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Related Concept Videos

Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation01:21

Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation

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Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
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Peripheral Artery Disease III: Interprofessional Care01:27

Peripheral Artery Disease III: Interprofessional Care

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Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
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Peripheral Artery Disease IV: Nursing Management01:26

Peripheral Artery Disease IV: Nursing Management

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 The nursing management of a patient with peripheral artery disease (PAD) begins with a thorough assessment of the patient’s health history and clinical manifestations.AssessmentHealth History: Evaluate the patient’s history of hypertension, hyperlipidemia, family history of cardiovascular issues, and lifestyle factors such as dietary patterns, smoking, and physical activity.Physical Examination:Assess the affected extremity for decreased or absent peripheral pulses,...
13
Peripheral Artery Disease I: Introduction01:30

Peripheral Artery Disease I: Introduction

11
Peripheral artery disease (PAD) predominantly results from atherosclerosis, which involves the accumulation of fatty deposits, or plaques, within the walls of arteries. This causes them to narrow and harden, significantly reducing blood flow. PAD predominantly affects the legs but also impacts other areas, such as the arms, thereby impairing overall circulation and organ function.Etiology of PAD:The principal cause of PAD is atherosclerosis, which results from fatty deposits inside the arterial...
11
Peripheral Artery Disease V: Postoperative Nursing Management01:23

Peripheral Artery Disease V: Postoperative Nursing Management

13
During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
13
Assessment of the Cardiovascular System III: Palpation01:27

Assessment of the Cardiovascular System III: Palpation

394
Palpation involves feeling the body to evaluate texture, size, consistency, and tenderness for assessing cardiovascular health. The following steps are organized in a head-to-toe order:
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...
394

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Racial Differences in Presentation and Outcomes After Peripheral Arterial Interventions: Insights From the NCDR-PVI

Howard M Julien1,2,3,4,5, Yongfei Wang6,7, Jeptha P Curtis6,7

  • 1Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (H.M.J., H.J.-C., L.A.E., A.S.N., A.C.F., S.A.M.K., T.K., C.B., G.C., J.C.).

Circulation. Cardiovascular Interventions
|June 20, 2023
PubMed
Summary

Black patients undergoing peripheral arterial intervention (PVI) had worse socioeconomic factors but received advanced therapies at similar rates. They experienced fewer repeat revascularizations and surgical interventions post-PVI.

Keywords:
angioplastyatherectomyischemic strokeperipheral artery diseaseracial groupsregistriessocial determinants of health

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Area of Science:

  • Cardiovascular Medicine
  • Health Disparities
  • Interventional Cardiology

Background:

  • Peripheral arterial intervention (PVI) is crucial for lower extremity artery disease.
  • Racial disparities in device use and outcomes for PVI are not fully understood.
  • The American College of Cardiology National Cardiovascular Data Registry-Peripheral Vascular Intervention (PVI) registry provides a valuable dataset for this analysis.

Purpose of the Study:

  • To assess racial differences in device utilization and clinical outcomes among patients undergoing lower extremity PVI.
  • To identify factors associated with the use of specific technologies like drug-eluting devices, intravascular imaging, and atherectomy.
  • To compare 1-year mortality, amputation rates, and repeat revascularizations between Black and White patients.

Main Methods:

  • Analysis of PVI registry data from April 2014 to March 2019.
  • Socioeconomic status evaluated using the Distressed Community Index.
  • Multivariable logistic regression and Cox proportional hazards models used for adjusted analyses.

Main Results:

  • Black patients (11.8%) were younger, had more comorbidities, and lower socioeconomic status than White patients.
  • Similar utilization rates for atherectomy and intravascular imaging, but higher rates of drug-eluting technologies in Black patients.
  • Black patients had lower rates of acute kidney injury, surgical revascularization, and repeat PVI at 1 year, with no difference in mortality or major amputation.

Conclusions:

  • Black patients undergoing PVI present with greater socioeconomic challenges and comorbidities.
  • Despite these factors, Black patients received advanced therapies at comparable rates and had fewer repeat interventions.
  • Findings highlight the need to address socioeconomic determinants of health in peripheral vascular interventions.