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2011, Number 6

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Cir Cir 2011; 79 (6)

Silent peripheral arterial disease in patients admitted to the emergency room

Loría-Castellanos J, Hernández-Cruz A

Language: Spanish
References: 28
Page: 520-525
PDF size: 258.36 Kb.


ABSTRACT

Background: Peripheral arterial disease (PAD) is a syndrome that manifests atherothrombotic systemic atherosclerosis. Detection during preclinical stages (silent) may help to identify individuals and populations at risk (elderly patients) for atherothrombotic disease (stroke or coronary).
Methods: We carried out an observational study approved by the investigation committee which, through a simple random method, included patients ›50 years admitted to the emergency room. After signing an informed consent, ankle-brachial index (ABI) was determined and patients were interviewed about risk factors, as well as specifying the reason for consultation. Descriptive statistics and χ2 were used for analysis.
Results: There were 100 patients; 53% were female. Average age was 67.05 ± 10.26 years and 54% of patients had ABI values considered as mild PAD. None had higher levels of severity. Inferential analysis showed a significant association with history of heart disease, renal failure, dyslipidemia, smoking and obesity, as well as the causes of admission of stroke and acute myocardial infarction.
Conclusions: The frequency of silent PAD in this population is higher than most reports. PAD was significantly associated with higher atherothrombotic syndromes and it will be necessary to establish appropriate preventive actions to limit its development.


REFERENCES

  1. Wissler RW. Theories and new horizons in the pathogenesis of atherosclerosis and the mechanisms of clinical effects. Arch Pathol Lab Med 1992;116:1281-1291.

  2. Khan NA, Rhaim SA, Anand SS, Simel DL, Panju A. Does the clinical examination predict lower extremity peripheral arterial disease? JAMA 2006;295:536-546.

  3. Fowkes RG, Housley E, Cawood EH, Macintyre CC, Ruckley CV, Prescott RJ. Edinburgh Artery Study: Prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population. Int J Epidemiol 1991;20:384-392.

  4. Hirsch AT, Criqui MH, Treat-Jacobson D, Regensteiner JG, Creager NA, Olin JW, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA 2001;286:1317-1324.

  5. Weitz JI, Byrne J, Clagett GP, Farkouh ME, Porter JM, Sackett DL, et al. Diagnosis and treatment of chronic arterial insufficiency of lower extremities: a critical review. Circulation 1996;94:3026-3049.

  6. Criqui MH, Langer RD, Fronek A, Feigelson HS, Klauber MR, Mc-Cann TJ, et al. Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med 1992;326:381-386.

  7. McDermott MM, Lui K, Guralnik JM, Shuti M, Criqui MH, Martin GJ, et al. The ankle brachial index independently predicts walking velocity and walking endurance in peripheral arterial disease. J Am Geriatr Soc 1998;46:1355-1362.

  8. Dormandy JA, Rutherford RD. Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg 2000;31:S1-S296.

  9. Hietanen H, Paakkönen R, Salomaa V. Ankle blood pressure as a predictor of total cardiovascular mortality. BMC Cardiovasc Dis 2008;8:3. doi:10.1186/1471-2261-8-3.

  10. Leng GC, Fowkes FGR. The Edinburgh claudication questionnaire: an improved version of the WHO/Rose questionnaire for use in epidemiological surveys. J Clin Epidemiol 1992;45:1101-1109.

  11. Allison MA, Hiatt WR, Hirsch AT, Coll JR, Criqui MH. A high ankle-brachial index is associated with increased cardiovascular disease morbidity and lowered quality of life. J Am Coll Cardiol 2008;51:1292-1298.

  12. Lahoz C, Mostaza JM. Índice tobillo-brazo: una herramienta útil en la estratificación del riesgo cardiovascular. Rev Esp Cardiol 2006;59:647-649.

  13. Fabsitz RR, Sidawy AN, Lee ET, Welty TK, Devereux RB, Howardo BV. Prevalence of peripheral arterial disease and associated risk factors in American Indians, the Strong Heart Study. Am J Epidemiol 1999;149:330-338.

  14. Fernández-Antoli P, Canalejo-Raya MA. Uso del Doppler portátil en patología vascular en atención primaria. Atencion Primaria 1998;22:467-467.

  15. Sebastián-Aparicio MP, Fernández de Leceta-Pinedo P, Arenas-Aguirregoitia C. Vasculopatía arterial periférica: pautas de actuación en atención primaria. Jano 1998;1259:36-44.

  16. Manzanoa L. Valor de la determinación del índice tobillo-brazo en pacientes de riesgo vascular sin enfermedad aterotrombótica conocida: estudio Vitamin. Rev Esp Cardiol 2006;59:662-670.

  17. Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic). Circulation 2006;113:e463-e54.

  18. American Diabetes Association. Peripheral arterial disease in people with diabetes. Diabetes Care 2003;26:3333-3341.

  19. CAPRIE Steering Committee. A randomised, blinded trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996;348(9038): 1329-1339.

  20. Tsai A, Folsom A, Rosamond W, Jones D. Ankle-brachial index and 7-year ischemic stroke incidence: The ARIC Study. Stroke 2001;32:1721-1724.

  21. Buitrón-Granados LV, Martínez-López CM, Escobedo-de la Peña J. Prevalence of peripheral arterial disease and related risk factors in an urban Mexican population. Angiology 2004;55:4.

  22. Contreras-Téllez EJ, Rodríguez-Moctezuma JR, López-Carmona JM, Munguía-Miranda C, Aranda-Moreno C, Peralta-Pedrero ML. Enfermedad arterial periférica y factores de riesgo en pacientes diabéticos tipo 2. Diferencias en medio urbano y suburbano. Rev Med Inst Mex Seguro Soc 2007;45:117-122.

  23. Bozkurt AK, Tasci I, Tabak O, Gumus M, Kaplan Y. Peripheral artery disease assessed by ankle-brachial index in patients with established cardiovascular disease or at least one risk factor for atherothrombosis. CAREFUL Study: A national, multi-center, cross-sectional observational study. BMC Cardiovasc Dis 2011, 11:4 doi: 10.1186/1471-2261-11-14. Disponible en http://www.biomedcentral.com/1471-2261/11/4

  24. Kim KJ, Lee BW, Kim HM, Shin JY, Kang ES, Cha BS, et al. Associations between cardio-ankle vascular index and microvascular complications in type 2 diabetes mellitus patients. J Atheroscler Thromb 2011;18:328-336.

  25. Sheikh MA, Bhatt DL, Li J, Lin S, Bartholomew JR. Usefulness of postexercise ankle-brachial index to predict all-cause mortality. Am J Cardiol 2011;107:778-782.

  26. McDermott MM, Guralnik JM, Tian L, Liu K, Ferrucci L, Liao Y, et al. Associations of borderline and low normal ankle-brachial index values with functional decline at 5-year follow-up: the WALCS (Walking and Leg Circulation Study). J Am Coll Cardiol 2009;53:1056-1062.

  27. Froehlich JB, Mukherjee D, Avezum A, Budaj A, Kline- Rogers EM, López-Sendón J, et al. Association of peripheral artery disease with treatment and outcomes in acute coronary syndromes. The Global Registry of Acute Coronary Events (GRACE). Am Heart J 2006;151:1123-1128.

  28. Chang ST, Chen CL, Chu CM, Chung CM, Hsu JT, Cheng HW, et al. Ankle-arm index as a predictor of lesion morphology and risk classification for coronary artery disease undergoing angioplasty. Int J Cardiol 2006;113:385-390.




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