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Segheto W, Correia MDA, Kanegusuku H, Wolosker N, Ritti-Dias RM. Functional capacity and excess of body adiposity in patients with peripheral artery disease. JOURNAL OF VASCULAR NURSING 2023; 41:240-244. [PMID: 38072579 DOI: 10.1016/j.jvn.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 09/28/2023] [Accepted: 10/07/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Wellington Segheto
- Graduated Program in Rehabilitation Sciences, Universidade Nove de Julho, Rua Vergueiro, 235/249 - 2 Subsolo Liberdade São Paulo SP, CEP 01504-001, Brazil.
| | - Marilia de Almeida Correia
- Graduated Program in Rehabilitation Sciences, Universidade Nove de Julho, Rua Vergueiro, 235/249 - 2 Subsolo Liberdade São Paulo SP, CEP 01504-001, Brazil; Graduated Program in Medicine, Universidade Nove de Julho, Rua Vergueiro, 235/249 - 2º Subsolo Liberdade São Paulo SP, CEP 01504-001, Brazil
| | - Hélcio Kanegusuku
- Hospital Israelita Albert Einstein Av. Albert Einstein, 627/701 - Morumbi, São Paulo SP, CEP 05652-900, Brazil
| | - Nelson Wolosker
- Hospital Israelita Albert Einstein Av. Albert Einstein, 627/701 - Morumbi, São Paulo SP, CEP 05652-900, Brazil
| | - Raphael Mendes Ritti-Dias
- Graduated Program in Rehabilitation Sciences, Universidade Nove de Julho, Rua Vergueiro, 235/249 - 2 Subsolo Liberdade São Paulo SP, CEP 01504-001, Brazil
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Boc V, Kozak M, Eržen B, Božič Mijovski M, Boc A, Blinc A. Prognostic Factors for Restenosis of Superficial Femoral Artery after Endovascular Treatment. J Clin Med 2023; 12:6343. [PMID: 37834987 PMCID: PMC10573648 DOI: 10.3390/jcm12196343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/24/2023] [Accepted: 09/30/2023] [Indexed: 10/15/2023] Open
Abstract
High incidence of superficial femoral artery (SFA) restenosis after percutaneous transluminal angioplasty (PTA) poses a persistent challenge in peripheral arterial disease (PAD) treatment. We studied how the patients' and lesions' characteristics, thrombin generation, overall haemostatic potential (OHP), and single nucleotide polymorphisms (SNPs) of the NR4A2 and PECAM1 genes affected the likelihood of restenosis. In total, 206 consecutive PAD patients with limiting intermittent claudication due to SFA stenosis who were treated with balloon angioplasty with bailout stenting when necessary were included. Patients' clinical status and patency of the treated arterial segment on ultrasound examination were assessed 1, 6, and 12 months after the procedure. Restenosis occurred in 45% of patients, with less than 20% of all patients experiencing symptoms. In the multivariate analysis, predictors of restenosis proved to be poor infrapopliteal runoff, higher lesion complexity, absence of treated arterial hypertension, delayed lag phase in thrombin generation, and higher contribution of plasma extracellular vesicles to thrombin concentration. Poor infrapopliteal runoff increased the risk of restenosis in the first 6 months, but not later. The negative effect of poor infrapopliteal runoff on SFA patency opens questions about the potential benefits of simultaneous revascularisation of below-knee arteries along with SFA revascularisation.
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Affiliation(s)
- Vinko Boc
- Department of Vascular Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.K.); (B.E.); (M.B.M.); (A.B.); (A.B.)
| | - Matija Kozak
- Department of Vascular Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.K.); (B.E.); (M.B.M.); (A.B.); (A.B.)
- Faculty of Medicine, Department of Internal Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Barbara Eržen
- Department of Vascular Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.K.); (B.E.); (M.B.M.); (A.B.); (A.B.)
- Faculty of Medicine, Department of Internal Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Mojca Božič Mijovski
- Department of Vascular Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.K.); (B.E.); (M.B.M.); (A.B.); (A.B.)
- Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Anja Boc
- Department of Vascular Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.K.); (B.E.); (M.B.M.); (A.B.); (A.B.)
- Faculty of Medicine, Institute of Anatomy, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Aleš Blinc
- Department of Vascular Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.K.); (B.E.); (M.B.M.); (A.B.); (A.B.)
- Faculty of Medicine, Department of Internal Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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Fletcher E, Miserlis D, Sorokolet K, Wilburn D, Bradley C, Papoutsi E, Wilkinson T, Ring A, Ferrer L, Haynatzki G, Smith RS, Bohannon WT, Koutakis P. Diet-induced obesity augments ischemic myopathy and functional decline in a murine model of peripheral artery disease. Transl Res 2023; 260:17-31. [PMID: 37220835 DOI: 10.1016/j.trsl.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 05/25/2023]
Abstract
Peripheral artery disease (PAD) causes an ischemic myopathy contributing to patient disability and mortality. Most preclinical models to date use young, healthy rodents with limited translatability to human disease. Although PAD incidence increases with age, and obesity is a common comorbidity, the pathophysiologic association between these risk factors and PAD myopathy is unknown. Using our murine model of PAD, we sought to elucidate the combined effect of age, diet-induced obesity and chronic hindlimb ischemia (HLI) on (1) mobility, (2) muscle contractility, and markers of muscle (3) mitochondrial content and function, (4) oxidative stress and inflammation, (5) proteolysis, and (6) cytoskeletal damage and fibrosis. Following 16-weeks of high-fat, high-sucrose, or low-fat, low-sucrose feeding, HLI was induced in 18-month-old C57BL/6J mice via the surgical ligation of the left femoral artery at 2 locations. Animals were euthanized 4-weeks post-ligation. Results indicate mice with and without obesity shared certain myopathic changes in response to chronic HLI, including impaired muscle contractility, altered mitochondrial electron transport chain complex content and function, and compromised antioxidant defense mechanisms. However, the extent of mitochondrial dysfunction and oxidative stress was significantly greater in obese ischemic muscle compared to non-obese ischemic muscle. Moreover, functional impediments, such as delayed post-surgical recovery of limb function and reduced 6-minute walking distance, as well as accelerated intramuscular protein breakdown, inflammation, cytoskeletal damage, and fibrosis were only evident in mice with obesity. As these features are consistent with human PAD myopathy, our model could be a valuable tool to test new therapeutics.
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Affiliation(s)
- Emma Fletcher
- Department of Biology, Baylor University, Waco, Texas
| | - Dimitrios Miserlis
- Department of Surgery, University of Texas at Austin Dell Medical School, Austin, Texas
| | | | - Dylan Wilburn
- Department of Health, Human Performance and Recreation, Baylor University, Waco, Texas
| | | | | | | | - Andrew Ring
- Department of Biology, Baylor University, Waco, Texas
| | - Lucas Ferrer
- Department of Surgery, University of Texas at Austin Dell Medical School, Austin, Texas
| | - Gleb Haynatzki
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska
| | - Robert S Smith
- Department of Surgery, Baylor Scott & White Medical Center, Temple, Texas
| | - William T Bohannon
- Department of Surgery, Baylor Scott & White Medical Center, Temple, Texas
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Ahmad AM, Abdel-Aziz HA. Laser acupuncture for claudication symptoms in peripheral artery disease — Does it work? A randomized trial. Hong Kong Physiother J 2022; 42:31-40. [PMID: 35782701 PMCID: PMC9244600 DOI: 10.1142/s1013702522500044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Peripheral artery disease (PAD) receives little attention despite its clinical consequences. Intermittent claudication is the most disturbing symptom of the disease resulting in marked limitations to functional walking performance. Treadmill walking exercise is the first-line non-pharmacological treatment in PAD; however, older patients may be unable to exercise because of the functional disability of the disease itself or deconditioning. Objective: In an attempt to seek an alternative intervention, this study aimed to assess the effect of laser acupuncture on patient-reported claudication symptoms and walk performance in PAD. Methods: Thirty male patients with PAD were assigned randomly to a control group ([Formula: see text], [Formula: see text] years old, [Formula: see text][Formula: see text]kg/m2) or a study group ([Formula: see text], [Formula: see text] years old, [Formula: see text][Formula: see text]kg/m2). Inclusion criteria were mild-to-moderate PAD, Fontaine stage II, unilateral or bilateral claudications, and older men. Exclusion criteria were asymptomatic PAD, resting pain, severe or critical limb ischemia, ischemic ulcers, and patients contraindicated for laser therapy. Both groups received pharmacological treatment, but only the study group received gallium aluminum arsenide (GaAlAs) laser therapy at nine acupuncture points, namely, Liver 2 (LV2), Stomach 41 (ST41), Urinary bladder 40 (UB40), UB60, UB61, Gall bladder 30 (GB30), GB34, GB38, and GB40 for 2 days/week and five consecutive weeks. A pen-type laser device was used at a wavelength of [Formula: see text][Formula: see text]nm, with a power output of [Formula: see text][Formula: see text]mW, a spot size of 0.08[Formula: see text]cm2, and an energy density of 2[Formula: see text]J/cm2, for 60[Formula: see text]s/point. The Edinburgh Claudication Questionnaire (ECQ) and the 6-min walk distance (6-MWD) were the endpoints of the study. The McNemar–Bowker Test and Generalized Estimating Equations Ordinal Logistic Regression Model were used for the within- and between-group statistical analyses of the categorical data of ECQ, respectively; and a mixed model MANOVA was used for the within- and between-group analyses of the 6-MWD data. Results: There was a significant improvement in patients’ response to ECQ only in the study group compared to the baseline ([Formula: see text]) and the controls ([Formula: see text]) after the intervention. The 6-MWD increased significantly in the study group compared to the baseline ([Formula: see text][Formula: see text]m versus [Formula: see text][Formula: see text]m, [Formula: see text]). Conclusion: The GaAlAs laser acupuncture applied at selected acupoints may be a promising intervention complementary to drug therapy that could help relieve claudication symptoms and improve physical functional performance in older men with PAD (Fontaine stage II). Trials were conducted under the Trial Registration No. PACTR201912698539774.
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Affiliation(s)
- Ahmad Mahdi Ahmad
- Department of Physical Therapy for Cardiovascular and Respiratory Disorders, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Poredos P, Boc V, Zlajpah U, Mangaroska AS, Poredos P. Walking Impairment Questionnaire and Walking Tests are Reliable Indicators of Success of Treatment of Peripheral Artery Disease. Angiology 2021; 73:331-337. [PMID: 34551598 DOI: 10.1177/00033197211045281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The functional capacity of patients with peripheral arterial disease (PAD) represents an important indicator of patient health and quality of life. The aim of this prospective study was to investigate the validity of a walking impairment questionnaire (WIQ) compared with walking tests for the estimation of the therapeutic effect of lower limb revascularization. The study included 36 patients with PAD in whom successful percutaneous revascularization of a lower limb was performed due to disabling intermittent claudication. Before the revascularization procedure and 4-6 weeks after successful revascularization, clinical examination, ankle brachial index (ABI) measurement, 6-min walk test, treadmill test, and WIQ were performed. After revascularization, significant improvement in walking capacity was shown by both 6-min walk test and treadmill exercise test as well as with WIQ. However, the increase in ABI was borderline. Significant correlations between improvement of 6-min walk test and treadmill exercise test results and the sum of WIQ points were found. The ABI was significantly correlated with treadmill maximal walking distance only. According to our results, the WIQ correlates well with walking tests and is a reliable indicator of effective revascularization of lower limb arterial occlusions, even in patients with a nonsignificant improvement of the ABI.
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Affiliation(s)
- Pavel Poredos
- Clinical Department of Vascular Diseases, 364687University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Vinko Boc
- Clinical Department of Vascular Diseases, 364687University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Urska Zlajpah
- Clinical Department of Vascular Diseases, 364687University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Ana Spirkoska Mangaroska
- Clinical Department of Vascular Diseases, 364687University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Peter Poredos
- Clinical Department of Anesthesiology and Intensive Care, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Poredos P, Zlajpah U, Poredos P, Mangaroska AS, Jezovnik MK. Use of the walking impairment questionnaire as a measure of functional assessment. VASA 2021; 50:286-293. [PMID: 33661020 DOI: 10.1024/0301-1526/a000941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: A significant consequence of peripheral arterial disease (PAD) is an impaired functional capacity and deteriorated quality of life. Therefore, our study aimed to investigate the usefulness of a symptom questionnaire and walk tests for the determination of the functional capacity of patients with intermittent claudication. Patients and methods: The study included 53 patients (38 males) with stable claudication distance (50-300m). A detailed history and physical examination, ankle-brachial index (ABI), treadmill exercise test, and 6-minute walk test were performed and compared to walking impairment questionnaire (WIQ). Results: Claudication distance reported from patients' history and 6-minute walk test were significantly correlated with ABI (p=0.033, p=0.044). There were no significant correlations between ABI and treadmill walk test or WIQ. Results of WIQ were significantly correlated with the history and the most of performed walk tests: treadmill initial and maximal claudication distance (p=0.004 and 0.012, respectively) and 6-minute walk test (p=0.026). 6-minute walk test was correlated with maximal claudication distance of treadmill (p=0.018), but not with an initial claudication distance. Conclusions: The validity of WIQ is comparable to walk tests and represents the useful technique for the investigation of the functional capacity of patients with PAD. A self-report based on WIQ enables a longer period of observation. It should be routinely used as a basic diagnostic tool for the estimation of the functional capacity of PAD patients with stable intermittent claudication.
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Affiliation(s)
- Pavel Poredos
- Department of Vascular Disease, University Medical Center Ljubljana, Slovenia.,Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Texas, USA
| | - Urska Zlajpah
- Department of Vascular Disease, University Medical Center Ljubljana, Slovenia
| | - Peter Poredos
- Department of Anesthesiology and Intensive Care, University Medical Center Ljubljana, Slovenia
| | | | - Mateja K Jezovnik
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Texas, USA
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