The relationship between contrast-induced nephropathy (CIN) and oxidative mechanisms is well documented. Our aim was to demonstrate the possible relationship between CIN and serum bilirubin as an antioxidant molecule. This retrospective study included 359 patients with peripheral artery disease (PAD) who underwent peripheral diagnostic angiography; 179 developed CIN after the intervention and another 180 were the control group, matched for age, gender, and cardiovascular risk factors. Baseline, 48- to 72-hour, and 30-day laboratory values, major adverse cardiovascular events, and dialysis requirements were recorded. Patients with CIN had significantly higher levels of uric acid, red cell distribution width, and neutrophil-to-lymphocyte ratio (NLR) but lower total bilirubin compared to the control patients ( P < .05). Multivariate logistic regression analysis showed that diabetes mellitus, left ventricular ejection fraction, uric acid, NLR, and total bilirubin levels were independent predictors of CIN development ( P = .01, P = .001, P = .001, P = .01, and P = .001, respectively). This study demonstrated that decreased total bilirubin was associated with CIN development after the administration of radiocontrast agents in patients with PAD.

The relationship between bilirubin levels and peripheral artery disease has been documented. Our aim was to demonstrate the possible relationship between serum bilirubin levels and abdominal aortic aneurysms (AAAs). The study included 219 patients, 110 had a previous diagnosis of AAA and 109 patients were normal controls. Only patients with AAAs which had a size of 40 to 54 mm were included in the study. Baseline laboratory values and 2 computerized tomographic measurements 12 months apart were recorded. Patients with AAA had significantly higher white blood cell (WBC) counts and neutrophil–lymphocyte ratio (NLR) but lower total and direct bilirubin levels compared with the control patients (P < .05). Multivariate logistic regression analysis showed that WBC, NLR, and total and direct bilirubin levels were independent predictors of the presence of an AAA (P = .03, P = .001, P = .001, and P = .001, respectively). White blood cells and total bilirubin level were independent predictors of a rapidly enlarging AAA (>10 mm/y, P = .002 and P < .001, respectively). This study demonstrated that increased WBC and decreased total bilirubin levels were independent predictors of an AAA, especially the subgroup in which the AAA was rapidly expanding.

Background: Lower extremity arterial disease (LEAD) is a well-established risk factor for concomitant coronary artery disease (CAD). There are no published data combining all three lower limb arterial segments (aortoiliac, femoropopliteal and below the knee vessels) in order to estimate CAD severity in LEAD patients. Herein has been derived a new scoring system for this purpose, which uses the well-known TASC II classification, Syntax score and, for the first time in medical literature, a Syntax II score. Methods: The study population consisted of 178 patients who underwent lower limb and coronary diagnostic angiography for assessment of LEAD and CAD at the same session. Syntax and Syntax II scores were calculated. TASC II classifications of the lower limb arteries were done. A new scoring system, called “Total Peripheral Score” (TPS), for lower limbs was also calculated. Results: A positive correlation was found between Total Peripheral Score and Syntax score and a less prominent positive correlation between Total Peripheral Score and Syntax II score (p < 0.001). A cut-off value of ‘6’ for the new score was found for estimating high risk subgorup of CAD (Syntax score > 32) (p < 0.001). Critical femoropopliteal arterial segment stenosis was the most predictive lower limb arterial zone for presence of severe CAD (Syntax score > 32) (p = 0.011). Conclusions: Taking into account all lower limb arterial segments for predicting CAD during lower limb arterial angiography was recommended. A Total Peripheral Score of more than ‘6’ is the practical cut-off value for estimating severe CAD. Femoropopliteal arterial critical stenosis is the most predictive arterial zone for estimating severe CAD. Background: Lower extremity arterial disease (LEAD) is a well-established risk factor for concomitant coronary artery disease (CAD). There are no published data combining all three lower limb arterial segments (aortoiliac, femoropopliteal and below the knee vessels) in order to estimate CAD severity in LEAD patients. Herein has been derived a new scoring system for this purpose, which uses the well-known TASC II classification, Syntax score and, for the first time in medical literature, a Syntax II score. Methods: The study population consisted of 178 patients who underwent lower limb and coronary diagnostic angiography for assessment of LEAD and CAD at the same session. Syntax and Syntax II scores were calculated. TASC II classifications of the lower limb arteries were done. A new scoring system, called “Total Peripheral Score” (TPS), for lower limbs was also calculated. Results: A positive correlation was found between Total Peripheral Score and Syntax score and a less prominent positive correlation between Total Peripheral Score and Syntax II score (p < 0.001). A cut-off value of ‘6’ for the new score was found for estimating high risk subgorup of CAD (Syntax score > 32) (p < 0.001). Critical femoropopliteal arterial segment stenosis was the most predictive lower limb arterial zone for presence of severe CAD (Syntax score > 32) (p = 0.011). Conclusions: Taking into account all lower limb arterial segments for predicting CAD during lower limb arterial angiography was recommended. A Total Peripheral Score of more than ‘6’ is the practical cut-off value for estimating severe CAD. Femoropopliteal arterial critical stenosis is the most predictive arterial zone for estimating severe CAD.

Vuruskan E, et al. Korean Circ J. 2015 Dec;46:0310. https://doi.org/10.4070/kcj.2016.0310

Background: The aim of this study was to compare the simultaneous double-protection method (proximal balloon plus distal filter) with distal-filter protection or proximal-balloon protection alone in asymptomatic patients during carotid artery stenting. Patients and methods: 119 consecutive patients were investigated for carotid artery stentings in the extracranial internal carotid artery with the use of distal filters (n = 41, 34.4 %), proximal balloon (MoMa) protection (n = 40, 33.6 %) or double protection (n = 38, 31.9 %). Magnetic resonance imaging (MRI) was performed on all patients before the procedure, and control diffusion-weighted MRI (DW-MRI) was obtained within 24–48 h after the procedure. Procedural data, complications, success rate, major adverse cardiovascular events, and MRI findings were collected. Results: New cerebral high-intensity (HI) lesions were observed in 47 (39.4 %) patients. HI lesions were observed in 22 (53.6 %), 15 (37.5 %), and 10 (26.3 %) of the patients with distal filters, proximal protection, and double protection, respectively (p = 0.004). The average number of HI lesions on DW-MRI was 1.80 in the distal-filter group, 0.90 in the proximal-balloon group, and 0.55 in the double-protection group (p < 0.001). Procedure and fluoroscopy times were slightly longer in the double-protection group compared to the distal- or proximal-protection groups (p = 0.001). Conclusions: The double (proximal plus distal) cerebral embolic protection technique is safe and effective for minimizing the risk of cerebral embolization, even in patients with asymptomatic carotid artery stenosis, despite slightly longer procedure and fluoroscopy times.

Worldwide, over 200 million people are diagnosed with lower extremity arterial disease (LEAD). LEAD significantly increases the risk of death and amputation of the lower limb. A new classification system (WIfI) has been proposed to initially assess all patients with ischemic rest pain or wounds and also predicts 1-year amputation risk. Elabela is a bioactive peptide and a part of the apelinergic system, which has beneficial effects on body fluid homeostasis and cardiovascular health. We aimed to investigate serum Elabela levels in LEAD. A total of 119 subjects were enrolled in this cross-sectional study, 60 of whom were in the LEAD group and 59 in the control group. All participants underwent physical examination and routine biochemical tests, including serum Elabela levels. Additionally, the LEAD group was divided into subgroups according to the Rutherford classification, ankle-brachial index (ABI) values, and WIfI risk scores. Serum low-density lipoprotein, Elabela, and high-sensitivity C-reactive protein (Hs-CRP) levels were statistically higher in the LEAD group (p=0.002, p<0.001, and p<0.001, respectively). In the Rutherford classification, as the stage increased, Elabela and Hs-CRP levels increased similarly (p<0.001). Elabela levels were statistically found to be positively correlated with Hs-CRP and WIfI amputation score but negatively correlated with ABI (p<0.001). Serum Elabela level, which is known to be increased in inflammatory processes, has the potential in predicting low extremity arterial obstruction and WIfI amputation risk in LEAD patients.