Predictors of outcome in stable outpatients with peripheral artery disease.

Patients with peripheral artery disease (PAD) are at increased risk for subsequent ischemic events. We used data from the FRENA Registry to find predictors of subsequent myocardial infarction (MI), ischemic stroke, and limb amputation in stable outpatients with PAD. As of January 2012, 1,270 patients with PAD were recruited, of whom 1,042 (82 %) had Fontaine stage II; 113 (8.9 %) stage III; and 115 (9.1 %) stage IV. Over a mean follow-up of 14 months, 35 patients developed MI, 25 had stroke, 39 underwent limb amputation, and 91 died. Among patients with Fontaine stage II, the incidence of MI (2.09 events per 100 patient-years; 95 % CI 1.43-2.97) or stroke (0.93; 95 % CI 0.52-1.56) was similar to that of limb amputation (3.22; 95 % CI 2.37-4.29). On multivariate analysis, patients with diabetes [hazard ratio (HR) 2.09; 95 % CI 1.05-4.18], prior coronary disease (HR 5.35; 95 % CI 2.24-12.8), or atrial fibrillation (HR 3.11; 95 % CI 1.52-6.37) were at increased risk for MI; female (HR 2.94; 95 % CI 1.32-6.67), those with prior stroke (HR 5.21; 95 % CI 1.22-22.2) or atrial fibrillation (HR 3.37; 95 % CI 1.45-7.85) at increased risk for stroke; and female (HR 2.38; 95 % CI 1.23-4.55), those with diabetes (HR 3.50; 95 % CI 1.58-7.73) or advanced stages of PAD were at increased risk for limb amputation. Prior coronary artery disease, diabetes and atrial fibrillation predicted subsequent MI; female gender, prior stroke and atrial fibrillation predicted stroke; and female gender, diabetes, and advanced stages of PAD predicted limb amputation.

Rubeosis iridis as a sign of underlying carotid stenosis.

Severe carotid stenosis may be associated with uncommon clinical symptoms. We report a case of ocular ischemic syndrome and subsequent rubeosis iridis due to a high-grade carotid stenosis. The patient recovered visual acuity and his normal iris coloring after carotid endarterectomy. Rubeosis iridis may be the only clinical sign associated with severe carotid stenosis, making it mandatory to rule out the presence of carotid narrowing when it is detected. Establishing an early diagnosis is essential to improve quality of life, prognosis, and patients' outcome.

[Prevalence of renal artery stenosis in patients with critical limb ischemia]. / Prevalencia de estenosis de la arteria renal en los pacientes con isquemia crónica grave de extremidades inferiores.

BACKGROUND AND OBJECTIVE: Our purpose was to evaluate the prevalence of renal artery stenosis in patients with critical limb ischemia and to study any clinical or laboratory indicator that could predict this association. PATIENTS AND METHOD: One hundred consecutive patients with critical limb ischemia evaluated by angiogram were included in the study from January to July 2003. Cardiovascular risk factors and renal function were analyzed. RESULTS: One hundred angiographic studies have been analyzed. Thirty nine (39%) of our patients had some type of pathology of the renal artery but the rest, 61 (61%), had normal and healthy renal arteries. In 5 patients, a bilateral renal pathology was found. Severe disease (> 60% stenosis, bilateral or renal occlusion) was present in 15 cases including 6 occlusions. Once we compared the patients with healthy renal arteries with the patients with different degrees of stenosis, we did not appreciate significant differences in hypertension, diabetes, coronary disease or smoking habit, nor with laboratory data such as creatinine, urea, c-reactive protein, total cholesterol or atherogenic index. No differences were found either comparing patients with normal renal artery with patients with bilateral pathology or with unilateral occlusion. CONCLUSIONS: There is a high prevalence of renal artery pathology in patients with critical limb ischemia although we have not found any clinical or laboratory factors useful to identify them.

Prevalencia de estenosis de la arteria renal en los pacientes con isquemia crónica grave de extremidades inferiores / Prevalence of renal artery stenosis in patients with critical limb ischemia

Fundamento y objetivo: Evaluar la prevalencia de la estenosis de la arteria renal en los pacientes con isquemia grave de las extremidades inferiores, y estudiar si existe algún indicador clínico o analítico que pueda ser útil para diferenciar a la población con enfermedad renal del resto de pacientes. Pacientes y método: Se ha estudiado prospectivamente mediante arteriografía renal a 100 pacientes ingresados de forma consecutiva en nuestro servicio por isquemia crónica de extremidades inferiores entre enero y julio de 2003. Se analizaron los factores de riesgo cardiovascular y la función renal mediante analítica. Resultados: Se realizaron 100 arteriografías. En 39 (39%) se observó enfermedad de arterias renales, mientras que éstas eran normales en 61 (61%). En 5 pacientes se encontró afectación bilateral. Se halló afectación grave (estenosis > 60%, afectación bilateral u obliteración renal) en 15 casos, que incluyeron 6 obliteraciones renales. Al comparar los pacientes que presentaban arteria renal sana con los que tenían una estenosis de la arteria renal no se obtuvieron diferencias respecto a la hipertensión arterial, diabetes mellitus, cardiopatía isquémica ni tabaquismo, y tampoco hubo diferencias en los parámetros analíticos estudiados: creatinina, urea, proteína C reactiva, colesterol total e índice aterogénico. Tampoco se hallaron diferencias al comparar el grupo de pacientes con arteria renal sana con aquellos que presentaban enfermedad bilateral o con los que presentaban oclusión de una arteria renal. Conclusiones: Existe una alta prevalencia de enfermedad vascular renal en los pacientes con isquemia grave de las extremidades inferiores. A pesar de ello, no hallamos ningún marcador clínico o analítico que la identifique

Background and objective: Our purpose was to evaluate the prevalence of renal artery stenosis in patients with critical limb ischemia and to study any clinical or laboratory indicator that could predict this association. Patients and method: One hundred consecutive patients with critical limb ischemia evaluated by angiogram were included in the study from January to July 2003. Cardiovascular risk factors and renal function were analyzed. Results: One hundred angiographic studies have been analyzed. Thirty nine (39%) of our patients had some type of pathology of the renal artery but the rest, 61 (61%), had normal and healthy renal arteries. In 5 patients, a bilateral renal pathology was found. Severe disease (> 60% stenosis, bilateral or renal occlusion) was present in 15 cases including 6 occlusions. Once we compared the patients with healthy renal arteries with the patients with different degrees of stenosis, we did not appreciate significant differences in hypertension, diabetes, coronary disease or smoking habit, nor with laboratory data such as creatinine, urea, c-reactive protein, total cholesterol or atherogenic index. No differences were found either comparing patients with normal renal artery with patients with bilateral pathology or with unilateral occlusion. Conclusions: There is a high prevalence of renal artery pathology in patients with critical limb ischemia although we have not found any clinical or laboratory factors useful to identify them

Análise dos resultados dos 100 primeiros aneurismas da aorta abdominal operados em um serviço de angiologia e cirurgia vascular / Outcome of the first 100 abdominal aortic aneurisms treated surgically in an angiology and vascular surgery service

Estudar as características dos pacientes e avaliar os resultados imediatos do tratamento cirúrgico dos 100 primeiros casos de aneurisma da aorta abdominal näo-rotos operados em um Serviço de Angiologia e Cirurgia Vascular, identificando os possíveis fatores prognósticos relacionados à mortalidade precoce...