Pub Date : 2022-06-07DOI: 10.1177/1358863X221096704
L. Portas, R. Bauersachs, K. Bowrin, J. Briere, Alexander Cohen, M. Huelsebeck, Schuyler W. Jones, J. Quint
Background: Symptoms, severity, and acuteness of peripheral artery disease (PAD) are major determinants of severe limb symptoms, subsequent risk of cardiovascular events, and mortality. Lower-extremity revascularization (LER) is a key option to relieve symptoms and to prevent limb loss in symptomatic patients with PAD. This study aimed to quantify the burden of disease among patients with PAD-LER in England. Methods: A retrospective population-based study of linked primary and secondary care electronic health records, included 13,869 adult patients (aged ⩾ 18 years) with PAD-LER from 2003 to 2018. The incidence of first ever PAD-LER was estimated both overall and by type of procedure (endovascular/surgical). Health resource utilization associated with PAD-related complications and treatment patterns were assessed. Results: A high annual incidence of lower-limb revascularization (41.2 per 1000 person years) and a nearly double incidence of endovascular first revascularization compared with open surgery were observed. More than 70% of patients with PAD-LER had a history of hyperlipidemia and hypertension and roughly one-third were diabetic and had a history of coronary artery disease. Cardiovascular mortality accounted for one-third (34.1 per 1000 person years) of all-cause mortality. Over 93% of patients were hospitalized for any reason and the commonest reasons for hospitalization were cardiovascular diseases and PAD with about one-third hospitalized for revascularization reoccurrence. Conclusion: There is a significant burden of PAD-LER to the individual and society with ongoing healthcare resource utilization, treatment, and increasing mortality.
{"title":"Assessment of the burden of disease for patients with peripheral artery disease undergoing revascularization in England","authors":"L. Portas, R. Bauersachs, K. Bowrin, J. Briere, Alexander Cohen, M. Huelsebeck, Schuyler W. Jones, J. Quint","doi":"10.1177/1358863X221096704","DOIUrl":"https://doi.org/10.1177/1358863X221096704","url":null,"abstract":"Background: Symptoms, severity, and acuteness of peripheral artery disease (PAD) are major determinants of severe limb symptoms, subsequent risk of cardiovascular events, and mortality. Lower-extremity revascularization (LER) is a key option to relieve symptoms and to prevent limb loss in symptomatic patients with PAD. This study aimed to quantify the burden of disease among patients with PAD-LER in England. Methods: A retrospective population-based study of linked primary and secondary care electronic health records, included 13,869 adult patients (aged ⩾ 18 years) with PAD-LER from 2003 to 2018. The incidence of first ever PAD-LER was estimated both overall and by type of procedure (endovascular/surgical). Health resource utilization associated with PAD-related complications and treatment patterns were assessed. Results: A high annual incidence of lower-limb revascularization (41.2 per 1000 person years) and a nearly double incidence of endovascular first revascularization compared with open surgery were observed. More than 70% of patients with PAD-LER had a history of hyperlipidemia and hypertension and roughly one-third were diabetic and had a history of coronary artery disease. Cardiovascular mortality accounted for one-third (34.1 per 1000 person years) of all-cause mortality. Over 93% of patients were hospitalized for any reason and the commonest reasons for hospitalization were cardiovascular diseases and PAD with about one-third hospitalized for revascularization reoccurrence. Conclusion: There is a significant burden of PAD-LER to the individual and society with ongoing healthcare resource utilization, treatment, and increasing mortality.","PeriodicalId":151049,"journal":{"name":"Vascular Medicine (London, England)","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127872669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-25DOI: 10.1177/1358863X221095278
B. Hawkins, Jun Li, L. Wilkins, T. Carman, A. Reed, D. Armstrong, P. Goodney, C. White, A. Fischman, M. Schermerhorn, D. Feldman, S. Parikh, M. Shishehbor
Chronic limb-threatening ischemia (CLTI) is the advanced stage of peripheral artery disease (PAD) characterized by rest pain or tissue loss. Up to 2 million individuals have this condition in the United States, and prevalence is anticipated to grow owing to aging of the population and increase in atherosclerotic risk factors such as diabetes and renal disease.1 In addition to the threat of limb dysfunction and amputation, patients with CLTI are at a high risk of cardioand cerebrovascular morbidity and mortality, with risk that exceeds that of most other cardiovascular patients. Within 1 year, 1 in 5 CLTI patients dies, and an additional one quarter will require major limb amputation.2 Care of the CLTI patient is complex, multifaceted, and multidisciplinary. Medical therapy, wound care, interpretation of noninvasive and invasive vascular testing, and the performance of revascularization procedures are integral to achieve limb salvage. Both surgical and endovascular revascularization have been established as effective treatment modalities that alleviate symptoms and promote healing. Decisions regarding revascularization strategy for individual patients are nuanced and depend in part on comorbidities, anatomy, functional status, conduit availability, presence of suitable bypass target, and other factors. Endovascular revascularization is performed by physicians across a variety of disciplines including vascular surgeons— the only specialty providing both endovascular and open surgical intervention—interventional radiologists, interventional cardiologists, and others.3 Irrespective of specialty, the endovascular specialist focused on CLTI should understand the role of surgical revascularization, understand the likelihood of short-term and long-term success with each type of revascularization, possess competencies that extend beyond catheter-based therapies, and integrate other CLTI SCAI/ACR/APMA/SCVS/SIR/SVM/SVS/VESS Position Statement on Competencies for Endovascular Specialists Providing CLTI Care
{"title":"SCAI/ACR/APMA/SCVS/SIR/SVM/SVS/VESS Position Statement on Competencies for Endovascular Specialists Providing CLTI Care","authors":"B. Hawkins, Jun Li, L. Wilkins, T. Carman, A. Reed, D. Armstrong, P. Goodney, C. White, A. Fischman, M. Schermerhorn, D. Feldman, S. Parikh, M. Shishehbor","doi":"10.1177/1358863X221095278","DOIUrl":"https://doi.org/10.1177/1358863X221095278","url":null,"abstract":"Chronic limb-threatening ischemia (CLTI) is the advanced stage of peripheral artery disease (PAD) characterized by rest pain or tissue loss. Up to 2 million individuals have this condition in the United States, and prevalence is anticipated to grow owing to aging of the population and increase in atherosclerotic risk factors such as diabetes and renal disease.1 In addition to the threat of limb dysfunction and amputation, patients with CLTI are at a high risk of cardioand cerebrovascular morbidity and mortality, with risk that exceeds that of most other cardiovascular patients. Within 1 year, 1 in 5 CLTI patients dies, and an additional one quarter will require major limb amputation.2 Care of the CLTI patient is complex, multifaceted, and multidisciplinary. Medical therapy, wound care, interpretation of noninvasive and invasive vascular testing, and the performance of revascularization procedures are integral to achieve limb salvage. Both surgical and endovascular revascularization have been established as effective treatment modalities that alleviate symptoms and promote healing. Decisions regarding revascularization strategy for individual patients are nuanced and depend in part on comorbidities, anatomy, functional status, conduit availability, presence of suitable bypass target, and other factors. Endovascular revascularization is performed by physicians across a variety of disciplines including vascular surgeons— the only specialty providing both endovascular and open surgical intervention—interventional radiologists, interventional cardiologists, and others.3 Irrespective of specialty, the endovascular specialist focused on CLTI should understand the role of surgical revascularization, understand the likelihood of short-term and long-term success with each type of revascularization, possess competencies that extend beyond catheter-based therapies, and integrate other CLTI SCAI/ACR/APMA/SCVS/SIR/SVM/SVS/VESS Position Statement on Competencies for Endovascular Specialists Providing CLTI Care","PeriodicalId":151049,"journal":{"name":"Vascular Medicine (London, England)","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116785284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-02DOI: 10.1177/1358863X211065494
Madeline E. Shivgulam, M. O'Brien, Jarrett A. Johns, Jennifer L. Petterson, Yanlin Wu, Ryan J. Frayne, D. Kimmerly
Introduction: Acute, laboratory-based bouts of prolonged sitting attenuate lower-limb arterial endothelial-dependent vasodilation. However, the impact of habitual sedentary patterns on popliteal artery endothelial health is unclear. We tested the hypothesis that greater habitual total sedentary time, more time spent in prolonged sedentary bouts, and fewer sedentary breaks would be associated with worse popliteal flow-mediated dilation (FMD) responses. Methods: This cross-sectional study used 98 healthy participants (19–77 years, 53 females) that wore an activPAL monitor on the thigh for 6.4 ± 0.8 days to objectively measure sedentary activity and completed a popliteal ultrasound assessment to determine FMD. Both relative (%baseline diameter) and absolute (mm) FMD were calculated. Using bivariate correlation and multiple regression analyses, we examined if there were relationships between sedentary outcomes and FMD while statistically controlling for any potential confounders. Results: In the multiple regression model, age (p = 0.006, β = −0.030, 95% CI = −0.051, −0.009) and total time in sedentary bouts > 1 hour (p = 0.031, β = −0.005, 95% CI = −0.009, −0.001) were independent predictors of relative FMD. Age (β = −0.002, 95% CI = −0.003, −0.001), mean blood flow (β = 0.013, 95% CI = 0.002, 0.024), moderate-intensity physical activity (β = 155.9E−5, 95% CI = 22.4E−5, 289.4E−5), sedentary breaks (β = 0.036, 95% CI = 0.007, 0.066), and total time spent in sedentary bouts > 1 hour (β = −25.02E−5, 95% CI = −47.67E−5, −2.378E−5) were predictors of absolute FMD (all, p < 0.047). All independent outcomes remained significant after partially controlling for all other predictor variables (all, p < 0.031). Conclusions: Habitual prolonged sedentary bouts and sedentary breaks, but not total sedentary time, were predictors of popliteal endothelial-dependent vasodilatory function. The patterns by which sedentary time is accumulated may be more important than the total sedentary time on lower-limb arterial health.
{"title":"Impact of habitual sedentary patterns on popliteal artery endothelial-dependent vasodilation in healthy adults","authors":"Madeline E. Shivgulam, M. O'Brien, Jarrett A. Johns, Jennifer L. Petterson, Yanlin Wu, Ryan J. Frayne, D. Kimmerly","doi":"10.1177/1358863X211065494","DOIUrl":"https://doi.org/10.1177/1358863X211065494","url":null,"abstract":"Introduction: Acute, laboratory-based bouts of prolonged sitting attenuate lower-limb arterial endothelial-dependent vasodilation. However, the impact of habitual sedentary patterns on popliteal artery endothelial health is unclear. We tested the hypothesis that greater habitual total sedentary time, more time spent in prolonged sedentary bouts, and fewer sedentary breaks would be associated with worse popliteal flow-mediated dilation (FMD) responses. Methods: This cross-sectional study used 98 healthy participants (19–77 years, 53 females) that wore an activPAL monitor on the thigh for 6.4 ± 0.8 days to objectively measure sedentary activity and completed a popliteal ultrasound assessment to determine FMD. Both relative (%baseline diameter) and absolute (mm) FMD were calculated. Using bivariate correlation and multiple regression analyses, we examined if there were relationships between sedentary outcomes and FMD while statistically controlling for any potential confounders. Results: In the multiple regression model, age (p = 0.006, β = −0.030, 95% CI = −0.051, −0.009) and total time in sedentary bouts > 1 hour (p = 0.031, β = −0.005, 95% CI = −0.009, −0.001) were independent predictors of relative FMD. Age (β = −0.002, 95% CI = −0.003, −0.001), mean blood flow (β = 0.013, 95% CI = 0.002, 0.024), moderate-intensity physical activity (β = 155.9E−5, 95% CI = 22.4E−5, 289.4E−5), sedentary breaks (β = 0.036, 95% CI = 0.007, 0.066), and total time spent in sedentary bouts > 1 hour (β = −25.02E−5, 95% CI = −47.67E−5, −2.378E−5) were predictors of absolute FMD (all, p < 0.047). All independent outcomes remained significant after partially controlling for all other predictor variables (all, p < 0.031). Conclusions: Habitual prolonged sedentary bouts and sedentary breaks, but not total sedentary time, were predictors of popliteal endothelial-dependent vasodilatory function. The patterns by which sedentary time is accumulated may be more important than the total sedentary time on lower-limb arterial health.","PeriodicalId":151049,"journal":{"name":"Vascular Medicine (London, England)","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134244362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-31DOI: 10.1177/1358863X16676355
Immad R. Sadiq, S. Goldhaber, Ping-Yu Liu, G. Piazza
Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis minimizes the risk of intracranial bleeding compared with systemic full-dose fibrinolytic therapy for pulmonary embolism (PE). However, major bleeding is nevertheless a potential complication. We analyzed the 150-patient SEATTLE II trial of submassive and massive PE patients to describe those who suffered major bleeding events following ultrasound-facilitated, catheter-directed, low-dose fibrinolysis and to identify risk factors for bleeding. Major bleeding was defined as GUSTO severe/life-threatening or moderate bleeds within 72 hours of initiation of the procedure. Of the 15 patients with major bleeding, four (26.6%) developed access site-related bleeding. Multiple venous access attempts were more frequent in the major bleeding group (27.6% vs 3.6%; p<0.001). All patients with major bleeding had femoral vein access for device delivery. Patients who developed major bleeding had a longer intensive care stay (6.8 days vs 4.7 days; p=0.004) and longer hospital stay (12.9 days vs 8.4 days; p=0.004). The frequency of inferior vena cava filter placement was 40% in patients with major bleeding compared with 13% in those without major bleeding (p=0.02). Massive PE (adjusted odds ratio 3.6; 95% confidence interval 1.01–12.9; p=0.049) and multiple venous access attempts (adjusted odds ratio 10.09; 95% confidence interval 1.98–51.46; p=0.005) were independently associated with an increased risk of major bleeding. In conclusion, strategies for improving venous access should be implemented to reduce the risk of major bleeding associated with ultrasound-facilitated, catheter-directed, low-dose fibrinolysis. ClinicalTrials.gov Identifier: NCT01513759; EKOS Corporation 10.13039/100006522
{"title":"Risk factors for major bleeding in the SEATTLE II trial","authors":"Immad R. Sadiq, S. Goldhaber, Ping-Yu Liu, G. Piazza","doi":"10.1177/1358863X16676355","DOIUrl":"https://doi.org/10.1177/1358863X16676355","url":null,"abstract":"Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis minimizes the risk of intracranial bleeding compared with systemic full-dose fibrinolytic therapy for pulmonary embolism (PE). However, major bleeding is nevertheless a potential complication. We analyzed the 150-patient SEATTLE II trial of submassive and massive PE patients to describe those who suffered major bleeding events following ultrasound-facilitated, catheter-directed, low-dose fibrinolysis and to identify risk factors for bleeding. Major bleeding was defined as GUSTO severe/life-threatening or moderate bleeds within 72 hours of initiation of the procedure. Of the 15 patients with major bleeding, four (26.6%) developed access site-related bleeding. Multiple venous access attempts were more frequent in the major bleeding group (27.6% vs 3.6%; p<0.001). All patients with major bleeding had femoral vein access for device delivery. Patients who developed major bleeding had a longer intensive care stay (6.8 days vs 4.7 days; p=0.004) and longer hospital stay (12.9 days vs 8.4 days; p=0.004). The frequency of inferior vena cava filter placement was 40% in patients with major bleeding compared with 13% in those without major bleeding (p=0.02). Massive PE (adjusted odds ratio 3.6; 95% confidence interval 1.01–12.9; p=0.049) and multiple venous access attempts (adjusted odds ratio 10.09; 95% confidence interval 1.98–51.46; p=0.005) were independently associated with an increased risk of major bleeding. In conclusion, strategies for improving venous access should be implemented to reduce the risk of major bleeding associated with ultrasound-facilitated, catheter-directed, low-dose fibrinolysis. ClinicalTrials.gov Identifier: NCT01513759; EKOS Corporation 10.13039/100006522","PeriodicalId":151049,"journal":{"name":"Vascular Medicine (London, England)","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129075831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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