Renal Artery Stenosis in Patients with Peripheral Artery Disease: Prevalence, Risk Factors and Long-term Prognosis.

The objective was to determine the prevalence and clinical determinants of renal artery stenosis (RAS) in patients undergoing digital subtraction angiography (DSA) for the assessment of peripheral artery disease (PAD), and to evaluate its prognostic significance. METHODS: All DSAs performed from January 2000 to January 2006 were retrospectively reviewed for assessment of PAD in patients naive for any prior revascularisation of lower-limb arteries. All DSA studies were read by two senior physicians blinded to outcome, and consensus was reached in cases of disagreement. RAS was defined as the presence of ≥50% stenosis in either renal artery. Patients' electronic medical files were systematically reviewed and follow-up was completed by contact with family physicians until January 2014. The primary outcome was composite, including death, peripheral revascularisation, or any limb amputation. Secondary outcomes were all-cause mortality, and another composite, including death and non-fatal myocardial infarction or stroke or coronary or carotid revascularisation. RESULTS: In total, 400 consecutive patients having a first DSA of lower extremities, two thirds of whom were for critical limb ischaemia, were studied. Thirteen patients were excluded owing to poor renal artery imaging. RAS was detected in 57 patients (14%). Only two factors were independently and significantly associated with RAS in multivariate analysis: diffuse PAD (involving both proximal and distal segments...
Source: PubMed: Eur J Vasc Endovasc ... - Category: Surgery Authors: Tags: Eur J Vasc Endovasc Surg Source Type: research

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ors Abstract BACKGROUND AND OBJECTIVES: Uromodulin is exclusively produced by tubular epithelial cells and released into urine and serum. Higher serum uromodulin has been associated with lower risk for kidney failure in Chinese patients with CKD and with lower risk for mortality in the elderly and in patients undergoing coronary angiography. We hypothesized that lower serum uromodulin is associated with mortality, cardiovascular events, and kidney failure in white patients with CKD. DESIGN, SETTING, PARTICIPANTS, &MEASUREMENTS: We measured serum uromodulin in 5143 participants enrolled in the German CKD (...
Source: Clinical Journal of the American Society of Nephrology : CJASN - Category: Urology & Nephrology Authors: Tags: Clin J Am Soc Nephrol Source Type: research
Walking is often touted as a perfect exercise to improve multiple aspects of health. But what if walking causes leg pain? Many people shrug off leg pain when they walk as a normal part of aging. In some cases, though, it’s the sign of peripheral artery disease (PAD), which can put heart and brain health at risk. While PAD doesn’t usually run in families, it’s more likely to occur as people age, or among people who smoke or have high blood pressure, high cholesterol, or diabetes. What causes leg pain if you have PAD? People with PAD have fatty deposits in arteries outside the heart — most often in th...
Source: Harvard Health Blog - Category: Consumer Health News Authors: Tags: Exercise and Fitness Healthy Aging Heart Health Hypertension and Stroke Pain Management Source Type: blogs
Conclusions: Embolism associated with asymptomatic carotid stenosis shows circadian variation with highest rates 4–6 h before midday. This corresponds with peak circadian incidence of stroke and other vascular complications. These and ASED Study results show that monitoring frequency, duration, and time of day are important in ES detection. Introduction Transcranial Doppler (TCD) detected microembolism in the ipsilateral middle cerebral artery (MCA) may help stratify the risk of stroke and other arterial disease complications in persons with advanced (≥60%) asymptomatic carotid stenosis. If so, this techniqu...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
A 60-something presented with hypotension, bradycardia, chest pain and back pain.She had a h/o aortic aneurysm, aortic insufficiency, peripheral vascular disease, and hypertension.  She had a mechanical aortic valve.  She was on anti-hypertensives including atenolol, and on coumadin, with an INR of 2.3. She was ill appearing.  BP was 70/49, pulse 60.A bedside echo showed good ejection fraction and normal right ventricle and no pericardial fluid. Here is the initial ECG:What do you think?This ECG actually looks like a left main occlusion (which rarely presents to the ED alive):  ST Elevation in...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
CONCLUSION:  Presence, but not extent, of CAD was an independent risk factor of the composite thromboembolic endpoint beyond the components already included in the CHA2DS2-VASc score. Consequently, we suggest that significant angiographically proven CAD should be included in the vascular disease criterion in the CHA2DS2-VASc score. PMID: 30419601 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - Category: Hematology Authors: Tags: Thromb Haemost Source Type: research
Conclusions: About 1 in 5 patients undergoing PET MPI are referred for coronary angiography within 90 days of testing, a rate greater than that reported for SPECT MPI, likely due to higher baseline risk of patients undergoing PET MPI testing. While referral rates for coronary angiography varied based on the presence or absence of prior documented clinical CAD and presence of test abnormalities, nearly 36% of patients with moderate-severe ischemia were not referred. Further work is needed to characterize why such patients are not referred for invasive evaluation to optimize the use of PET MPI in this high-risk population.
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Cardiovascular Clinical Science Poster Session Source Type: research
Abstract ObjectivesOur aims were to examine the prevalence and genetic predictors of aspirin and clopidogrel high on‐treatment platelet reactivity (HoTPR), and associated adverse cardiovascular outcomes in patients with peripheral arterial disease (PAD). BackgroundThe association of aspirin and clopidogrel HoTPR with outcomes in PAD remains unclear. MethodsThis is a prospective cohort study of patients with angiographically documented PAD involving carotid and lower extremity arteries. Aspirin and clopidogrel HoTPR (using the VerifyNow Assay) and associated genetic predictors were compared to clinical outcomes. The prima...
Source: Catheterization and Cardiovascular Interventions - Category: Cardiovascular & Thoracic Surgery Authors: Tags: PERIPHERAL VASCULAR DISEASE Source Type: research
Authors: Katta N, Balla S, Velagapudi P, Mittal M, Agrawal H, Kumar A, Aggarwal K Abstract Cardiovascular disease is the major cause of morbidity and mortality in chronic kidney disease patients. Because of a higher occurrence of asymptomatic coronary artery disease and increased perioperative cardiovascular mortality in kidney transplant patients, screening for coronary artery disease before transplant surgery is essential. Various studies have shown that cardiac stress testing is an unreliable screening method in these patients because of significant variability in sensitivity and negative predictive value. We su...
Source: Advances in Peritoneal Dialysis. Conference on Peritoneal Dialysis - Category: Urology & Nephrology Tags: Adv Perit Dial Source Type: research
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Source: Circulation: Cardiovascular Interventions - Category: Cardiology Authors: Tags: Catheter-Based Coronary and Valvular Interventions Peripheral Vascular Disease Source Type: research
Conclusions Multivessel CAD in Brazil is associated with traditional risk factors for atherosclerosis, except for smoking. Age, diabetes, and chronic renal failure were the strongest predictors for multivessel CAD assessed by coronary angiography.
Source: Revista Brasileira de Cardiologia Invasiva - Category: Cardiology Source Type: research
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