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1.
Revista Digital de Postgrado ; 9(2): 208, ago. 2020. tab, graf
Article in Spanish | LILACS (Americas), LIVECS | ID: biblio-1103357

ABSTRACT

La diabetes mellitus tipo 2 (DM2) representa un problema de salud pública, debido a su alta incidencia y prevalencia en el mundo. Un método para evaluar el riesgo de desarrollar DM2 es la escala Latin American Finnish Diabetes Risk Score (LA FINDRISC). La DM2 es un factor de riesgo de enfermedad arterial periférica (EAP) la cual puede ser diagnosticada mediante el índice tobillo-brazo (ITB). Objetivo: evaluar la presencia y severidad de enfermedad arterial periférica mediante ITB y relacionarlo con el riesgo de desarrollar DM2 según LA FINDRISC. Métodos: estudio descriptivo, correlacional, de corte transversal. Se evaluaron 134 personas y se les midió glicemia capilar para descartar diabetes. Posteriormente, se realizó el LA FINDRISC y el ITB. Resultados: El puntaje LA FINDRISC y la glicemia alteradas en ayunas aumentaron proporcionalmente (R2=0,5). Esta relación no se observó entre LA FINDRISC y el ITB arrojado por la población general. Sin embargo, al seleccionar los pacientes con vasos no comprimibles aparece una correlación positiva (R2=0,36) entre los dos instrumentos diagnósticos. Conclusión: LA FINDRISC y el ITB son instrumentos de diagnósticos no invasivo, sencillos y válidos para detectar riesgo de desarrollar DM2, y detectar presencia y severidad de enfermedad arterial periférica, respectivamente(AU)


Type 2 diabetes mellitus (DM2) represents a public health problem, due to its high incidence and prevalence in the world. One method to assess the risk of developing DM2 is the Latin American Finnish Diabetes Risk Score (LA FINDRISC) scale. DM2 is a risk factor for peripheral arterial disease (PAD) which can be diagnosed using the ankle-brachial index (ABI). Objective: to evaluate the presence and severity of peripheral arterial disease using ABI and to relate it to the risk of developing DM2 according to LA FINDRISC. Methods: descriptive, correlational, cross-sectional study. 134 people were evaluated, and capillary glycemia was measured to rule out diabetes. Subsequently, the LA FINDRISC and the ITB were held. Results: The LA FINDRISC score and impaired fasting blood glucose increased proportionally (R2 = 0.5). This relationship was not observed between LA FINDRISC and the ITB showed by the general population. However, when selecting patients with non-compressible vessels, a positive correlation (R2 = 0.36) appears between the two diagnostic instruments. Conclusion: FINDRISC and ITB are simple and valid non-invasive diagnostic instruments to detect the risk of developing DM2, and detect the presence and severity of peripheral arterial disease, respectively(AU)


Subject(s)
Humans , Male , Female , Body Mass Index , Diabetes Mellitus, Type 2/physiopathology , Diagnostic Techniques, Cardiovascular , Peripheral Arterial Disease/complications , Body Weights and Measures , Anthropometry , Abdominal Circumference
2.
Rev. cuba. angiol. cir. vasc ; 20(2): e387, jul.-dic. 2019.
Article in Spanish | LILACS (Americas) | ID: biblio-1003855

ABSTRACT

Introducción: Los pacientes con enfermedad arterial periférica sometidos a cirugía vascular no cardíaca programada presentan un riesgo significativo de complicaciones cardiovasculares, debido a la enfermedad cardíaca sintomática o asintomática subyacente. Objetivo: Valorar el riesgo coronario en los pacientes tributarios de cirugía vascular no cardíaca. Métodos: Estudio descriptivo prospectivo en 35 pacientes del Servicio de Angiología y Cirugía Vascular del Hospital Clínico Quirúrgico Hermanos Ameijeiras. El período de estudio osciló entre octubre de 2013 y mayo de 2016. Las variables cualitativas se expresaron como frecuencias absolutas y relativas. Se evaluó la asociación entre las variables mediante el test de Fischer, se usó el coeficiente de Pearson para relacionar los valores del índice de presiones tobillo brazo y los niveles del calcio score. Resultados: Predominó el sexo masculino y la edad menor de 60 años. El tabaquismo y la hipertensión arterial fueron los factores de riesgo de mayor frecuencia. A pesar de no existir diferencia significativa (p = 0,563) al asociar el calcio score y el índice de presiones tobillo-brazo, sí existió una correlación lineal negativa entre ellos. Las complicaciones perioperatorias presentadas en el grupo de moderado-alto riesgo quirúrgico fueron la fibrilación ventricular, el infarto agudo de miocardio y el paro cardíaco. Conclusiones: La valoración del riesgo coronario es una herramienta útil en la detección de lesiones coronarias significativas que pueden favorecer la aparición de complicaciones perioperatorias en los pacientes que son tributarios de tratamiento quirúrgico revascularizador no cardíaco(AU)


Introduction: Patients with peripheral arterial disease undergoing scheduled non-cardiac vascular surgery present a significant risk of cardiovascular complications due to underlying symptomatic or asymptomatic heart disease. Objective: To assess coronary risk in patients eligible for non-cardiac vascular surgery. Methods: A prospective descriptive study was carried out in 35 patients of the Angiology and Vascular Surgery service in Hermanos Ameijeiras Hospital. The study was conducted between October 2013 and May 2016. Qualitative variables were summarized as absolute and relative frequencies. It was assessed the association between the variables using the Fischer´s test; Pearson´s coefficient was used to relate the values of the index of ankle- arm pressure and the levels of calcium score. Results: Male sex predominated; and ages less than 60 years. Smoking habit and high blood pressure were the most common risk factors. Although there is no significant difference (p= 0,563) when associating the calcium score and the ankle-brachial pressure index, there was a negative linear correlation between them. The peri-operative complications presented in the moderate to high surgical risk group were ventricular fibrillation, acute myocardial infarction and cardiac arrest. Conclusions: Identification of coronary risk is a useful tool in the detection of significant coronary lesions that may favor the emergence of peri-operative complications in patients who are scheduled for non-cardiac revascularization's surgical treatment(AU)


Subject(s)
Male , Middle Aged , Cardiovascular Diseases/prevention & control , Peripheral Arterial Disease/complications , Epidemiology, Descriptive , Prospective Studies , Longitudinal Studies , Peripheral Arterial Disease/therapy
3.
Rev. cir. (Impr.) ; 71(3): 210-215, jun. 2019. tab
Article in Spanish | LILACS (Americas) | ID: biblio-1058259

ABSTRACT

OBJETIVO: Evaluar las características de los pacientes sometidos a angioplastía en miembros inferiores, así como establecer posibles asociaciones entre los factores que lleven a complicaciones de la misma. MATERIALES Y MÉTODO: Estudio descriptivo, observacional, retrospectivo de corte transversal durante 18 meses en el que se evaluaron aquellos pacientes con enfermedad arterial periférica sometidos a angioplastía de miembros inferiores, sus características demográficas, clínicas, quirúrgicas y las complicaciones postoperatorias. RESULTADOS: Se evaluaron 158 registros de pacientes con edades entre 30 y 95 años. El 65,2% (n = 103) de los procedimientos se realizaron de forma electiva, los vasos intervenidos con mayor frecuencia fueron la arteria femoral superficial (64%), el tipo de intervención endovascular más frecuente fue la combinación de balón + balón medicado (32,9%), el tratamiento farmacológico postoperatorio más usado fue la combinación de ácido acetilsalicílico (ASA) y clopidogrel (86,1%). Se presentaron 21 casos de complicaciones, la más frecuente fue la amputación menor (52%). Se encontró mayor riesgo de amputación menor cuando el procedimiento quirúrgico es realizado de forma urgente (p = 0,012; OR [IC 95%]: 4,8 [1,4-16,5]). DISCUSIÓN: La complicación posangioplastía con diferencia estadísticamente significativa fue la amputación menor cuando el procedimiento se realizó de manera urgente, esta asociación pudo estar relacionada con el estado clínico del paciente en el momento del ingreso y no con el procedimiento quirúrgico. CONCLUSIÓN: La angioplastía realizada de urgencias fue un procedimiento tan seguro como cuando se realiza de forma programada, dado por la misma proporción de sangrado o disección arterial.


AIM: Evaluate the characteristics of patients undergoing angioplasty in the lower limbs, as well as to establish possible associations between the factors leading to complications. MATERIALS AND METHODS: Observational descriptive, cross-sectional and retrospective study conducted during 18 months in which patients with peripheral arterial disease undergoing angioplasty of the lower limb were included, as well their demographic, clinical, and surgical characteristics and the postoperative complications. RESULTS: 158 records of patients between 30 and 95 years were evaluated. 65.2% (n = 103) of the procedures were performed not urgently, the most frequently intervened vessels were the superficial femoral artery (64%), the most frequent type of endovascular intervention was the combination of balloon + medicated ball (32.9%), the most used postoperative pharmacological treatment was the combination of acetylsalicylic acid (ASA) and clopidogrel (86.1%). There were 21 cases of complications, the most frequent complication was minor amputation (52%). A higher risk of minor amputation was found when the surgical procedure was performed urgently (p = 0.012, OR [95% CI]: 4.8 [1.4-16.5]). DISCUSION: The post-angioplasty complication with statistically significant difference was minor amputation when the procedure was performed urgently, this association was related to the clinical status of the patient at the time of admission and not to the surgical procedure. CONCLUSION: Angioplasty performed urgently is as safe as elective procedures, given by the same proportion of bleeding or arterial dissection.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Angioplasty/methods , Lower Extremity/blood supply , Peripheral Arterial Disease/therapy , Postoperative Complications/epidemiology , Comorbidity , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Treatment Outcome , Peripheral Arterial Disease/complications , Amputation/statistics & numerical data
4.
Int. j. cardiovasc. sci. (Impr.) ; 31(4): 405-413, jul.-ago. 2018. tab
Article in English | LILACS (Americas) | ID: biblio-954108

ABSTRACT

The identification of peripheral artery disease (PAD) can help prevent further progression of the disease and additional complications, considering that this condition is a risk factor for all-cause mortality and cardiovascular death. Objective: To assess the prevalence of PAD in the Baependi Heart Study and investigate associated risk factors in different age groups. Methods: A total of 1,627 individuals (of both genders and aged 18 - 102 years) residing in the municipality of Baependi (Minas Gerais, Brazil) were selected for this study. Anthropometric and biochemical parameters were evaluated by standard techniques. Physical activity level was determined by the International Physical Activity Questionnaire - Short Form (IPAQ-SF). The screening of PAD was performed by determination of the ankle-brachial index (ABI). The level of statistical significance was set at 5%. Results: In the overall sample, the prevalence of PAD was 1.05%, and reached 5.2% after the age of 70 years. The frequency and intensity of smoking were higher in individuals with PAD. A prior history of myocardial infarction and a higher prevalence of hypertension, diabetes, obesity, and sedentary lifestyle were also associated with PAD. In addition, PAD was more frequent in blacks than whites. In multivariable analysis, age, diabetes, smoking, and physical inactivity remained independently associated with PAD. Conclusion: The prevalence of PAD was low and increased clearly with age in our sample from a Brazilian rural population. Furthermore, the main risk factors for PAD in the investigated sample were smoking, sedentary lifestyle, diabetes mellitus, and age


A identificação da doença arterial periférica (DAP) pode atenuar a progressão e suas complicações adicionais, uma vez que a DAP é um fator de risco para mortalidade geral e cardiovascular. Objetivo: Avaliar a prevalência de DAP na população do Estudo Corações de Baependi e investigar fatores de risco associados em diferentes grupos etários. Métodos: Foram selecionados 1.627 indivíduos (ambos os sexos e idade entre 18 e 102 anos) residentes no município de Baependi (Minas Gerais, Brasil). Os parâmetros antropométricos e bioquímicos foram avaliados por meio de protocolos padrões. O nível de atividade física foi determinado pelo Questionário Internacional de Atividade Física - Versão Curta (IPAQ-SF). A triagem da DAP foi realizada pelo índice tornozelo-braço (ITB). O nível de significância estatística adotado nas análises foi de 5%. Resultados: Na população total, a prevalência de DAP foi de 1,05% e atingiu 5,2% após os 70 anos de idade. A frequência e intensidade do tabagismo foram maiores nos indivíduos com DAP. Uma história prévia de infarto do miocárdio e maior prevalência de hipertensão, diabetes, obesidade e sedentarismo também estiveram associados à DAP. Além disso, a DAP foi mais frequente em negros que em brancos. Após análise multivariada, a idade, diabetes, tabagismo e inatividade física permaneceram independentemente associados à DAP. Conclusão: A prevalência de DAP foi baixa e claramente aumentou com a idade em nossa amostra de uma população rural brasileira. Além disso, os principais fatores de risco para DAP foram tabagismo, sedentarismo, diabetes e idade


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Rural Population , Prevalence , Risk Factors , Peripheral Arterial Disease/complications , Peripheral Arterial Disease/diagnosis , Tobacco Use Disorder/complications , Cardiovascular Diseases/mortality , Epidemiologic Studies , Body Mass Index , Anthropometry/methods , Statistical Analysis , Surveys and Questionnaires , Cohort Studies , Diabetes Mellitus/diagnosis , Ankle Brachial Index , Sedentary Behavior , Arterial Pressure , Hypertension
5.
Int. j. cardiovasc. sci. (Impr.) ; 31(4)jul.-ago. 2018. tab
Article in Portuguese | LILACS (Americas) | ID: biblio-910632

ABSTRACT

A identificação da doença arterial periférica (DAP) pode atenuar a progressão e suas complicações adicionais, uma vez que a DAP é um fator de risco para mortalidade geral e cardiovascular. Avaliar a prevalência de DAP na população do Estudo Corações de Baependi e investigar fatores de risco associados em diferentes grupos etários. Foram selecionados 1.627 indivíduos (ambos os sexos e idade entre 18 e 102 anos) residentes no município de Baependi (Minas Gerais, Brasil). Os parâmetros antropométricos e bioquímicos foram avaliados por meio de protocolos padrões. O nível de atividade física foi determinado pelo Questionário Internacional de Atividade Física - Versão Curta (IPAQ-SF). A triagem da DAP foi realizada pelo índice tornozelo-braço (ITB). O nível de significância estatística adotado nas análises foi de 5%. Na população total, a prevalência de DAP foi de 1,05% e atingiu 5,2% após os 70 anos de idade. A frequência e intensidade do tabagismo foram maiores nos indivíduos com DAP. Uma história prévia de infarto do miocárdio e maior prevalência de hipertensão, diabetes, obesidade e sedentarismo também estiveram associados à DAP. Além disso, a DAP foi mais frequente em negros que em brancos. Após análise multivariada, a idade, diabetes, tabagismo e inatividade física permaneceram independentemente associados à DAP. A prevalência de DAP foi baixa e claramente aumentou com a idade em nossa amostra de uma população rural brasileira. Além disso, os principais fatores de risco para DAP foram tabagismo, sedentarismo, diabetes e idade


The identification of peripheral artery disease (PAD) can help prevent further progression of the disease and additional complications, considering that this condition is a risk factor for all-cause mortality and cardiovascular death. To assess the prevalence of PAD in the Baependi Heart Study and investigate associated risk factors in different age groups. A total of 1,627 individuals (of both genders and aged 18 - 102 years) residing in the municipality of Baependi (Minas Gerais, Brazil) were selected for this study. Anthropometric and biochemical parameters were evaluated by standard techniques. Physical activity level was determined by the International Physical Activity Questionnaire - Short Form (IPAQ-SF). The screening of PAD was performed by determination of the ankle-brachial index (ABI). The level of statistical significance was set at 5%. In the overall sample, the prevalence of PAD was 1.05%, and reached 5.2% after the age of 70 years. The frequency and intensity of smoking were higher in individuals with PAD. A prior history of myocardial infarction and a higher prevalence of hypertension, diabetes, obesity, and sedentary lifestyle were also associated with PAD. In addition, PAD was more frequent in blacks than whites. In multivariable analysis, age, diabetes, smoking, and physical inactivity remained independently associated with PAD. The prevalence of PAD was low and increased clearly with age in our sample from a Brazilian rural population. Furthermore, the main risk factors for PAD in the investigated sample were smoking, sedentary lifestyle, diabetes mellitus, and age


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Peripheral Arterial Disease/complications , Peripheral Arterial Disease/diagnosis , Prevalence , Risk Factors , Rural Population , Ankle Brachial Index , Anthropometry/methods , Arterial Pressure , Body Mass Index , Cardiovascular Diseases/mortality , Cohort Studies , Diabetes Mellitus/diagnosis , Epidemiologic Studies , Hypertension , Sedentary Behavior , Statistical Analysis , Surveys and Questionnaires , Tobacco Use Disorder/complications
6.
Rev. bras. cir. cardiovasc ; 30(3): 365-372, July-Sept. 2015. tab
Article in English | LILACS (Americas) | ID: lil-756518

ABSTRACT

AbstractObjective:The purpose of this study was to evaluate the risk factors for ischemic stroke in patients undergoing cardiac surgery.Methods:From January 2010 to December 2012, 519 consecutive patients undergoing cardiac surgery were analyzed prospectively. The sample was divided into two groups: patients with stroke per and postoperative were allocated in Group GS (n=22) and the other patients in the group CCONTROL (n=497). The following variables were compared between the groups: gender, age, carotid stenosis > 70%, diabetes on insulin, chronic obstructive pulmonary disease, peripheral arteriopathy, unstable angina, kidney function, left ventricular function, acute myocardial infarction, pulmonary arterial hypertension, use of cardiopulmonary bypass. Ischemic stroke was defined as symptoms lasting over 24 hours associated with changes in brain computed tomography scan. The variables were compared using Fisher’s exact test, Chi square, Student’s t-test and logistic regression.Results:Stroke occurred in 4.2% of patients and the risk factors statistically significant were: carotid stenosis of 70% or more (P=0.03; OR 5.07; IC 95%: 1.35 to 19.02), diabetes on insulin (P=0.04; OR 2.61; IC 95%: 1.10 to 6.21) and peripheral arteriopathy (P=0.03; OR 2.61; 95% CI: 1.08 to 6.28).Conclusion:Risk factors for ischemic stroke were carotid stenosis of 70% or more, diabetes on insulin and peripheral arteriopathy.


ResumoObjetivo:O objetivo do presente trabalho foi avaliar os fatores de risco para acidente vascular encefálico isquêmico em pacientes submetidos à cirurgia cardíaca.Métodos:Entre janeiro de 2010 e dezembro de 2012, foram analisados prospectivamente 519 pacientes consecutivos submetidos à cirurgia cardíaca. A amostra foi dividida em dois grupos: os pacientes com acidente vascular encefálico isquêmico (AVEi) trans e pós-operatório foram alocados no grupo GAVEi (n=22) e os demais pacientes no grupo CControle (n=497). As seguintes variáveis foram comparadas entre os grupos: sexo, idade, estenose carotídea >70%, diabetes em uso de insulina, doença pulmonar obstrutiva crônica, arteriopatia periférica, função renal, angina instável, função do ventrículo esquerdo, infarto agudo do miocárdio recente, hipertensão arterial pulmonar, uso de circulação extracorpórea. Acidente vascular encefálico isquêmico foi definido como presença de sintomas de duração maior que 24 horas associados à alteração em tomografia de crânio. As variáveis foram comparadas, por meio do teste exato de Fisher, Qui quadrado, teste t de Student e regressão logística.Resultados:Verificou-se a ocorrência de acidente vascular encefálico isquêmico em 4,2% dos pacientes e os fatores de risco estatisticamente significativos foram: estenose carotídea de 70% ou mais (P=0,03; OR 5,07; IC 95%: 1,35 a 19,02), diabetes em uso de insulina (P=0,04; OR 2,61; IC 95%: 1,10 a 6,21) e arteriopatia periférica (P=0,03; OR 2,61; IC 95%: 1,08 a 6,28).Conclusão:Foram fatores de risco para acidente vascular encefálico isquêmico: estenose carotídea de 70% ou mais, presença de diabetes em uso de insulina e presença de arteriopatia periférica.


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Brain Ischemia/etiology , Cardiac Surgical Procedures/adverse effects , Perioperative Period , Stroke/etiology , Brain Ischemia/mortality , Cardiac Surgical Procedures/mortality , Carotid Stenosis/complications , Diabetes Mellitus, Type 1/complications , Intraoperative Complications/etiology , Logistic Models , Peripheral Arterial Disease/complications , Postoperative Complications/etiology , Risk Factors , Severity of Illness Index , Stroke/mortality , Treatment Outcome
7.
Rev. bras. cardiol. invasiva ; 23(3): 220-225, jul.-set.2015. ilus, tab
Article in Portuguese | LILACS (Americas), SES-SP, SESSP-IDPCPROD, SES-SP | ID: lil-794202

ABSTRACT

As intervenções endovasculares na artéria femoral superficial para o tratamento da doença arterial oclusiva periférica têm crescido nas últimas décadas. A primeira e a segunda geração de stents na artériafemoral superficial falharam em demonstrar a melhora da perviedade do vaso tratado, devido às altas taxas defratura. O objetivo deste estudo foi avaliar os desfechos clínicos no curto prazo com o uso de stents de nitinolsuperflexíveis de terceira geração no tratamento de lesões ateroscleróticas na artéria femoral superficial. Métodos: Trata-se de um estudo retrospectivo, realizado em único centro, no período de junho de 2013 a maio de 2014. Um total de 27 pacientes foi submetido à angioplastia com stents de nitinol superflexíveis de terceira geração em lesões ateroscleróticas da arterial femoral superficial. Resultados: A média de idades foi de 68 ± 12 anos, 55,6% eram do sexo feminino e 74,1%, diabéticos. Os pacientes foram classificados em TASC B e C em 77,7% dos casos. O sucesso técnico foi de 100%. Houve aumento do índice tornozelo-braquial de 0,35 ± 0,1 pré-intervenção para 0,75 ± 0,2 na alta hospitalar. O seguimento médio dos pacientes foi de 6,7 ± 2,3 meses. A taxa de patência primária foi de 96,3%. A taxa de salvamento de membro foi de 100%. Não ocorreram fraturas de stent documentadas por raios X. Conclusões: A angioplastia com uso de stent de nitinol superflexível de terceira geração demonstrou ser efetiva no tratamento das lesões ateroscleróricas da artéria femoral superficial...


Endovascular interventions in the superficial femoral artery for the treatment of peripheral arterial occlusive disease have increased over the last decades. The first- and second-generation stents in the superficial femoral artery have failed to demonstrate improved patency of the treated vessel due to high fracture rates. The aim of this study was to evaluate the clinical, short-term outcomes of using third-generation superflexible nitinol stents in the treatment of atherosclerotic lesions in the superficial femoral artery. Methods: This was a retrospective study carried out in a single center, from June 2013 to May 2014. A total of 27 patients underwent angioplasty with third-generation superflexible nitinol stents in atherosclerotic lesions of the superficial femoral artery. Results: The mean age was 68 ± 12 years, 55.6% were females, and 74.1% were diabetics. Patients were classified as TASC B and C in 77.7% of cases. Technical success was 100%. There was an increase in the anklebrachial index from 0.35 ± 0.1 before the intervention to 0.75 ± 0.2 at hospital discharge. The mean followupof patients was 6.7 ± 2.3 months. The primary patency rate was 96.3%. The limb salvage rate was 100%. There were no stent fractures documented by X-rays. Conclusions: Angioplasty with third-generation superflexible nitinol stent placement was shown to beeffective in the treatment of atherosclerotic lesions of the superficial femoral artery...


Subject(s)
Humans , Male , Female , Aged , Femoral Artery/surgery , Peripheral Arterial Disease/complications , Peripheral Arterial Disease/therapy , Endovascular Procedures , Stents , Angioplasty/methods , Popliteal Artery/surgery , Aspirin/administration & dosage , Retrospective Studies , Postoperative Period , Plaque, Atherosclerotic/complications , Plaque, Atherosclerotic/therapy , Treatment Outcome
8.
Rev. guatem. cardiol. (Impresa) ; 24(2): 2-4, jun.-dic. 2014. tab
Article in Spanish | LILACS (Americas) | ID: biblio-869908

ABSTRACT

Objetivo: Determinar la utilidad diagnóstica del índice Tobillo-Brazo por el método palpatorio comparado conel método Doppler en la detección de la enfermedad arterial periférica en pacientes hospitalizados en el Departamento de Medicina Interna del Hospital General San Juan de Dios, durante julio-agosto de 2013.Métodos: Estudio descriptivo transversal de concordancia, en 186 pacientes en el Departamento de Medicina Interna del Hospital General San Juan de Dios, sin diagnóstico previo de enfermedad arterial periférica. Secalculó a cada participante el índice Tobillo-Brazo por método palpatorio y luego con sonda Doppler portátilde 8 mHz. Se analizaron los datos utilizando el índice de Kappa. Resultados: Encontramos 31 pacientes positivos por ambos métodos (palpatorio y Doppler), 5 falsos positivos (solo por método palpatorio), 145negativos por ambos métodos y 6 positivos únicamente por Doppler. Se obtuvo un índice de Kappa de 0.8085el cual corresponde a una adecuada fuerza de concordancia. Conclusiones: La utilidad diagnóstica delíndice Tobillo-Brazo por método palpatorio es apropiada para el diagnóstico de enfermedad arterial periférica,con sensibilidad de 83.3% y especificidad de 96.6% y una apropiada fuerza de la concordancia determinada por el índice de Kappa.


Objective: Determine the diagnostic value of ankle-arm index by palpatory method compared to the Dopplermethod in the detection of peripheral arterial disease in patients hospitalized in the Internal Medicine Department, of Hospital General San Juan de Dios, during July-August 2013. Methods: A cross-matching, descriptive and transversal study in 186 patients at the Department of Internal Medicine, of Hospital GeneralSan Juan de Dios, previously undiagnosed peripheral arterial disease. Each participant Ankle-arm index wascalculated by palpatory method and then with portable 8 MHz Doppler probe. Data using the Kappa indexwere analyzed. Results: We found 31 patients positive by both methods (palpatory and Doppler), 5 falsepositives (just palpatory method), 145 negative by both methods and only 6 positive Doppler. Kappa index of0.8085 which corresponds to a suitable strength of agreement was obtained. CONCLUSIONS: The diagnosticvalue of ankle-arm index palpatory method is suitable for the diagnosis of peripheral arterial disease, withsensitivity of 83.3% and specificity of 96.6% and an appropriate strength of agreement determined by Kappa.


Subject(s)
Humans , Echocardiography, Doppler , Peripheral Arterial Disease/complications , Peripheral Arterial Disease/diagnosis , Ankle Brachial Index
9.
Rev. Col. Bras. Cir ; 41(5): 311-318, Sep-Oct/2014. tab, graf
Article in English | LILACS (Americas) | ID: lil-729957

ABSTRACT

Objective: To study the stenosis of the carotid arteries in patients with symptomatic peripheral arterial disease. Methods: we assessed 100 consecutive patients with symptomatic peripheral arterial disease in stages of intermittent claudication, rest pain or ulceration. Carotid stenosis was studied by echo-color-doppler, and considered significant when greater than or equal to 50%. We used univariate analysis to select potential predictors of carotid stenosis, later taken to multivariate analysis. Results: The prevalence of carotid stenosis was 84%, being significant in 40% and severe in 17%. The age range was 43-89 years (mean 69.78). Regarding gender, 61% were male and 39% female. Half of the patients had claudication and half had critical ischemia. Regarding risk factors, 86% of patients had hypertension, 66% exposure to smoke, 47% diabetes, 65% dyslipidemia, 24% coronary artery disease, 16% renal failure and 60% had family history of cardiovascular disease. In seven patients, there was a history of ischemic cerebrovascular symptoms in the carotid territory. The presence of cerebrovascular symptoms was statistically significant in influencing the degree of stenosis in the carotid arteries (p = 0.02 at overall assessment and p = 0.05 in the subgroups of significant and non-significant stenoses). Conclusion: the study of the carotid arteries by duplex scan examination is of paramount importance in the evaluation of patients with symptomatic peripheral arterial disease, and should be systematically conducted in the study of such patients. .


Objetivo: estudar estenose das artérias carótidas nos pacientes com doença arterial periférica sintomática. Métodos: avaliaram-se consecutivamente 100 portadores de doença arterial periférica sintomática, nos estágios de claudicação intermitente, dor em repouso ou lesão trófica. A estenose carotídea foi estudada pelo eco-color-doppler, sendo considerada significativa quando maior ou igual a 50%. A análise univariada foi utilizada para selecionar os potenciais preditores de estenose carotídea, levados posteriormente para análise multivariada. Resultados: a prevalência de estenose carotídea foi 84%, sendo significativa em 40% e acentuada em 17%. A idade variou de 43 a 89 anos (média de 69,78). Quanto ao sexo, 61% foram do sexo masculino e 39% do feminino. Metade dos pacientes da amostra era claudicante e metade tinha isquemia crítica. Quanto aos fatores de risco, 86% dos pacientes apresentaram hipertensão arterial sistêmica, 66% exposição ao fumo, 47% diabetes, 65% dislipidemia, 24% coronariopatia, 16% insuficiência renal e 60% história familiar positiva para doenças cardiovasculares. Em sete pacientes, havia história de alguma sintomatologia cérebro-vascular isquêmica no território carotídeo. A presença de sintomatologia cérebro-vascular mostrou-se estatisticamente significativa para influenciar o grau de estenose nas artérias carótidas (p=0,02 na avaliação global e p=0,05 nos subgrupos de estenoses significativas e não significativas). Conclusão: o estudo das artérias carótidas através do exame de duplex-scan é de suma importância na avaliação dos pacientes portadores de doença arterial periférica sintomática, devendo-se realizar o estudo de forma sistemática nos pacientes. .


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Carotid Stenosis/etiology , Peripheral Arterial Disease/complications , Severity of Illness Index , Prospective Studies , Middle Aged
10.
Einstein (Säo Paulo) ; 12(3): 358-360, Jul-Sep/2014. graf
Article in Portuguese | LILACS (Americas) | ID: lil-723931

ABSTRACT

A claudicação intermitente está frequentemente associada à doença aterosclerótica, mas diagnósticos diferenciais devem ser pesquisados em pacientes sem fatores de risco tradicionais. A doença cística adventicial, de etiologia incerta, acomete em maior proporção a artéria poplítea e, eventualmente, apresenta-se como claudicação intermitente. Apresentamos um caso da doença e seu manejo cirúrgico, e discutimos a etiopatogenia, os aspectos diagnósticos e terapêuticos da enfermidade.


Intermittent claudication is frequently associated with atherosclerotic disease, but differential diagnosis must be sought in patients with no traditional risk factors. Cystic adventitial disease, of unknown etiology, most frequently affects the popliteal artery, and occasionally presents as intermittent claudication. We report a case of this disease and the surgical treatment, and discuss some aspects related to etiopathogenesis, diagnosis and treatment of this condition.


Subject(s)
Humans , Male , Middle Aged , Adventitia , Intermittent Claudication/etiology , Popliteal Artery , Peripheral Arterial Disease/complications , Popliteal Cyst/complications , Adventitia/pathology , Adventitia/surgery , Intermittent Claudication/pathology , Intermittent Claudication/surgery , Peripheral Arterial Disease/pathology , Peripheral Arterial Disease/surgery , Popliteal Artery/pathology , Popliteal Artery/surgery , Popliteal Cyst/pathology , Popliteal Cyst/surgery
11.
Article in English | WPRIM (Western Pacific) | ID: wprim-186814

ABSTRACT

BACKGROUND: This study evaluated the effects of Beraprost sodium (Berasil) on subjective leg symptoms in patients with peripheral arterial disease caused by diabetes mellitus. METHODS: Ninety-four diabetic patients with peripheral arterial disease were treated with Beraprost in a fixed-dose, prospective, multicenter, cohort study. Beraprost (40 microg) was administered orally 3 times daily (120 microg/day) for 12 weeks. We developed a new disease-specific symptom questionnaire, which evaluated the effect of peripheral arterial disease on leg discomfort in daily life and assessed therapeutic responses to treatment. Patients were asked for their subjective assessment of symptoms on a written questionnaire before treatment and after 12 weeks of therapy. RESULTS: There was significant improvement in all estimated subjective symptoms (burning, coldness, edema, exertional pain, stabbing, and paresthesias) in the lower extremities at 12 weeks (p < 0.001). There were 18 patients with neuropathy in whom significant improvement was noted for 6 subjective symptoms at 12 weeks (p < 0.05). Adverse events considered to be drug-related were observed in 4 patients (4.3%), all of which were mild and resolved with discontinuation of the medication. CONCLUSIONS: Beraprost is effective as a treatment for improving various subjective symptoms in the lower extremities, such as burning, coldness, edema, exertional pain, stabbing, and paresthesias, in diabetic patients with peripheral arterial disease.


Subject(s)
Adult , Aged , Aged, 80 and over , Cohort Studies , Diabetes Complications/drug therapy , Epoprostenol/analogs & derivatives , Female , Humans , Male , Middle Aged , Peripheral Arterial Disease/complications , Platelet Aggregation Inhibitors/therapeutic use , Prospective Studies , Statistics, Nonparametric
12.
Article in English | WPRIM (Western Pacific) | ID: wprim-188340

ABSTRACT

Peripheral artery disease (PAD) is an important marker for the risk stratification of patients with coronary artery disease (CAD). We investigated the prevalence of PAD in patients undergoing percutaneous coronary intervention (PCI) with CAD and the relationship between ankle-brachial pressure index (ABPI) and CAD severity. A total of 711 patients undergoing PCI for CAD from August 2009 to August 2011 were enrolled. PAD diagnosis was made using the ABPI. The prevalence of PAD was 12.8%. In PAD patients, mean values of right and left ABPI were 0.71 +/- 0.15 and 0.73 +/- 0.15. Patients with PAD had a higher prevalence of left main coronary disease (14.3% vs 5.8%, P = 0.003), more frequently had multivessel lesions (74.9% vs 52.1%, P < 0.001) and had higher SYNTAX score (18.2 +/- 12.3 vs 13.1 +/- 8.26, P = 0.002). Using multivariate analysis, we determined that left main CAD (OR, 2.954; 95% CI, 1.418-6.152, P = 0.004) and multivessel CAD (OR, 2.321; 95% CI, 1.363-3.953, P = 0.002) were both independently associated with PAD. We recommend that ABPI-based PAD screening should be implemented in all patients undergoing PCI with CAD, especially in severe cases.


Subject(s)
Aged , Ankle Brachial Index , Asian Continental Ancestry Group , Coronary Artery Disease/diagnosis , Female , Humans , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Percutaneous Coronary Intervention , Peripheral Arterial Disease/complications , Prevalence , Republic of Korea/epidemiology , Risk Factors , Severity of Illness Index
13.
J. vasc. bras ; 11(4): 263-268, out.-dez. 2012. ilus, tab
Article in Portuguese | LILACS (Americas) | ID: lil-659719

ABSTRACT

CONTEXTO: O teste de caminhada de seis minutos e o teste de esforço em esteira têm sido frequentemente utilizados para quantificação da limitação funcional dos pacientes com doença arterial periférica. Todavia, ainda não está bem estabelecido se os resultados desses testes são correlacionados. OBJETIVOS: Relacionar a distância total de caminhada (DTC) obtida nos testes de seis minutos e de esforço em esteira em pacientes com doença arterial periférica e sintomas de claudicação intermitente. MÉTODOS: A amostra foi composta por 34 pacientes (65,5 ± 8,9 anos) de ambos os gêneros (26 homens e 8 mulheres). Os indivíduos realizaram o teste de seis minutos em corredor de 30 metros e o teste de esforço em esteira ergométrica utilizando-se protocolo específico para essa população, com intervalo de pelo menos sete dias entre os testes. Para a análise dos dados, foi utilizada a análise de correlação de Pearson. RESULTADOS: Houve correlação significante na DTC obtida nos testes de seis minutos e de esforço em esteira (r=0,48, p<0,01). Foi observada correlação significante entre a DTC obtida nos testes nos pacientes com menor comprometimento hemodinâmico do membro (r=0,69; p=0,01), enquanto que, nos pacientes com maior comprometimento hemodinâmico do membro, a correlação não foi significante (r=0,03, p=0,91). Além disso, foi observada correlação significante entre os testes tanto nos pacientes com baixos níveis de adiposidade (r=0,57; p=0,02) como nos pacientes com altos níveis de adiposidade (r=0,48, p<0,05). CONCLUSÃO: Os resultados deste estudo mostram que os dados obtidos do teste de seis minutos e de esforço em esteira são correlacionados, exceto em pacientes com maior comprometimento hemodinâmico do membro.


BACKGROUND: Six minute walk test and treadmill test have been used to evaluate the functional limitations of peripheral artery disease patients. However, whether these tests are correlated remain poorly known. OBJECTIVE: To analyze the relationship between the total walk distance (TWD) assessed in the six minute walk test and in the treadmill test in patients with peripheral artery disease and symptoms of intermittent claudication. METHODS: Thirty-four patients (65.5 ± 8.9 yrs) of both genders (26 men 8 women) participated of the study. They performed the 6 minute walk test in a 30 meters hall and the treadmill test with a specific protocol, with an interval of at least 7 days between the tests. Pearson correlation coefficient was used for data analysis. RESULTS: Significant correlation was observed between TWD assessed in the six minute walk test and in the treadmill test. (r=0.48, p<0.01). Significant correlation between the TWD assessed in the tests were observed in the patients with lower hemodynamic limb commitment (r=0.69; p=0.01), while in the patients with higher hemodynamic limb commitment the correlation was not significant (r=0.03, p=0.91). Furthermore, a significant correlation between TWD obtained in the tests was observed in patients with low (r=0.57; p=0.02), and high levels of adiposity (r=0.48, p<0.05). CONCLUSION: The results of this study shown that walking capacity obtained with the six minute walk test and treadmill test are correlated, except in the patients with higher limb hemodynamic commitment.


Subject(s)
Humans , Male , Female , Intermittent Claudication/diagnosis , Peripheral Arterial Disease/complications , Lower Extremity/pathology , Exercise Test/classification , Walking/classification , Hemodynamics
14.
Rev. bras. cardiol. (Impr.) ; 25(4): 330-339, jul.-ago. 2012.
Article in Portuguese | LILACS (Americas) | ID: lil-652623

ABSTRACT

O estágio dos sintomas do paciente com doença isquêmica de membros inferiores determina o tipo detratamento. Apesar das terapias já conhecidas um grupo desses pacientes não é candidato ao tratamento cirúrgicoou continua com dor mesmo após o tratamento, o que afeta a sua qualidade de vida. O entendimento dosmecanismos moleculares envolvidos no desenvolvimento vascular possibilita respeitar e compreender os benefíciose limites das terapias moleculares para o tratamento das doenças isquêmicas de membros inferiores. Neste artigodescreve-se a perspectiva atual da terapia celular e da terapia gênica no tratamento da isquemia crítica demembros inferiores.


Subject(s)
Humans , Peripheral Arterial Disease/complications , Ischemia/physiopathology , Lower Extremity , Cell- and Tissue-Based Therapy/methods , Cell- and Tissue-Based Therapy , Genetic Therapy/methods , Genetic Therapy , Risk Factors
15.
Article in Portuguese | LILACS (Americas) | ID: lil-538835

ABSTRACT

JUSTIFICATIVA E OBJETIVOS: O diabetes mellitus é um importante problema de saúde pública, tanto pela sua alta prevalência, quanto pela suas complicações, entre elas o pé diabético que é causa frequente de amputações e acarreta comprometimento na produtividade e qualidade de vida dos pacientes. O objetivo deste estudo foi determinar a prevalência de pé diabético em um hospital terciário e descrever os fatores de risco associados, as complicações e a classificação das lesões segundo "Wagner". MÉTODO: Estudo transversal, retrospectivo, descritivo, realizado no período de julho a setembro de 2008, no Setor de Emergência do Hospital Geral de Fortaleza, por meio da análise de prontuários dos pacientes atendidos com diagnóstico clínico de "pé diabético". RESULTADOS: Foram analisados 67 de 1631 prontuários de pacientes com diagnóstico de pé diabético, dos quais 47,8% eram do sexo masculino e 52,2% do sexo feminino, com idade média de 65,7 anos, sendo 58,2% provenientes de Fortaleza. Em relação aos fatores de risco, os mais encontrados foram hipertensão (91,1%) e tabagismo (46,4%). Quanto às complicações mais associadas, identificou-se doença arterial periférica (83,7%) e doença cerebrovascular (48,8%). O grau de lesão mais frequente foi 4 (56,7%), seguido de 5 (29,8%). O tratamento predominante foi o cirúrgico (97%). CONCLUSÃO: A prevalência do pé diabético foi de 4,1%, sendo mais comum no sexo feminino, com idade média de 66 anos e procedentes de Fortaleza. A hipertensão arterial foi o fator de risco mais frequente e a doença arterial periférica a complicação mais encontrada nessa população. As lesões de grau 4 predominavam nos pacientes portadores de pé diabético.(AU)


BACKGROUND AND OBJECTIVES: Diabetes mellitus is an important public health problem, both for its high prevalence and complications, including diabetic foot which is a frequent cause of amputations and causes severe impairment in productivity and quality of life of patients. The objective this study was identify the patients that are "diabetic foot" carriers in a high complexity hospital and describe the factors of associated risks, epidemiological factors and the classification of the existent lesions, according to "Wagner". METHOD: A cross-sectional study, retrospective, descriptive, from July to September 2008, at the Emergency of the General Hospital of Fortaleza, by the analysis of medical records of patients presenting clinical diagnosis of diabetic foot. RESULTS: 67 patients were analyzed, of which 47.8% were in the male gender and 52.2% in the female gender, with median age 65.7; of which 58.2% came or were from Fortaleza. Concerning the risk factors, the biggest were the hypertension (91.1%) and the tobacco (46.4%). Concerning the associated complications, there was the peripheral arterial disease (83.7%) and the vascular brain disease (48.8%). The most frequent degree was 4 (56.7%), followed by 5 (29.8%). The treatment that prevailed was surgical (97%). CONCLUSION: The prevalence of diabetic foot was 4.1%, more common in females, mean age 66 years and coming from Fortaleza. The most common risk factor was hypertension. Peripheral arterial disease was the most common complication. Finally, according to Wagner's classification, the most prevalent degree of injury was grade 4.(AU)


Subject(s)
Humans , Diabetic Foot/epidemiology , Diabetes Mellitus/pathology , Peripheral Arterial Disease/complications , Hypertension/epidemiology , Epidemiology, Descriptive , Cross-Sectional Studies/instrumentation , Retrospective Studies , Risk Factors
16.
Article in English | WPRIM (Western Pacific) | ID: wprim-187252

ABSTRACT

This study aimed to investigate prevalence of asymptomatic carotid artery stenosis (ACAS) in Korean patients with peripheral arterial disease (PAD) and identify predictive factors of ACAS in patients with PAD. Between 1994 and 2008, 546 patients who underwent bypass surgery due to PAD were identified in a single tertiary teaching hospital. Of those, 409 patients underwent preoperative screening carotid duplex ultrasonography (CDUS). Patients who had an episode of cerebrovascular event or previous carotid artery intervention were excluded and then a retrospective analysis was made of 340 patients. The degree of internal carotid artery (ICA) stenosis was determined by the criteria of Society of Radiologists in Ultrasound Consensus Conference. To determine the risk factors of ACAS, demographic, coexisting medical condition and lesion characteristics were tested with binary logistic regression model. The prevalence of > or =70% ICA stenosis was 14%. ICA occlusion was detected in 7.1%. Multivariate analysis revealed age >65 yr (OR: 2.610, 95% CI: 1.197-5.691) and coronary artery disease (CAD, OR: 2.333, 95% CI: 1.169-4.657) are predictive factors of > or =70% stenosis. A PAD patient who needs revascularization, particularly, >65 yr or has a concomitant CAD, can be a good candidate of screening CDUS.


Subject(s)
Adult , Age Factors , Aged , Aged, 80 and over , Atherosclerosis/complications , Carotid Stenosis/complications , Chronic Disease , Coronary Artery Disease/diagnosis , Demography , Female , Humans , Ischemia/complications , Lower Extremity , Male , Middle Aged , Peripheral Arterial Disease/complications , Predictive Value of Tests , Prevalence , Republic of Korea/epidemiology , Risk Factors , Ultrasonography, Doppler, Duplex
17.
Al-Azhar Medical Journal. 2007; 36 (3): 387-394
in English | IMEMR (Eastern Mediterranean) | ID: emr-126412

ABSTRACT

The purpose of this study was to determine the natural history of peripheral arterial disease [PAD] complicating type2-diabetics, in particular the influence of PAD on the risk of cardiac death and the adequacy of PAD risk factor management. The study was a prospective study of diabetic patients. The study was performed at Al-Azhar University Hospitals on 15o patients with type 2-diabetes between March 2004 and May 2005, with follow-up period at least 2-years. All patients had a valid data at baseline and three or more subsequent consecutive annual reviews. Assessment consisted of a range of clinical and biochemical variables including the ankle/brachial index [ABI]. PAD was defined as an ABI

Subject(s)
Humans , Male , Female , Peripheral Arterial Disease/complications , Death , Blood Pressure
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