INDEX

A lymphangiogenesis, 164, 194 Abdominal aortic , plasmid DNA, 193, 194, 195, 198 cIassification, 212, 213 therapeutic angiogenesis, 191, 192 repair, 212 vasculogenesis, 189, 191 ABI, see Ankle-brachial index Angiography, see Catheter angiography; ACE inhibitor, see Angiotensin-converting Computed tomography angiography; enzyme inhibitor Magnetic resonance angiography Acidic fibroblast growth factor (aFGF), gene Angiotensin-converting enzyme (ACE) therapy critic al Iimb ischemia trials, inhibitor, 198 diabetes management, 162, 163 Acrocyanosis, presentation and management, hemostatic factor effects, 166 290 Ankle-brachial index (ABI), Acute limb ischemia (ALI), see also Arterial acute limb ischemia outcomes, 136, 137 ; Atheromatous embolism, continuous wave Doppler measurement, clinical presentation, 293, 295, 296, 299 64,65 diagnosis, 297, 298 intermittent cIaudication work-up, 39 differential diagnosis, 125, 297 interpretation, 65 , 294 medial calcinosis, 63, 64, 69, 269 etiology, 293, 294 sensitivity and specificity, 22 instigating causes, 294, 295 Ankylosing spondylitis, large-vessel laboratory studies, 297 and management, 333, 334 pathology, 295 Antiplatelet therapy, see specific agents , 295, 296 Aortoiliac disease, prognosis, 298 aneurysm, 212, 213 treatment, criticallimb ischemia management, pharmacotherapy, 298, 299 angioplasty, 107 surgery, 298 bypass grafting, 107, 108 Adventitial cysts, intermittent cIaudication les ion cIassification, 107 differential diagnosis, 43, 44 occIusive disease management, aFGF, see Acidic fibroblast growth factor aortofemoral bypass, 226, 227 ALI, see Acute limb ischemia axillofemoral bypass, 227-229 Amputation, endovascular therapy, 212 acute Iimb ischemia management, 138 Arginine, criticallimb ischemia management, 114 intermittent cIaudication management, Angiogenesis, 179, 180, 183 arteriogenesis relationship, 191 mechanism of action, 179 growth factors, Arrhythmia, perioperative medical gene therapy, see Gene therapy management, 256, 257 types, 189, 191 Arterial , vascular endothelial growth factor, intermittent cIaudication differential 192-194 diagnosis, 46

347 348 Index

peripheral blood flow effects, 64 physical measures, 131 Arterial embolism, see also Acute limb reperfusion injury, 134 ischemia, surgical revascularization versus atheroembolism, 81-82, 125,293-299 thrombolysis trials, 133, 134 clinic al presentation, 120 thrombectomy, 132, 133 detection, 64 thrombolysis, 131 etiology, timing,130 atrial fibrillation, 121, 122 vascular imaging, 127, 128 overview, 120 Arteriogenesis, overview, 191 patent foramen ovale, 121 (A VF), construction ventricular thrombi, 120, 121 for criticallimb ischemia management, intermittent claudication differential 237,238 diagnosis, 46, 47 , sites, 122, 123 collateral , see Collateral arteries Arterial , see also Acute limb layers, 1,2 ischemia, location and structural variation, 56 catheter angiography, 88 medial calcification, 63, 69 classification of severity, 128-130 resistance of systems, 55, 56 clinical history, 123 size classification, 55 definition, 93 women, causes of occlusive disease, 281, 282 differential diagnosis, Arthritis, intermiUent claudication differential arterial trauma or dissection, 126 diagnosis, 41 atheroembolism, 125 Aspirin, hypercoagulable syndromes, 127 critic al limb ischemia management, 106, overview, 124, 125 111,112 popii te al artery aneurysm thrombosis, thrombus formation prevention, 167 126 , see also specific diseases, popliteal artery cysts and entrapment, coprevalence of syndromes, 28, 29, 32, 243 126 definition, 1 vasculitis, 126 lesion classification and features, 2 , 125 mortality, 1 Doppler velocimetry, 127 response to injury hypothesis, 5 echocardiography, 128 risk factors, 3-5, 25, 26 etiology, 123 Atherothrombosis, phases of development, follow-up and anticoagulation, 135 166, 167 laboratory tests, 128 A VF, see Arteriovenous fistula outcomes, B limb-related outcome, 136, 137 procedural mortality and morbidity, 137 Basic fibroblast growth factor (bFGF), recurrence, 137, 138 gene therapy, critical limb ischemia trials, physical examination, 124, 138 198 severity factors, 119, 120 intermittent claudication management, 180 sites, 123 Beh~et' s disease, large-vessel vasculitis and treatment, management, 332, 333 amputation, 138 bFGF, see Basic fibroblast growth factor angioplasty, 131, 132 Blood flow, velocity-pressure relationships, anticoagulation, 130, 131 60 approach by severity, 135, 136 Buerger's disease, see Thromboangiitis embolectomy, 132 obliterans fasciotomy, 134, 135 Buflomedil, intermittent claudication lesion, 135 management, 177, 183 Index 349

C Collateral arteries, CAD, see Coronary artery disease anatomy and hemodynamics, 62, 63 Cardiomyopathy, perioperative medical components, 61 management, 256 flow resistance, 61, 62 Camitine, intermittent claudication Composite graft, criticallimb ischemia management, 177, 178, 183 management, 238 Carotid artery, Computed tomography angiography (CT A), stenting, advantages, 86 complications, 204, 207 contrast agents, 86 contraindications, 207 image processing, 87, 89 indications, 205, 207 limitations, 86, 87 transluminal angioplasty, 204, 205 principles, 86 Catheter angiography, prospects, 90, 91 acute limb ischemia, 88 Coronary artery disease (CAD), chronic limb ischemia, 88, 90, 101, 102 peripheral arterial disease coprevalence, complications, 80-82 28,29,32,243,244 contrast agents, 76 revascularization surgery outcomes in film-screen versus digital subtraction peripheral arterial disease, angiography, 76, 77 balloon angioplasty, 245, 246 foot angiography, 80 coronary artery bypass surgery, 245 infrainguinal angiogram, 77, 79 retrospective studies, 244 large-vessel vasculitis, 335 stenting, 246 prospects, 90, 91 vascular surgery peri operative risks in Seldinger technique, 75 peripheral arterial disease patients, evaluation, 80 intraoperative management, suprainguinal angiography, 77 anesthesia, 257, 258 vasculitis and small vessel disease, 90 monitoring, 258 CA VA T AS trial, 205 mortality,244 Cerebrovascular disease, 23, 28-29, 95-96 perioperative medical management, Charcot foot, arrhythmias, 256, 257 causes,277 cardiomyopathy, 256 clinical presentation, 277 heart failure, 255, 256 fracture, 277 , 255 management, 277, 278 ischemie heart disease, 254, 255 pathophysiology,277 valvular heart disease, 256 Chelation therapy, intermittent claudication postoperative surveillance, 258, 259 management outcomes, 181 preoperative evaluation, Chronic limb ischemia, see Critical limb clinic al predictors, 247, 248 ischemia combining clinic al risk and testing, Cilostazol, 252 dosing, 176 complications, 253 intermittent claudication management, functional capacity, 248, 249 175-177,183 goals, 246, 247 mechanism of action, 175 long-term prognostic value, 254 side effects and precautions, 176, 177 surgical-specific risk, 249 women and peripheral arterial disease, 284 risk stratification testing, CLI, see Critical limb ischemia ambulatory electrocardiography, 251 Clopidogrel, dobutamine stress echocardiogram, cardiovascular event prevention, 167-169 250,251 dosing,168 echocardiography, 251, 252 safety, 168 myocardial perfusion imaging, 250 350 Index

treadmill stress test, 249, 250 CT A, see Computed tomography angiography C-reactive protein (CRP), D giant cell levels, 324, 325 peripheral arterial disease elevation, 25, Defibrotide, intermittent claudication 26, 165 management, 180, 183 statin effects on levels, 165 Diabetes, Criticallimb ischemia (CLI), amputation rates, 265 catheter angiography, 88, 90, 10 1, 102 angiotensin-converting enzyme inhibitor comorbidity, 95, 96 management, 162, 163 definition, 93 atherosclerosis acceleration, 162 differential diagnosis, 100, 101 atherosclerosis risk factor, 3 Doppler ultrasound, 101 Charcot foot, 277, 278 epidemiology, 97, 98 criticallimb ischemia risk factor, 94, 95 follow-up examination, 114 economic impact, 266 laboratory tests, 105 endothelial dysfunction, 11, 12 medical history, 98, 99 epidemiology, 161, 265 natural history, 96, 97 foot management, pathogenesis, 94 footwear, 274-276 physical examination, 99, 100 orthotics, 277 prevalence, 31 overview, 273 volume recordings, 101 , risk factors, 94, 95 healing,274 surveillance, 112-114 pathophysiology of formation, 273, transcutaneous oxygen tension measurement, 274 101 glycemic control, 162 treatment, hemodynamic evaluation, 69 amputation, 114 medial artery calcification, 63, 69, 161 anticoagulation therapy, 112 peripheral arterial disease, aortoiliac disease, clinic al presentation and evaluation, angioplasty, 107 268,269 bypass grafting, 107, 108,226-229 pathological arterial changes, 267, 268 les ion classification, 107 prevalence studies, 27 aspirin, 106, 111, 112 prevention, 267 bed position, 105 risk factors, 24, 161-163, 268 foot care, 105 treatment, infrainguinal disease, antiplatelet agents, 270 angioplasty, 110, 111,233,234,236 footwear, 269, 270 bypass grafting, 109, 232-236 percutaneous transluminal lesion classification, 109 angioplasty, 270, 271 profundaplasty, 110, 231, 232 surgical revascularization, 271, 272 infrapopliteallesion classification, wound healing factors, 110, 111 abnormal cellular/inflammatory lumbar sympathectomy, 112 pathways, 266, 267 patient selection for surgery, 225, 239 peripheral neuropathy, 266 prospects, 114, 115 vascular disease and tissue , 267 prostanoids, 112 Dipyridamole, thrombus formation prevention, risk factor modification, 105, 106 167 thrombolysis, 219-220 Dobutamine stress echocardiogram, preoperative Critic al stenosis, definition, 63 assessment for coronary vascular surgery, CRP, see C-reactive protein 250,251 Index 351

Doppler ultrasound, see Ultrasound percutaneous transluminal angioplasty, 215-217 E stenting, 217 Echocardiography, Fibrinogen, acute limb ischemia work-up, 128 glycoprotein IIb/IIIa receptor binding, 167 preoperative assessment for coronary mutations in peripheral arterial disease, 166 vascular surgery, 251, 252 Fibroblast growth factor, see Acidic fibroblast Electrocardiography, preoperative assessment growth factor; Basic fibroblast growth for coronary vascular surgery, 251 factor End-stage renal disease (ESRD), infrainguinal Fibrodysplasia, intermittent claudication revascularization, 238, 239 differential diagnosis, 44, 45 Endothelium, , presentation and dysfunction, management, 287 diabetes, 11, 12 hypercholesterolemia, 11 G hyperhomocysteinemia, 13 GCA, see Giant ceH arteritis hypertension, 12, 13 Gene therapy, mechanisms,7-9 acidic fibroblast growth factor, 198 overview,7 basic fibroblast growth factor, 198 peripheral arterial disease, 9, 10 recombinant protein therapy comparison, functions, 2, 5, 6 194,195 gross anatomy, 5 vascular endothelial growth factor, vasodilators, 7 criticallimb ischemia trials, 195, 196, 198 Endovascular therapy, see Percutaneous ischemia site-specificity for angiogenesis transluminal angioplasty induction, 194 ESRD, see End-stage renal disease mechanisms of action, 198 Exercise rehabilitation, intermittent thromboangiitis obliterans management, claudication, 314 bas eline assessment, 147, 149 transfer approaches, 193, 194 contraindications, 149 vectors and delivery approaches, 195 endpoints, 145, 146 Giant ceH arteritis (GCA), exercise limitations, 145 clinic al presentation, 286, 321-324 exit assessment, 153 diagnosis, 286, 325 goals, 149 epidemiology, 286, 320 home-based management, 152, 153, 155 histology, 320, 321 mechanisms of benefit, 153, 154 history of study, 320 precautions, 153 laboratory findings, 324, 325 prescription, management, 287, 325, 326 concepts, 149, 150 pathogenesis,321 methods, 150, 152 prognosis, 326, 327 progres sion of training sessions, 152 Glucocorticoids, reimbursement, 153, 155 giant ceH arteritis management, 325, 326 screening, 146, 147 Takayasu' s arteritis management, 331 walking benefits, 145, 146, 173 H F Heart failure, perioperative medical Fasciotomy, acute limb ischemia management, management, 255, 256 134,135 Hemodilution, intermittent claudication Femoral-femoral bypass, iliac occlusive management outcomes, 181 disease management, 229, 230 Heparin, atheromatous embolism manage• Femoropopliteallesions, ment, 298, 299 352 Index

HMG-CoA reductase inhibitors, 11, 164, tibial bypass, 234-236 165 endartectomy of superficial artery, 234 H ypercholesterolemia, indications for surgical revascularization, atherosclerosis risk factor, 3 230,231 control outcomes, 165 profundaplasty, 110, 231, 232 endothelial dysfunction, Il diabetic foot surgical revascularization, 272 Hyperhomocysteinemia, end-stage renal disease and infrainguinal atherosclerosis risk factor, 5 revascularization, 238, 239 critical limb ischemia risk factor, 95 lesion cIassification, 109 endothelial dysfunction, 13 Insulin resistance syndrome, see Syndrome X peripheral arterial disease risk factor, 25, 165 Intermittent claudication (IC), vitamin supplementation for correction, 165 assessment, Hyperlipidemia, hemodynamics, 48, 49 atherosclerosis risk factor, 3 physicallimitation, 49, 50 control outcomes, 164, 165 clinical presentation, 21, 22, 31, 35, 36 criticallimb ischemia risk factor, 95 differential diagnosis, peripheral arterial disease risk factor, 24, adventitial cysts, 43, 44 163, 164 arterial dissection, 46 Hypertension, arterial embolus, 46, 47 atherosclerosis risk factor, 3,4 arthritis, 41 control outcomes, 163 fibrodysplasia, 44, 45 criticallimb ischemia risk factor, 95 iliac artery endofibrosis, 45 endothelial dysfunction, 12, 13 McArdle's disease, 47 perioperative medical management, 255 neurogenic cIaudication, 39-41 peripheral arterial disease risk factor, 24, popliteal entrapment syndrome, 41, 42 25, 163 thromboangiitis obliterans, 41 vasculitis,47 1 venous cIaudication, 46 IC, see Intermittent claudication etiology, 35, 36 Iliac artery, natural history, angioplasty, 213-215 mortality and coronary outcomes, 48 bypass, peripheral outcomes and functional aortounilateral femoral bypass, 229 status, 47, 48 femoral-femoral bypass, 229, 230 physical examination, iliofemoral bypass, 229 ankle-brachial index, 39 overview,213 auscultation, 37, 38 endarterectomy, 229 color and temperature of feet, 38 endofibrosis, intermittent claudication palpation, 36-38 differential diagnosis, 45 prevalence, 36 stenting, 214, 215 treatment, Ilopost, thromboangiitis obliterans absolute claudicant distance as end- management, 312 point for trials, 173 , arginine, 179, 180 atherosclerosis risk factor, 25, 26, 165, 166 buflomedil, 17 pathogenesis of atherosclerosis, 165, 166 carnitine, 177, 178 Infrainguinal disease, cilostazol, 175-177 criticallimb ischemia management, comparison of drugs, 183, 184 angioplasty, 110, 111,233,234,236 defibrotide, 180 bypass grafting, exercise rehabilitation, see Exercise femoral popliteal bypass, 232, 233 rehabilitation, intermittent overview, 109 claudication Index 353

growth factors, 180 Neurogenic claudication, ineffective agents, 181, 182 clinic al presentation, 39, 40 initial claudicant distance as endpoint intermittent claudication differential for trials, 173, 174 diagnosis, 39-41 naftidrofuryl, 177 pathophysiology,39 pentoxifylline, 174, 175 treatment, 41 prostaglandins, 178, 179 Nitric oxide (NO), Intravascular ultrasound, see Ultrasound acety1choline induction, 8 diffusion, 8 K discovery as vasodilator, 7 Ketanserin, intermittent claudication endothelial dysfunction, management outcomes, 180, 181 diabetes, 11, 12 L hypercholesterolemia, 11 hyperhomocysteinemia, 13 Laminar blood flow, arteries, 58 hypertension, 12, 13 Large-vessel vasculitis (L VV), see also Giant peripheral arterial disease, 9, 10 cell arteritis; Takayasu' s arteritis, metabolism, 8 angiography, 335, 337 pleiotropic effects, 8, 9 causes, Nitric oxide synthase (NOS), ankylosing spondylitis, 333, 334 impairment mechanisms, 9 Beh<;et's disease, 332, 333 isoforms,8 relapsing polychondritis, 333 NO, see Nitric oxide diagnosis, 319 Noninvasive tests, see also Ankle-brachial Doppler uItrasound, 337, 338 index, UItrasound management, 339 spectral analysis, 66-67 Lumbar sympathectomy, treadmill exercise test, 39,48-50,65-66, criticallimb ischemia management, 112 174,249-250 thromboangiitis obliterans management, 313 NOS, see Nitric oxide synthase LVV, see Large-vessel vasculitis p M Magnetic resonance angiography (MRA), P AD, see Peripheral arterial disease advantages, 82, 83 Pentoxify lline, aortoiliac disease, 90 dosing, 175 chronic limb ischemia, 88 intermittent cIaudication management, disadvantages, 85 174, 175, 183 gadolinium-enhanced imaging, 83, 85 mechanism of action, 174 large-vessel vasculitis, 337 Percutaneous transluminal angioplasty (PTA), prospects, 90, 91 acute limb ischemia management, 131, 132 signal origins, 82 coronary outcomes in peripheral arterial techniques, overview, 83 disease patients, 245, 246 McArdle' s disease, intermittent claudication critical Iimb ischemia management, differential diagnosis, 47 aortoiliac disease, 107 Menopause, peripheral arterial disease impact, infrainguinal disease, 110, 111 283 diabetic foot, 270, 271 MICRO-HOPE trial, 162-163 femoropopliteal angioplasty, 215-217 MRA, see Magnetic resonance angiography iliac artery, 213-215 Myocardial perfusion imaging, preoperative as- , 209-211 sessment for coronary vascular surgery, 250 subclavian artery stenosis, 203-204 Peripheral arterial disease (PAD), N classification by Rutherford, 94, 95 N aftidrofuryl, intermittent claudication coprevalence of atheroscIerotic syndromes, management, 177, 183 28,29,32 354 Index

endothelial dysfunction, 9, 10 Relapsing polychondritis (RPC), large-vessel hemodynamic evaluation, see also specific vasculitis and management, 333 techniques, Renal artery stenosis, long-term follow-up, epidemiology, 208, 209 without therapy, 70 interventions, with therapy, 70, 71 contraindications, 210 patient selection for therapy, 70 indications, 209, 210 intermittent claudication, see Intermittent preservation of renal function, 211 claudication stenting outcomes, 210, 211 limb ischemia, see Acute limb ischemia; natural history, 209 Criticallimb ischemia Reynold's number, equation, 57 natural history and treatment effects, 21, RPC, see Relapsing polychondritis 22,29,30 S nomenclature, 21 prevalence studies, 26-28 Smoking, risk factors, 22-26, 31, 159-166 atherosclerosis risk factor, 3 vascular imaging, see specific techniques cessation, women, approaches, 161 epidemiology, 282 impact on disease, 160, 161 non-atherosclerotic causes, 285-290 criticallimb ischemia risk factor, 94 pharmacotherapy, 284 peripheral arterial disease risk factor, 22, risk factors and modification, 283, 284 23,159-161 surgical revascularization, 284, 285 thromboangiitis obliterans risks, 304, 305 Peripheral neuropathy women and peripheral arterial disease, 283 diabetic, 69, 100, 266, 270, 273, 274 Streptokinase, thromboangiitis obliterans ischemic, 98, 124, 128-130, 134 management, 313 Plethysmography, ca1f -flow Subclavian artery, stenosis interventions, relationships during exercise, 587, 59 203,204 Poiseuille's law, Surgery arterial blood flow implications, 57 acute limb ischemia, 132-133 equation, 56, 57 adventitial cysts, 44 Popliteal entrapment syndrome, ankylosing spondylitis, 334 acute limb ischemia differential diagnosis, aortofemoral bypass, 107,226-227,229- 126 230 intermittent claudication differential aortounilateral femoral bypass, 229 diagnosis, 41, 42 arterial dissection, 46, 126 treatment, 43 arteriovenous fistula, 237-238 Profundaplasty, infrainguinal disease man• atheromatous emboli, 298 agement, 110, 231, 232 axillofemoral bypass, 108, 227-229 Prostacyclin, vasodilation, 9 Beh<;et' s disease, 332-333 Prostaglandins, intermittent claudication chronic critical limb ischemia, 106-111, management, 178, 179, 183 233 PT A, see Percutaneous transluminal angio• complications, 233, 236 plasty composite graft, 238 end stage renal disease, 238-239 R femoral endarterectomy, 234 Raynaud's phenomenon, femoral femoral bypass, 108, 229-230 classification and causes, 288, 289 femoropopliteal bypass, 109-110, 232- epidemiology, 288 233,272 management, 289 femorotibial bypass, 234-235, 272 Index 355

fibromuscular dysplasia, 45 hypercoagulability, 305, 306 graft choice, 232-233 immunologic mechanisms, 305 iliac endarterectomy, 229 intermittent claudication differential iliofemoral bypass, 229 diagnosis, 41 impotence, 226-227 laboratory tests, 309, 3lO indications, 225, 230-231 les ion pathology, 306, 307 inframalleolar bypass, 235-236, 272 management, intermittent claudication, 47,225-239 drug therapy, 312 isolated popliteal bypass, lO9, 233 general measures, 314, 315 neurogenic claudication, 41 growth factor therapy, 314 popliteal artery entrapment syndrome, smoking cessation, 312 42-43 surgical revascularization, 313 profundoplasty, 231-232 thrombolytic therapy, 313 tibial bypass, 234-236, 272 women, 288 thromboangiitis obliterans, 313 sites of involvement, 307, 308 Takayasu' s arteritis, 331 smoking risks, 304, 305 patches, cuffs, 237 vasculitis features, 303, 304 in women, 284-285 Thrombolytic therapy, see specific agents Surgical revascularization, see specific Tibial artery, lesions and angioplasty, 236 procedures bypass, 234-236 Surgical revascularization, see specific lesions Tibioperoneallesions, angioplasty, 217-219 and procedures Ticlopidine, Sympathectomy 112,289,313 cardiovascular event prevention, 167-169 Syndrome X, 4-5, 24 intermittent claudication management, 180 atherosclerosis risk factor, 4, 5, 162 side effects, 167, 168 synovitis, 321-323, 328-329, 333 Tissue-type plasminogen activator, in the Elderly Program, levels and thrombotic risk, 166 25 thrombolytic therapy, 219, 220 Toe-brachial systolic pressure index (TSPI), T continuous wave Doppler measurement, Takayasu' s arteritis, 64,65 clinical presentation, 285, 327, 328 interpretation, 65 diagnosis, 285, 286, 330 TRAFFIC tria!, 198 epidemiology, 285, 327 Transcutaneous oxygen tension (TcP02), histology, 327 criticallimb ischemia, 101 history of study, 327 diabetic foot assessment, 269 laboratory testing, 329, 330 Treadmill exercise testing, 39, 48-50, 65- management, 286, 330, 331 66,174,249-250 pathogenesis, 327 exercise rehabilitation patient assessment, prognosis, 332 147 in women, 281 peripheral arterial disease diagnosis, 65, 66 T AO, see Thromboangiitis obliterans stress test, preoperative assessment for TCP02' see Transcutaneous oxygen tension coronary vascular surgery, 249, 250 Thromboangiitis obliterans (T AO), TSPI, see Toe-brachial systolic pressure clinical presentation, 287, 288, 308, 309 index differential diagnosis, 311, 312 Turbulence, blood t1ow, 57 endothelial function, 306 epidemiology, 287, 303, 304 U genetics, 306 Ultrasound, 356 Index

continuous wave Doppler measurement related factors, 194 of ankle-brachial index, 64, 65 Vasculitis, see also specific diseases, criticallimb ischemia, 10 1 acute limb ischemia differential diagnosis, duplex ultrasound, 126 aortoiliac disease, 68 imaging,90 diagnostic criteria, 67, 68 intermittent claudication differential infrapopliteal occlusive disease, 68, 69 diagnosis, 47 superficial femoral/popliteal artery Vasculogenesis,overview, 189, 191 disease,68 Vasospasm, acute limb ischemia differential technical issues, 66, 67 diagnosis, 125 intravascular ultrasound, 82 VEGF, see Vascular endothelial growth large-vessel vasculitis and Doppler factor ultrasound, 337, 338 Vein cuff, criticallimb ischemia management, treadmill exercise test, 39, 48-50, 65-66, 237 174,249-250 Vein patch, criticallimb ischemia management, Urokinase, thrombolytic therapy, 219, 220 237 Venous claudication, intermittent claudication V differential diagnosis, 46 Valvular heart disease, peri operative medical Vertebral artery, management, 256 angioplasty, 208 Vascular endothelial growth factor (VEGF), stenting, 208 angiogenesis stimulation, 193 Vitamin E, intennittent claudication management discovery, 192 outcomes, 180 expression regulation, 192, 193 von Willebrand factor (vWF), levels in gene therapy, peripheral arterial disease, 167 criticallimb ischemia trials, 195, 196, vWF, see von Willebrand factor 198 ischemia site-specificity for angiogenesis W induction, 194 Walking Impairment Questionnaire (WIQ), mechanisms of action, 198 physicallimitation assessment, 49, thromboangiitis obliterans management, 175, 176 314 Warfarin, atheromatous embolism management, transfer approaches, 193, 194 298,299 isoforms, 194 WIQ, see Walking Impairment Questionnaire