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Published on: October 22, 2014
The prevalence of polyvascular disease in patients referred for peripheral arterial disease
R Vidakovic1, O Schouten, R Kuiper
1Department of Vascular Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands.
Insights
Polyvascular disease is common in vascular surgery patients. Higher inflammation levels, indicated by high-sensitivity C-reactive protein (hs-CRP), correlate with more affected vascular territories.
Area of Science:
- Vascular Surgery
- Cardiovascular Disease
- Inflammation Markers
Background:
- Peripheral arterial disease (PAD) often coexists with atherosclerosis in other vascular beds.
- Understanding the prevalence and drivers of polyvascular disease is crucial for risk stratification.
Purpose of the Study:
- To assess polyvascular disease in patients with PAD.
- To investigate the relationship between polyvascular disease, inflammation, and clinical risk factors.
Main Methods:
- 431 vascular surgery patients with atherosclerosis were studied.
- Ultrasonography assessed atherosclerosis in carotid, cardiac, abdominal aorta, and lower limb territories.
- High-sensitivity C-reactive protein (hs-CRP) and cardiovascular risk factors were recorded.
Main Results:
- Polyvascular disease was present in 71% of patients.
- hs-CRP levels significantly increased with the number of affected vascular territories (p<0.001).
- Age ≥70, male gender, BMI ≥25 kg/m², and hs-CRP were independently associated with polyvascular disease.
Conclusions:
- Polyvascular disease is highly prevalent in vascular surgery patients.
- Systemic inflammation, measured by hs-CRP, is moderately associated with the extent of polyvascular disease.
Objective:
To objectively assess the presence of polyvascular disease in patients with peripheral arterial disease and its relation to inflammation and clinical risk factors.
Methods:
A total of 431 vascular surgery patients (mean age 68 years, men 77%) with atherosclerotic disease were enrolled. The presence of atherosclerosis was assessed using ultrasonography. Affected territories were defined as: (1) carotid, stenosis of common or internal carotid artery of >or=50%, (2) cardiac, left ventricular wall motion abnormalities, (3) abdominal aorta, diameter >or=30 mm and (4) lower limb, ankle-brachial pressure index <0.9. Cardiovascular risk factors and high-sensitivity C-reactive protein (hs-CRP) levels were noted in all.
Results:
One vascular territory was affected in 29% of the patients, whereas polyvascular disease was found in 71%: two affected territories in 45%, three in 23% and four in 3% of patients. Levels of hs-CRP increased with the number of affected vascular territories (p<0.001). Multivariable logistic regression analysis showed age >or=70 years, male gender, body mass index (BMI)>or=25 kg m(-2), and hs-CRP to be independently associated with polyvascular disease.
Conclusion:
Polyvascular disease is a common condition in patients who have undergone vascular surgery. The level of systemic inflammation, reflected by hs-CRP levels, is moderately associated with the extent of polyvascular disease.
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Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above the...