Estudos sugerem que a periodontite possa ser um fator de risco para o início, desenvolvimento e desfecho da aterosclerose, por meio de mecanismos bacterianos e imunoinflamatórios. Objetivo: Avaliar a influência do tratamento periodontal (TP) em pacientes com doença arterial obstrutiva periférica (DAOP) e periodontite, correlacionando o perfil inflamatório apresentado por esses pacientes após o TP. Materiais e Métodos: Parâmetros clínicos periodontais (índice de placa IP, índice gengival IG, profundidade de sondagem PS, nível clínico de inserção NCI), e os marcadores imunológicos IL-1β, TNF, IL-6, IL-17, IFN-γ, MMP-8, V-CAM-1 e E-selectina foram analisados em fluido crevicular gengival (FCG) e soro desses pacientes (DAOP/DP) (n=25) após TP completo. As amostras de FCG foram coletadas em 3 tempos: no baseline, 45 e 90 dias após o tratamento e de soro nos tempos: baseline e 90 dias. Após reavaliação do tratamento periodontal não cirúrgico, aos 45 dias, foi realizado a o tratamento cirúrgico nos pacientes que apresentaram bolsas residuais 5 mm. Os parâmetros hematológicos de glicemia em jejum, hemoglobina glicada, triglicérides, colesterol total e frações em sangue periférico foram obtidos no baseline e aos 90 dias. Um grupo com DAOP, mas sem doença periodontal (DAOP) (n=15) foi conduzido, em paralelo, para verificação do padrão de melhora. Resultados: Não foram encontradas reduções significativas no perfil lipídico, glicêmico e inflamatório após o TP nos períodos analisados (p > 0.05). No entanto, observou-se correlação moderada positiva aos 45 dias, do NCI em relação aos níveis de 1Lη (r=0,532; p=0,0157) e aos 90 dias, entre o NCI e IL-17 (r=0,501; p=0,0243), ambas no FCG. No soro também foi observada correlação positiva moderada entre a redução do NCI e diminuição da MMP-8 (r=0,621; p=0,0035) aos 90 dias. Conclusão: O TP repercutiu na redução local das citocinas inflamatórias relacionadas à doença periodontal e na redução sistêmica da MMP-8, que é um mediador importante no processo de ruptura das placas ateroscleróticas / Several studies suggest that periodontitis may be a risk factor for the onset and development of atherosclerosis, through bacterial and immunological mechanisms. Objective: To evaluate the influence of periodontal treatment (PT) in patients with peripheral arterial disease (PAD) and periodontitis and to correlate the inflammatory profile presented by these patients after PT. Materials and Methods: Periodontal clinical parameters (plaque index - PI, gingival index - GI, probing depth - PD, clinical attachment level - CAL) and immunological parameters IL-1β, TNF, IL-6, IL-17 , IFN-γ, MMP-8, V-CAM-1 and E-selectin were analyzed in gingival crevicular fluid (GCF) and serum of these patients (PAD /PD) (n = 25) after complete PT. The GCF samples were collected in 3 times: baseline, 45 and 90 days after treatment and serum at baseline and 90 days. After reassessment of the non-surgical periodontal treatment, at 45 days, the surgical treatment was performed in patients with residual pockets 5 mm. Hematologic parameters of fasting glycemia, glycated hemoglobin, triglycerides, total cholesterol, LDL cholesterol and HDL in peripheral blood were obtained at the baseline and 90 days. A group with PAD, but without periodontal disease (PAD) (n = 15) was conducted in parallel to verify the improvement pattern. Results: There were no significant reductions in the lipid, glycemic and inflammatory profile after PT in the analyzed periods (p> 0.05). However, a moderate positive correlation was observed at 45 days for CAL in relation to the GCF levels of 1L-1 (r = 0.532, p = 0.0157) and between the CAL at 90 days of IL-17 (r = 0.501, p = 0.0243). Moderate positive correlation was also observed in the serum between the reduction of CAL and decrease of MMP-8 (r = 0.621; p = 0.0035) at 90 days. Conclusion: PT has repercussions on the local reduction of inflammatory cytokines related to periodontal disease and on the systemic reduction of MMP-8, which is an important mediator in the process of atherosclerotic plaque rupture

Doença cardiovascular é uma causa importante de morte em pacientes em diálise. Doença arterial obstrutiva periférica (DAOP) é um fator prognóstico de doença cardiovascular. Índice de pressão tornozelo-braquial (ITB) é um método não invasivo usado para o diagnóstico de DAOP. A diferença entre ITB pré e pós diálise ainda não foi formalmente testada e foi um dos objetivos deste estudo. Além disso, nós avaliamos o ITB como marcador de mortalidade em pacientes incidentes em hemodiálise. ITB foi obtido por método oscilométrico automático em uma população de pacientes incidentes em hemodiálise. Este estudo foi desenhado para testar a aplicabilidade da determinação do ITB com o uso de 2 aparelhos oscilométricos simultâneos de pressão arterial (Omron Corp 705 CP Corp, Tokyo, Japan) comparando pré e pós diálise assim como lados direito e esquerdo. 123 pacientes (85 homens e 38 mulheres) idade 53±19 anos foram incluídos. Medidas de pressão arterial do lado direito e do lado esquerdo apresentaram médias semelhantes (p=0,565), assim como em 3 sessões consecutivas de diálise, tempo 1, 2 e 3 (coeficiente de variação menor que 5). Nenhuma diferença foi encontrada entre ITB pré e pós diálise, tanto no lado direito quanto no lado esquerdo, assim como nos tempos 1, 2 e 3. Em pacientes com história de DAOP, o ITB pré vs. pós diálise teve uma tendência a ser significante no lado direito (p=0,088). Durante o período de acompanhamento, 31 pacientes morreram. Estes pacientes eram mais velhos e apresentaram maiores níveis de cálcio. Diabetes, hipertensão e qualquer outro fator de risco cardiovascular não estiveram associados com mortalidade. Pacientes com ITB baixo (<0,9) e alto (>1,3) apresentaram maior mortalidade que pacientes com ITB normal (0.9-1.3). Foi concluído que medidas de ITB pré e pós diálise mostraram baixa variabilidade. O ITB em pacientes com história de DAOP deve ser avaliado com mais atenção. A presente técnica usada neste estudo pode ser usada como marcador de mortalidade em pacientes incidentes em hemodiálise / Cardiovascular disease is an important cause of death in patients on dialysis. Peripheral arterial disease (PAD) is a prognostic factor for cardiovascular disease. Ankle-brachial index (ABI) is a non-invasive method used for the diagnosis of PAD. The difference between ABI pre and post dialysis was not yet formally tested, and it was one objective of this study. In addition, we evaluate the ABI in predict mortality in incident patients on hemodialysis. ABI was assessed by automated oscillometric device in incident patients on hemodialysis. This study was designed to assess the applicability of ABI determination with the employment of two automated oscillometric blood pressure devices simultaneously (Omron Corp 705 CP Corp, Tokyo, Japan), comparing pre and post dialysis as well right and left side. The measurements were done by using two oscillometric devices simultaneously to measure blood pressure in upper and lower extremities. 123 patients (85 men and 35 women), age 53±19 years were enrolled. Blood pressure measurements on the right side and on the left side presented similar means (p=0,565), as well in the consecutive sessions, times 1, 2 and 3, (coefficient of variation lower than 5). We found no difference in ABI pre and post dialysis, either on the right or left side, as well in times 1, 2 and 3. In patients with history of PAD, the ABI pre vs. post dialysis was of borderline significance on the right side (p=0.088). During the follow-up period, 31 patients died. These patients were older and presented higher calcium level. Diabetes, hypertension and any other cardiovascular risk factor were not associated with mortality. Patients with either low ABI or high ABI (<0.9 and >1.3, respectively) presented higher mortality than patients with normal ABI (0.9-1.3). We concluded that ABI measured pre and post dialysis offered low variability. The ABI in patients with history of PAD should be evaluating with caution. The current method applied in this study can predict mortality among incident patients on hemodialysis

A doença arterial periférica (DAP) é uma síndrome degenerativa multifatorial que acomete principalmente idosos e tem como principais características a redução da qualidade de vida e o aumento da mortalidade cardiovascular. Dentre as limitações funcionais impostas pela doença, a mais evidente é a piora da capacidade locomotora decorrente da claudicação intermitente (períodos alternados de isquemia e reperfusão). Atualmente não existem tratamentos farmacológicos capazes de bloquear a progressão da DAP, caracterizada pela redução da capacidade oxidativa muscular, excessivo estresse oxidativo e consequente acúmulo de aldeídos reativos no leito afetado. Com base nisso, o presente trabalho visou caracterizar o papel da enzima aldeído desidrogenase 2 na progressão da DAP. Para isso caracterizamos o modelo animal de DAP, e verificamos que camundongos C57Bl/6 após a cirurgia de oclusão de fluxo apresentam redução da atividade catalítica da enzima ALDH2. Fato acompanhado por uma intolerância ao esforço físico, atrofia e prejuízo na contratilidade muscular, além de desarranjo sarcomérico e mitocondrial. Em modelo de cultura celular, a inativação da enzima ALDH2, após hipóxia e reoxigenação levou à prejuízo na angiogênese e disfunção mitocondrial. Mesmo fenômeno observado nos animais DAP tratados com inibidor, que desenvolveram disfunção mitocondrial e pobre resposta à atividade física. Em modelo de genético de redução da atividade da enzima ALDH2, foi possível ver exacerbada disfunção muscular. Baseado nesses resultados, acreditamos que a enzima ALDH2 desempenha um importante papel na progressão da doença arterial periférica, sendo um possível alvo terapêutico. / Peripheral arterial disease (PAD) is a multifactorial disease which mainly affects elderly reducing quality of life and increasing cardiovascular mortality. Among the functional limitations imposed by the disease, the progressive worsening of locomotor capacity arising from intermittent periods of ischemia and reperfusion, are related to reduced muscle oxidative capacity, excessive oxidative stress and consequent accumulation of reactive aldehydes in the affected leg. We recently demonstrated that lipid peroxidation induced-toxic aldehydes accumulation contributes to ischemic heart disease progression. Interestingly, oxidation of these aldehydes through aldehyde dehydrogenase 2 (ALDH2) activation is cardioprotective. Based on that, this work characterizes the role of ALDH2 during PAD progression. The PAD animal model presents decreased skeletal muscle ALDH2 enzyme activity associated with exercise intolerance, muscle atrophy, poor muscle contraction, skeletal muscle sarcomeric disruption and giant mitochondrial accumulation. After ALDH2 inhibitor treatment, cell culture submitted to hypoxia/reoxygenation stress showed no angiogenesis and mitochondrial dysfunction. Similar data was seen at animal model, where PAD mice treated with ALDH2 inhibitor shows mitochondrial dysfunction, greater atrophy and affected physical exercise response. Also, transgenic mice for ALDH2 (which has a reduced ALDH2 activity) submitted to PAD showed a smaller muscle contraction, compared to wild type PAD mice. Our data points to ALDH2 as an important therapeutic target to develop new therapy strategies to counteract PAD progression.

Peripheral arterial disease (PAD) is a disease which may cause gradual narrowing and possibly congestion of arteries that are responsible for nourishing the lower limbs. Most often this condition develops consequently with atherosclerosis. The most advanced stage of PAD is called critical limb ischemia. The changes induced by atherosclerosis affect not only the lower limb arteries, but at the time of the diagnosis of PAD all arteries in the body are already affected. Therefore PAD belongs among cardiovascular diseases and its diagnosis is a negative prognostic factor of the overall cardiovascular risk. The aim of treatment interventions is to reduce complications that accompany this ailment and their impact on the patient's life. The aim of the thesis was to find out to what extend the patients are informed about the causes of PAD, options of its treatment and the impact of prevention and life style on the overall prognosis of the disease. The first objective of the thesis is to find out if patients are aware of the risks of PAD treatment, one of which is leg amputation. The second objective is to find out whether the patients are sufficiently informed about their condition. The third objective is to evaluate whether patients follow the prescribed treatment. The fourth objective is to find out whether patients are willing to change their life style in order to eliminate the risk of lower limb amputation. A part of interviews with patients was to educate them about their condition, the necessity of following the treatment regimen and the impact of lifestyle on the affected leg prognosis. At the end, the interviewed received educational handouts with information about the most important suggested procedures to follow. The practical part of the thesis is based on qualitative research. The data was collected in semi-structured interviews. The interviews were conducted in two steps. The first step was to educate patients about PAD and distribute informational handouts. The second round of interviews took place intentionally several months after the first ones. Their purpose was to assess the impact of education on patients' compliance with treatment and regimen. The research shows the majority of the interviewed were well-informed about the crucial aspects of their condition and treatment procedures. The participants understood the given information and considered it satisfactory. However, it was surprising that patients had not looked for information themselves. Simultaneously, it was ascertained that most of the respondents were aware of the prognosis and risks related to the treatment. The two-step interviews showed some respondents were not aware of the causes of their disease. It can be therefore assumed that their ignorance of the risk factors and their impact on the development of the disease is the reason why patients do not give enough importance to the suggested treatment regimen. Furthermore, it was found out that they had not look for a substitute solution if they are not able to follow the recommended treatment regimen. The results of this thesis show that although the elimination of the risk factors is crucial for patients' future they do not pay enough attention to them. There are two aspects to it; either patients trivialize the potential risks or are apathetic or are not sufficiently informed. It is hard to have some impact on patients' apathy and trivialization of their condition. Nevertheless, it is possible to influence the second aspect, which is the subject of the final part of the thesis and the educational handout. As was discovered during the interviews, the information provided by doctors during ambulatory treatment is not thorough and does not include practical advice how to follow treatment regimen. Patients should be informed by nurse either personally or during the sessions. In this way the patient should be also selfmotivated in their treatment.

Doença cardiovascular é uma causa importante de morte em pacientes em diálise. Doença arterial obstrutiva periférica (DAOP) é um fator prognóstico de doença cardiovascular. Índice de pressão tornozelo-braquial (ITB) é um método não invasivo usado para o diagnóstico de DAOP. A diferença entre ITB pré e pós diálise ainda não foi formalmente testada e foi um dos objetivos deste estudo. Além disso, nós avaliamos o ITB como marcador de mortalidade em pacientes incidentes em hemodiálise. ITB foi obtido por método oscilométrico automático em uma população de pacientes incidentes em hemodiálise. Este estudo foi desenhado para testar a aplicabilidade da determinação do ITB com o uso de 2 aparelhos oscilométricos simultâneos de pressão arterial (Omron Corp 705 CP Corp, Tokyo, Japan) comparando pré e pós diálise assim como lados direito e esquerdo. 123 pacientes (85 homens e 38 mulheres) idade 53±19 anos foram incluídos. Medidas de pressão arterial do lado direito e do lado esquerdo apresentaram médias semelhantes (p=0,565), assim como em 3 sessões consecutivas de diálise, tempo 1, 2 e 3 (coeficiente de variação menor que 5). Nenhuma diferença foi encontrada entre ITB pré e pós diálise, tanto no lado direito quanto no lado esquerdo, assim como nos tempos 1, 2 e 3. Em pacientes com história de DAOP, o ITB pré vs. pós diálise teve uma tendência a ser significante no lado direito (p=0,088). Durante o período de acompanhamento, 31 pacientes morreram. Estes pacientes eram mais velhos e apresentaram maiores níveis de cálcio. Diabetes, hipertensão e qualquer outro fator de risco cardiovascular não estiveram associados com mortalidade. Pacientes com ITB baixo (<0,9) e alto (>1,3) apresentaram maior mortalidade que pacientes com ITB normal (0.9-1.3). Foi concluído que medidas de ITB pré e pós diálise mostraram baixa variabilidade. O ITB em pacientes com história de DAOP deve ser avaliado com mais atenção. A presente técnica usada neste estudo pode ser usada como marcador de mortalidade em pacientes incidentes em hemodiálise / Cardiovascular disease is an important cause of death in patients on dialysis. Peripheral arterial disease (PAD) is a prognostic factor for cardiovascular disease. Ankle-brachial index (ABI) is a non-invasive method used for the diagnosis of PAD. The difference between ABI pre and post dialysis was not yet formally tested, and it was one objective of this study. In addition, we evaluate the ABI in predict mortality in incident patients on hemodialysis. ABI was assessed by automated oscillometric device in incident patients on hemodialysis. This study was designed to assess the applicability of ABI determination with the employment of two automated oscillometric blood pressure devices simultaneously (Omron Corp 705 CP Corp, Tokyo, Japan), comparing pre and post dialysis as well right and left side. The measurements were done by using two oscillometric devices simultaneously to measure blood pressure in upper and lower extremities. 123 patients (85 men and 35 women), age 53±19 years were enrolled. Blood pressure measurements on the right side and on the left side presented similar means (p=0,565), as well in the consecutive sessions, times 1, 2 and 3, (coefficient of variation lower than 5). We found no difference in ABI pre and post dialysis, either on the right or left side, as well in times 1, 2 and 3. In patients with history of PAD, the ABI pre vs. post dialysis was of borderline significance on the right side (p=0.088). During the follow-up period, 31 patients died. These patients were older and presented higher calcium level. Diabetes, hypertension and any other cardiovascular risk factor were not associated with mortality. Patients with either low ABI or high ABI (<0.9 and >1.3, respectively) presented higher mortality than patients with normal ABI (0.9-1.3). We concluded that ABI measured pre and post dialysis offered low variability. The ABI in patients with history of PAD should be evaluating with caution. The current method applied in this study can predict mortality among incident patients on hemodialysis

Doctor of Philosophy / Department of Anatomy and Physiology / Thomas J. Barstow / Peripheral arterial disease (PAD) is a manifestation of the systemic disease of atherosclerosis that results in arterial stenoses of the lower extremities. Patients with PAD demonstrate slowed dynamics of pulmonary oxygen uptake (VO2 kinetics) following the onset of exercise and a profound reduction in peak oxygen uptake and work capacity. However, whereas the primary pathophysiology of PAD results from the lower extremity hemodynamic limitation, there are abnormalities distal to the arterial stenoses in PAD-affected skeletal muscle that may also contribute to the impaired exercise responses. Thus, the potential contributions of abnormal muscle metabolism versus local circulatory defects in the PAD exercise impairment remains unclear. In this context, the purpose of the dissertation was to advance our understanding of the abnormal pulmonary VO2 kinetics in PAD and characterize the local muscle deoxygenation responses during the rest-exercise transition exercise in health and PAD. The present series of investigations were designed to: 1. localize the abnormal pulmonary VO2 kinetics in PAD to the affected lower extremities, 2. characterize the kinetics of calf muscle deoxygenation during walking in PAD and healthy subjects, 3. describe muscle deoxygenation kinetics in relation to exercise work rate and blood flow in PAD and health, and 4. evaluate the effect of arterial revascularization on pulmonary VO2 kinetics in PAD. These investigations revealed a persistent abnormality in muscle oxygen utilization in PAD-affected skeletal muscle that was not associated with the severity of hemodynamic compromise. In particular, we observed slowed pulmonary VO2 kinetics in PAD only during exercise of the PAD-affected skeletal muscles. Moreover, muscle deoxygenation kinetics following the onset of walking and lower intensity calf exercise were prolonged in PAD subjects while leg blood flow responses were normal. However, at higher work rates, PAD muscle deoxygenation kinetics accelerated, demonstrating a work rate and presumably blood flow dependence. Lastly, arterial revascularization tended to improve, but not consistently normalize, pulmonary VO2 kinetics in PAD subjects. Thus, these investigations demonstrate abnormal oxygen uptake kinetics in PAD and provide evidence that local abnormalities of the affected skeletal muscle may contribute to the abnormal VO2 kinetics and exercise intolerance of patients with PAD.

Orientador: Wilson Nadruz Junior / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T09:54:44Z (GMT). No. of bitstreams: 1 Gemignani_Tiago_D.pdf: 3089084 bytes, checksum: aedee263d43b0d61197caea8058ed566 (MD5) Previous issue date: 2013 / Resumo: As artérias dos membros inferiores são submetidas a uma maior sobrecarga hemodinâmica na posição ortostática. Este estudo avaliou os efeitos da variação postural sobre a tensão circunferencial na parede das artérias poplíteas, carótidas e braquiais, bem como investigou a correlação entre a tensão circunferencial e a presença de placas ateroscleróticas nestas artérias em uma população com fatores de risco cardiovascular. Duzentos e três indivíduos (118 mulheres e 85 homens) com fatores de risco cardiovascular (tabagismo, hipertensão arterial e diabetes mellitus) foram estudados clínica e laboratorialmente, sendo a pressão arterial mensurada nos braços e panturrilhas, tanto em posição supina como ortostática. As artérias foram avaliadas por ultrassonografia, enquanto a tensão circunferencial foi calculada de acordo com a Lei de Laplace. Nos indivíduos participantes, observou-se a presença de placas ateroscleróticas em 47%, 29% e 0% das artérias poplíteas, carótidas e braquiais, respectivamente. As medidas de tensão circunferencial em artérias carótidas não foram associadas à presença de placas ateroscleróticas após ajuste pelas variáveis confundidoras. Por outro lado, as análises de regressão logística e de modelo linear geral mostraram, após ajuste pelas variáveis confundidoras, que a tensão circunferencial sistólica ortostática foi o único parâmetro hemodinâmico local que demonstrou correlação significativa com placas ateroscleróticas poplíteas em toda amostra estudada. Na análise específica por sexos, apesar da correlação positiva com a presença de placas ateroscleróticas poplíteas em ambos os sexos, a tensão circunferencial sistólica ortostática exibiu associação independente com placas ateroscleróticas somente em mulheres, após ajuste pelas variáveis confundidoras. Em conclusão, a tensão circunferencial ortostática poplítea e não a em posição supina, é associada com placas ateroscleróticas em artérias poplíteas, particularmente em mulheres. Estes dados sugerem que a posição ortostática pode desempenhar uma função importante na aterogênese das artérias dos membros inferiores, modificando as forças hemodinâmicas locais, podendo, contudo, haver diferença entre os sexos / Abstract: Lower limb arteries are exposed to higher hemodynamic burden in erectile posture. This study evaluated the effects of body posture on popliteal, carotid and brachial circumferential wall tension (CWT) and investigated the relationship between local CWT and atherosclerotic plaques in subjects with cardiovascular risk factors. Two hundred and three subjects (118 women and 85 men) with cardiovascular risk factors (smoking, hypertension or diabetes mellitus) underwent clinical and laboratory analysis and had their blood pressure measured in the arm and calf in supine and orthostatic positions. Arteries were evaluated by ultrasound analysis, while CWT was calculated according to Laplace's law. Among the enrolled participants, 47%, 29% and none presented popliteal, carotid and brachial plaques, respectively. Carotid CWT measurements were not associated with local plaques after adjustment for potential confounders. Conversely, general linear model and logistic regression analyses adjusted for potential confounders demonstrated that peak orthostatic CWT was the only local hemodynamic parameter showing significant relationship with popliteal plaques in the whole sample. In gender-specific analyses, although positively correlated with popliteal plaques in both genders, local peak orthostatic CWT exhibited an independent association with popliteal plaques after adjustment for potential confounders only in women. In conclusion, popliteal CWT measured in orthostatic posture, rather than in supine position, is associated with popliteal atherosclerotic plaques, particularly in women. These findings suggest that orthostatic posture might play a role in the atherogenesis of leg arteries by modifying local hemodynamic forces and that there may be gender differences in this regard / Doutorado / Clinica Medica / Doutor em Clínica Médica

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-19T18:55:06Z No. of bitstreams: 1 Adilson Santos Andrade de Sousa.pdf: 1247821 bytes, checksum: 9a8380bf13484c105223476f4ae7b8b5 (MD5) / Made available in DSpace on 2018-07-19T18:55:06Z (GMT). No. of bitstreams: 1 Adilson Santos Andrade de Sousa.pdf: 1247821 bytes, checksum: 9a8380bf13484c105223476f4ae7b8b5 (MD5) Previous issue date: 2018-04-29 / Patients with peripheral arterial disease have low levels of physical activity and high cardiovascular risk. Although peripheral arterial disease has a similar prevalence between men and women, studies have shown that the consequences of the disease are extremely different between the sexes. Studies show that women have lower functional capacity and lower levels of physical activity than men. However, the sexes are different from the barriers to the practice of physical activity and cardiovascular health indicators have not yet been studied. Objective: To compare the barriers to the practice of physical activity, cardiovascular function and arterial rigidity among men and women with peripheral arterial disease. Material and Method: this is a descriptive epidemiological study. The study included 267 patients with peripheral arterial disease and symptoms of intermittent claudication divided into two studies, 102 patients in the first study and 167 patients in the second study. The patients were submitted to the evaluation of physical activity level and barriers to the practice of physical activity, as well as cardiovascular health indicators (auscultatory arterial pressure, autonomic cardiovascular modulation, and arterial stiffness). Results: Women had a higher rate of increase by 34% compared to men who presented 29%, women had a rate of increase corrected by 75 beats per minute 31%, men had 25%. Women with peripheral arterial disease had lower levels of physical activity with moderate and vigorous intensity and reported more frequently than the following barriers to physical activity: lack of companionship to practice physical activity, fear of physical activity aggravate the disease, no place to sit when pain is felt and no place to practice physical activity. Conclusion: Regarding the cardiovascular variables, women present higher reflected wave indicators than men, as well as presented more barriers to physical activity compared to men. / Pacientes com doença arterial periférica apresentam baixos níveis de atividade física e elevado risco cardiovascular. Embora a doença arterial periférica tenha prevalência similar entre homens e mulheres, estudos têm mostrado que as consequências da doença são extremamente diferentes entre os sexos. Estudos mostram que as mulheres apresentam menor capacidade funcional e menores níveis de atividade física do que os homens. Porém, o quanto os sexos são diferentes às barreiras para a prática de atividade física e os indicadores de saúde cardiovascular ainda não foram estudados. Objetivo: Comparar as barreiras para a prática de atividade física, função cardiovascular e rigidez arterial entre homens e mulheres com doença arterial periférica. Material e Método: trata-se de um estudo epidemiológico descritivo. Fizeram parte do estudo 267 pacientes com doença arterial periférica e sintomas de claudicação intermitente divididos em dois estudos, no primeiro estudo foram 102 pacientes e no segundo estudo 167 pacientes. Os pacientes foram submetidos à avaliação do nível de atividade física e das barreiras para a prática de atividade física, bem como dos indicadores da saúde cardiovascular (pressão arterial auscultatória, modulação autonômica cardiovascular, e rigidez arterial).Resultados: As mulheres apresentaram maior índice de aumento 34% em comparação aos homens que apresentaram 29%, as mulheres apresentaram um índice de aumento corrigido por 75 batimentos por minuto 31%, os homens apresentaram 25%. As mulheres com doença arterial periférica apresentaram menores níveis de atividade física com intensidade moderada e vigorosa e reportam mais frequentemente que as seguintes barreiras para a prática de atividade físca: falta de companhia para a prática de atividade física, medo da atividade física agravar a doença, não ter lugar para sentar quando sente dor e não ter lugar para a prática de atividade física. Conclusão: Com relação às variáveis cardiovasculares as mulheres apresentam maiores indicadores de onda refletida do que os homens, bem como apresentaram mais barreiras para a prática de atividade física em comparação aos homens.

Popliteal artery entrapment syndrome has been reported to be a rare disease typically found in athletic and otherwise healthy young adults. It manifests as a temporary lower limb pain that occurs in connection with physical exercise. It is caused by an anatomic anomaly, usually anaberrant head of the gastrocnemius muscle that compresses the popliteal artery on the backside of the knee joint. The popliteal artery is the main vessel supplying blood to the lower part of the leg and the condition, if left untreated, can lead to serious complications such as thrombosis or aneurysm. If detected in time and surgically corrected patients can expect full recovery within weeks.The purpose of this study was to examine a group of healthy asymptomatic individuals (n=50)using ultrasound and a series of provocation to see if there was a possibility of entrapment. A secondary objective was to find which maneuvers during the ultrasound would provide the best results. They were subjected to ultrasound examinations at rest, during plantar flexion without resistance, against a light resistance and against substantial resistance.The results showed that most of the test subjects could temporarily constrict blood flow greatly although ultrasound imagery alone was not enough to confirm diagnosis. It seems that detected occlusion of the artery in conjunction with other diagnostic data such as AnkleBrachial Index and symptomatology can be useful both in confirming or ruling out PAESwithout the use of more expensive and invasive methods.

Introduction Bypass surgery for infrainguinal disease is indicated when a patient presents with chronic (disabling claudication or chronic limb-threatening ischaemia) or acute ischemia. Duplex ultrasound surveillance can be used in the follow-up period to detect grafts in risk of failure. If detected before occlusion occurs an intervention can prolong patency. Aim The purpose of this study was to evaluate the outcome of the procedure, whether there are factors associated with no improvement, and to elucidate the value of routine ultrasound surveillance. Methods Patients who underwent lower extremity bypass surgery at Falu hospital between 2010 and 2020 were identified from the national registry Swedvasc. Clinical outcome was based on change in the Rutherford classification. Duplex ultrasound measured peak systolic velocities. A significant stenosis was defined as a 2-3.5-fold increase in ratio of adjacent velocities in the bypass. For a non-significant stenosis, the ratio had to be increased but by less than 2 times. Results 114 patients underwent bypass surgery. Mean age was 70 years. Postoperative surveillance was carried out for 78 patients. Of these, 40 (51.3%) presented with an abnormality and further 30 of them (75%) received further intervention. There was a correlation between cardiac risk and outcome at the 30-day follow-up. For the majority of the not-surveilled, a major adverse event occurred within 1 year. Conclusions Bypass surgery was beneficial for the majority. Cardiac risk was a negative predictor for outcome. Most patients attending the surveillance benefited from early detection of risk of graft failure. To improve its value and efficacy, guidelines are needed within the clinic.