Asymptomatic peripheral artery disease: Silent but deadly

Peripheral Artery Disease (PAD) is a manifestation of atherosclerosis characterized by diminished perfusion of the limb and a state of dysmetabolism. The asymptomatic PAD phenotype is a relatively recent classification. It is unknown how many people currently live with asymptomatic PAD because there are no universal screening recommendations for patients at risk for PAD. Patients with asymptomatic PAD suffer from a similar risk profile of morbidity and mortality as their counterparts with claudication. Despite this increased risk, there is a dearth of clinical investigations into therapies that specifically benefit the asymptomatic PAD population.

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Maurice Green
Clinical validation of smartphone-based activity tracking in peripheral artery disease patients

Peripheral artery disease (PAD) is a vascular disease that leads to reduced blood flow to the limbs, often causing claudication symptoms that impair patients’ ability to walk. The distance walked during a 6-min walk test (6MWT) correlates well with patient claudication symptoms, so we developed the VascTrac iPhone app as a platform for monitoring PAD using a digital 6MWT. In this study, we evaluate the accuracy of the built-in iPhone distance and step-counting algorithms during 6MWTs. One hundred and fourteen (114) participants with PAD performed a supervised 6MWT using the VascTrac app while simultaneously wearing an ActiGraph GT9X Activity Monitor. Steps and distance-walked during the 6MWT were manually measured and used to assess the bias in the iPhone CMPedometer algorithms.

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Stephen Jacobs
Diabetic Foot Ulcers: Prevention, Diagnosis and Classification

Diabetic foot complications are the most common cause of nontraumatic lower extremity amputations in the industrialized world. The risk of lower extremity amputation is 15 to 46 times higher in diabetics than in persons who do not have diabetes mellitus. Furthermore, foot complications are the most frequent reason for hospitalization in patients with diabetes, accounting for up to 25 percent of all diabetic admissions in the United States and Great Britain.

Peripheral arterial occlusive disease is four times more prevalent in diabetics than in non-diabetics. The arterial occlusion typically involves the tibial and peroneal arteries but spares the dorsalis pedis artery. Smoking, hypertension and hyperlipidemia commonly contribute to the increased prevalence of peripheral arterial occlusive disease in diabetics.

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Irene Jaffe
Physical Activity Levels in Peripheral Artery Disease Patients

Patients with peripheral artery disease (PAD) and symptoms of intermittent claudication have walking impairment, several comorbid conditions and increased cardiovascular risk,1,2 due to the disease characteristics and severity. Supervised exercise training has been considered a cornerstone in the clinical therapeutic approach in PAD patients,3 as it improves several components of physical function and quality of life.4-6 Similarly, positive effects of device-monitored, home-based exercise training programs to improve the walking capacity in these patients have also been reported.7 However, these interventions are available for a restricted number of patients, limiting applicability in the public health context. Therefore, recommendations to increase physical activity levels remain the most often used approach in clinical practice.

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Stephen Jacobs
Discordance of peripheral artery disease diagnosis

Lower extremity arterial disease (LEAD) is a highly prevalent disease with more than 200 million patients affected worldwide with only half presenting exertional limb symptoms.. The measurement of the ankle-brachial pressure index at rest (ABI) is the gold standard method for diagnosis of LEAD, with a value greater than 0.90 being considered normal. However, in some cases, ABI can be normal in spite of the presence of exertional limb symptoms. In these cases, international guidelines recommend to perform other tests, including exercise tests.

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Stephen JacobsComment