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BackgroundShort sleep duration and poor sleep quality are important risk factors for atherosclerosis. The use of smart bracelets that measure sleep parameters, such as sleep stage, can help determine the effect of sleep quality on lower-extremity atherosclerosis in patients with type 2 diabetes.ObjectiveTo investigate the correlation between sleep disorders and lower-extremity atherosclerosis in patients with type 2 diabetes.MethodsAfter admission, all patients were treated with lower-extremity arterial ultrasound and graded as having diabetic lower-extremity vascular lesions according to the results. A smart bracelet was used to obtain the patient sleep data. The correlation between sleep patterns and diabetic lower-extremity atherosclerosis, diabetic foot, and various metabolic indices was verified.ResultsBetween August 2021 and April 2022, we screened 100 patients with type 2 diabetes, with 80 completing sleep monitoring. Univariate ordered logistic regression analysis indicated that patients with a sleep score below 76 (OR = 2.707, 95%CI: 1.127–6.488), shallow sleep duration of 5.3 h or more (OR=3.040, 95 CI: 1.005–9.202), wakefulness at night of 2.6 times or more (OR = 4.112, 95%CI: 1.513–11.174), and a deep sleep continuity score below 70 (OR = 4.141, 95%CI: 2.460–615.674) had greater risk of high-grade lower limb atherosclerosis. Multivariate ordinal logistic regression analysis revealed that the risk of high-grade lower limb atherosclerosis was higher in patients with 2.6 or more instances of nighttime wakefulness (OR = 3.975, 95%CI: 1.297–12.182) compared with those with fewer occurrences. The sleep duration curve of patients with different grades of diabetic lower-extremity atherosclerosis was U-shaped. According to the results of the one-way analysis of variance, the higher the deep sleep continuity score, the lower the Wagner scale score for diabetic foot (P

Patients with peripheral arterial disease (PAD) are at high risk of major adverse cardiac events (MACE) and major adverse limb events (MALE). Recently, antithrombotic therapies employing antiplatelet and anticoagulant drugs have proven to be valid in reducing MACE in patients with PAD and polyvascular disease and MALE, particularly in patients who have already been revascularized and remain at increased risk of MALE. However, more aggressive antithrombotic therapies lead to an increased risk of bleeding. Antithrombotic therapy and revascularization procedures entail an increased hemorrhagic risk that is also linked to having received more vigorous antithrombotic therapies. Therefore, it appears crucial to have specifically targeted scores for a PAD patient to assess bleeding and thrombotic risks. The correct utilization of a risk score will determine the variable risk factors for bleeding that can be corrected or modified, as well as identify patients at high risk that require regular reexamination and follow-up. Clinical risk scores do not represent the absolute reality, and inter-score variability must be taken into account. Moreover, several risk scores have been created to be basic and to facilitate and improve clinical decisions in daily practice. Many risk scores based on points vary according to the configuration of the studies, population type, and ethnic group, and many of the risk factor elements in a specific score are unlikely to sustain same weight for that risk. The best approach continues to be devising an uncomplicated, functional, validated, and precise score that can be adjusted to different clinical contexts and populations, while considering the mutable composition of clinical risk. [ABSTRACT FROM AUTHOR]

ObjectivesFemale gender has been shown to negatively affect the outcomes of surgical bypass for peripheral arterial disease (PAD). We examined gender-related disparities in outcomes of endovascular PAD procedures in a large population-based study.MethodsWe used discharge data from California hospitals to identify patients who had PAD interventions during 2005 to 2009. Logistic regression was used for 12-month reintervention, and Cox proportional hazard regression was used for amputation-free survival comparisons.ResultsA total of 25 635 patients had endovascular procedures (11 389 [44.4%] women). Women were more likely than men (34.5% vs 30.1%, P < .0001) to have critical limb ischemia (CLI). Twelve-month reintervention rate in women was similar to men. Amputation-free survival was better among women than men (hazard ratio 0.84, 95% confidence interval [CI] 0.76-0.93, P = .0006).ConclusionDespite presenting more frequently with CLI, women had better amputation-free survival than men following endovascular procedures. Future research should determine whether findings favor one type of PAD treatment modality over another for women.

Appropriate and accurate assessment and management of lower limb wounds requires a timely, holistic assessment of the patient and their wound, including the recording of an ankle-brachial pressure index (ABPI) (Wounds UK, 2019a). A manual ABPI procedure requires advanced skills, using a handheld ABPI device, and is undertaken by a healthcare professional who is appropriately trained. In addition, the procedure is time consuming, taking a minimum of 40 minutes, and is subjective in its results, based on the technique and skill of the operator. This article describes an innovative service evaluation project that has seen the introduction of 20 automated ABPI machines into 19 general practices and a community vascular clinic in Staffordshire. The project has included the development of a care pathway, recruitment of wound champions, and training within each of the practices. Evaluation of the project is ongoing but tracks ABPI readings, assessment and wound management of patients, onward referrals and outcomes for patients, to ensure that the project's potential to improve patient care is realised. [ABSTRACT FROM AUTHOR]

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This review examines current evidence for baseline functional impairment and changes with therapy in patients with peripheral arterial disease (PAD) – ranging from patients without claudication or critical limb ischemia (CLI) but other exertional leg symptoms (erroneously referred to as asymptomatic in the Fontaine classification system), to patients with claudication and those with CLI. The review points out that the status of functional outcomes research is markedly different in focus and development in the different levels of disease severity – paradoxically less studied in the more severe CLI population than in patients with claudication, for example. [ABSTRACT FROM AUTHOR]

Elevated blood cholesterol is a major risk factor for atherosclerosis. Recent studies show that lowering cholesterol reduces the risk of vascular disease, but the precise mechanisms for vascular improvement are not fully understood. Furthermore, it is not known whether the beneficial effects of cholesterol lowering extend to the skin microvasculature. In this unran-domized, open design study, we used iontophoresis and laser Doppler flowmetry to examine forearm skin perfusion in hypercholesterolaemic patients with PAOD before and after cholesterol- lowering therapy with fluvastatin. Endothelium-dependent and -independent vasodilatation were measured following skin ion-tophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP), respectively. Before cholesterol-lowering, vascular responses to ACh and SNP were reduced significantly in patients compared with responses in control subjects ( p, 0.001 and p, 0.05, ANOVA, respectively). Fluvastatin therapy (40 mg/day) for 24 weeks significantly reduced total cholesterol (7.3 6 0.3 to 6.0 6 0.2 mmol/l, p, 0.001) and LDL cholesterol (5.4 6 0.5 to 4.2 6 0.4 mmol/l, p, 0.01). Vasodilatation to SNP was significantly improved at week 24 ( p, 0.05). In patients with hypercholesterolaemia and PAOD, cholesterol-lowering with statin therapy significantly improved endothelium-independent vascular responses to SNP in skin microvessels. The application of the non-invasive techniques of iontophoresis and laser Doppler flowmetry may provide useful markers for the assessment of microvascular function in this group of patients. [ABSTRACT FROM AUTHOR]

Recurrence of left atrial myxoma is rare. A male aged 18 years developed recurrence of left atrial myxoma despite excision of the tumour along with an ample cuff of the atrial septum around the tumour stalk, two years earlier. The patient presented with peripheral arterial embolus and underwent right femoropopliteal embolectomy and excision of the recurrent atrial myxoma. The presentation of recurrent left atrial myxoma with peripheral arterial embolism has perhaps not been reported earlier. Etiopathology of recurrence of myxomas and surgical treatment are discussed. [ABSTRACT FROM AUTHOR]