcera venosa y las opciones terapéuticas, conocimiento de la terapia de compresión, práctica de los estilos de vida saludables. Conclusiones: el cuidado de enfermería al paciente con úlcera venosa debe comenzar por reconocer a la persona desde una perspectiva holística y en reciprocidad con su entorno, lo que implica un proceso de atención integral que va más allá de la úlcera y valora al paciente como un sujeto activo en el cuidado, para que se familiarice con su herida y esté en capacidad de detectar señales de mejoría o de alarma, así como de conocer la terapia de compresión y opciones terapéuticas y de llevar a su cotidianidad la práctica de estilos de vida saludables

Introduction: Venous ulcers are lesions developed mainly on the lower limbs. They cause continuous and disabling pain, impair mobility, alter self-image, and interfere with daily life activities. Venous ulcers are serious. They are caused by chronic venous insufficiency and permanent venous hypertension. People suffering from venous ulcers should receive comprehensive nursing care that contributes to self-care. Objective: To describe the strategies nursing professionals should consider for promoting self-care in people with venous ulcers. Method: Integrative review of the literature. Databases and electronic resources were searched: Medline using PubMed, Health, Epistemonikos, and SciELO. Research and review articles related to the study problem, published in English, Portuguese, or Spanish between 2010 and 2020, were included. This is a risk-free study, and copyrights were respected. Results: A sample of 41 publications was analyzed. The main themes derived from the analysis were the nursing care process and self-care, getting familiar with venous ulcers and therapeutic options, knowledge of compression therapy, and practice of healthy lifestyles. Conclusions: Nursing care for patients with venous ulcers should begin by recognizing a person from a holistic perspective and reciprocally with their environment. This approach implies a comprehensive care process that goes beyond the ulcer and values patients as active subjects of care so that they become familiar with their wounds and detect signs of improvement or warning. They can also know about compression therapy and therapeutic options and take the practice of healthy lifestyles into their daily lives.

Introdução: As úlceras vasculares são lesões que se desenvolvem principalmente nos membros inferiores, são acompanhadas de dor contínua e incapacitante, dificultam a mobilidade, alteram a própria imagem corporal e podem interferir nas atividades da vida diária. As úlceras venosas são graves, causadas pela insuficiência venosa crônica e hipertensão venosa permanente, e a pessoa que as sofre deve receber cuidado de enfermagem integral que contribua para o autocuidado. Objetivo: Descrever as estratégias que o profissional de enfermagem deve levar em consideração para promover o autocuidado em pessoas com úlceras vasculares venosas. Metodologia: Revisão integrativa da literatura. Realizou-se busca nas bases de dados e recursos eletrônicos: Medline por meio do PubMed Health, Epistemonikos SciELO. Foram incluídos artigos de pesquisa e revisão relacionados ao problema em estudo, publicados em inglês, português ou espanhol, no período 2010-2020. Estudo sem risco, os direitos autorais são respeitados. Resultados: Foi analisada uma amostra de 41 publicações. Os principais tópicos resultantes da análise foram: processo de atenção de enfermagem e autocuidado, familiarização com a úlcera venosa e as opções terapêuticas, conhecimento da terapia compressiva, prática de estilos de vida saudáveis. Conclusões: O cuidado de enfermagem ao paciente com úlcera venosa deve começar por reconhecer à pessoa desde uma perspectiva holística e em reciprocidade com seu meio, o que implica um processo de atendimento integral que vai além da úlcera e valoriza ao paciente como sujeito ativo no cuidado para que ele se familiarize com sua ferida e seja capaz de detectar sinais de melhora ou alarme, bem como aprender sobre terapia compressiva e as opções terapêuticas e praticar estilos de vida saudáveis em sua vida diária.

Telemedicina en cirugía vascular y endovascular: experiencia en un centro universitario

Background: Telemedicine became a relevant means to provide healthcare without face-to-face medical evaluation during the COVID-19 pandemic. Aim: To describe the effectiveness of telemedicine in vascular surgery. Materials and Methods: Review of medical records of all vascular surgery consultations carried out in a clinical hospital between April and October 2020. The main outcome measured was the resolution of the reason for consultation. Secondary outcomes were the need to request laboratory tests or imaging, the need to evaluate the patient in person, and the need for referral to hospitalization or emergency service. Results: One hundred-six new consultations and their follow-up (remotely or in person) were analyzed. A definitive diagnosis could be reached in 74% of consultations, treatment could be instituted or modified in 69% of them, and the reason for consultation could be resolved in 74% of cases. Laboratory and imaging tests were requested in 36 and 63% of consultations, respectively. Four percent of patients were referred to the emergency department or hospitalization. Conclusions: In the vast majority of consultations, it was possible to achieve a definitive diagnosis, prescribe a treatment and resolve the reason for consultation without the need for a face-to-face medical evaluation.

Caracterización de los pacientes con enfermedades vasculares periféricas fallecidos en un período de cuatro años / Characterization of patients with peripheral vascular diseases who died in a period of four years

Introducción: Las enfermedades vasculares periféricas constituyen un problema de salud en el ámbito mundial por resultar causa importante de discapacidad y de invalidez. Objetivo: Caracterizar a los pacientes con enfermedades vasculares periféricas fallecidos en un período de cuatro años. Método: Se realizó un estudio descriptivo y analítico en los pacientes fallecidos entre enero de 2015 y diciembre de 2018. Se estudiaron variables sociodemográficas y clínicas. Se estimaron las frecuencias absolutas y relativas, así como la tasa de mortalidad. Se identificó la asociación entre las variables con la causa directa de muerte. Resultados: El 42,7 por ciento de los diabéticos fallecieron; de estos, el 57,5 por ciento estaban descompensados. La hipertensión arterial, el tabaquismo y la diabetes mellitus fueron los factores de riesgo más frecuentes. La tasa de mortalidad total resultó 0,171/1000 ingresos. Como enfermedades arteriales más frecuente aparecieron los AAA (28,1 por ciento ) y la angiopatía diabética (25 por ciento ); y, como parte de esta última, el pie (25,7 por ciento ). La aneurismectomía con injerto por sustitución representó la cirugía revascularizadora más realizada (58,8 por ciento ). El shock hipovolémico y el tromboembolismo pulmonar predominaron como complicaciones posquirúrgicas (15,7 por ciento ). El shock séptico (31,6 por ciento ) y la bronconeumonía bacteriana (25,7 por ciento) fueron las causas directas de muerte. Conclusiones: Se logró caracterizar a los pacientes con enfermedades vasculares periféricas fallecidos en los últimos cuatro años, por lo que estimaron la tasa de prevalencia y la tendencia anual de la mortalidad en el Instituto Nacional de Angiología y Cirugía Vascular en ese período; asimismo, las variables asociadas a las causas directas de muerte(AU)

Introduction: Peripheral vascular diseases are a global health problem because they are a major cause of disability. Objective: Characterize patients with peripheral vascular diseases who died over a period of four years. Method: A descriptive and analytical study was conducted in patients who died between January 2015 and December 2018. Socio-demographic and clinical variables were studied. Absolute and relative frequencies were estimated, as well as the mortality rate. The association between the variables with the direct cause of death was identified. Results: 42.7 percent of diabetic patients died; of these, 57.5 percent were decompensated. High blood pressure, smoking and diabetes mellitus were the most frequent risk factors. The total mortality rate was 0.171/1000 admissions. The most frequent arterial diseases were AAA (28.1 percent) and diabetic angiopathy (25 percent); and, as part of the latter, foot angiopathy (25.7 percent). Aneurysmectomy with graft substitution represented the most performed revascularizing surgery (58.8 percent). Hypovolemic shock and pulmonary thromboembolism predominated as post-surgical complications (15.7 percent). Septic shock (31.6 percent) and bacterial bronchopneumonia (25.7 percent) were the direct causes of death. Conclusions: It was possible to characterize patients with peripheral vascular diseases who died in the last four years, so they estimated the prevalence rate and the annual trend of mortality at the National Institute of Angiology and Vascular Surgery in that period; also, the variables associated with direct causes of death(AU)

Infecciones asociadas a la atención sanitaria en el Instituto Nacional de Angiología y Cirugía Vascular / Infections associated with health care at the National Institute of Angiology and Vascular Surgery

Introducción: Las infecciones asociadas a la asistencia sanitaria constituyen un problema de salud. Objetivo: Caracterizar las infecciones asociadas a la asistencia sanitaria en los tres servicios del Instituto Nacional de Angiología y Cirugía Vascular durante 2019. Métodos: Estudio longitudinal de epidemiología clínica en 89 pacientes ingresados en 2019, a los que se les diagnosticó una infección asociada a la asistencia sanitaria. Las variables de estudio fueron: edad, sexo, meses del año, servicio asistencial, enfermedades asociadas, gérmenes más frecuentes y principales localizaciones. Se calcularon las frecuencias absolutas y relativas. Resultados: Se encontró una tasa porcentual acumulada de 6,6 por cada 100 egresos, con predominio del sexo masculino y mayor frecuencia en los pacientes de la quinta década de vida. La herida quirúrgica contribuyó con 43 casos de los 89 reportados, seguida por la bronconeumonía bacteriana con 18. La principal enfermedad asociada fue la diabetes mellitus y los gérmenes más frecuentes aislados resultaron Stafilococus aureus, Pseudomona sp y Acinetobacter bawmani. Conclusiones: La tasa de incidencia de infecciones asociadas a la asistencia sanitaria en el Instituto Nacional de Angiología y Cirugía Vascular durante 2019 no difiere de las presentadas en años anteriores y se corresponden con los reportes internacionales(AU)

Introduction: Health care associated infections are a health problem. Objective: Characterize healthcare associated infections in the three services of the National Institute of Angiology and Vascular Surgery during 2019. Methods: Longitudinal study of clinical epidemiology in 89 patients admitted in 2019, who were diagnosed with an infection associated with health care. The study variables were: age, sex, months of the year, care service, associated diseases, more frequent germs and main locations. Absolute and relative frequencies were calculated. Results: A cumulative percentage rate of 6.6 per 100 discharges was found, with male predominance and higher frequency in patients in the fifth decade of life. The surgical wound was present in 43 of the 89 cases reported, followed by bacterial bronchopneumonie with 18. The main associated disease was diabetes mellitus and the most common isolated germs were Stafilococus aureus, Pseudomonasp and Acinetobacter baumannii. Conclusions: The incidence rate of healthcare associated infections at the National Institute of Angiology and Vascular Surgery during 2019 does not differ from those presented in previous years and corresponds to international reports(AU)

Síntomas neurológicos motores de inicio súbito en el síndrome de Leriche / Sudden onset motor neurological symptoms in Leriche's syndrome

Resumen El síndrome de Leriche es una enfermedad poco frecuente, con gran morbilidad y mortalidad, que ocurre debido a oclusión de las ramas principales de la aorta abdominal por debajo de la bifurcación de las arterias renales. Clínicamente, se caracteriza por la tríada de claudicación, impotencia y disminución de los pulsos femorales. El diagnóstico se confirma por ecografía Doppler abdominal o angiografía por tomografía computarizada y el tratamiento se basa en el restablecimiento del flujo por debajo del nivel de la oclusión. Se presenta el caso de un paciente con cuadro clínico atípico de dolor lumbar, paraparesia y livideces de miembros inferiores de inicio súbito, con rápido deterioro de su estado general que requirió intervención endovascular urgente. En esta ocasión, los síntomas neurológicos pueden ser explicados por la reducción del flujo sanguíneo de la arteria espinal magna, que en el 25 % de la población se origina en L1 o por debajo de ella y puede generar isquemia de la médula espinal. La presentación atípica de este reporte lo convierte en un desafío clínico de gran importancia.

Abstract Leriche syndrome is a rare disease with high morbidity and mortality that occurs due to occlusion of the main branches of the abdominal aorta below the bifurcation of the renal arteries. Clinically, it is characterized by the triad of claudication, impotence and decreased femoral pulses. Diagnosis is confirmed by abdominal Doppler ultrasound or computed tomography angiography and treatment is based on restoration of arterial flow below the level of occlusion. We present the case of a patient with an atypical clinical presentation of sudden onset of low back pain, paraparesis and lividity of the lower limbs, with rapid deterioration of his general condition that required urgent endovascular intervention. On this occasion, the neurological symptoms can be explained by reduced blood flow in the magna spinal artery, which in 25% of the population originates at or below L1 and can generate spinal cord ischemia. The atypical presentation of this report makes it a clinical challenge of great importance.

Efectividad del uso del Heberprot-P en gerontes con úlceras de pie diabético / Effectiveness of the application of Heberprot-P in the elderly with diabetic foot ulcers

RESUMEN Introducción: el Heberprot-P es un fármaco que ha demostrado ser eficaz en el tratamiento de las úlceras del pie diabético. Objetivo: caracterizar la evolución de los gerontes con úlceras de pie diabético tratados con Heberprot-P en Pinar de Río. Métodos: se realizó un estudio observacional, descriptivo longitudinal y retrospectivo en gerontes tratados con Heberprot-P por presentar úlceras del pie diabético en el periodo 2017-2020. El universo estuvo constituido por 140 pacientes, se estudió la totalidad. Se empleó estadística descriptiva mediante frecuencias absolutas y relativas porcentuales. Resultados: se encontró predominio de pacientes de sexo femenino (55,72 %), del grupo de edades entre 60 y 69 años (60 %) y con pie diabético neuro-infeccioso (67,14 %). La infección de la úlcera se detectó en 10 pacientes (7,1 %) y se asoció con la falta de granulación (p=0,003; OR=16,11; IC95%=1,90-726,03). El 13,6 % de los pacientes requirió de amputación. Se encontró asociación entre la no granulación y el requerimiento de amputación (p<0,05). El 37,9 % de los pacientes presentaron alguna reacción a la administración del Heberprot-P. Conclusiones: el tratamiento con Heberprot-P mostró resultados positivos. La presencia de eventos adversos fue relativamente alta, lo que ratifica al Heberprot-P como un fármaco eficaz y seguro para acelerar la curación de las úlceras del pie diabético y prevenir la necesidad de amputación.

ABSTRACT Introduction: Heberprot-P is a treatment that has proved to be effective in the treatment of diabetic foot ulcers. Objective: to characterize the evolution of the elderly with diabetic foot ulcers treated with Heberprot-P in Pinar de Rio. Methods: an observational, descriptive, longitudinal and retrospective study was carried out in the elderly treated with Heberprot-P for presenting diabetic foot ulcers in the period 2017-2020. The target group comprised 140 patients, and all of them were studied. Descriptive statistics was applied using absolute and relative percentage frequencies. Results: it was found a predominance of female patients (55,72 %), of the age group between 60 and 69 years (60 %) and with neuro-infectious diabetic foot (67,14 %). Ulcer infection was detected in 10 patients (7,1 %) and was associated with lack of granulation (p=0,003; OR=16.11; 95%CI=1.90-726.03). Amputation was required in 13,6 % of patients. An association was found between non-granulation and the requirement for amputation (p<0,05); 37,9 % of the patients presented some adverse response to the administration of Heberprot-P. Conclusions: the treatment with Heberprot-P showed encouraging results. The presence of adverse events was relatively high, being these of low repercussions, which ratifies Heberprot-P as an effective and safe treatment to accelerate the healing of diabetic foot ulcers and prevent the need for amputation.

Relationship between cerebrovascular disease and peripheral vascular disease in patients with type 2 diabetes mellitus / 中国基层医药

Objective:To compare the incidence of carotid artery and lower extremity arterial disease between patients with type 2 diabetes mellitus complicated by cerebrovascular disease and those with no cerebrovascular disease and investigate the risk relationship between diabetic peripheral vascular disease and cerebrovascular disease.Methods:A total of 133 patients with type 2 diabetes mellitus complicated by cerebrovascular disease who received treatment in the Department of Endocrinology, The First People's Hospital of Kunming, China between June 2015 and June 2016 were included in the observation group. Sixty-six type 2 diabetes mellitus patients with no cerebrovascular disease were included in the control group. The incidence and severity of carotid artery and lower extremity arterial disease were compared between the observation and control groups. Stepwise logistic regression was performed taking whether cerebrovascular disease exists as a dependent variable. The risk factors for developing cerebrovascular disease in patients with type 2 diabetes mellitus were investigated.Results:The number of patients who had carotid plague in the observation group was significantly higher than that in the control group [66.17% (88/133) vs. 42.42% (28/66)]. Cervical vascular disease in the observation group was severer than that in the control group. In the observation group, 24.81% (33/133) of patients had rough carotid intima, and 9.02% (12/133) of patients had no rough carotid intima. In the control group, 33.33% (22/66) of patients had rough carotid intima, and 24.24% (16/66) of patients had no rough carotid intima. There was significant difference in the incidence of rough carotid intima between observation and control groups ( χ2 = 14.140, P = 0.030). The proportion of patients who had lower extremity carotid plaque in the observation group was higher than that in the control group [72.93% (97/133) vs. 42.42% (28/66)]. Lower extremity arterial disease in the observation group was severer than that in the control group. In the observation group, 22.56% (30/133) of patients had rough intima of lower extremity arteries and 4.51% (6/133) of patients had no rough intima of lower extremity arteries. In the control group, 33.33% (22/66) of patients had rough intima of lower extremity arteries and 24.24% (16/66) of patients had no rough intima of lower extremity arteries. There was significant difference in the proportion of rough intima of lower extremity arteries between observation and control groups ( χ2 = 24.030, P < 0.001). Logistic regression analysis showed that age, glycosylated hemoglobin, and the presence of lower extremity vascular disease were the risk factors for cerebrovascular disease [95% CI = 1.098 (1.051 -1.146), 1.240 (1.015-1.515), 3.802 (1.094-13.212)]. Conclusion:Peripheral vascular disease in patients with type 2 diabetes mellitus complicated by cerebrovascular disease is severer than that in patients with type 2 diabetes mellitus but without cerebrovascular disease. Aging, poor blood glucose control and lower extremity vascular disease are the risk factors for developing cerebrovascular disease in patients with type 2 diabetes mellitus. Lower extremity vascular disease has a certain value for predicting the occurrence of cerebrovascular disease in patients with type 2 diabetes mellitus.

Management of lower limb ischemia during operative repair of acute type a aortic dissection by distal crossover grafts: a case series

Abstract Objective: To describe our experience of nine patients with extra-anatomical bypass for clinically ischemic distal limb during repair of acute Type A aortic dissection (ATAAD). Methods: We retrospectively examined a series of nine patients who underwent surgery for ATAAD. We identified a subset of the patients who presented with concomitant radiographic and clinical signs of lower limb ischemia. All but one patient (axillobifemoral bypass) underwent femorofemoral crossover grafting by the cardiac surgeon during cooling. Results: One hundred eighty-one cases of ATAAD underwent surgery during the study period with a mortality of 19.3%. Nine patients had persistent clinical evidence of lower limb ischemia (4.9%) and underwent extra-anatomical bypass during cooling. Two patients underwent additional fasciotomies. Mean delay from symptoms to surgery in these nine patients was 9.5 hours. Two patients had bilateral amputations despite revascularisation and, of note, had long delays in presentation for surgery (> 12 hours). There were no mortalities during these inpatient episodes. Outpatient radiographic follow-up at the first opportunity demonstrated 100% patency. Conclusion: Our experience suggests that, during complicated aortic dissection, limb ischemia may have a devastating outcome including amputation when diagnosis and referral are delayed. Early diagnosis and surgery are crucial in preventing this potentially devastating complication.

Risk prediction of cardiovascular diseases and comparison of two prediction models

Background: Cardiovascular diseases (CVD) are the world leading causes of death in non-communicable diseases. The aim of this study is to predict cardiovascular risk and compare two prediction models.Methods: This cross-sectional study involved 440 sample size of beverage industrial participants. The 10-year prediction was processed by World Health Organization/International Society of Hypertension (WHO/ISH) score chart and Framingham general risk score. WHO stepwise questionnaire and biomedical forms was used. Data was collected and analyzed by SPSS 16.0 version.Results: The overall CVD low risk prediction (<10%) by Framingham general risk score (FGRS) and WHO/ISH score chart was 74.5%, 95.4%, respectively while the CVD elevated risk (≥10%) was 25.5%, 4.6%, respectively. Gender CVD risk (≥10%) was 16.1% of male versus 9.3% of female by FGRS while 2.7% of male versus 1.5% of female classified by WHO/ISH. CVD risk increases in both of the models with age but very much in FGRS. 8.4% of employees versus 5.2% of spouses was classified as having the risk of 10-20% by FGRS while WHO/ISH classified 2.5% of employees and 0.9% of spouses as having the risk of 10-20%. FGRS classified 11.7% of all participant as having the risk above 20% while WHO/ISH classified only 1% as having the risk above 20%. Two model’s kappa agreement level was fair or minimal interrater reliability with 0.25 with p value <0.001 and the correlated receiver operating characteristic curve (ROC) curve of FGRS and WHO/ISH of 0.887 area under the curve (AUC), 0.847AUC all with a p value <0.001, respectively.Conclusions: FGRS predicted more risk in participants than WHO/ISH and was with minimal kappa agreement.

Ankle-brachial Index and associated factors in individuals with coronary artery disease

SUMMARY OBJECTIVE Analyzing the association between ABI and the main risk factors for coronary artery disease in coronary patients. METHODS Were selected 156 adult patients from a hospital in Maceió, Alagoas. Were evaluated with risk factors age, obesity, hypertension, diabetes mellitus, smoking, and dyslipidemia. PAOD screening was performed by the ankle-brachial index (ABI). The Mann-Whitney, chi-square, and Fisher's exact tests were used. Confidence Interval of 95% and a significance of 5%. RESULTS 67.3% (n=105) males, 52.6% (n=82) elderly, 23.1% (n = 34) obese, 72.4% 6% (n=113) hypertensive, 34.6% (n=54) diabetics, 53.2% (n=83) smokers, 34.6% (n=54) dyslipidemic and 70.5% (n=110) with a family history of CAD. 16.7% (n=26) of the individuals presented PAOD. Three factors were associated with PAOD: age group ≥ 60 years (OR:3.656; p=0.005), diabetes mellitus (OR:2.625; p=0.024) and hypertension (OR:5.528; p=0.008). No significant difference was observed in the variables smoking, dyslipidemia, family history of CAD, and obesity. CONCLUSION The independent risk factors for PAOD were age, diabetes mellitus, and systemic arterial hypertension.

RESUMO OBJETIVO Analisar a associação entre o ITB e os principais fatores de risco para doença arterial coronariana em indivíduos coronariopatas. MÉTODOS Foram selecionados 156 pacientes adultos de um hospital de Maceió, Alagoas. Foram avaliados como fatores de risco idade, obesidade, hipertensão, diabetes mellitus, tabagismo e dislipidemia. A triagem da DAOP foi realizada pelo índice tornozelo-braquial (ITB). Foram utilizados os testes de Mann-Whitney, qui-quadrado e exato de Fisher. Intervalo de Confiança de 95% e significância de 5%. RESULTADOS 67,3% (n=105) do sexo masculino, 52,6% (n=82) idosos, 23,1% (n=34) obesos, 72,4% (n=113) hipertensos, 34,6% (n=54) diabéticos, 53,2% (n=83) tabagistas, 34,6% (n=54) dislipidêmicos e 70,5% (n=110) com história familiar de DAC; 16,7% (n=26) dos indivíduos apresentaram DAOP. Três fatores foram associados à DAOP: faixa etária ≥60 anos (OR:3,656; p=0,005), diabetes mellitus (OR:2,625; p=0,024) e (OR:5,528; p=0,008). Não foi observada diferença significativa nas variáveis tabagismo, dislipidemia, história familiar de DAC e obesidade. CONCLUSÃO Os fatores de risco independentes para DAOP foram idade, diabetes mellitus e hipertensão arterial sistêmica.

Fatores de risco relacionados à mortalidade em pacientes internados por Doença Arterial Periférica / Risk Factors related to patients hospitalized for Peripheral Arterial Disease

Introdução: Pacientes portadores de vasculopatia periférica internam recorrentemente para procedimentos cirúrgicos ou tratamento clínico devido a complicações da doença de base. O real impacto da desnutrição nesses pacientes durante a internação ainda é pouco compreendido. Objetivo: Investigar os fatores de risco associados à mortalidade em pacientes internados com doença vascular periférica devido a complicação da doença vascular. Métodos: Estudo observacional retrospectivo avaliou cento e dezessete pacientes acima de 18 anos admitidos no serviço de cirurgia vascular de hospital terciário no período de junho de 2013 a agosto de 2014 por complicação da doença vascular. Avaliados parâmetros clínicos, comorbidades, dados demográficos, complicações durante a internação e estado nutricional. Dados coletados por meio de entrevista, aplicação do questionário Avaliação Global Subjetiva (AGS), exame físico e laboratoriais e dados de prontuário. Resultados: Cento e dezessete pacientes com doença vascular periférica avaliados em relação a complicações vasculares durante internação. Mortalidade geral de 7,7% e pacientes desnutridos ou com suspeita de desnutrição eram 39% da amostra Através da análise multivariada, tanto a classificação AGS (OR 6,15 CI 1,092-34,74 P = 0,039) quanto a presença de doença cardíaca (OR 8,51 CI 1,56-47,44 P = 0,015) foram fatores preditores independentes para mortalidade. Pacientes com doença vascular classificados em suspeita de estarem desnutridos ou desnutridos apresentaram chance de ir a óbito durante a internação aumentada em 6,15 vezes, enquanto a cardiopatia elevou essa chance 8,51 vezes. Conclusão: Pacientes internados por complicação de doença vascular periférica apresentam como fatores de risco para mortalidade a desnutrição e a presença de doença cardíaca.(AU)

Patients with peripheral vasculopathy are routinely hospitalized for surgical procedures or clinical treatment due to complications of the underlying disease. The real impact of malnutrition in these patients during hospitalization is still poorly understood. Aim: This study aimed to assess mortality predictors in patients with peripheral vascular disease during hospitalization. Methods: This retrospective observational study evaluate one hundred and seventeen patients over 18 years admitted to the vascular surgery service of a tertiary hospital in the period of June 2013 and August 2014 due to complications of vascular disease. They were assessed for clinical parameters, comorbidities, demographics, complications during hospitalization and nutritional status. Data were collected through interviews, the questionnaire Subjective Global Nutritional Assessment (SGA), laboratory exam and physical examination. Results: One hundred and seventeen patients with peripheral vascular disease were followed during admission due to vascular complications. Overall mortality was 7.7%, and malnourished patients or patients at nutritional risk were 39,0% of the sampled population By multivariate analysis both rating by SGA (OR 6.15, CI 1.092 to 34.74, P = 0.039), the presence of heart disease (OR 8.51 CI 1,56 to 47.44 P = 0.015) were independent predictors of mortality. When the patient was classified as malnourished or suspected of being malnourished by SGA it increased 6.15 times the odds of death during hospitalization, while the presence of heart disease increased by 8.51 times. Conclusion: Patients hospitalized for complications of peripheral vascular disease present as risk factors for mortality: malnutrition and the presence of heart disease. (AU)

Applications of Compression Therapy in Vascular Diseases and its Research Progress / 医用生物力学

Vascular diseases including cardiovascular and cerebrovascular diseases and peripheral vascular diseases of the lower extremities are serious threats to human health. The emergence of compression therapy is of great significance for the effective prevention and treatment of these vascular diseases and the therapeutic value of compression therapy has been confirmed by many research results at present. Compression therapy is a non-invasive physical therapy implemented through a series of compression therapy devices, including external counterpulsation for the treatment of various ischemic diseases, intermittent pneumatic compression for the treatment of some peripheral vascular diseases in the lower extremities, graduated compression stockings for the treatment of deep vein thrombosis, and so on. This review summarizes clinical applications of these typical compression therapies in cardiovascular and cerebrovascular diseases and peripheral vascular diseases of the lower extremities, analyzes their advantages and limitations, and discusses the necessity and significance of biomechanical research on compression therapies.

Experiencia de trabajo en cirugía vascular en Ecuador / Experiences working in vascular surgeries in Ecuador

Introducción: Las enfermedades vasculares periféricas comprenden un variado número de entidades nosológicas que afectan a los sistema arterial (excluidos los vasos del corazón, e intracraneales) y venolinfáticos del organismo. Objetivo: Describir las características de los pacientes que necesitaron ser atendidos por un cirujano vascular por presentar algún tipo de enfermedad vascular periférica. Métodos: Estudio descriptivo realizado en el total de pacientes atendidos por consulta externa y hospitalizados en el Servicio de Cirugía Vascular del Instituto Ecuatoriano de Seguridad Social; Hospital Manuel Ignacio Montero Valdivieso. El período de estudio fue de dos años (septiembre de 2014 a octubre de 2016). Se tuvieron en cuenta las siguientes enfermedades vasculares periféricas: enfermedades vasculares periféricas, insuficiencia venosa crónica, pie diabético, trombosis venosa profunda y trombosis arterial aguda Los resultados se expresaron en trabajo con las frecuencias absolutas y relativas. Resultados: La insuficiencia venosa crónica fue la causa más frecuente de hospitalización y consulta externa. Se encontró un predominio del sexo femenino. La úlcera del pie diabético se ubicó en orden decreciente de frecuencia entre las enfermedades consideradas. El desbridamiento quirúrgico o limpieza quirúrgica fue el procedimiento más empleado. La amputación mayor se realizó en todos los pacientes que tuvieron una trombosis arterial aguda de extremidades inferiores. Conclusiones: Se describen las características de los pacientes atendidos por el cirujano vascular en Ecuador, así como las enfermedades vasculares periféricas más frecuentes atendidas que son motivo de consulta externa y de hospitalización(AU)

Introduction: Peripheral vascular diseases include a varied number of nosologic entities that affect the arterial (excluding heart and intracranial vessels) and venolymphatic systems of the organism. Objective: To characterize patients who needed to be treated by a vascular surgeon after presenting some type of peripheral vascular disease. Method: A descriptive and prospective study was carried out in all the patients treated by external consultation and to the patients hospitalized in the service of Vascular surgery of the Ecuadorian Institute of Social Security and Manuel Ignacio Montero Valdivieso Hospital. The study lasted two years ( from September 2014 to October 2016). The following peripheral vascular diseases were taken into account: peripheral vascular diseases, chronic venous insufficiency, diabetic foot, deep-vein thrombosis and acute arterial thrombosis. The results were expressed in this paper with absolute and relative frequencies. Results: Chronic venous failure was the most frequent cause of hospitalization and outpatient consultation. A prevalence of female sex was found. The diabetic foot ulcer was observed in a decreasing order of frequency. Surgical debridement and/or surgical cleaning were the most used procedures. Major amputations were performed in all patients who had an acute arterial thrombosis of the lower limbs. Conclusions: It was possible to characterize the patients treated by the vascular surgeon in Ecuador, as well as the most frequent peripheral vascular diseases attended that needed outpatient consultation and hospitalization(AU)

Raynaud's phenomenon in the occupational context

SUMMARY OBJECTIVE To review articles that evaluated the prevalence of Raynaud's phenomenon of occupational origin. METHODS The search for articles was carried out in the Medline (via PubMed), Embase, Web of Science, Scientific Electronic Library Online (SciELO), and Latin America and Caribbean Health Sciences Literature (Lilacs) databases. RESULTS 64 articles were obtained from the electronic search; 18 articles met the eligibility criteria. All studies discussed the exposure to vibrations in the upper limbs. In 6 of them, the thermal issue was directly or indirectly addressed. No studies have addressed exposure to vinyl chloride. CONCLUSIO In general, a higher prevalence of Raynaud's phenomenon was found among vibratory tool operators compared to non-exposed workers, with an increase in the number of cases the higher the level of vibration and the time of exposure. Cold is a triggering and aggravating factor of the Raynaud phenomenon and seems to play an important role in the emergence of vascular manifestations of the hand-arm vibration syndrome.

RESUMO OBJETIVO Realizar um estudo de revisão dos artigos que avaliaram a prevalência do fenômeno de Raynaud de origem ocupacional. MÉTODOS A busca pelos artigos foi realizada nas bases de dados Medline (via PubMed), Embase, Web of Science, Scientific Eletronic Library Online (SciELO) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs). RESULTADOS Sessenta e quatro artigos foram obtidos a partir da busca eletrônica, dos quais 18 cumpriram os critérios de elegibilidade. Todos os estudos discutiram sobre a exposição a vibrações localizadas em membros superiores. Em seis deles, a questão térmica foi direta ou indiretamente abordada. Nenhum estudo abordou a exposição ao cloreto de vinila. CONCLUSÃO De maneira geral, constatou-se maior prevalência do fenômeno de Raynaud entre operadores de ferramentas vibratórias em comparação aos não expostos, com aumento do número de casos quanto maior o nível de vibração e tempo de exposição. O frio é fator desencadeante e agravante do fenômeno de Raynaud e parece exercer papel importante para o surgimento das manifestações vasculares da síndrome de vibração de mãos e braços.

Influence of Mild Peripheral Arterial Obstructive Disease in the Functional Capacity / Influência da Doença Arterial Obstrutiva Periférica Leve Sobre a Capacidade Funcional

The peripheral arterial obstructive disease (PAOD) is a chronic illnes that has as main symptom intermittent claudication and causes a progressive functional impairment of the patient. The literature is still inconclusive when it addresses the relationship among functional capacity, endurance, muscle contraction speed, and degree of blood flow impairment in patients with PAOD. The objective of this study was to evaluate the physical fitness individuals with bilateral PAOD, claudication and ankle-brachial index between 0.8 and 0.9, to verify the impact of the disease in this outcome and to analyze the association among the tests. Forty individuals, with mean age 56 years were divided in: group PAOD (n=20) and control group (n=20) were subjected to the following tests: Five-Times-Sit-to-Stand Test (FTSST), Heel-rise test (HRT), test of gait speed usual (UV) and maximum (MV), shuttle walking test (SWT). There was a significant difference among the variables obtained through HRT, UV, MV and SWT, showing a worse performance of the group with PAOD compared to the control. The FTSST test showed no differences among the groups. Analyzing the whole sample, the presence of PAOD is an indicator of poor performance in TDBP. This study suggests that people with mild PAOD present reduced performance in functional endurance tests of the lower limbs and that there is a direct relationship between walking speed and patency of local arterial flow, demonstrating in an unprecedented way the need for evaluation of this public, considering the possibility of initial identification of the symptoms and giving greater efficiency in the therapeutic planning of maintenance of the functionality. (AU)

A doença arterial obstrutiva periférica (DAOP) é uma doença crônica que tem como sintoma principal a claudicação intermitente e causa um progressivo comprometimento funcional do paciente. A literatura ainda é inconclusiva quando aborda a relação entre a capacidade funcional, endurance, velocidade de contração muscular e grau de comprometimento de fluxo sanguíneo em pacientes com DAOP. O objetivo deste estudo foi avaliar a aptidão física de indivíduos com DAOP bilateral, claudicantes e Índice tornozelo-braço entre 0,8 e 0,9, verificar o impacto da doença neste desfecho e analisar a associação entre os testes. Quarenta indivíduos, com faixa etária média de 56 anos, divididos em grupo DAOP (n=20) e grupo controle (n=20), foram submetidos aos testes: Teste senta-levanta (TSL), teste ponta de pé (TPP), testes de velocidade usual (VU) e máxima (VM), teste de deslocamento bidirecional progressivo (TDBP). Houve diferença significativa entre as variáveis do TPP, VU, VM e TDBP, mostrando pior performance do grupo com DAOP comparado ao controle. O teste TSL não apresentou diferença entre os grupos. Analisando os grupos em conjunto a presença de DAOP foi indicadora de pior desempenho no TDBP. Este estudo sugere que pacientes com DAOP leve apresentam redução da performance nos testes funcionais de endurance dos membros inferiores e que existe uma relação direta entre a velocidade da marcha e a patência do fluxo arterial local, demonstrando de forma inédita, a necessidade de avaliação deste público, considerando a possibilidade de identificação inicial dos sintomas e conferindo maior eficiência no planejamento terapêutico de manutenção da funcionalidade. (AU)

Prevalence characters of peripheral artery disease and associated factors among Beijing residents aged equal and above 35 years old / 中华心血管病杂志

Objective@#To investigate the prevalence characters of peripheral artery disease (PAD) and associated factors among people aged 35 and above in Beijing.@*Methods@#This was a cross-sectional study. A total of 5 208 community-based individuals aged equal and above 35 in Beijing were chosen with stratified multistage random sampling method. Structure questionnaire was used to collected the information of demographic factors, habits and chronic disease history. Ankle brachial blood pressure was detected and ankle brachial index (ABI) was calculated. ABI was used to diagnose PAD (ABI≤0.90). Based on the 2010 Beijing Municipal Population Census, the age-and gender-specific weight-adjusted sample was acquired to estimate the prevalence of PAD and corresponding 95% confidence intervals (CI). Multivariate logistic regression analysis was performed to estimate the associated factors of PAD.@*Results@#The age-and sex-standardized prevalence of PAD was 3.84% (200/5 208, 95%CI 3.32%-4.36%). There was no significant difference between male and female (3.83%(102/2 664, 95%CI 3.10%-4.56%) vs. 3.85% (98/2 544, 95%CI 3.10%-4.60%), P=0.965). The prevalence of PAD in urban was higher than that in rural (4.34% (163/3 755, 95%CI 3.69%-4.99%) vs. 2.55% (37/1 453, 95%CI 1.74%-3.36%), P=0.001). Furthermore, the prevalence of PAD increased with age (Ptrend<0.01), and the difference between genders did not change with ageing (all P>0.05). In addition, age (OR=1.03, 95%CI 1.01-1.04), urban (OR=1.52, 95%CI 1.08-2.12), smoking (OR=1.83, 95%CI 1.29-2.59), hypertension (OR=1.61, 95%CI 1.17-2.22) and diabetes (OR=1.44, 95%CI 1.08-1.93) were related with increased risk of PAD in logistic regression analysis models.@*Conclusions@#The prevalence of PAD increases with age in Beijing and there are significant difference between urban and rural on prevalence of PAD. Age, urban, smoking, hypertension and diabetes are related with increased risk of PAD.