The Experts below are selected from a list of 231 Experts worldwide ranked by ideXlab platform
Bernard J Gersh - One of the best experts on this subject based on the ideXlab platform.
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long term survival in patients with coronary artery Disease importance of Peripheral Vascular Disease
Journal of the American College of Cardiology, 1994Co-Authors: Kim A Eagle, Charanjit S Rihal, Eric D Foster, Mary C Mickel, Bernard J GershAbstract:Objectives. The purpose of this study was to determine the importance of Peripheral arterial Disease in predicting long-term survival in patients with clinically evident coronary artery Disease. Background. Patients in the Coronary Artery Surgery Study (CASS) Registry were followed up for >10 years. Methods. Survival in 2,296 patients with Peripheral arterial Disease was compared with that of 13,953 patients without Peripheral arterial Disease using Kaplan-Meier survival curves. All patients had known stable coronary artery Disease. Clinical, electrocardiographic (ECG), chest X-ray film and catheterizalion variables of the two groups were compared using the chi-square statistic or the two-sample t test. The independent effect of Peripheral arterial Disease (as well as other variables) on mortality was determined utilizing a Cox proportional hazards model. Results. Patients with Peripheral Vascular Disease were more likely to have hypertension, diabetes, family history of coronary artery Disease, previous angina or myocardial infarction, previous coronary bypass surgery or to have smoked. They also had a higher incidence of congestive heart failure, ECG abnormality and modestly increased frequency of three-vessel Disease. Independent correlates of long-term mortality for the entire cohort included age, smoking, diabetes, number of Diseased coronary vessels, left ventricular function, hypertension, pulmonary Disease, anginal class, previous myocardial infarction and Peripheral Vascular Disease (all p < 0.061). At any point in time, patients with Peripheral Vascular Disease had a 25% greater likelihood of mortality than patients without Peripheral Vascular Disease (multivariate chi-square 25.83, hazard ratio 1.25, 95% confidence interval 1.15 to 1.36, p < 0.0001). Conclusions. Peripheral Vascular Disease is a strong, independent predictor of long-term mortality in patients with stable coronary artery Disease. Aggressive attempts at secondary Disease prevention are warranted in this high risk group.
Laybourn C - One of the best experts on this subject based on the ideXlab platform.
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Prevalence of renal artery stenosis in patients with Peripheral Vascular Disease and hypertension.
Journal of human hypertension, 1996Co-Authors: K. Wachtell, H Ibsen, Mh Olsen, Laybourn CAbstract:The aim of this study was to evaluate the prevalence of renal artery stenosis in patients with clinical signs of Peripheral Vascular Disease and hypertension. One hundred patients, mean age 69 years (range 45-88) with symptoms and clinical signs of severe Peripheral ischemia, underwent aortography to determine the degree of Peripheral Vascular Disease and possible renal artery stenosis. History of claudication, and measurement of systolic distal blood pressure (BP) and calculation of the Ankle Brachial Index was used to define the severity of Peripheral Vascular Disease. A total of 31% had renal artery stenosis (14% greater than 50% reduction in luminal diameter). In a subgroup of patients with hypertension and Peripheral Vascular Disease (n = 74), 34% had renal artery stenosis. In the subgroup of patients with renal artery stenosis, 81% have hypertension. Patients with renal artery stenosis and lumen reduction of more than 50%, 93% have hypertension (P < or = 0.001). In conclusion this study shows that the combination of Peripheral Vascular Disease and hypertension is an important clinical clue for renoVascular Disease. Examination for reno-Vascular Disease in this population should be considered, since the prevalence of the condition is high. Furthermore examination for renal Vascular Disease in this population is mandatory, before treatment with angiotensin converting enzyme (ACE) inhibitors is initiated, since treatment might lead to serious renal function impairment.
Graham A. Macgregor - One of the best experts on this subject based on the ideXlab platform.
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Renal artery stenosis: A common and important problem in patients with Peripheral Vascular Disease
The American journal of medicine, 1994Co-Authors: Constantinos G. Missouris, Timothy M. Buckenham, Francesco P. Cappuccio, Graham A. MacgregorAbstract:Abstract objective: To study the prevalence, severity, Vascular risk factors, and clinical implications of renal artery stenosis in patients with Peripheral Vascular Disease. design: Cross-sectional study of consecutive patients who were electively referred from the department of Vascular surgery for lower limb digital subtraction angiography. setting: St. George's Hospital, London, United Kingdom. subjects: One hundred twenty-seven patients presenting with intermittent claudication or lower limb ischemic ulceration. main outcome measures: Prevalence and clinical importance of renal artery stenosis in patients with Peripheral Vascular Disease adjusted for the confounding effects of age and hypertension. results: Of the 127 patients, 57 (44.9%) had renal artery Disease, of whom 22 (17.3%) had mild Disease, 20 (15.7%) had severe Disease, and 15 (11.8%) had bilateral renal artery stenosis. There was a significant positive relationship between the presence of renal artery stenosis and the severity of Peripheral Vascular Disease (p = 0.00015). The risk of having renal artery stenosis was nearly four times greater in those with three to four vessels affected and nearly seven times greater in those with five or more vessels affected as compared with those with a milder degree of Peripheral Vascular Disease (one or two vessels affected). This association persisted when the confounding effect of age and hypertension was accounted for. Six patients (31.6%) with renal artery stenosis who underwent reVascularization for Peripheral Vascular Disease died during the early postoperative period of cardiac or renal complications. None of the patients with normal renal arteries who had similar surgery developed postoperative complications (p = 0.005). conclusions: Renal artery stenosis is a common independent feature in patients with Peripheral Vascular Disease, and its prevalence increases with the increasing severity of the Peripheral Vascular Disease. The postoperative risk following reVascularization for Peripheral Vascular Disease appears to be greater in those patients with renal artery stenosis. All patients studied with digital subtraction angiography for Peripheral Vascular Disease should have an aortic flush performed to image the renal arteries. This information may be used to identify those patients likely to develop postoperative complications during Peripheral reVascularization.
Attilio Maseri - One of the best experts on this subject based on the ideXlab platform.
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risk of myocardial infarction and angina in patients with severe Peripheral Vascular Disease
Circulation, 2002Co-Authors: Elisabetta Rossi, Luigi M Biasucci, Franco Citterio, Simona Pelliccioni, Claudia Monaco, Francesca Ginnetti, Dominick J Angiolillo, Gianni Grieco, Giovanna Liuzzo, Attilio MaseriAbstract:Background— Patients undergoing reVascularization procedures for Peripheral Vascular Disease (PVD) have a greatly increased risk for coronary artery Disease (CAD) that is predicted only partly by c...
K. Wachtell - One of the best experts on this subject based on the ideXlab platform.
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Prevalence of renal artery stenosis in patients with Peripheral Vascular Disease and hypertension.
Journal of human hypertension, 1996Co-Authors: K. Wachtell, H Ibsen, Mh Olsen, Laybourn CAbstract:The aim of this study was to evaluate the prevalence of renal artery stenosis in patients with clinical signs of Peripheral Vascular Disease and hypertension. One hundred patients, mean age 69 years (range 45-88) with symptoms and clinical signs of severe Peripheral ischemia, underwent aortography to determine the degree of Peripheral Vascular Disease and possible renal artery stenosis. History of claudication, and measurement of systolic distal blood pressure (BP) and calculation of the Ankle Brachial Index was used to define the severity of Peripheral Vascular Disease. A total of 31% had renal artery stenosis (14% greater than 50% reduction in luminal diameter). In a subgroup of patients with hypertension and Peripheral Vascular Disease (n = 74), 34% had renal artery stenosis. In the subgroup of patients with renal artery stenosis, 81% have hypertension. Patients with renal artery stenosis and lumen reduction of more than 50%, 93% have hypertension (P < or = 0.001). In conclusion this study shows that the combination of Peripheral Vascular Disease and hypertension is an important clinical clue for renoVascular Disease. Examination for reno-Vascular Disease in this population should be considered, since the prevalence of the condition is high. Furthermore examination for renal Vascular Disease in this population is mandatory, before treatment with angiotensin converting enzyme (ACE) inhibitors is initiated, since treatment might lead to serious renal function impairment.