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ObjectiveLow/middle-income countries face a disproportionate burden of cardiovascular diseases. However, among cardiovascular diseases, burden of and associations with lower extremity disease (LED) (peripheral arterial disease and/or neuropathy) is neglected. We investigated the prevalence and factors associated with LED among individuals known to have cardiovascular disease risk factors (CVDRFs) in Malawi, a low-income country with a significant prevalence of CVDRFs.DesignThis was a stratified cross-sectional study.SettingThis study was conducted in urban Lilongwe Area 25, and the rural Karonga Health and Demographic Surveillance Site.ParticipantsParticipants were at least 18 years old and had been identified to have two or more known CVDRFs.Main outcome measuresLED—determined by the presence of one of the following: neuropathy (as assessed by a 10 g monofilament), arterial disease (absent peripheral pulses, claudication as assessed by the Edinburgh claudication questionnaire or Ankle Brachial Pulse Index (ABPI) <0.9), previous amputation or ulceration of the lower limbs.ResultsThere were 806 individuals enrolled into the study. Mean age was 52.5 years; 53.5% of participants were men (n=431) and 56.7% (n=457) were from the rural site. Nearly a quarter (24.1%; 95% CI: 21.2 to 27.2) of the participants had at least one symptom or sign of LED. 12.8% had neuropathy, 6.7% had absent pulses, 10.0% had claudication, 1.9% had ABPI <0.9, 0.9% had an amputation and 1.1% had lower limb ulcers. LED had statistically significant association with increasing age, urban residence and use of indoor fires.ConclusionsThis study demonstrated that a quarter of individuals with two or more CVDRFs have evidence of LED and 2.4% have an amputation or signs of limb threatening ulceration or amputation. Further epidemiological and health systems research is warranted to prevent LED and limb loss.

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surgery was 6.8% (4/59) and 22% (13/59), respectively, with almost a third (4/13) of these patients dying from cancer rather than aneurysm rupture. Conclusion: The short-term aneurysm-related mortality in elective turndowns is low, with a significant number of patients succumbing for other reasons. Given the plethora of treatment options available, objective selection of patients who will benefit most from intervention is increasingly important.

spinal cord ischemia, respiratory and renal and insufficiency. Secondary end points included blood loss, operative time, ICU stay, the length of hospital stay. Results: Primary endpoints: 30 days mortality rate 24.1% (7.18% standard group, p ¼ 0.001), spinal cord ischemia rate 13.8% (14.1% standard group, p ¼ 0.964), respiratory failure rate 13.8% (4.95% standard group, p ¼ 0.0442) and renal failure rate 27.6% (26.2% standard group, p ¼ 0.869). Secondary endpoints: mean blood loss 7062 mL (5246 mL standard group, p ¼ 0.018), mean operative time 5,39 h (4,79 h standard group, p ¼ 0.021), mean ICU stay 3.4 days (2.7 days standard group, p ¼ 0.068), length of hospital stay 10.7 days (10.4 days standard group, p ¼ 0.852). Conclusion: Previous thoracic endovascular repair is a significant preoperative risk factor for patients requiring subsequent open TAA repair. Not only does it increase the complexity of the repair with longer operative time and blood loss but also there is a worsening in terms of both mortality and respiratory morbidity.