Document Detail

Successful lower extremity angioplasty improves brachial artery flow-mediated dilation in patients with peripheral arterial disease.
MedLine Citation:
PMID:  18771886     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Peripheral arterial disease (PAD) is associated with systemic impaired flow-mediated dilation (FMD) and increased risk for cardiovascular events. Decreased FMD may be caused by a decrease in arterial shear stress due to claudication and inflammation due to muscle ischemia and reperfusion. We assumed that endovascular revascularization of lower limb arterial obstructions ameliorates FMD and lowers inflammation through improvement of peripheral perfusion.
METHODS: The study was a prospective, open, randomized, controlled, single-center follow-up evaluation assessing the effect of endovascular revascularization on brachial artery reactivity (FMD) measured by ultrasound, white blood cell (WBC) count, high-sensitive C-reactive protein (hs-CRP), and fibrinogen. We investigated 33 patients (23 men) with chronic and stable PAD (Rutherford 2 to 3) due to femoropopliteal obstruction. Variables were assessed at baseline and after 4 weeks in 17 patients (group A) who underwent endovascular revascularization and best medical treatment, and in 16 patients (group B) who received best medical treatment only.
RESULTS: FMD did not differ between group A and B (4.96% +/- 1.86% vs 4.60% +/- 2.95%; P = .87) at baseline. It significantly improved after revascularization in group A (6.44% +/- 2.88%; P = .02) compared with group B at 4 weeks of follow-up (4.53% +/- 3.17%; P = .92), where it remained unchanged. The baseline ankle-brachial index (ABI) was similar for group A and B (0.63 +/- 0.15 vs 0.66 +/- 0.10; P = .36). At 4 weeks of follow-up, ABI was significantly increased in group A (1.05 +/- 0.15; P = .0004) but remained unchanged in group B (0.62 +/- 0.1). WBC counts of the two groups were comparable at baseline (group A: 7.6 +/- 2.26 x 10(6)/mL and group B: 7.8 +/- 2.02 x 10(6)/mL, P = .81). In group A, the leukocyte count significantly decreased after angioplasty from 7.6 +/- 2.26 to 6.89 +/- 1.35 x 10(6)/mL (P = .03). For group B, WBC count did not differ significantly compared with baseline (7.76 +/- 2.64 x 10(6)/mL; P = .94). No effects were observed on hs-CRP or fibrinogen from endovascular therapy.
CONCLUSION: Endovascular revascularization with reestablishment of peripheral arterial perfusion improves FMD and reduces WBC count in patients with claudication. Revascularization may therefore have clinical implications beyond relief of symptoms, for example, reducing oxidative stress caused by repeated muscle ischemia or increased shear stress due to improved ambulatory activity.
Marc Husmann; Janine Dörffler-Melly; Christoph Kalka; Nicolas Diehm; Iris Baumgartner; Antonio Silvestro
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2008-09-04
Journal Detail:
Title:  Journal of vascular surgery     Volume:  48     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-10-30     Completed Date:  2008-11-13     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1211-6     Citation Subset:  IM    
Cardiovascular Department, Division of Clinical and Interventional Angiology, University Hospital Berne and University of Berne, Berne, Switzerland.
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MeSH Terms
Aged, 80 and over
Angioplasty, Balloon*
Ankle / blood supply
Arterial Occlusive Diseases / blood,  complications,  physiopathology,  therapy*
Brachial Artery / physiopathology*,  ultrasonography
C-Reactive Protein / metabolism
Femoral Artery / physiopathology*,  ultrasonography
Fibrinogen / metabolism
Inflammation Mediators / blood
Intermittent Claudication / etiology,  physiopathology,  therapy
Ischemia / etiology,  physiopathology,  therapy
Leukocyte Count
Lower Extremity / blood supply*
Middle Aged
Peripheral Vascular Diseases / blood,  complications,  physiopathology,  therapy*
Popliteal Artery / physiopathology*,  ultrasonography
Prospective Studies
Regional Blood Flow
Time Factors
Treatment Outcome
Reg. No./Substance:
0/Inflammation Mediators; 9001-32-5/Fibrinogen; 9007-41-4/C-Reactive Protein

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