1
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Nguyen D, D'Andrea M, Joule D, Kulwin J, Rojas C, Zhou W. Barriers to Antiplatelet and Statin Adherence Following Major Vascular Intervention. Ann Vasc Surg 2024:S0890-5096(24)00245-0. [PMID: 38821476 DOI: 10.1016/j.avsg.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/12/2024] [Accepted: 03/21/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVES Antiplatelet and statins therapies are associated with improved cardiovascular outcomes following major vascular intervention. Many vascular surgery institutions are reporting improved prescribing rates for aspirin, P2Y12 antagonists, and statins. Nevertheless, there remains limited publication describing rates and patient-perceived barriers for postoperative adherence. The purpose of this study is to investigate patient non-adherence to antiplatelet and statin therapies following major vascular intervention. METHODS A retrospective review of patients who underwent major vascular intervention at a single academic center was performed. The prescribing rates of aspirin, P2Y12 antagonists, and statins were reviewed. Postoperative adherence, defined as consistent intake as prescribed, was evaluated at 1, 3, 6, 9, and 12 months using electronic documentation of both follow-up clinic appointments and phone call assessments then corroborated with pharmacy fulfillment records. Patient-reported barriers for medication adherence were also examined. RESULTS A total of 101 subjects underwent major vascular intervention between January 2020 and July 2020, 98% of whom were discharged on at least one antiplatelet or statin agent. Approximately 90% of patients were discharged with aspirin, 32% with a P2Y12 antagonist, and 96% with a statin. All patients who maintained adherence up to 6 months continued to report adherence at 9 and 12 months. Consistent adherence at 12 months was documented in 76% of patients on aspirin, 81% on P2Y12 antagonism therapy, and 73% on statins. New adverse drug reactions represented the most common barrier to achieving adherence (37%[n=20]). Preoperative therapy with aspirin, P2Y12 antagonists, and statins were all independently predictive for postoperative adherence to the same regimen (p<0.001). Female gender was also associated with higher rates of adherence to postoperative P2Y12 antagonism therapy (p<0.05). CONCLUSIONS The current prescribing rates for antiplatelet and statin agents are promising, but postoperative non-adherence remains a multifaceted issue.
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Affiliation(s)
- Daniel Nguyen
- The University of Arizona College of Medicine - Tucson, 1501 N Campbell Ave, Tucson, Arizona 85724.
| | - Melissa D'Andrea
- The University of Arizona College of Medicine - Tucson, 1501 N Campbell Ave, Tucson, Arizona 85724
| | - Dylan Joule
- The University of Arizona College of Medicine - Tucson, 1501 N Campbell Ave, Tucson, Arizona 85724
| | - Jeremy Kulwin
- The University of Arizona College of Medicine - Tucson, 1501 N Campbell Ave, Tucson, Arizona 85724
| | - Connie Rojas
- Genome Center, The University of California, 451 Health Sciences Drive, Davis, California 95616
| | - Wei Zhou
- The University of Arizona College of Medicine - Tucson, 1501 N Campbell Ave, Tucson, Arizona 85724; The University of Arizona Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, 1501 N Campbell Ave, PO Box 245072, Tucson, Arizona 85724.
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2
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Menêses A, Krastins D, Nam M, Bailey T, Quah J, Sankhla V, Lam J, Jha P, Schulze K, O'Donnell J, Magee R, Golledge J, Greaves K, Askew CD. Toward a Better Understanding of Muscle Microvascular Perfusion During Exercise in Patients With Peripheral Artery Disease: The Effect of Lower-Limb Revascularization. J Endovasc Ther 2024; 31:115-125. [PMID: 35898156 DOI: 10.1177/15266028221114722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Leg muscle microvascular blood flow (perfusion) is impaired in response to maximal exercise in patients with peripheral artery disease (PAD); however, during submaximal exercise, microvascular perfusion is maintained due to a greater increase in microvascular blood volume compared with that seen in healthy adults. It is unclear whether this submaximal exercise response reflects a microvascular impairment, or whether it is a compensatory response for the limited conduit artery flow in PAD. Therefore, to clarify the role of conduit artery blood flow, we compared whole-limb blood flow and skeletal muscle microvascular perfusion responses with exercise in patients with PAD (n=9; 60±7 years) prior to, and following, lower-limb endovascular revascularization. MATERIALS AND METHODS Microvascular perfusion (microvascular volume × flow velocity) of the medial gastrocnemius muscle was measured before and immediately after a 5 minute bout of submaximal intermittent isometric plantar-flexion exercise using contrast-enhanced ultrasound imaging. Exercise contraction-by-contraction whole-leg blood flow and vascular conductance were measured using strain-gauge plethysmography. RESULTS With revascularization there was a significant increase in whole-leg blood flow and conductance during exercise (p<0.05). Exercise-induced muscle microvascular perfusion response did not change with revascularization (pre-revascularization: 3.19±2.32; post-revascularization: 3.89±1.67 aU.s-1; p=0.38). However, the parameters that determine microvascular perfusion changed, with a reduction in the microvascular volume response to exercise (pre-revascularization: 6.76±3.56; post-revascularization: 2.42±0.69 aU; p<0.01) and an increase in microvascular flow velocity (pre-revascularization: 0.25±0.13; post-revascularization: 0.59±0.25 s-1; p=0.02). CONCLUSION These findings suggest that patients with PAD compensate for the conduit artery blood flow impairment with an increase in microvascular blood volume to maintain muscle perfusion during submaximal exercise. CLINICAL IMPACT The findings from this study support the notion that the impairment in conduit artery blood flow in patients with PAD leads to compensatory changes in microvascular blood volume and flow velocity to maintain muscle microvascular perfusion during submaximal leg exercise. Moreover, this study demonstrates that these microvascular changes are reversed and become normalized with successful lower-limb endovascular revascularization.
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Affiliation(s)
- Annelise Menêses
- VasoActive Research Group, School of Health, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Digby Krastins
- VasoActive Research Group, School of Health, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Michael Nam
- Department of Cardiology, Sunshine Coast University Hospital, Birtinya, QLD, Australia
| | - Tom Bailey
- VasoActive Research Group, School of Health, University of the Sunshine Coast, Sippy Downs, QLD, Australia
- Physiology and Ultrasound Laboratory in Science and Exercise, Centre for Research on Exercise, Physical Activity & Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Jing Quah
- Department of Cardiology, Sunshine Coast University Hospital, Birtinya, QLD, Australia
| | - Vaibhav Sankhla
- Department of Cardiology, Sunshine Coast University Hospital, Birtinya, QLD, Australia
| | - Jeng Lam
- Department of Cardiology, Sunshine Coast University Hospital, Birtinya, QLD, Australia
| | - Pankaj Jha
- Department of Vascular Surgery, Sunshine Coast University Hospital, Birtinya, QLD, Australia
| | - Karl Schulze
- Sunshine Vascular Clinic, Buderim, QLD, Australia
| | - Jill O'Donnell
- Department of Vascular Surgery, Sunshine Coast University Hospital, Birtinya, QLD, Australia
| | - Rebecca Magee
- Department of Vascular Surgery, Sunshine Coast University Hospital, Birtinya, QLD, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University and Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, QLD, Australia
| | - Kim Greaves
- Department of Cardiology, Sunshine Coast University Hospital, Birtinya, QLD, Australia
- Sunshine Coast Health Institute, Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - Christopher D Askew
- VasoActive Research Group, School of Health, University of the Sunshine Coast, Sippy Downs, QLD, Australia
- Sunshine Coast Health Institute, Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
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3
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Paraskevas KI, Mukherjee D, Papas TT. Benefits of Statins and Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK-9) Inhibitors for Patients with Peripheral Arterial Disease. Curr Vasc Pharmacol 2024; 22:8-10. [PMID: 38037835 DOI: 10.2174/0115701611292747231129080204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023]
Affiliation(s)
- Kosmas I Paraskevas
- Department of Vascular Surgery, Red Cross Hospital, Athens, Greece
- Department of Vascular Surgery, Central Clinic of Athens, Athens, Greece
| | - Debabrata Mukherjee
- Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, U.S.A
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4
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5
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Katsiki N, Giannoukas AD, Athyros VG, Mikhailidis DP. Lipid-lowering treatment in peripheral artery disease. Curr Opin Pharmacol 2018; 39:19-26. [DOI: 10.1016/j.coph.2018.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/14/2018] [Accepted: 01/19/2018] [Indexed: 12/19/2022]
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6
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Desai P, Helkin A, Odugbesi A, Stein J, Bruch D, Lawler J, Maier KG, Gahtan V. Fluvastatin inhibits intimal hyperplasia in wild-type but not Thbs1 -null mice. J Surg Res 2017; 210:1-7. [DOI: 10.1016/j.jss.2016.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 09/23/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
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7
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8
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Paraskevas KI, Phillips MJ, Shearman CP. Screening for Peripheral Arterial Disease Using the Ankle-Brachial Index in Diabetic and Other High-Risk Patients: Pros and Cons. Angiology 2015. [PMID: 26207009 DOI: 10.1177/0003319715597090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kosmas I Paraskevas
- Department of Vascular Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Mike J Phillips
- Department of Vascular Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Clifford P Shearman
- Department of Vascular Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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9
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Spanos K, Georgiou E, Saleptsis V, Athanasoulas A, Sakkas L, Giannoukas AD. Effectiveness of Intravenous Ilomedin Infusion and Smoking Cessation in the Treatment of Acutely Symptomatic Buerger Disease. Angiology 2015; 66:114-117. [DOI: 10.1177/0003319713516379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
We assessed the effectiveness of iloprost treatment in the management of symptomatic Buerger disease (BD) and assessed smoking cessation compliance, based on a single-center experience. Thirteen patients with BD were treated with sessions of intravenous (IV) Ilomedin infusion. At 1-year follow-up, pain status alteration, number of analgesics required, ankle–brachial index (ABI) change, compliance with supervised smoking cessation, and amputation-free rate were recorded. The pain status improved considerably according to a visual analog scale, the number of analgesics required was significantly reduced, and all patients improved their pain-free walking distance, the ABI, and their self-reported quality of life. Only 2 patients required minor amputations. Combination of IV Ilomedin infusion, supervised smoking cessation, and a specific follow-up protocol may lead to improvement in pain-free walking distance, pain status, quality of life, and substantial reduction in amputation risk.
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Affiliation(s)
- Kostas Spanos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Evangelia Georgiou
- Department of Rheumatology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Vassileios Saleptsis
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athanasios Athanasoulas
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Lazaros Sakkas
- Department of Rheumatology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athanasios D. Giannoukas
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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10
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Antoniou GA, Fisher RK, Georgiadis GS, Antoniou SA, Torella F. Statin therapy in lower limb peripheral arterial disease: Systematic review and meta-analysis. Vascul Pharmacol 2014; 63:79-87. [DOI: 10.1016/j.vph.2014.09.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 07/27/2014] [Accepted: 09/12/2014] [Indexed: 12/17/2022]
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11
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Vogel TR, Dombrovskiy VY, Galiñanes EL, Kruse RL. Preoperative Statins and Limb Salvage After Lower Extremity Revascularization in the Medicare Population. Circ Cardiovasc Interv 2013; 6:694-700. [DOI: 10.1161/circinterventions.113.000274] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Statins stabilize atherosclerotic plaque, decrease mortality after surgical procedures, and are linked to anti-inflammatory effects. The objective of this study was to evaluate preoperative administration of statins and longitudinal limb salvage after lower extremity endovascular revascularization and lower extremity open surgery.
Methods and Results—
Patients were selected from 2007 to 2008 Medicare claims using the
International Classification of Diseases, Ninth Revision, Clinical Modification
, diagnosis codes for claudication (N=8128), rest pain (N=3056), and ulceration/gangrene (N=11 770) and Current Procedural Terminology codes for endovascular revascularization (N=14 353) and open surgery (N=8601). Half (N=11 687) were identified as statin users before revascularization using Part D files. Amputations were identified using Current Procedural Terminology codes. Statin users compared with nonusers had lower amputation rates at 30 days (11.5% versus 14.4%;
P
<0.0001), 90 days (15.5% versus 19.3%;
P
<0.0001), and 1 year (20.9% versus 25.6%;
P
<0.0001). Survival analysis demonstrated improved limb salvage during 1 year for statin users compared with nonusers for the diagnosis of claudication (
P
=0.003), a similar trend for rest pain (
P
=0.061), and no improvement for ulceration/gangrene (
P
=0.65).
Conclusions—
Preoperative statins were associated with improved 1-year limb salvage after lower extremity revascularization. The strongest association was found for patients with the diagnosis of claudication. Statins seem to be underused among Medicare patients with peripheral artery disease. Further evaluation of the use of preoperative statins and the potential benefits for peripheral vascular interventions is warranted.
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Affiliation(s)
- Todd R. Vogel
- From the Division of Vascular Surgery (T.R.V., E.L.G.), and Department of Family and Community Medicine (R.L.K.), University of Missouri, School of Medicine, Columbia; and Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (V.Y.D.)
| | - Viktor Y. Dombrovskiy
- From the Division of Vascular Surgery (T.R.V., E.L.G.), and Department of Family and Community Medicine (R.L.K.), University of Missouri, School of Medicine, Columbia; and Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (V.Y.D.)
| | - Edgar Luis Galiñanes
- From the Division of Vascular Surgery (T.R.V., E.L.G.), and Department of Family and Community Medicine (R.L.K.), University of Missouri, School of Medicine, Columbia; and Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (V.Y.D.)
| | - Robin L. Kruse
- From the Division of Vascular Surgery (T.R.V., E.L.G.), and Department of Family and Community Medicine (R.L.K.), University of Missouri, School of Medicine, Columbia; and Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (V.Y.D.)
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12
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Paraskevas KI, Mukherjee D, Whayne TF. Peripheral arterial disease: implications beyond the peripheral circulation. Angiology 2012; 64:569-71. [PMID: 23221278 DOI: 10.1177/0003319712466730] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Peripheral arterial disease (PAD) affects a considerable percentage of the population. The manifestations of this disease are not always clinically overt. As a result, PAD remains underdiagnosed and undertreated. PAD is not just a disease of the peripheral arteries, but also an indication of generalized vascular atherosclerosis. PAD patients also have a high prevalence of other arterial diseases, such as coronary/carotid artery disease and abdominal aortic aneurysms. PAD is also a predictor of increased risk of lung and other cancers. The most often used examination for the establishment of the diagnosis of PAD, the ankle-brachial pressure index (ABPI), is also a predictor of generalized atherosclerosis, future cardiovascular events and cardiovascular mortality. Several markers that have been linked with PAD (e.g. C-reactive protein, serum bilirubin levels) may also have predictive value for other conditions besides PAD (e.g. kidney dysfunction). The management of PAD should therefore not be restricted to the peripheral circulation but should include measurements to manage and decrease the systemic atherosclerotic burden of the patient.
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13
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Papatheodorou K, Papanas N, Papazoglou D, Gioka T, Antonoglou C, Glaros D, Maltezos E. Monocyte chemoattractant protein 1 is correlated with glycemic control and peripheral arterial disease in type 2 diabetic patients with metabolic syndrome. Angiology 2012; 64:223-9. [PMID: 22492254 DOI: 10.1177/0003319712440143] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We evaluated the serum levels of monocyte chemoattractant protein 1 (MCP-1) and their association with peripheral arterial disease (PAD) in 199 patients with type 2 diabetes mellitus (T2DM) and metabolic syndrome ([MetS], group A) in comparison with 109 healthy controls (group B). In group A, MCP-1 levels were significantly (P < .001) higher than group B and exhibited a positive correlation with HbA1c (P < .001) and a negative correlation with ankle-brachial index (P < .001). In the same group, patients with PAD had significantly higher MCP-1 levels compared with those without PAD (P < .001). In conclusion, T2DM patients with MetS exhibit higher serum MCP-1 levels. The latter is associated with worse glycemic control and PAD. These results suggest a potential contributory role for MCP-1 in the pathogenesis of PAD in the presence of hyperglycemia and MetS in T2DM.
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Affiliation(s)
- K Papatheodorou
- Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis Greece.
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14
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Tiaka EK, Papanas N, Manolakis AC, Maltezos E. The role of hyperbaric oxygen in the treatment of diabetic foot ulcers. Angiology 2011; 63:302-14. [PMID: 21873346 DOI: 10.1177/0003319711416804] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Diabetic foot ulcers are still extremely difficult to heal. Therefore, therapeutic options to improve healing rates are continuously being explored. Hyperbaric oxygen (HBO) has been used in addition to standard treatment of the diabetic foot for more than 20 years. Evidence suggests that HBO reduces amputation rates and increases the likelihood of healing in infected diabetic foot ulcers, in association with improved tissue oxygenation, resulting in better quality of life. Nonetheless, HBO represents an expensive modality, which is only available in few centers. Moreover, adverse events necessitate a closer investigation of its safety. Finally, it is not entirely clear which patients stand to benefit from HBO and how these should be selected. In conclusion, HBO appears promising, but more experience is needed before its broad implementation in the routine care of the diabetic foot.
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Affiliation(s)
- Elisavet K Tiaka
- Outpatient Clinic of the Diabetic Foot, Second Department of Internal Medicine, Democritus University of Thrace, Greece
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15
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Paraskevas KI, Mikhailidis DP, Veith FJ. Optimal statin type and dosage for vascular patients. J Vasc Surg 2011; 53:837-44. [PMID: 21215572 DOI: 10.1016/j.jvs.2010.10.114] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 10/14/2010] [Accepted: 10/23/2010] [Indexed: 12/29/2022]
Abstract
Statins are an essential component of the management of patients suffering from vascular diseases. As there is neither any consensus nor any guidelines regarding this issue, we aimed to define the optimal statin type and dosage for these patients. MEDLINE was searched for studies comparing different statin types and dosages for vascular patients. In the absence of adverse effects, rosuvastatin or atorvastatin ≥ 20 mg/d is the optimal statin type and dosage for vascular patients. The management of statin-induced adverse events and the options for statin-intolerant patients are also discussed. Routine statin treatment is associated with several beneficial effects in vascular patients whether managed conservatively or undergoing open vascular surgery/endovascular interventions. If possible, statins should not be discontinued before open or endovascular procedures and treatment should be resumed as soon as possible. Future studies should evaluate the effects of an increased statin loading dose prior to vascular procedures.
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16
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Paraskevas KI, Katsiki N, Tzovaras AA, Koupidis SA, Mikhailidis DP. Peripheral arterial disease and HIV-positive patients. Angiology 2011; 62:7-9. [PMID: 21134992 DOI: 10.1177/0003319710386473] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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17
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Screening for peripheral artery disease in dialysis patients: an opportunity for early disease detection and timely initiation of appropriate therapeutic measures. Int Urol Nephrol 2011; 43:143-5. [PMID: 21210222 DOI: 10.1007/s11255-010-9892-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Accepted: 12/21/2010] [Indexed: 10/18/2022]
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18
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Paraskevas KI, Kotsikoris I, Koupidis SA, Giannoukas AD, Mikhailidis DP. Ankle—Brachial Index: A Marker of Both Peripheral Arterial Disease and Systemic Atherosclerosis As Well As a Predictor of Vascular Events. Angiology 2010; 61:521-3. [DOI: 10.1177/0003319710371620] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | | | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK,
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19
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Paraskevas KI, Giannoukas AD, Mikhailidis DP. The Impact of Impaired Renal Function on Long-Term Outcomes in Patients With Peripheral Arterial Disease. Angiology 2010; 61:415-6. [DOI: 10.1177/0003319709361199] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Athanassios D. Giannoukas
- Department of Vascular Surgery, University Hospital of Larissa, University of Thessaly Medical School, Larissa, Greece
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinic), Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, United Kingdom,
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20
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Bisdas T, Paraskevas KI, Pichlmaier M, Wilhelmi M, Haverich A, Teebken OE. Dorsal (Posterior) Versus Medial Approach for the Surgical Repair of Popliteal Artery Aneurysms. Angiology 2010; 61:248-52. [DOI: 10.1177/0003319709355802] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The surgical approach-of-choice for the management of popliteal artery aneurysms (PAAs) remains controversial. We compared the results of the medial (MA) and dorsal (posterior) surgical approach (DA). Fifty patients (44 males/6 females; median age [range]: 59 [49-84] years) treated for 58 atherosclerotic PAAs were studied (MA: 29 PAAs; DA: 29 PAAs). The 3-year graft patency rates were higher after DA compared with MA (76% vs 52%, respectively), but the difference was not significant (P = .056). There were no differences between the 2 approaches in amputation, restenosis, reoperation, and wound infection rates. Dorsal approach and the MA may be alternative approaches with similar long-term results. Due to the controversial results reported so far, a meta-analysis may be necessary to establish the surgical approach-of-choice. Future studies should take into account additional factors, other than the surgical technique, when assessing outcome (eg, preoperative statin use, age, and emergency vs routine surgery).
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Affiliation(s)
- Theodosios Bisdas
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | | - Maximilian Pichlmaier
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Matthias Wilhelmi
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Omke Enno Teebken
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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21
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Shao JS, Cheng SL, Sadhu J, Towler DA. Inflammation and the osteogenic regulation of vascular calcification: a review and perspective. Hypertension 2010; 55:579-92. [PMID: 20101002 PMCID: PMC2853014 DOI: 10.1161/hypertensionaha.109.134205] [Citation(s) in RCA: 178] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Jian-Su Shao
- Department of Medicine, Washington University in St. Louis, Center for Cardiovascular Research, IM-B Campus Box 8301, 660 South Euclid Ave, St. Louis, MO 63110, USA
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22
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Paraskevas KI, Giannoukas AD, Mikhailidis DP. Renal Function Impairment in Peripheral Arterial Disease: An Important Parameter that Should not Be Neglected. Ann Vasc Surg 2009; 23:690-9. [DOI: 10.1016/j.avsg.2009.06.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 02/15/2009] [Accepted: 06/04/2009] [Indexed: 11/30/2022]
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23
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Abstract
AIMS To assess the changing rate of amputation in patients with diabetes over a 7-year period. METHODS All patients undergoing lower extremity amputation in Tayside, Scotland between 1 January 2000 and 31 December 2006 were identified. Temporal linkage of cases to the diabetes database was used to ascertain which amputations were in patients with diabetes. RESULTS The incidence of major amputations fell from 5.1 [95% confidence interval (CI) 3.8-6.4] to 2.9 (95% CI 1.9-3.8) per 1000 patients with diabetes (P < 0.05). There is a clear linear trend in the adjusted incidence of major amputation (P = 0.023 and 0.027 for age- and sex-adjusted, and duration- and sex-adjusted incidences, respectively). The adjusted incidence of total amputations followed decreased linear regression trend over the whole study period when adjusted for age and sex or diabetes duration and sex (P = 0.002). CONCLUSIONS There has been a significant reduction in the incidence of major lower extremity amputation in patients with diabetes over the 7-year period.
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Paraskevas KI, Bessias N, Tzorbatzoglou J, Mikhailidis DP, Andrikopoulos V. Effect of Statins on Renal Function in Patients With Peripheral Arterial Disease. Vasc Endovascular Surg 2008; 42:620-1; author reply 621. [DOI: 10.1177/1538574408326183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Nikolaos Bessias
- Department of Vascular Surgery "" Cross" Hospital Athens, Greece
| | | | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics) Royal Free Hospital Campus University College London (UCL) London, United Kingdom
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Koutouzis M, Paraskevas KI, Rallidis LS, Barbatis C, Nomikos A, Tzavara V, Tsopanomichalou M, Lioupis C, Bessias N, Andikopoulos V, Mikhailidis DP, Kyriakides ZS. Statin treatment, carotid atherosclerotic plaque macrophage infiltration and circulating inflammatory markers. Open Cardiovasc Med J 2008; 2:110-4. [PMID: 19471553 PMCID: PMC2627526 DOI: 10.2174/1874192400802010110] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Revised: 11/12/2008] [Accepted: 11/13/2008] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Statin treatment is considered as first line therapy in patients with atherosclerotic disease. We evaluated the effect of pre-treatment with statins on carotid plaque infiltration by macrophages and on the circulating levels of proinflammatory cytokines in patients who underwent carotid endarterectomy. PATIENTS AND METHODS One hundred fourteen patients were enrolled; 89 men and 25 women (mean age 67+/-8 years; range 42-83 years). Fifty three patients (46%) were on statin treatment at least 3 months before endarterectomy and 61 (54%) had never received statin treatment. The serum levels of high sensitivity C reactive protein (hsCRP), serum amyloid A (SAA), tumor necrosis factor alpha (TNFalpha), interleukin (IL)-1beta and IL-6 were evaluated preoperatively. The intensity of macrophage infiltration was evaluated by immunochemistry, using the monoclonal antibody CD 68. The area of the plaque covered by macrophages was measured as a proportion of the whole plaque area, using a custom designed image tool analysis. RESULTS Patients on statins had lower serum total cholesterol levels (172+/-50 vs 194+/-35 mg/dl, p= 0.014), lower low density cholesterol levels (103+/-44 vs 123+/-31 mg/dl, p= 0.010) and lower serum hsCRP levels (1.8 [1.1-3.4] vs 3.4 [1.3-4.9] mg/l, p= 0.03), while SAA, TNFalpha, IL-6 and IL-1beta levels did not differ between the 2 groups. The infiltration of atherosclerotic plaque by macrophages was similar in statin treated patients and in controls (0.55+/-0.15% vs 0.49+/-0.19%, p= 0.21). CONCLUSION Patients on statins have similar macrophage accumulation in their carotid atherosclerotic plaques compared with patients not on statins. Inflammatory markers were also similar in both groups except for hsCRP which was significantly lower in those taking statins.
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Affiliation(s)
| | | | | | - Calypso Barbatis
- Department of Histopathology, Red Cross Hospital, Athens, Greece
| | | | - Vasiliki Tzavara
- 1Department of Internal Medicine, Red Cross Hospital, Athens, Greece
| | | | - Christos Lioupis
- Department of Vascular Surgery, Red Cross Hospital, Athens, Greece
| | | | | | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics) and Dept. of Surgery, Royal Free Hospital campus, University College London (UCL), London, UK
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Dindyal S, Sharma P, Kyriakides C. Regarding "Cilostazol reduces restenosis after endovascular therapy in patients with femoropopliteal lesions". J Vasc Surg 2008; 48:1357; author reply 1357. [PMID: 18971047 DOI: 10.1016/j.jvs.2008.06.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2008] [Revised: 06/16/2008] [Accepted: 06/16/2008] [Indexed: 10/21/2022]
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Toli K, Paraskevas KI, Poulakou MV, Agrogiannis G, Kavantzas N, Xanthopoulos V, Iliopoulos DG, Mantas I, Papachristodoulou A, Patsouris E, Mikhailidis DP, Perrea DN. Association between plasma levels and immunolocalization of cytokines in heart valve lesions: a possible target for treatment? Expert Opin Ther Targets 2008; 12:1209-15. [DOI: 10.1517/14728222.12.10.1209] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Paraskevas KI, Papas TT, Pavlidis P, Bessias N, Andrikopoulos V. The Importance of Conservative Measures in Peripheral Arterial Disease: An Update. Angiology 2008; 59:529-33. [DOI: 10.1177/0003319708318381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | | | | | - Nikolaos Bessias
- Department of Vascular Surgery, Red Cross Hospital, Athens, Greece
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29
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Paraskevas KI, Bessias N, Papas TT, Andrikopoulos V, Mikhailidis DP. Is High-sensitivity C-reactive Protein Associated with Subclinical Peripheral Atherosclerosis? Angiology 2008; 60:8-11. [DOI: 10.1177/0003319708330707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
| | - Nikolaos Bessias
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinic), Royal Free Hospital Campus, University College Medical School, University College London (UCL), London
| | | | | | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinic), Royal Free Hospital Campus, University College Medical School, University College London (UCL), London
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30
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Paraskevas KI, Baker DM, Pompella A, Mikhailidis DP. Does Diabetes Mellitus Play a Role in Restenosis and Patency Rates Following Lower Extremity Peripheral Arterial Revascularization? A Critical Overview. Ann Vasc Surg 2008; 22:481-91. [DOI: 10.1016/j.avsg.2007.12.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Accepted: 12/26/2007] [Indexed: 10/21/2022]
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Paraskevas KI, Bessias N, Papas TT, Gekas CD, Andrikopoulos V, Mikhailidis DP. Do Different Vascular Risk Factors Affect All Arteries Equally? Angiology 2008; 59:397-401. [DOI: 10.1177/0003319708318383] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Established vascular risk factors (ie, smoking, hypertension, diabetes mellitus, and dyslipidemia) play an important role in the development of vascular disease. Emerging evidence suggests that some of these risk factors may have a more intense effect on specific arterial beds, a finding that holds implications for a prognostic role for certain types of vascular disease.
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Affiliation(s)
| | - Nikolaos Bessias
- Department of Vascular Surgery, Red Cross Hospital, Athens, Greece
| | | | | | | | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention clinics), Royal Free Hospital campus, University College London, United Kingdom,
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Alnaeb ME, Boutin A, Crabtree VP, Mikhailidis DP, Seifalian AM, Hamilton G. Assessment of Lower Extremity Peripheral Arterial Disease Using a Novel Automated Optical Device. Vasc Endovascular Surg 2008; 41:522-7. [DOI: 10.1177/1538574407305092] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The resting ankle-brachial pressure index (rABPI) is used in the diagnosis of lower extremity peripheral arterial disease (PAD) in symptomatic and asymptomatic patients. This article compares the rABPI with a new optical device based on photoplethysmograph (PPG) technology with new algorithms for the assessment of PAD. Functional PPG (fPPG) is a promising noninvasive automated device using a novel cuffless functional test for assessing mild or significant PAD without the operator dependency issues associated with rABPI. This system utilizes both changes in pulsatile arterial blood volume and skin color redness in lower limbs. All subjects underwent rABPI, fPPG, and duplex angiography (DA). Significant correlation was found between fPPG and DA scores, rABPI and DA, and fPPG and rABPI. In the hands of operators with little experience, fPPG may prove to be superior to rABPI and may be useful as a simple screening tool for early detection of PAD in primary care.
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Affiliation(s)
| | - Adrien Boutin
- Vascular Unit, Royal Free Hampstead NHS Trust Hospital, London
| | | | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry and Department of Surgery, Royal Free Hospital and University College Medical School, London
| | | | - George Hamilton
- Academic Division of Surgical and Interventional Sciences, University College London
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Paraskevas KI, Baker DM, Vrentzos GE, Mikhailidis DP. The role of fibrinogen and fibrinolysis in peripheral arterial disease. Thromb Res 2007; 122:1-12. [PMID: 17669476 DOI: 10.1016/j.thromres.2007.06.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Revised: 06/11/2007] [Accepted: 06/15/2007] [Indexed: 10/23/2022]
Abstract
Peripheral arterial disease (PAD) is associated with high rates of cerebrovascular and cardiovascular events; PAD is a marker of systemic atherosclerosis. As a result, standard therapy for all PAD patients should be directed at both peripheral and systemic atherosclerosis. Modification of established risk factors in the form of smoking cessation, correcting hypertension, optimizing diabetic control and normalizing lipids is essential. Furthermore, novel risk factors have emerged including fibrinogen and other hemostatic factors. Fibrinogen is a coagulation factor and a marker of the acute phase response (inflammation), a platelet activator, a major determinant of plasma viscosity and a component of the atherosclerotic plaque. Fibrinogen appears not only to predict the severity of PAD, but also serves as a marker for future development of PAD. Whether reducing the levels of fibrinogen and other coagulation factors will decrease the incidence and progression of PAD remains to be resolved. This review summarizes the role of fibrinogen in the pathogenesis of PAD and its association with other hemostatic factors. The role of fibrinolysis in patients with PAD is also considered.
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Affiliation(s)
- Kosmas I Paraskevas
- Department of Clinical Biochemistry and Academic Department of Surgery, Royal Free Hospital, London, UK.
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Fatourou EM, Paraskevas KI, Seifalian AM, Hamilton G, Mikhailidis DP. The role of established and emerging risk factors in peripheral vascular graft occlusion. Expert Opin Pharmacother 2007; 8:901-11. [PMID: 17472536 DOI: 10.1517/14656566.8.7.901] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Several studies have evaluated the association between established as well as emerging vascular risk factors with peripheral graft occlusion. There is evidence for a link between the risk for graft occlusion and total serum cholesterol, low-density lipoprotein cholesterol and triglyceride levels. The overall effect of smoking shows a 2.35-fold increase in risk of graft failure. Studies involving diabetic patients undergoing peripheral bypass may have failed to detect higher occlusion rates, possibly due to increased morbidity and mortality as well as higher amputation rates even if the graft is patent. Both antiplatelet agents and anticoagulation seem to be effective in the prevention of graft occlusion. Unconvincing data have been published with regards to the effect of hypertension on graft patency. Emerging factors such as fibrinogen, lipoprotein (a), C-reactive protein and homocysteine levels should also be considered when assessing the risk of graft occlusion. More research is needed to prevent graft occlusion due to the obvious clinical relevance, quality of life and cost issues.
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Affiliation(s)
- E M Fatourou
- Department of Clinical Biochemistry, Royal Free Hospital and Royal Free University College Medical School, London, UK
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