Measurement of arterial stiffness in subjects with vascular disease: Are vessel wall changes more sensitive than increase in intima-media thickness?

Background And Aims: It is widely accepted that subjects with vascular disease have increased arterial stiffness and intima-media thickness (IMT) when compared with healthy controls. The aim of this study was to investigate indices of arterial stiffness and IMT in the common carotid arteries (CCAs) of subjects with and without peripheral arterial disease (PAD), in order to look for evidence of change in wall quality and quantity to explain increased stiffness that has been found in the arteries of subjects with vascular disease.

Methods And Results: The arterial distension waveform (ADW), IMT, diameter and brachial blood pressure were measured to calculate Young's Modulus (E) and elastic modulus (Ep) in the common carotid arteries of subjects with and without PAD.

Effect of ramipril on renal function in patients with intermittent claudication.

Background: The Heart Outcomes Prevention Study (HOPE) demonstrated that ramipril resulted in a blood-pressure-independent 25% reduction in cardiovascular events in patients with peripheral arterial disease (PAD). Despite this, general practitioners and vascular surgeons remain reluctant to prescribe ACE inhibitors in this group of patients because of concerns about renal artery stenosis (RAS). We aimed to define the effect of ramipril on renal function in patients with intermittent claudication (IC).

A reproducibility study of a TDI-based method to calculate indices of arterial stiffness.

The aim of the study was to investigate the reproducibility of estimation of Young's modulus E and pressure strain elastic modulus Ep, derived from a tissue Doppler imaging (TDI) wall motion technique. Healthy subjects had their arteries insonated at the same sitting by two different observers and at two different sittings by the same observer. From 32 subjects in the reproducibility study, within-scan coefficient of variation (CV) was 4.

The low incidence of surgery for non-cardiac vascular disease in UK Asians may be explained by a low prevalence of disease.

Aims: Firstly, to compare rates of surgery for non-cardiac vascular disease in Caucasians and Asians and secondarily to assess the prevalence of peripheral arterial disease (PAD) and abdominal aortic aneurysm (AAA) in the male UK Asian population.

Methods: Analysis of a prospective database followed by an epidemiological survey of 100 unselected Pakistani males, in which demographic and anthropometric data were collected alongside aortic ultrasonography and measurement of ankle: brachial pressure index (ABPI).

Results: Although 14.

Assessment of smoking status in patients with peripheral arterial disease.

Objective: To assess the utility of a novel rapid urinary cotinine assay to detect and quantify the level of smoking in patients with peripheral arterial disease.

Methods: This was a cross-sectional study in a vascular surgical outpatient department of a large teaching hospital. Participants were 100 consecutive subjects presenting to a hospital outpatient clinic with a diagnosis of intermittent claudication confirmed by a positive Edinburgh claudication questionnaire and an ankle-brachial pressure index of less than 0.

Peri-operative myocardial injury in patients undergoing surgery for critical limb ischaemia.

Introduction: Although up to a half of patients undergoing abdominal aortic aneurysm (AAA) repair suffer myocardial injury, as indicated by a rise in cardiac troponin I (cTnI), this is infrequently accompanied by a rise in creatine kinase (CK)-MB fraction or electrocardiogram (ECG) changes. This study compares for the first time peri-operative cTnI, CK-MB and ECG changes in patients undergoing surgery for critical lower limb ischaemia (CLI).

Methods: Twenty-nine patients (20 men, median age 75 [range, 57-95] years) were studied prospectively.

ACE inhibitors increase type III collagen synthesis: a potential explanation for reduction in acute vascular events by ACE inhibitors.

Introduction: Large trials have shown that angiotensin converting enzyme inhibitor (ACE-I) therapy reduces the risk of myocardial infarction and stroke. Acute vascular events are thought to be initiated by plaque rupture. Animal models of atherosclerosis show an increase in extra cellular matrix when given ACE-I therapy.

Strategies to improve the effectiveness of abdominal aortic aneurysm screening programmes.

Objective: Ruptured abdominal aortic aneurysms (rAAAs) occurring in patients with screen-detected aneurysms could be regarded as a failure of screening and reduce effectiveness of screening. To understand this issue, we studied the reasons why rAAAs occur in screened patients and estimated the cost-benefit ratio if these ruptures could be prevented.

Methods: All rAAAs occurring in the Huntingdon district in the UK during the study period (1991-2000) were traced via a combination of hospital admission, accident and emergency attendance, and intensive therapy unit admission records, operating theatre registers and post-mortem reports.

Dietary folate and vitamin B6 are independent predictors of peripheral arterial occlusive disease.

Background: It has been suggested that hyperhomocysteinemia (HHcy) is an independent risk factor for peripheral arterial occlusive disease (PAOD). However, the relationship between dietary folate and vitamin B6, cofactors in the metabolism of homocysteine (Hcy), and PAOD is unclear.

Aims: To study the relationship between dietary folate and B6 and PAOD.

LDL cholesterol is associated with small abdominal aortic aneurysms.

Objective: To examine the relationship between serum lipids and abdominal aortic aneurysms (AAA).

Methods: Two hundred and six males (>50 years) with AAA (> or =30 mm) detected in a population based screening programme were compared with 252 age-matched male controls in a nested case-control study. Smoking status, previous medical and family histories, height, weight, blood pressure, ankle brachial pressure index (ABPI) and non-fasting lipid profile were recorded.

The prevalence of hyperhomocysteinemia, methylene tetrahydrofolate reductase C677T mutation, and vitamin B12 and folate deficiency in patients with chronic venous insufficiency.

Introduction: Hyperhomocysteinemia (HHcy) is a risk factor for venous thromboembolism, which in turn is a major cause of chronic venous insufficiency. HHcy may be more common in patients with chronic venous insufficiency, but the cause is unknown.

Methods: One hundred hospital outpatients (52 women; median age, 66.

The utilisation of superficial venous surgery for chronic venous insufficiency by the U.K. Asian population.

Background: The epidemiology of superficial venous disease is relatively well defined in the U.K. Caucasian population.

Near patient cholesterol testing in patients with peripheral arterial disease.

Aims: To assess the bias, precision and utility of the Bioscanner 2000 for near patient testing of total cholesterol (NPTC) in patients with peripheral arterial disease (PAD).

Methods: One hundred consecutive patients attending a hospital-based clinic with symptomatic PAD underwent non-fasting NPTC using finger prick blood sample and a laboratory total cholesterol (TC) using blood drawn from an antecubital fossa vein.

Results: The Bioscanner 2000 showed good precision with a coefficient of variation of 1.

Effectiveness and cost of screening for abdominal aortic aneurysm: results of a population screening program.

Objectives: We undertook this study to calculate the cost per life-year gained in the first round of a screening program for abdominal aortic aneurysm (AAA) and to estimate the costs in a subsequent round.

Methods: This was an intervention study, with follow-up for ruptured aneurysms. Men older than 50 years were screened for asymptomatic AAA.

Ethnicity and peripheral arterial disease.

Introduction: the prevalence of peripheral arterial disease (PAD) is relatively well defined for the Caucasian population. Given the susceptibility of Asians and Afro-Caribbeans to coronary heart disease and stroke respectively, and the high prevalence of cardiovascular risk factors in both groups, one would expect a high prevalence of peripheral arterial disease.

Methods: a search of MEDLINE (1966-2002) was undertaken for studies on the incidence and prevalence of PAD, abdominal aortic aneurysms (AAA) and cerebrovascular disease in different ethnic groups.

Accuracy of serial screening for abdominal aortic aneurysms by ultrasound.

Objectives: To assess the accuracy of screening for abdominal aortic aneurysms (AAAs) by ultrasound (US).

Setting: An aneurysm screening programme in Huntingdon.

Methods: False negative tests were identified by tracing all patients with a ruptured aneurysm who were screened and then finding the number classified as normal on US.

Are antihypertensive drugs associated with abdominal aortic aneurysms?

Objective: The aim of this study was to investigate the association between anti-hypertensive drugs, the risk of developing an abdominal aortic aneurysm (AAA), aortic wall stiffness, collagen turnover, and change in aortic diameter. STUDY DESIGN, SETTINGS AND METHODS: Data on present medication, smoking status, and medical history of participants in two population-based aneurysm screening programs in the United Kingdom were collected by use of questionnaire. Aortic elasticity was measured by M-mode ultrasound scanning.

Cecal volvulus occurring after laparoscopic appendectomy.

Less than 2% of cases of intestinal obstruction in adults is caused by cecal volvulus. Although recent abdominal surgery has been implicated, no previous case of cecal volvulus has been reported after laparoscopic appendectomy.

The incidence of small abdominal aortic aneurysms and the change in normal infrarenal aortic diameter: implications for screening.

Aim: to study the incidence of small abdominal aortic aneurysms (AAA), and to investigate what proportion of normal infrarenal aortic diameters (IAD) expand with age.

Methods: longitudinal follow-up in a population-based aneurysm screening programme. The infrarenal aortic diameter (IAD) was measured by ultrasound.

The association between connective tissue laxity and the risk of an abdominal aortic aneurysm.

Aims: to investigate whether connective tissue laxity is associated with abdominal aortic aneurysms (AAA).

Methods: a nested case control study in a population-based screening programme. The presence of pes planus, scoliosis, pectus deformities, flexible auricular cartilages and Gorling's sign were combined with the Beighton joint mobility score to form a connective tissue laxity score.

Ruptured abdominal aortic aneurysm in the Huntingdon district: a 10-year experience.

A study was undertaken to establish the true incidence of ruptured abdominal aortic aneurysms (RAAA) in the Huntingdon districts. RAAAs in the Huntingdon district between 1986 and 1995 were studied retrospectively. Data were collected from hospital records and hospital and community autopsies.

Incidence among men of asymptomatic abdominal aortic aneurysms: estimates from 500 screen detected cases.

Objectives: To determine the incidence of asymptomatic abdominal aortic aneurysms and the implications for an ultrasound screening programme in England and Wales.

Methods: First screen data were obtained from the Chichester and Huntingdon screening studies and used to estimate the prevalence of abdominal aortic aneurysms. The incidence of new, asymptomatic aneurysms was estimated from the prevalence rates observed in the Huntingdon screening study.

Growth rates and risk of rupture of abdominal aortic aneurysms.

Background: Early identification of abdominal aortic aneurysms (AAAs) may reduce the risk of death from rupture by providing the opportunity for elective repair. Before a screening policy for AAA is implemented, the growth rates of AAAs and the accompanying risk of rupture without intervention should be established.

Methods: The growth rates of AAAs were calculated using longitudinal aneurysmal growth data from screening studies in Chichester and Huntingdon.

The infrarenal aortic diameter in relation to age: only part of the population in older age groups shows an increase.

Objectives: To resolve whether the infrarenal aortic diameter (IAD) continues to increase throughout life; to ascertain the relationship between IAD and age, sex, body size, and smoking status, and to determine whether these factors influence the IAD over the entire range of aortic diameters or only in a proportion.

Setting: Combined cross-sectional data from two population-based screening programmes for abdominal aortic aneurysms (AAA) in Huntingdon (U.K.