Epidemiology of Peripheral Arterial Disease and Critical Limb Ischemia

Dua, Anahita; Lee, Cheong

doi:10.1053/j.tvir.2016.04.001

Cited by 223 publications

(169 citation statements)

References 23 publications

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“…In our included 10 studies, the highest prevalence of PAD was 41% and average prevalence was 26.0%. The prevalence of PAD was 3% ~ 10% in the general population [22]. This may be explained by several reasons: Firstly, it may be related to the old age in HD patients.…”

Section: Discussionmentioning

confidence: 99%

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Association of peripheral arterial disease with all-cause and cardiovascular mortality in hemodialysis patients: a meta-analysis

et al. 2016

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BackgroundRecent studies have shown an association between peripheral arterial disease (PAD) and increased risk of mortality in hemodialysis (HD) patients; however, the estimates vary widely and are inconsistent. It is necessary to elucidate the degree of mortality risk for PAD patients in HD population.MethodsPubMed, EMBASE, Web of Science and Cochrane Library (from inception to September 4th, 2016) were systematically searched for cohort studies assessing the association between PAD and mortality in HD patients. We calculated the pooled risk ratios (RRs) with 95% confidence intervals (CI) of all-cause and cardiovascular (CV) mortality using random effects models. Subgroup analyses were conducted to explore the source of heterogeneity.ResultsThe search identified 2,973 potentially eligible records and 10 studies (n = 32,864) were included. Our meta-analysis revealed that PAD significantly increased the risk of all-cause mortality (RR 2.15, 95 % CI 1.67–2.77, n = 32,864) and CV mortality (RR 2.99, 95 % CI 1.66-5.38, n = 31,794) in HD patients after multivariate adjustment. Subgroup analyses showed the study design and follow-up time might be two sources of heterogeneity.ConclusionPAD may be a prognostic marker of all-cause and CV mortality in HD patients. More attention should be paid to diagnosis and management of PAD in HD patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0397-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

“…The prevalence rose with age [23]. It was 15% ~ 20% in persons > 70 years old [22] and by the age of 80, the prevalence was around 20% [23]. Of note, the mean ages in our 10 studies ranged from 56.4 to 65 years old.…”

Section: Discussionmentioning

confidence: 99%

Association of peripheral arterial disease with all-cause and cardiovascular mortality in hemodialysis patients: a meta-analysis

et al. 2016

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“…1,2 Revascularization is often required for advanced stages of the disease, with autologous vein grafts providing the most durable bypass conduit. 3,4 Despite advancements in treatment options, significant midterm failure rates greatly limit clinical benefit for patients with advanced PAD.…”

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confidence: 99%

Perivascular delivery of resolvin D1 inhibits neointimal hyperplasia in a rabbit vein graft model

Werlin

Chen

et al. 2018

Journal of Vascular Surgery

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Objective: Inflammation is a key driver of excessive neointimal hyperplasia within vein grafts. Recent work demonstrates that specialized proresolving lipid mediators biosynthesized from omega-3 polyunsaturated fatty acids, such as resolvin D1 (RvD1), actively orchestrate the process of inflammation resolution. We investigated the effects of local perivascular delivery of RvD1 in a rabbit vein graft model. Methods: Ipsilateral jugular veins were implanted as carotid interposition grafts through an anastomotic cuff technique in New Zealand white rabbits (3–4 kg; N = 80). RvD1 (1 μg) was delivered to the vein bypass grafts in a perivascular fashion, using either 25% Pluronic F127 gel (Sigma-Aldrich, St. Louis, Mo) or a thin bilayered poly(lactic-co-glycolic acid) (PLGA) film. No treatment (bypass only) and vehicle-loaded Pluronic gels or PLGA films served as controls. Delivery of RvD1 to venous tissue was evaluated 3 days later by liquid chromatography-tandem mass spectrometry. Total leukocyte infiltration, macrophage infiltration, and cell proliferation were evaluated by immunohistochemistry. Elastin and trichrome staining was performed on grafts harvested at 28 days after bypass to evaluate neointimal hyperplasia and vein graft remodeling. Results: Perivascular treatments did not influence rates of graft thrombosis (23%), major wound complications (4%), or death (3%). Leukocyte (CD45) and macrophage (RAM11) infiltration was significantly reduced in the RvD1 treatment groups vs controls at 3 days (60%−72% reduction; P < .01). Cellular proliferation (Ki67 index) was also significantly lower in RvD1-treated vs control grafts at 3 days (40%−50% reduction; P < .01). Treatment of vein grafts with RvD1-loaded gels reduced neointimal thickness at 28 days by 61% vs bypass only (P < .001) and by 63% vs vehicle gel (P < .001). RvD1-loaded PLGA films reduced neointimal formation at 28 days by 50% vs bypass only (P < .001). RvD1 treatment was also associated with reduced collagen deposition in vein grafts at 28 days. Conclusions: Local perivascular delivery of RvD1 attenuates vein graft hyperplasia without associated toxicity in a rabbit carotid bypass model. This effect appears to be mediated by both reduced leukocyte recruitment and decreased cell proliferation within the graft. Perivascular PLGA films may also impart protection through biomechanical scaffolding in this venous arterialization model. Our studies provide further support for the potential therapeutic role of specialized proresolving lipid mediators such as D-series resolvins in modulating vascular injury and repair. (J Vasc Surg 2018;■:1–12.) Clinical Relevance: Autologous vein bypass grafts are the most durable means for revascularization in peripheral vascular disease; however, midterm and long-term outcomes are limited by vein graft hyperplasia with associated vein graft failure. Endogenous proresolving lipid mediators such as resolvin D1 have the potential to attenuate vein graft hyperplasia by accelerating repair. This study provides proof of co...

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“…9,10 Nearly all recommendations conclude that an appropriate patient is one who demonstrates reasonable therapeutic expectations, is free of significant psychiatric barriers or secondary gain, and has a pain generator that is not reasonably treatable by an alternative, more conservative, modality. [9][10][11] While SCS therapy has been used to treat a wide variety of conditions, the most common indications are combined trunk and limb pain (TLP), inclusive of failed back surgery syndrome (FBSS), 12 complex regional pain syndrome (CRPS), [13][14][15] neuropathic pain including painful diabetic neuropathy (PDN), 16 critical limb ischemia (CLI), 17 and refractory angina pectoris (RAP). 18 As the cost and efficacy of SCS therapy continue to be called into question by public health administrators, payers, and policy makers, there is an increasing demand for high-level evidence for efficacy and cost-effectiveness.…”

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confidence: 99%

Spinal Cord Stimulation 50 Years Later

Mekhail

Visnjevac

Azer

et al. 2018

Regional Anesthesia and Pain Medicine

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To assess the efficacy of spinal cord stimulation (SCS) for each indication, one must critically assess each specific clinical outcome to identify outcomes that benefit from SCS therapy. To date, a comprehensive review of clinically relevant outcome-specific evidence regarding SCS has not been published. We aimed to assess all randomized controlled trials from the world literature for the purpose of evaluating the clinical outcome-specific efficacy of SCS for the following outcomes: perceived pain relief or change pain score, quality of life, functional status, psychological impact, analgesic medication utilization, patient satisfaction, and health care cost and utilization. Interventions were SCS, without limitation to the type of controls or the type of SCS in the active arms. For each study analyzed, a quality assessment was performed using a validated scale that assesses reporting, external validity, bias, confounding, and power. Each outcome was assessed specific to its indication, and the primary measure of each abovementioned outcome was a summary of the level of evidence. Twenty-one randomized controlled trials were analyzed (7 for trunk and limb pain, inclusive of failed back surgery syndrome; 8 for refractory angina pectoris; 1 for cardiac X syndrome; 3 for critical limb ischemia; 2 for complex regional pain syndrome; and 2 for painful diabetic neuropathy). Evidence assessments for each outcome for each indication were depicted in tabular format. Outcome-specific evidence scores were established for each of the abovementioned indications, providing both physicians and patients with a summary of evidence to assist in choosing the optimal evidence-based intervention. The evidence presented herein has broad applicability as it encompasses a breadth of patient populations, variations of SCS therapy, and comparable controls that, together, reflect comprehensive clinical decision making.

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Epidemiology of Peripheral Arterial Disease and Critical Limb Ischemia

Cited by 223 publications

References 23 publications

Association of peripheral arterial disease with all-cause and cardiovascular mortality in hemodialysis patients: a meta-analysis

Association of peripheral arterial disease with all-cause and cardiovascular mortality in hemodialysis patients: a meta-analysis

Perivascular delivery of resolvin D1 inhibits neointimal hyperplasia in a rabbit vein graft model

Spinal Cord Stimulation 50 Years Later

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