Prabhakar, D (2014) Study the prevalence of Asymptomatic Carotid Artery Disease in patients with Critical Limb Ischemia. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION: Carotid artery disease is associated with a risk of stroke. Approximately 88% of strokes are ischemic and about 20% of these originate from large artery stenosis. To prevent ischemic stroke, carotid endarterectomy has been recommended for asymptomatic patients with severe carotid stenosis based on evidence from multicenter prospective randomized trials. Carotid duplex ultrasonography (CDUS) is an accuracy-proven non-invasive diagnostic examination to detect asymptomatic carotid artery stenosis (ACAS). However, for the general population, CDUS has a limited role in screening of carotid disease because of a low overall prevalence of clinically relevant disease. Because coronary artery disease (CAD), cerebrovascular disease (CVD) and peripheral arterial disease (PAD) originate from atherosclerosis, these three diseases occasionally exist together. Therefore, screening CDUS may be useful for those populations. Several previous studies reported that the prevalence of ACAS was relatively high in patients with critical limb ischemia. In India, the prevalence of asymptomatic carotid artery disease in patients with critical limb ischemia has not yet been reported. AIM OF THE STUDY: 1. To study the prevalence of Asymptomatic Carotid Artery Disease in patients with Critical Limb Ischemia. 2. To identify predictive factors of ACAD in patients with CLI. MATERIALS AND METHODS: 250 consecutive patients with critical limb ischemia admitted in our department underwent carotid duplex scanning. A questionnaire was used to collect data concerning known risk factors. INCLUSION CRITERIA: Patients with critical limb ischemia. Age > 30 yrs. EXCLUSION CRITERIA: 1. Known CVA patients. 2. Patients with history of TIA. 3. Previous carotid artery intervention. METHOD: For all patients Carotid duplex scan was done by the Radiology department. Carotid lesions were documented using Modified Washington duplex criteria. ANALYSIS: Two hundred and fifty consecutive patients were studied over 1 year. The mean age of the patients was 50±20 years; there were 242 (96.8%) men and 8 (3.2%) women; 72% of the patients had a history of smoking, 10.4% had coronary artery disease, 5.6% had hypertension, 5.6 % had dyslipidemia and 17.2% had diabetes mellitus. Eighteen (7%) patients had carotid artery disease detected by carotid artery duplex scanning of which insignificant Carotid artery disease found in 10 patients, significant carotid artery stenosis in 5 patients and complete occlusion of ICA in 3 patients. CONCLUSION: The prevalence of asymptomatic carotid artery disease in Indian subgroup patients with critical limb ischemia is 7%. However this study demonstrates a relatively high prevalence of carotid artery disease in patients with peripheral arterial disease due to atherosclerotic occlusion is 16.4% (p < 0.05) which is statistically significant. All patients with peripheral vascular disease with large vessel occlusion due atherosclerosis have to be screened for carotid artery disease.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Asymptomatic Carotid Artery Disease, Critical Limb Ischemia. |
| Subjects: | MEDICAL > Vascular Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 15 Feb 2020 04:01 |
| Last Modified: | 20 Feb 2020 00:53 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/11945 |
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