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"Introduction: Peripheral arterial disease (PAD) is the most common macroangiopathic complication in type II diabetes mellitus, arising from inadequate blood sugar control. In the presence of PAD, the risk of limb loss will also increase, and arterial bypass is one method to reduce the risk of amputation. In Indonesia, the level of patency for the arterial bypass has not yet been published. On bypass with venous grafts, the patency rates at the location of infrapopliteal reach at 70-80%, while the prosthetic graft is 30-50%. Method: From 2009 to 2012, patients with arterial bypasses were analyzed. The level of patency was described by ultrasound examination and pulsation on clinical examination in the distal anastomosis, reduced pain, and other examinations that support adequate revascularization. Identification of risk factors that affect patency, particularly protective risk factors, were also taken into account. Results: From 2009 to 2012, 29 patients with infra-inguinal arterial bypass were collected. The ratio of men to women was 5:1, with a one-year patency rate of 88% in men, and 75% in women, for an overall of 86.2%. The irreversible risk factor affecting patency was male (p = 0.117). Modifiable risk factors that decreasing patency level were smoking (p = 0.042) and more advanced stage of PAD (p = 0.067). Smoking cessation (p = 0.041) and the use of drugs after bypass procedure (p = 0.072) were known to increase the level of patency. Conclusion: The one-year patency rate for infra-inguinal artery bypass was 37-89%. Smoking cessation was known to increase the level of patency."

"ABSTRAK Aterosklerosis adalah penyakit sistemik, Peripheral artery disease PAD dan Carotid artery stenosis CS secara luas mencakup penyakit vaskular yang keduanya dikenal sebagai manifestasi spesifik aterosklerosis. Mengingat etiologi umum aterosklerosis perifer yang bisa terjadi di lokasi vaskular yang berbeda, keberadaan penyakit di satu tempat meningkatkan frekuensi penyakit simptomatik dan asimtomatik di tempat lain. Karena keduanya memiliki penyebab yang sama, maka terdapat hipotesis bahwa keduanya berkorelasi satu sama lain. Tujuan penelitian adalah untuk mengetahui faktor-faktor risiko yang berhubungan dengan Carotid artery stenosis CS pada pasien lower extremityPeripheral artery disease PAD berat serta mengetahui prevalensi Carotid artery stenosis CS dan ketebalan Intimal media thicknes IMT pada pasien dengan penyakit lower extremity Peripheral artery disease PAD berat. Penelitian ini dilakukan di RSUPN Cipto Mangunkusumo selama Februari-Mei 2018. Penelitian ini bersifat prospektif, data diambil dari data sekunder berdasarkan anamnesis dan hasil laboratorium sedangkan derajat stenosis dan intimal media thickness dilakukan carotid duplex ultrasound DUS dengan United imaging ultrasound menggunakan probe 8,5 Mhz. Data dikumpulkan, direvisi, dikodekan dan dimasukkan ke paket statistik untuk ilmu sosial SPSS versi 20 dan yang berikut ini dilakukan : Data kualitatif disajikan sebagai jumlah dan persentase sementara data kuantitatif disajikan sebagai rata-rata, standar deviasi, rentang median dan interkuartil. Kurva karakteristik operasi penerima digunakan untuk menilai titik potong terbaik dengan sensitivitas, spesifisitas, nilai prediksi positif dan nilai prediktif negatif. Interval kepercayaan ditetapkan 95 dan margin kesalahan ditetapkan hingga 5 sehingga p-value dianggap signifikan sebagai P> 0,05. Hasil penelitiandidapatkan 50 subjek dengan rentang umur antara 49-80 tahun 63,8 8,8 tahun , dimana yang berjenis kelamin laki-laki sebanyak 31 62 , dan perempuan sebanyak 19 38 . Didapatkan korelasi antara hiperkolesterol dan riwayat merokok dengan derajat Carotid Stenosis dengan nilai ABSTRACT Atherosclerosis is a systemic disease, Peripheral arterial disease PAD and Carotid artery stenosis CS widely include vascular disease bothh known as specific manifestation of atheroscleroris. Given the common etiology of peripheral atherosclerosis that can occur in different vascular sites, the presence of disease in one place increases the frequency of symptomatic and asymptomatic disease elsewhere. Since both have the same cause, there is a hypothesis that the two are correlated with each other. The objective of the study were to investigate the risk factor associated with Carotid artery stenosis CS in patients with severe lower extremity Peripheral arterial disease PAD and to know the prevalence of Carotid artery stenosis CS and degree of Intimal media thickness IMT in patients with severe lower extremity Peripheral arterial disease PAD . This research was conducted at Cipto Mangunkusumo General Hospital during February-May 2018. This is prospective research, the data was taken from secondary data based on hystory taking and laboratory result while the degree of stenosis and intimal media thickness is carotid duplex ultrasound DUS with United imaging ultrasound, using linier probe 8,5 Mhz. Data are collected, revised, encoded and fed into statistical package for social-science SPSS version 20, and the following are performed : Qualitative data are presented as quantities and percentages while quantitative data are presented as mean, standart deviation, median and interquartile range. The reciever operating characteristic curve is use to asses the best ctoff point with sensitivity, specificity, positive predictive value and negative predictive value. The confidence interval is set 95 and the margin error is set to 5 so p-value is considered significant as p"

"ABSTRAKPenyebab PAD yang paling sering adalah atherosclerosis. PAD berhubungan dengan penyakit atherosklerosis lain seperti renal artery stenosis (RAS). Angka harapan hidup menurun pada pasien yang mengalami RAS, terutama yag stenosisnya diatas 60% namun belum sampai ke tahap gagal ginjal kronik. Dengan penatalaksanaan yang holistik diharapkan angka harapan hidup pasien semakin meningkat.Tujuan: Untuk mengetahui prevalensi RAS pada pasien PAD serta melihat hubungan antara Angio Score, riwayat hipertensi dan diabetes melitus terhadap derajat RAS yang terjadi.Metode: Desain yang digunakan adalah desain potong lintang. Penelitian ini dilakukan di RSUPN Dr. Cipto Mangunkusumo selama periode Februari hingga Mei 2019. Penelitian dilakukan di RSUPN Dr. Cipto Mangunkusumo dengan diagnosis lower extremity PAD dan dari pemeriksaan CT Angiografi didapatkan stenosis pada pembuluh darah tungkai, serta tampak arteri renalis pada pemeriksaan CTA yang dilakukan pada pasien tersebut. Pengambilan sampel dilakukan dengan metode total sampling.Hasil: sampel terbanyak berjenis kelamin wanita (50,8%) sedangkan pria sebanyak 32 orang (49,2%). Sebanyak 90,8% pasien yang diteliti menderita diabetes sedangkan 61,5% dari sampel menderita hipertensi. RAS derajat 1 merupakan yang terbanyak ditemukan. Tidak ada hubungan ANGIO Score terhadap usia, jenis kelamin dan diabetes mellitus, namun ada terhadap hipertensi. Terdapat hubungan antara RAS dengan usia dan hipertensi, namun tidak terdapat hubungan terhadap diabetes mellitus dan jenis kelamin. ANGIO Score dan RAS terdapat hubungan yang bermakna (p<0,001).Simpulan: Perbandingan ANGIO Score berdasarkan derajat stenosis mendapatkan hasil uji Kruskall Wallis mendapatkan nilai p<0,001 dan dilanjutkan dengan uji Mann Whitney mendapatkan bahwa perbedaan sudah terjadi saat perbandingan derajat stenosis 0 dengan derajat 1 dan seterusnya (p<0,001). Semakin tinggi nilai ANGIO Score (cut off pada score 9), angka spesifitas semakin tinggi.

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ABSTRACTBackground: The most common cause of PAD is atherosclerosis. PAD is associated with other atherosclerosis diseases such as renal artery stenosis (RAS). Life expectancy decreases in patients who experience RAS, especially those with stenosis above 60% but have not yet reached the stage of chronic renal failure. With holistic management, it is expected that the patient's life expectancy will increase.Objective: To determine the prevalence of RAS in PAD patients and to see the relationship between Angio Score, history of hypertension and diabetes mellitus to the degree of RAS that occurred.Method: The design used is a cross-sectional design. This research was conducted at RSUPN Dr. Cipto Mangunkusumo during the period February to May 2019. The study was conducted at RSUPN Dr. Cipto Mangunkusumo with a diagnosis of lower extremity PAD, which obtained an ABI score of <0.9, severe ischemia until both unilateral and bilateral limb necrosis and CT angiography examination found stenosis in the leg veins, and the appearance of the renal artery on CTA examination performed on patients that is. Sampling is done by the total sampling method.Results: the most samples were female (50.8%) while men were 32 (49.2%). As many as 90.8% of patients studied had diabetes while 61.5% of the samples suffered from hypertension. 1st degree RAS is the most found. There is no relationship between ANGIO Score with age, gender and diabetes mellitus, but there is a hypertension. There is a relationship between RAS and age and hypertension, but there is no relationship to diabetes mellitus and gender. ANGIO Score and RAS have a significant relationship (p <0.001).Conclusion: The comparison of ANGIO Score based on the degree of stenosis obtained the results of the Kruskall Wallis test obtained a p value of <0.001 and continued with the Mann Whitney test found that the difference had occurred when the ratio of stenosis degrees was 0 with degrees 1 and so on (p <0.001). The higher the ANGIO score (cut off at score 9), the higher the specificity."

"Laporan ini bertujuan untuk memaparkan analisis perawatan pasien diabetes melitus dengan Peripheral Arterial Disease (PAD) yang menggunakan model konservasi Levine sebagai kerangka kerjanya. 31 pasien DM juga terlibat dalam perawatan ini. Proyek tindakan keperawatan berbasis pembuktian ilmiah (Evidence Based Nursing Paractice) dilakukan untuk meningkatkan intervensi pengukuran Ankle Brachial Index (ABI) post exercise pada pasien DM dengan intermiten klaudikasio. Proyek inovasi menghasilkan panduan berupa booklet latihan kekuatan dan keseimbangan padea pasien DM dengan neuropati perifer. Hasil analisis menunjukkan bahwa model konservasi Levine dapat diterapkan pada perawatan pasien DM dan pengukuran ABI menunjukkan hasil yang lebih objektif jika pengukuran dilakukan setelah latihan. Pasien DM dengan neuropati perifer memperoleh manfaat dari latihan kekuatan dan keseimbangan melalui pemberian booklet.

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This report aims to describe the analysis of nursing care for diabetic patients with Peripheral Arterial Disease (PAD) using Levine?s conservation model as a framework. 31 diabetic patients involve in this care. The Evidence Based Nursing Practice (EBNP) project was conducted to improve the measurement intervention of Ankle Brachial Index (ABI) post exercise in diabetic patients with intermitten claudicatio. The inovation project produce guideline booklet of strength and balance exercise in patients with diabetic peripheral neuropathy. The analysis shows that Levine?s conservation model could be applied in the care for patients with diabetes and the ABI measurement shows more objective results following exercise. Diabetic patients with peripheral neuropathy are benefited from the strength and balance exercise training are given from the booklet."

"The chief complain of chronic peripheral arterial occlusion disease is intermittent clodication, or calf pain during exercise that is relieved by resting. As the disease advances, pain occurs even during resting. The main cause for this disease is atherosclerosis.Clinical evaluation of patients comprise of questionnaire, exploration of atherosclerosis risk factors such as smoking, hyperlipidemia, diabetes mellitus, hypertension, etc. Pulse examination, ankle-brachial pressure index (ABPl) measurements and leg segmenta! blood pressure assessments are integral examinations in such patients. Another important test is functional assessments using the treadmill, or other tests to cause hyperemia.The chief management is to prevent common morbidity and mortality due to atherosclersosis such as coronary heart disease and its complications, as well as cerebrovascular disease and its complications. Management is also targeted towards preventing the progress of peripheral arterial occlusion disease.Specific management for peripheral arterial occlusion disease that is clearly beneficial to improve symptoms is physical exercise. Drugs such as pentoxyphylline, naftidrofuryl, buflomedil, and cilostazol are of little benefit only. Aspirin is useful to prevent cardiovascular, but is useless to improve symptoms.Prior to offering interventional procedures (angiopfasty and for stent insertion) or surgery, the following issues should be contemplated: I) the patient does not respond to physical exercise and risk factor modification, b) there is severe disability, c) there is no longer other disease that limits activity, and d) the morphology of the lesion is in line with the intervention, with a low risk and high probability for initial and long-term success"

"Pendahuluan : Disfungsi endotel merupakan awal timbutnya aterosklerosis yang pada kondisi lanjut akan menychabkan penyakit jantung koroner (PJK). Teh hijau dilaporkan mampu memperbaiki disfungsi endotel karena kandungan katekin yang ada di dalamnya. Penelitian menunjukkan teh hijau mampu meningkatkan produksi prostasiklin pada kultur sel aorta babi.Tujuan penelitian : Untuk mcmbuktikan hahwa pemberian teh hijau sekali minum dapat memberi efek terhadap peningkatan produksi 6-ketoprostaglandin Fl-a sebagai metabolic prostasiklin dan penurunan kadar tromboksan B2 sebagai metabolit tromboksan A2 pada penderita PJK.Metode : Penelitian dilakukan pada 25 penderita yang terhukti PJK dari pemeriksaan angiografi koroner. Sampel dibagi menjadi 2 kelompok. Kelompok 1 mendapat teh hijau terlebih dahulu dan Kelompok l1 mendapat plasebolair putih terlebih dahulu. Setelah masa wash-Put selama 1 minggu, dilakukan cross-over. Dihitung kadar 6-ketoprostaglandin Fl-a sebagai metabolit prostasiklin don tromboksan B2 sebagai metabolit tromboksan A2 sebelum dan sesudah pemberian teh hijau dan plasebo. Dllakukan pemeriksaan kadar 6-ketoprostaglandin Fl-a dan tromboksan B2 pada 20 orang sehat usia 18-25 tabula sebagai acuan nilai normal.Hasil : Didapatkan peningkatan kadar 6-ketoprostaglandin Fl-a yang bermakna pada kedua kelompok. Pada kelompok I sebeiuni pemberian tab hijau kadar 6-ketoprostaglandin Fl -a 5.126 (2.808-6.237) menjadi 6.575 (4.788-7.638) ng/ml (p= 0.012). Pada kelompok plasebo tidak didapatkan peningkatan yang bermakna (p= 0.328). Pada kelompok II kadar 6-ketoprostaglandin Fl-ct sebelum teh hijau 6.044 (2.804-11.693) menjadi 7.212 (4.028-11.175) ng/ml (p= 0.011). Pada plasebo tidak didapatkan peningkatan yang bermakna (p= 0.325). Pada pemeriksaan kadar tromboksan B2 tidak didapatkan penurunan yang bermakna balk pada kelompok I maupun pada kelompok II. Pada kelompok I sebelum pemberian teh hijau 0.472 (0.122-0.630) menjadi 0.092 (0.056-0.135) ng/ml (p= 0.68). Pada kelompok l1 sebelum pemberian teh hijau 0.1 11 (0.029-0.630) meningkat menjadi 0.660 (0.018-0.958) ng/ml (p= 0.055). Hadar 6-ketoprostaglandin F1-u pada penderita PJK lehih rendah secara bermakna dibanding orang sehat (p<0.001). Pada pemeriksaan kadar tromboksan B2 pada penderita PJK lehih rendah secara bermakna dibanding prang sehat (p<0.001)Kesimpulan : pemberian teh hijau sekali minum mampu meningkatkan produksi 6-ketoprostaglandin Fl-a yang merupakan metabolit aktif prostasiklin pada penderita penyakit jantung koroner, akan tctapi tidak memberikan efek penurunan kadar tromboksan B2 yang merupakan metabolit aktiFdari tromboksan A2.

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Introduction : Endothelial dysfunction is an early process of atherosclerosis that in long term will cause coronary artery disease. Green tea has been reported to improve endothelial function because of catechin substance in green tea. Study had showed that green tea could increase the prostacyclin production in bovine aorta cell culture.

Objective :To gain evidence that one time consuming of green tea may increase 6-ketoprostaglandin Fl-a production as a metabolite of prostacyclin and decrease thromboxane B2 production as a metabolite of thromboxane A2 in coronary artery disease patients.

Method : Study has been conducted to 25 patients proven to have coronary artery disease by coronary angiography. Sample was grouped into two groups. Groups I firstly receive green tea and Group II firstly receive placebo (mineral water). After washout period for one week, sample was being cross-overed. The level of 6-ketoprostaglandin Fl-a as a metabolite of prostacyclin and thromboxane B2 as a metabolite of thromboxane A2 were measured before and after green tea and water consumption. We also measure the level of 6-ketoprostaglandin Fl -a and thromboxane B2 in 20 healthy persons aged 18 -25 years old as a normal value.

Result : There were significant increasing level of 6-ketoprostaglandin Fl-a of both groups. In Group I, the level of 6-ketoprostaglandin Fl-a before green tea consumption was 5.126(2.808-6.237) and raised up to 6.575(4.788-7.638) ng/ml(p= 0.012). Meanwhile in placebo group there were no significant increase level of 6-ketoprostaglandin Fl-a (p= 0.328). In group II the level of 6-ketoprostaglandin Fl-a before green tea consumption was 6.044(2.804-11.693) and raised up to 7.212(4.028-11.175) ng/ml (p= 0.011). As for placebo group, there were no significant increase level of 6-ketoprostaglandin F l -a (p= 0.325). Thromboxane B2 measurement result shows no significant decrease both in group I and group H. In group I, thromboxan B2 level before green tea consumption was 0.472(0.122-0.630) and raised up to 0.092(0.056-0_l35) ng/ml(p= 0.68). As for group H, thromboxane B2 level before green tea consumption was 0.111(0.029-0.630) and raised up to 0.660(0.018-0.958) ng/ml (p= 0.055). The level of 6-ketoprostaglandin Fl-a in coronary artery disease patients was significantly bellow healthy persons (p<0.001). The level of thromboxane B2 in coronary atery disease patients were also significantly bellows healthy persons (p<0.001).

Conclusion : One time green tea consumption can increase 6-ketoprostaglandin Fl-a production as an active metabolite of prostacyclin in coronary artery disease patients but does not decrease thromboxan B2 level, an active metabolite of thromboxan A2."

"Latar belakang: Mesin cardiopulmonary bypass (CPB) yang digunakan untuk operasi conventional coronary artery bypass graft (CCABG) meningkatkan risiko terjadinya gangguan fungsi ginjal pascaoperasi. Teknik operasi off-pump coronary artery bypass (OPCAB) tidak menggunakan mesin CPB, sehingga diharapkan dapat menurunkan kejadian acute kidney injury (AKI) pascaoperasi. Gangguan fungsi ginjal pascaoperasi dapat berkomplikasi menjadi penyakit ginjal kronik dan bahkan meningkatkan mortalitas.Tujuan: Membandingkan gangguan fungsi ginjal pascaoperasi OPCAB dan CCABG dengan menilai peningkatan kreatinin serum, derajat AKI, dan kebutuhan hemodialisis pascaoperasi.Metode: Penelitian ini menggunakan metode penelitian kohort retrospektif yang dilakukan dengan menganalisis data rekam medis pasien di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita tahun 2019 – 2021. Data kreatinin serum pascaoperasi diambil pada waktu 24 jam dan 48 jam pascaoperasi, kemudian hasilnya dibandingkan di antara kedua kelompok. Derajat AKI pascaoperasi dan kebutuhan hemodialisis pascaoperasi yang terjadi di antara kedua kelompok juga dibandingkan.Hasil: . Kelompok pasien OPCAB (n = 277) dan CCABG (n = 770) memiliki data demografis yang tidak berbeda bermakna. Kelompok OPCAB memiliki nilai median kreatinin serum pascaoperasi yang lebih rendah pada waktu 24 jam (1,04 mg/dL vs 1,20 mg/dL; p <0,05) dan 48 jam pascaoperasi (1,12 mg/dL vs 1,21 mg/dL; p<0,05). Kejadian AKI pascaoperasi pada semua stadium dan kebutuhan hemodialisis pascaoperasi juga lebih rendah secara bermakna pada kelompok OPCAB.Kesimpulan: Teknik operasi OPCAB menghasilkan kreatinin serum dan derajat AKI lebih rendah serta kebutuhan hemodialisis pascaoperasi yang lebih sedikit dibandingkan dengan CCABG.

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Background: Cardiopulmonary bypass (CPB) machine, that is used in conventional coronary artery bypass graft (CCABG), increases the risk of postoperative renal dysfunction. Off-pump coronary artery bypass technique does not utilize the CPB machine, therefore is expected to decrease postoperative acute kidney injury (AKI) incidents. Postoperative renal dysfunction can complicate into chronic kidney disease and even increases mortality risk.

Purpose: To compare the postoperative renal dysfunction after OPCAB and CCABG by evaluating the increase of creatinine serum, AKI, and postoperative hemodialysis.

Methods: For this retrospective cohort study, we analyzed the data from patient’s medical record in National Cardiovascular Center Harapan Kita from 2019 to 2021. The patients in OPCAB group (n=277) and CCABG group (n=770) had similar demographic characteristics. Postoperative creatinine serum was measured at 24 hours and 48 hours postoperative, then the results were compared between the two groups. Postoperative AKI and hemodialysis were also compared.

Results: The OPCAB group had lower median value of postoperative creatinine serum at 24 hours (1.04 mg/dL vs 1.20 mg/dL; p <0.05) and 48 hours postoperation. (1.12 mg/dL vs 1.21 mg/dL; p<0.05). All stages of postoperative AKI and hemodialysis were also lower significantly in the OPCAB group.

Conclusion: OPCAB technique resulted in lower postoperative creatinine serum, AKI rates, and less hemodialysis neeeds compared with CCABG technique ."

"[LATAR BELAKANGPenyebab terbanyak Penyakit Arteri Perifer (PAP) pada usia diatas 40 tahun adalah aterosklerosis. Prevalensi penyakit aterosklerosis perifer meningkat pada kasus dengan diabetes melitus, dislipidemia, hipertensi dan perokok. Critical Limb Ischemia (CLI) merupakan manifestasi dari PAP berat, CLI dikaitkan dengan risiko kehilangan tungkai yang sangat tinggi. Pada pasien CLI tanpa adanya revaskularisasi, pasien biasanya akan dilakukan amputasi dalam hitungan minggu atau bulan. Revaskularisasi secara terbuka memiliki morbiditas yang cukup banyak. Seiring kemajuan teknologi, revaskularisasi secara terbuka perlahan-lahan digantikan dengan adanya intervensi endovaskuler dalam dua dekade terakhir. Revaskularisasi endovaskuler di Departemen Ilmu Bedah RSCM baru mulai dilakukan pada tahun 2012 dan di Indonesia saat ini belum ada studi yang menilai hasil dari tindakan revaskularisasi.METODEMetode yang diambil adalah analitik komparatif berpasangan dengan disain penelitian longitudinal pre-post study. Selama Agustus 2013 hingga Agustus 2014 didapatkan 16 pasien yang masuk kriteria inklusi. Dilakukan pengambilan data nilai ABI sebelum dan sesudah revaskularisasi endovaskuler. ABI digunakan sebagai penilaian efektivitas revaskularisasi.HASILHasil didapatkan nilai mean ABI sebelum tindakan 0,7±0,118 dan nilai mean ABI sesudah tindakan 0,844±0,127. Didapatkan peningkatan nilai ABI sesudah tindakan 0,14. Dari hasil uji T berpasangan didapatkan nilai p=0,001. Secara statististik didapatkan peningkatan yang signifikan antara nilai ABI sebelum tindakan dan sesudah tindakan.KESIMPULANDapat ditarik kesimpulan tindakan revaskularisasi endovaskuler terhadap pasien PAP efektif berdasarkan nilai ABI;BACKGROUNDPeripheral Arterial Disease (PAD) above 40 years old mostly cause by atherosclerotic. Peripheral Atherosclerotic prevalence increase with DM, dyslipidemia, hypertension and smoking. CLI had higher amputation risk. Without revascularization CLI patients will do amputation within week or month. Surgical revascularizaton had many morbidity, endovascular revascularization established within 2 decade. Endovascular revascularization in RSCM surgery department established at 2012 and in Indonesia no research to evaluate revascularization effectiveness.METHODSResearch method is dependent category comparative analytic with longitudinal pre-post study. Within August 2013 to August 2014, we collect 16 patients that rolled on inclusion criteria. We collect ABI results before endovascular revascularization and ABI results after endovascular revascularization. ABI were used to evaluated revascularization effectiveness.RESULTSResults are ABI mean before endovascular revascularization 0,7±0,118 and ABI mean after endovascular revascularization 0,844±0,127. There were ABI increased after endovascular revascularization mean 0.14. Statistic analysis with pairing T-test result p=0.001. Based on statistic analysis there were significant increase between ABI before endovascular revascularization and ABI after endovascular revascularization.CONCLUSIONEndovascular revascularization in PAD patients effective base on ABI, BACKGROUNDPeripheral Arterial Disease (PAD) above 40 years old mostly cause by atherosclerotic. Peripheral Atherosclerotic prevalence increase with DM, dyslipidemia, hypertension and smoking. CLI had higher amputation risk. Without revascularization CLI patients will do amputation within week or month. Surgical revascularizaton had many morbidity, endovascular revascularization established within 2 decade. Endovascular revascularization in RSCM surgery department established at 2012 and in Indonesia no research to evaluate revascularization effectiveness.METHODSResearch method is dependent category comparative analytic with longitudinal pre-post study. Within August 2013 to August 2014, we collect 16 patients that rolled on inclusion criteria. We collect ABI results before endovascular revascularization and ABI results after endovascular revascularization. ABI were used to evaluated revascularization effectiveness.RESULTSResults are ABI mean before endovascular revascularization 0,7±0,118 and ABI mean after endovascular revascularization 0,844±0,127. There were ABI increased after endovascular revascularization mean 0.14. Statistic analysis with pairing T-test result p=0.001. Based on statistic analysis there were significant increase between ABI before endovascular revascularization and ABI after endovascular revascularization.CONCLUSIONEndovascular revascularization in PAD patients effective base on ABI]"

"LATAR BELAKANG: Penyakit Arteri Perifer (PAP) merupakan sumbatan aliran darah arteri selain koroner dan intrakranial. PAP dihasilkan dari proses atherosklerosis, emboli, trombus, dan inflamasi yang mengarah ke stenosis arteri. PAP asimptomatik menempati 3-10% populasi dunia, dan meningkat hingga 15-20% pada 70 tahun ke atas. Divisi kami mencatat 18,1-24,7% pasien kaki diabetik dengan PAP mengalami amputasi pada kurun waktu 3 tahun terakhir. Evaluasi ultrasonografi Doppler pada arteri utama ekstremitas bawah diharapkan mampu mendeteksi secara dini apakah pasien akan diamputasi atau tidak baik mayor maupun minor. METODE: Metode yang diambil adalah analitik komparatif kategorik independen dengan disain penelitian kohort retrospektif. Selama Januari 2010 hingga Desember 2011 didapatkan 24 pasien yang masuk kriteria inklusi. Arteri yang diperiksa a.femoralis, a.poplitea, a.tibialis posterior, dan a.dorsalis pedis dengan tampilan spektral mulai dari monofasik, bifasik, atau trifasik terutama dengan pelebaran spektral. Ultrasonografi salah satu modalitas ”operator dependent”, untuk mengurangi bias, peneliti menggunakan operator ultrasonografi adalah peneliti sendiri, trainee atau konsultan divisi kami. HASIL: Hasil didapatkan spektral bifasik hingga monofasik pada a.femoralis 25,0%, a.poplitea 58,3%, a.tibialis posterior 41,6%, a.dorsalis pedis 45,8%, angka amputasi mayor dan minor masing-masing 4%. Perhitungan statistik didapatkan untuk a.femoralis p=0,054 (95% CI), a.poplitea p=0,006 (95% CI), a.tibialis posterior p=0,010 (95% CI), dan a.dorsalis pedis p=0,021 (95% CI). Secara statistik, prediksi amputasi dapat bermakna pada ultrasonografi Doppler pada a.poplitea, a.tibialis posterior, dan a.dorsalis pedis. KESIMPULAN: Dapat ditarik kesimpulan pemeriksaan ultrasonografi Doppler penting dilakukan pada setiap pasien PAP untuk mengevaluasi secara khusus keadaan empat arteri utama ekstremitas bawah pasien dan untuk prediktor amputasi.

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BACKGROUND: Peripheral Arterial Disease (PAD) is an occlusive disease of the blood flow artery beside coronary and intracranial artery. PAD is a result of atherosclerotic process, embolism, thrombus, and inflammation which toward of artery stenosis. Asymptomatic PAD counts 3-10% of worl population, and increasing until 15-20% in patient more than 70 years old. Our division counts 18.1-24.7% of diabetic foot patient with PAD undergoes amputation within this three years. Evaluation of duplex ultrasound in the main artery of lower extremity hopefully can detect whether patient will undergo limb salvage or limb loss, as early as possible, major or minor amputation.

METHODS: Research method is independent category comparative analytic with retrospective cohort design. Within January 2010 to December 2011, we collect 24 patients that rolled on inclusion criteria. We examined femoral, poplitea, posterior tibial, and dorsalis pedis artery, which showed monophasic, biphasic, and triphasic spectrum of duplex imaging of the ultrasound, and all of them has broadening spectrum.Ultrasound is an operator dependent modality, to decrease the bias of this research, operator of the ultrasound is researcher, fellowship doctors and consultants of our division.

RESULTS: Results are 25% in femoral artery, 58.3% in popliteal artery, 41.6% in posterior tibial artery, and 45.8% in dorsalis pedis artery, which counts for biphasic and monophasic spectrum. Amputation rate is 4% for each minor and major amputation. Statistic analysis for correlation of arterial spectrum with amputation are, femoral artery p=0,054 (95% CI), popliteal artery p=0,006 (95% CI), posterior tibial artery p=0,010 (95% CI), and dorsalis pedis artery p=0,021 (95% CI).

CONCLUSION: Based on statistic analysis, amputation can be significant in duplex imaging of popliteal, posterior tibial, and dorsalis pedis artery. Conslusion regards duplex imaging to be performed in four main arteries of lower extremity, to predict limb loss."

"Latar belakang: Hubungan antara HbA1c dengan kejadian mortalitas dan morbiditas pada pasien diabetes yang menjalani CABG telah dijelaskan dalam banyak penelitian sebelumnya. Namun, peran HbA1c pada populasi pasien non-diabetes dengan PJK yang menjalani BPAK belum pernah dilakukan, khususnya di Indonesia. Penelitian ini bertujuan untuk mengetahui apakah kadar HbA1c praoperasi memiliki hubungan dan dapat memprediksi keluaran awal pascaoperasi setelah BPAK pada pasien non-diabetes dengan penyakit arteri koroner. Metode: Penelitian ini merupakan studi kohort retrospektif pada pasien non-diabetes dengan penyakit jantung koroner yang menjalani BPAK sejak Januari 2022 hingga Desember 2023 di Pusat Jantung Nasional Harapan Kita. Kemudian, data kadar HbA1c praoperasi serta keluaran pascaoperasi yaitu mortalitas intrahospital dan morbiditas pascaoperasi seperti durasi penggunaan ventilator mekanik, lama rawat inap di ICU, lama rawat inap di rumah sakit, Major Adverse Cardiovascular Event (MACE), dan infeksi luka operasi diambil dari rekam medis pasien. Data variabel kontinu dinilai dengan menggunakan uji T atau uji Mann-Whitney U, sedangkan data nominal dinilai menggunakan uji Chi square atau Fischer. Analisis multivariat akan dilakukan lebih lanjut untuk hasil yang signifikan. Hasil: Sebanyak 391 subjek memenuhi kriteria dalam penelitian ini. Usia rata-rata subjek adalah 58,69 ± 8,29 tahun. Subjek dengan prediabetes (n = 268) memiliki perbedaan yang signifikan  secara statistik dalam median durasi ventilator dibandingkan dengan kelompok HbA1c normal (p = 0,009). Namun, tidak didapatkan hubungan yang signifikan antara HbA1c praoperasi dengan mortalitas intrarawat, lama rawat inap di ICU, lama rawat inap di rumah sakit, kejadian MACE, dan infeksi luka operasi pascaoperasi. Simpulan: Tidak terdapat hubungan antara HbA1c praoperasi pada pasien non-diabetes dengan PJK yang telah menjalani BPAK dengan mortalitas intrarawat, lama rawat inap di ICU, lama rawat inap di rumah sakit, kejadian MACE, dan infeksi luka operasi pascaoperasi. Pasien HbA1c normal praoperasi diasosiasikan signifikan secara statistik mempunyai durasi ventilasi mekanik yang lebih pendek dibandingkan pada pasien prediabetes dengan PJK yang telah menjalani BPAK.

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Background: The association between HbA1c with mortality and morbidity events in diabetic patients undergoing CABG have been explained in many previous studies. However, the predictive value of this in the non-diabetic patient population has not received sufficient attention, especially in Indonesia. This study investigated whether the pre-operative HbA1c level had an association and could predict early post-operative outcomes after CABG in non-diabetic patients with coronary artery disease. Methods: This retrospective cohort study involved non-diabetic patients with coronary artery disease who underwent CABG from January 2022 until December 2023 at National Cardiovascular Center Harapan Kita. Pre-operative HbA1c level and post-operative incidence of intrahospital mortality and morbidities such as mechanical ventilator duration, length of ICU stay, length of hospital stay, major adverse cardiovascular event (MACE), and sternal wound infections were collected. Continuous variable is assessed using T test or Mann- Whitney U test. Nominal data are assessed using Chi square or Fischer test. Multivariate analysis will be conducted further for significant results. Results: Three hundred-ninety-one subjects were involved in this study. The mean age of all subjects was 58.69 ± 8.29 years. Subjects with pre-diabetes (n = 268) have statistically significant difference in median ventilator duration compared to normal HbA1c group (p = 0.009). However, there was no significant association between pre-operative HbA1c and early post-operative intrahospital mortality, length of ICU stay, length of hospital stay, major adverse cardiovascular event (MACE), and sternal wound infections in this population. Conclusion: Pre-operative glycated hemoglobin level is not associated with early mortality, length of ICU stay, length of hospital stay and MACE. However, there is statistically significant lower mechanical ventilator duration in normal HbA1c compared to pre-diabetic patients with CAD who have undergone CABG."