Differences in presentation of symptoms between women and men with intermittent claudication

<p>Abstract</p> <p>Background</p> <p>More women than men have PAD with exception for the stage intermittent claudication (IC). The purpose of this study was to evaluate differences in disease characteristics between men and women when using current diagnostic criteria for making the diagnosis IC, defined as ABI < 0.9 and walking problems.</p> <p>Study Design</p> <p>Cohort study</p> <p>Methods</p> <p>5040 elderly (median age 71) subjects participated in a point-prevalence study 2004. They had their ABI measured and filled out questionnaires covering medical history, current medication, PAD symptoms and walking ability. The prevalence of IC was 6.5% for women and 7.2% for men (P = 0.09). A subset of subjects with IC (N = 56) was followed up four years later with the same procedures. They also performed additional tests aiming to determine all factors influencing walking ability.</p> <p>Results</p> <p>Men with IC had more concomitant cardiovascular disease and a more profound smoking history than women. Women, on the other hand, reported a lower walking speed (P < 0.01) and more joint problems (P = 0.018). In the follow up cohort ABI, walking ability and amount of atherosclerosis were similar among the sexes, but women more often reported atypical IC symptoms.</p> <p>Conclusion</p> <p>Sex differences in the description of IC symptoms may influence diagnosis even if objective features of PAD are similar. This may influence accuracy of prevalence estimates and selection to treatment.</p

International Variations in Amputation Practice : A VASCUNET Report

Objectives: To study international differences in incidence and practice patterns as well as time trends in lower limb amputations related to peripheral arterial disease and/or diabetes mellitus. Methods: Data on lower limb amputations during 2010-2014 were collected from population based administrative data from countries in Europe and Australasia participating in the VASCUNET collaboration. Amputation rates, time trends, in hospital or 30 day mortality and reimbursement systems were analysed. Results: Data from 12 countries covering 259 million inhabitants in 2014 were included. Individuals aged >= 65 years ranged from 12.9% (Slovakia) to 20.7% (Germany) and diabetes prevalence among amputees from 25.7% (Finland) to 74.3% (Slovakia). The mean incidence of major amputation varied between 7.2/100,000 (New Zealand) and 41.4/100,000 (Hungary), with an overall declining time trend with the exception of Slovakia, while minor amputations increased over time. The older age group (>= 65 years) was up to 4.9 times more likely to be amputated compared with those younger than 65 years. Reported mortality rates were lowest in Finland (6.3%) and highest in Hungary (20.3%). Countries with a fee for service reimbursement system had a lower incidence of major amputation compared with countries with a population based reimbursement system (14.3/100,000 versus 18.4/100,000, respectively, p <.001). Conclusions: This international audit showed large geographical differences in major amputation rates, by a factor of almost six, and an overall declining time trend during the 4 year observation of this study. Diabetes prevalence, age distribution, and mortality rates were also found to vary between countries. Despite limitations attributable to registry data, these findings are important, and warrant further research on how to improve limb salvage in different demographic settings. (C) 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.Peer reviewe

International variations and sex disparities in the treatment of peripheral arterial occlusive disease : a report from VASCUNET and the International Consortium Of Vascular Registries

Objective: The aim of this study was to determine sex specific differences in the invasive treatment of symptomatic peripheral arterial occlusive disease (PAOD) between member states participating in the VASCUNET and International Consortium of Vascular Registries.Methods: Data on open surgical revascularisation and peripheral vascular intervention (PVI) of symptomatic PAOD from 2010 to 2017 were collected from population based administrative and registry data from 11 countries. Differences in age, sex, indication, and invasive treatment modality were analysed.Results: Data from 11 countries covering 671 million inhabitants and 1 164 497 hospitalisations (40% women, mean age 72 years, 49% with intermittent claudication, 54% treated with PVI) in Europe (including Russia), North America, Australia, and New Zealand were included. Patient selection and treatment modality varied widely for the proportion of female patients (23% in Portugal and 46% in Sweden), the proportion of patients with claudication (6% in Italy and 69% in Russia), patients’ mean age (70 years in the USA and 76 years in Italy), the proportion of octogenarians (8% in Russia and 33% in Sweden), and the proportion of PVI (24% in Russia and 88% in Italy). Numerous differences between females and males were observed in regard to patient age (72 vs. 70 years), the proportion of octogenarians (28% vs. 15%), proportion of patients with claudication (45% vs. 51%), proportion of PVI (57% vs. 51%), and length of hospital stay (7 days vs. 6 days).Conclusion: Remarkable differences regarding the proportion of peripheral vascular interventions, patients with claudication, and octogenarians were seen across countries and sexes. Future studies should address the underlying reasons for this, including the impact of national societal guidelines, reimbursement, and differences in health maintenance.peer-reviewe

International Consortium of Vascular Registries Consensus Recommendations for Peripheral Revascularisation Registry Data Collection

Objective/Background: To achieve consensus on the minimum core data set for evaluation of peripheral arterial revascularisation outcomes and enable collaboration among international registries. Methods: A modified Delphi approach was used to achieve consensus among international vascular surgeons and registry members of the International Consortium of Vascular Registries (ICVR). Variables, including definitions, from registries covering open and endovascular surgery, representing 14 countries in ICVR, were collected and analysed to define a minimum core data set and to develop an optimum data set for registries. Up to three different levels of variable specification were suggested to allow inclusion of registries with simpler versus more complex data capture, while still allowing for data aggregation based on harmonised core definitions. Results: Among 31 invited experts, 25 completed five Delphi rounds via internet exchange and face to face discussions. In total, 187 different items from the various registry data forms were identified for potential inclusion in the recommended data set. Ultimately, 79 items were recommended for inclusion in minimum core data sets, including 65 items in the level 1 data set, and an additional 14 items in the more specific level 2 and 3 recommended data sets. Data elements were broadly divided into (i) patient characteristics; (ii) comorbidities; (iii) current medications; (iv) lesion treated; (v) procedure; (vi) bypass; (vii) endarterectomy (viii) catheter based intervention; (ix) complications; and (x) follow up. Conclusion: A modified Delphi study allowed 25 international vascular registry experts to achieve a consensus recommendation for a minimum core data set and an optimum data set for peripheral arterial revascularisation registries. Continued global harmonisation of registry infrastructure and definition of items will overcome limitations related to single country investigations and enhance the development of real world evidence. (C) 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.Peer reviewe

Epidemiological aspects of peripheral arterial disease

Peripheral arterial disease (PAD) is defined as atherosclerosis in the arteries distal to the aortic bifurcation, with or without symptoms in the legs. It is diagnosed by ankle brachial pressure index (ABI) measurements and symptoms, and a confirmed diagnosis is associated with an increased cardiovascular (CV) mortality reaching the same levels as in patients with symptomatic coronary disease. The overall aim of this study was to describe PAD epidemiology and its consequences from a societal perspective with special focus on sex differences. Eight-thousand subjects, aged 60-90 years, were selected at random and invited to participate in a survey performed in 2004. Of those 63% participated and had their ABI measured and they also completed questionnaires covering medical history, current medication, PAD symptoms and walking ability. A subset of subjects with intermittent claudication (IC) at inclusion was followed up 2008 with the same procedures. A walking test and duplex scanning of leg arteries, echocardiography and an interview were added to gain further insight of disease specifics. Survey data and published studies were finally used to estimate cost-effectiveness of CV risk prevention with drugs in subclinical PAD. PAD prevalence was 18% and varied with stage of disease, geographic region and patients sex. Women dominated when diagnosis was based on ABI only, but for diagnosis of IC, it was more frequent among men. The prevalence of critical limb ischemia was around one percent. Risk factor profiles differed among PAD stages and sexes. Men, for example, reported having diabetes mellitus and stroke more often than women, who in turn reported hypertension more frequently. Smoking for 10 years was associated with having PAD in women, but for men this relationship occurred first after 30 years of smoking. Women also reported use of less CV preventive medication. Women with IC had a lower walking speed and more joint problems than men, and in the follow up cohort most IC disease specifics were similar. Another difference was that women reported atypical symptoms more often than men. The cost-effectiveness modelling revealed that of the evaluated drugs, ACE-inhibitors (ACE-i), statins, aspirin and clopidogrel, there were differences. ACE-i displayed the largest reduction of CV events leading to the highest mean gain in quality-adjusted life-years compared with the other treatments. It was far below willingness to pay thresholds. Aspirin treatment did not appear to be cost-effective due to low rate of event reduction. In conclusion, the studies performed in this thesis points out that PAD is common among elderly, and especially so in women. Risk factors occurring simultaneously with PAD are the known ones and many subjects with this disease have only PAD and do not report smoking habits. A majority is not medicating to reduce their high CV disease risk. Diagnosis of IC is a particular problem for epidemiological studies, and the prevalence of this PAD stage may therefore be underestimated in women. ACE-i may be the drug of choice for early prevention of CV risk in PAD and the benefits of aspirin may be overrated

RESEARCH ARTICLE Open Access

Differences in presentation of symptoms between women and men with intermittent claudicatio

The Swedish vascular registry Swedvasc 1987-2018 : 31years of quality improvement and research

The Swedish vascular registry, Swedvasc, was created in 1987 as aregional registry and achieved national coverage in 1994. This article describes how the registry developed during those 31years. The aims of the registry were to enhance quality improvement and research within the field of vascular surgery. The registry was validated on several occasions and in 2015 an independent international validation took place, showing both excellent external (no missing cases) and internal validity (comparing the variables in the registry with case records). The Swedvasc was instrumental in the creation of Vascunet in 1997, the international collaboration of vascular registries in Europe, Australia and New Zealand. Enabling international comparisons of indications, techniques and outcomes has proven to be agreat force in quality improvement. This collaboration is now turning global, including the North American registry the Society for Vascular Surgery Vascular Quality Initiative (SVS-VQI) and hopefully soon also including the Japanese registry. The Swedvasc is used as an integral part of routine healthcare and over 10,000 procedures are registered annually. This provides clinicians, clinics, health authorities and researchers with real-world data from an unselected nationwide population. Registry data have been used to describe patterns of treatment and outcomes over time and for monitoring quality of care locally, nationally and internationally and for quality improvement projects. The clinical data available in Swedvasc provide an important source not only for assessment and development of healthcare but also for research and over 100 original articles based on Swedvasc data have been published. Arandomization module has been included in the registry since 2014 and opens up anew clinical trial paradigm; registry-based randomized clinical trials