Angiology

Peripheral arterial disease (PAD) is a marker of atherosclerosis, which is not well studied in the population with human immunodeficiency virus (HIV). We prospectively enrolled HIV-infected patients who had normal resting ankle-brachial index (rABI) readings. All participants performed either a treadmill walking test (TT) or pedal plantar flexion test (PFT). Patients were divided into 2 groups according to postexercise changes; PAD and No-PAD group. The 2 groups were compared with regard to established cardiovascular disease risk factors and other HIV infection parameters. Peripheral arterial disease was present in 30 (26.5%) of 113 consecutive HIV-infected patients included in the study. Mean age was 47 ± 10 years. The risk factors studied did not differ significantly among the 2 groups except for male gender, which was significantly associated with PAD (RR: 4.15; CI: 1.6 to 11.1: P < .0008). The prevalence of PAD, diagnosed by significant drop in postexercise ABI and ankle pressure in patients with HIV is high.

Skin perfusion pressure (SPP) is a measure of peripheral circulation; low SPP (<40 mm Hg) indicates poor wound healing. Cilostazol is used to alleviate symptoms and improve walking distance in patients with peripheral artery disease (PAD), but its effect on SPP is unknown. We enrolled patients whose symptoms were Rutherford class 3 or 4 and whose SPP was <40 mm Hg. We analyzed patient symptoms, ankle-brachial index (ABI), and SPP before and 1 month after treatment with cilostazol. We analyzed 20 legs of 14 patients. Cilostazol improved symptoms in 12 legs. The average heart rate increased from 76 ± 16 to 84 ± 20 beats/min (P < .05). Cilostazol did not increase the ABI but caused a significant increase in the SPP from 24.5 ± 8.88 to 42.8 ± 21.0 mm Hg (P < .01). Cilostazol increases microvascular circulation in severely ischemic limbs and may be useful in critical limb ischemia.

Background: Abdominal aortic aneurysm (AAA) is a complex disease with a largely unknown pathophysiological background and a strong genetic component. Various studies have tried to link specific genetic variants with AAA. Methods: Systematic review of the literature (1947-2009). Results: A total of 249 studies were identified, 89 of which were eventually deemed relevant to this review. Genetic variants (polymorphisms) in a wide variety of genes, most of which encode proteolytic enzymes and inflammatory molecules, have been associated with AAA development and progression. Conclusion: The genetic basis of AAA remains unknown, and most results from ‘‘candidate-gene’’ association studies are contradictory. Further analyses in appropriately powered studies in large, phenotypically well-characterized populations, including genome-wide association studies, are necessary to elucidate the exact genetic contribution to the pathophysiology of AAA.

The effects of acute exercise on arterial compliance in older adults are unknown. Large and small arterial compliance were assessed during and 24 hours following a 30-minute bicycle ergometer test and on a nonexercise, control condition. The change in large artery compliance was similar between the exercise and nonexercise conditions (P = 0.876). Small artery compliance during the exercise day was higher than the nonexercise day at 45, 60, and 75 minutes following exercise (P < .001), was 17% higher 30 minutes postexercise than at rest (P < .001), and decreased by 20% between 30 minutes (4.5 ± 0.4 mL/mm Hg × 100) and 120 minutes (3.6 ± 0.3 mL/mm Hg × 100) after exercise (P = .027). The current study shows 30 minutes of moderate-intensity exercise transiently increases small arterial compliance 30 minutes after exercise but does not elicit more sustained increases in either large or small arterial compliance.

We assessed the effect of epinephrine on human monocytes. Monocytes were isolated from 16 healthy obese and 10 lean healthy subjects. Insulin sensitivity was assessed by euglycemic hyperinsulinemic clamp. Obese subjects were subdivided into 2 sub-groups, insulin sensitive (IS) and insulin resistant (IR). Monocyte properties [attachment to laminin 1, migration through laminin 1, oxidized-low density lipoprotein (oxLDL) phagocytosis] were assessed pre- and post-stimulation in vitro with epinephrine. Experiments were repeated after incubation with a Na+/H + exchanger-1 inhibitor (NHE-1) (cariporide). Epinephrine increased monocyte attachment to laminin in lean and obese IR subjects through involvement of NHE-1, PKC, NO synthase, NADPH oxidase and actin polymerization. In contrast, epinephrine did not affect monocyte migration. Epinephrine increased oxLDL phagocytosis in all groups studied. Incubation with cariporide attenuated oxLDL phagocytosis. Epinephrine induces monocyte dysfunction which may be atherogenic.

Purpose: To describe the safety and efficacy of percutaneous transluminal angioplasty and stent placement in patients presenting with suprahepatic inferior vena cava (IVC) outflow compromise in the early postoperative period following orthotopic liver transplantation. Methods and Results: Between October 2002 and April 2009, 3 patients presented with IVC outflow compromise in the first 2 months following orthotopic liver transplantation. All 3 underwent percutaneous transluminal angioplasty and stent placement without complication and showed significant clinical improvement at short and intermediate term follow-up. Conclusion: Percutaneous transluminal angioplasty and Gianturco stent placement is a safe and effective treatment for IVC outflow compromise in the early postoperative period following orthotopic liver transplantation.

Introduction: Chronic venous insufficiency is the most common vascular disease in the adult population. However, randomized clinical trials (RCTs) comparing therapeutic options are limited. Patients and Methods: A total of 180 patients with saphenofemoral junction and great saphenous reflux detected on duplex were randomized to either ultrasound-guided radiofrequency ablation (RFA) or standard surgical treatment. The study participants blindly chose an assignment card that placed them in either group A (ultrasound-guided RFA of the great saphenous vein [GSV]; n = 90); or group B (surgical management n = 90). Patients were followed up for 24 months. Results: The primary occlusion rate in group A was 94.5% versus 100% in group B. Radiofrequency ablation had a lower overall complication rate (P = .02) and shorter post-intervention hospital stay (P = .001). Kaplan-Meier analysis showed no significant differences in recurrence rates at 24 months follow-up (P = .45). Radiofrequency ablation was significantly more expensive (P = .003). Conclusion: Great saphenous vein occlusion was achieved efficiently in 94% of our group using RFA with minimal complications and obvious advantages as compared to standard surgery.

Dilated cardiomyopathy (DCM) is associated with increased inflammatory response reflected among other markers in high-sensitivity C-reactive protein (hsCRP) and soluble interleukin-2 receptor (sIL-2R) levels. We examined prospectively 60 consecutive patients with DCM. Of them, 30 were dyslipidemic (group I) and 30 normolipidemic (group II). Group I patients were randomized to either simvastatin therapy (20 mg/day, group Ia, n = 15) or hypolipidemic diet therapy (group Ib, n = 15). Patients were re-evaluated 6 months later. High-sensitivity C-reactive protein and sIL-2R levels were significantly higher in group I compared with group II patients (19.5 ± 3.4 vs 3.03 ± 3.5 mg/L, P = .01, 1137 ± 441 vs 599 ± 235 pg/mL, P = .001, respectively). There was a significant correlation between sIL-2R and hsCRP levels in dyslipidemic patients but not in normolipidemic patients. Significant reduction of hsCRP and sIL-2R levels was observed only in group Ia patients. Patients with DCM having dyslipidemia have increased inflammatory response, which is reduced after 6 months of statin therapy.

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The use of coronary artery bypass grafting (CABG) in primary treatment of acute myocardial infarction is still debated. We evaluated the predictors of mortality in patients undergoing primary CABG for ST-elevated myocardial infarction (STEMI). Between January 2003 and January 2008, all patients referred to our institution with STEMI who did not qualify for primary angioplasty and required CABG were included in this study. Survivors and nonsurvivors were compared retrospectively in terms of demo-graphics, preoperative, intraoperative, and postoperative characteristics. Preoperatively confirmed cases of STEMI (n = 150) were included in the analysis. There were 114 survivors and 36 nonsurvivors. In-hospital mortality rate was 22%. In Cox regression analysis age, cardiogenic shock (Killip ≥3), preoperative cardiac troponin levels, preoperative use of intra-aortic balloon counterpulsation (IABP), previous myocardial infarction, and percutaneous coronary intervention were independent predictors of in-hospital mortality. After multivariate analysis, factors predicting in-hospital mortality were age, preoperative cardiac troponin levels, and preoperative IABP. Age, preoperative cardiac troponin levels, and preoperative IABP use were predictive factors of in-hospital mortality in patients undergoing primary CABG for STEMI.

We evaluated the relationship between coronary artery stenosis status and established cardiovascular risk factors in a large population of 1228 patients who consecutively underwent coronary angiography. Smoking proved to be the most important predictive factor for angiographically significant coronary artery disease (CAD), followed by dyslipidemia, diabetes, family history, and hypertension in a descending order of significance. Obesity rates did not differ significantly between the CAD positive and negative groups, nor changed significantly as the number of affected vessels increased. Smoking, dyslipidemia, and diabetes were positively associated with atherosclerotic involvement of all 3 major coronary arteries, whereas hypertension related only to significant stenosis of left anterior descending and left circumflex artery. The only established risk factors that could reliably predict left main stem disease were diabetes and age. Furthermore, large-scale studies will delineate the implications of the existing interrelationship between clinical and angiographic features.

High-intensity resistance training increases muscle size, but reduces arterial compliance. Muscular blood flow reduction (BFR) during low-intensity training has been shown to elicit muscle hypertrophy. However, the effect on arterial compliance is unknown. We examined the effects of walk training with BFR on carotid arterial compliance and muscle size in the elderly adults. Both BFR-walk training (BFR-W, n = 13, 66 ± 1 year) and control-walk training (CON-W, n = 10, 68 ± 1 year) groups performed 20 minutes treadmill walking at an exercise intensity of 45% of heart rate reserve, 4 days/week for 10 weeks. The BFR-W group wore pressure cuffs on both legs during training. Maximum knee joint strength (∼15%) and MRI-measured thigh muscle cross-sectional area (3%) increased in the BFR-W, but not in the CON-W. Carotid arterial compliance improved in both BFR-W (50%) and CON-W (59%) groups. Walk training with blood flow reduction can improve thigh muscle size/strength as well as carotid arterial compliance, unlike high-intensity training, in the elderly.

Telomere shortening has been shown to contribute to the pathogenesis of atherosclerosis directly or through influencing cardiovascular risk factors. We examined telomere length (TL) and change in ankle-brachial index (ABI) over 5 years in a Chinese population aged 65 years and older living in the community. Telomere length was determined using the quantitative polymerase chain reaction (PCR) method in 976 men and 1030 women. Ankle-brachial index was measured using Doppler ultrasound. Analysis of covariance was used to examine the relationship between quartiles of TL and baseline ABI values as well as percentage change in ABI, adjusting for confounders. Women had longer TL and lower ABI values compared with men, and there was a significant trend for an inverse association between TL and percentage decline in ABI after adjustment for confounders. No significant association was observed in men. The findings support the association between TL and markers of atherosclerosis in older women but not men.

Endovascular procedures may play a role in renal artery stenosis (RAS) treatment in attempt to preserve renal function and improve hypertension control. We determined renal outcome and the incidence of restenosis in patients with RAS treated with renal percutaneous transluminal angioplasty and stenting (RPTAs) and medical therapy versus patients with RAS treated only with medical therapy. We performed an observational study based on 93 patients with RAS. In all, 53 patients underwent RPTAs in association with medical therapy and 40 patients were only treated pharmacologically. In patients receiving RPTAs, a better renal outcome, a decrease of restenosis rate, and systolic—diastolic blood pressure were associated with angiotensin receptor blockers (ARBs) + angiotensin-converting enzyme inhibitors (ACE-is) therapy. In patients treated with medical therapy alone, renal improvement was related to ARBs in association with BBs (β-blockers; P < .0001). This study suggests that medical therapy may exert beneficial effects in patients with RAS.