Abstract-Atherosclerosis is common in the adductor hiatus region. The aim of this study was to evaluate atherosclerosis in relation to themorphological structure of the femoropopliteal region. Two anatomic features are thought to play an important role in the origin of these lesions: (1) curvature of the vessel, which may lead to unfavorable local hemodynamic factors that change during leg flexion; and (2)

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Muscle strength and muscle endurance, combined with quadriceps muscle area are the main predictors of maximal exercise performance in patients with CHF.

Introduction Subclavian artery stenosis occurs up to 4.6% in patients who are referred for a coronary artery bypass graft (CABG). Subclavian artery stenosis can compromise the blood flow in the ipsilateral mammary artery. Case presentation In this case report, we describe a patient with prior history of CABG and peripheral vascular disease, who presented with recurrent chest pain symptoms. Cardiac perfusion imaging using Rubidium-82 positron emission tomography showed extensive ischaemia in the anterior wall. Coronary angiography showed an ipsilateral (left) severe subclavian stenosis, while there was no significant stenosis in the bypass grafts. Patient’s symptoms resolved after percutaneous intervention of the left subclavian artery. Discussion The presence of subclavian artery stenosis can result in myocardial ischaemia after prior CABG utilizing the internal mammary artery. A history of peripheral vascular disease and a blood pressure difference between the upper extremities greater than 15 mmHg are clinical predictors of subclavian artery stenosis. Percutaneous angioplasty and stenting is considered the first-line treatment for subclavian artery stenosis. Surgical management should be considered after failure of endovascular treatment in low-surgical-risk patients.

BackgroundAtherosclerotic renal artery stenosis (ARAS) is common in cardiovascular diseases and associated with hypertension, renal dysfunction and/or heart failure. There is a paucity of data about the prevalence and the role of ARAS in the pathophysiology of combined chronic heart failure (CHF) and chronic kidney disease (CKD). We investigated the prevalence in patients with combined CHF/CKD and its association with renal function, cardiac dysfunction and the presence and extent of myocardial fibrosis.MethodsThe EPOCARES study (ClinTrialsNCT00356733) investigates the role of erythropoietin in anaemic patients with combined CHF/CKD. Eligible subjects underwent combined cardiac magnetic resonance imaging (cMRI), including late gadolinium enhancement, with magnetic resonance angiography of the renal arteries (MRA).ResultsMR study was performed in 37 patients (median age 74 years, eGFR 37.4 ± 15.6 ml/min, left ventricular ejection fraction (LVEF) 43.3 ± 11.2%), of which 21 (56.8%) had ARAS (defined as stenosis >50%). Of these 21 subjects, 8 (21.6%) had more severe ARAS >70% and 8 (21.6%) had a bilateral ARAS >50% (or previous bilateral PTA). There were no differences in age, NT-proBNP levels and medication profile between patients with ARAS versus those without. Renal function declined with the severity of ARAS (p = 0.03), although this was not significantly different between patients with ARAS versus those without. Diabetes mellitus was more prevalent in patients without ARAS (56.3%) against those with ARAS (23.8%) (p = 0.04). The presence and extent of late gadolinium enhancement, depicting myocardial fibrosis, did not differ (p = 0.80), nor did end diastolic volume (p = 0.60), left ventricular mass index (p = 0.11) or LVEF (p = 0.15). Neither was there a difference in the presence of an ischemic pattern of late enhancement in patients with ARAS versus those without.ConclusionsARAS is prevalent in combined CHF/CKD and its severity is associated with a decline in renal function. However, its presence does not correlate with a worse LVEF, a higher left ventricular mass or with the presence and extent of myocardial fibrosis. Further research is required for the role of ARAS in the pathophysiology of combined chronic heart and renal failure.