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The article discusses vascular emergency in patients with acute limb ischemia (ALI) and atherothrombosis. Topics discussed include irresponsive clinical investigation for ALI incidence, absence of emergency platform for treating sudden disruption of arterial blood flow and offers suggestions for professional societies to perform diagnostic and treatment guidelines with use of electrocardiogram (ECG) and echocardiography.

We aimed to evaluate whether carotid intima-media thickness (CIMT) or the presence of plaque can confer additional predictive value of future cardiovascular (CV) ischemic events in patients with pre-existing atherosclerotic vascular disease. We identified 2317 patients enrolled in the REduction of Atherothrombosis for Continued Health (REACH) registry who had atherosclerotic vascular disease and baseline CIMT measurements. The entire range of CIMT was divided into quartiles and the fourth quartile (≥ 1.5 mm) was defined as carotid plaque. Mean ± standard deviation baseline CIMT was 1.31 ± 0.65 mm. Associated CV ischemic events and vascular-related hospitalizations were evaluated over a 2-year follow-up. There was a positive increase in adjusted hazard ratios (HRs) for all-cause mortality (p = 0.04 for trend) and the quadruple endpoint (CV death, myocardial infarction (MI), stroke, hospitalization for CV events) with increasing quartiles of CIMT (p = 0.0008 for trend), which was mainly driven by the fourth quartile (carotid plaque). HRs for all-cause mortality, CV death, CV death/MI/stroke and the quadruple endpoint comparing the highest (carotid plaque) with the lowest CIMT quartile were 2.09 (95% CI, 1.07–4.10; p = 0.03); 2.49 (1.10–5.67; p = 0.03); 1.71 (1.10–2.67; p = 0.02); and 1.73 (1.31–2.27; p = 0.0001). In conclusion, our analyses suggest that the presence of carotid plaque, rather than the thickness of intima-media, appears to be associated with increased risk of CV morbidity and mortality, but confirmation of these findings in other population and prospective studies is required. [ABSTRACT FROM AUTHOR]

The article presents the nature and scope of the clinical performance measures for adults with peripheral artery disease(PAD) which was developed by the Peripheral Artery Disease Performance Measures Writing Committee in the U.S. It says that the performance measures deal with lower extremity and aortic disease, as covered by the ACC/AHA 2005 guidelines for the patients with PAD. Mandatory sequential steps in the development of performance systems, PAD guidelines, and outcome measures are cited.