***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE To evaluate prospect ively the safety and effectiveness of aortoiliac magnetic resonance ( MR ) angiography enhanced with MS-325 ( gadofosveset trisodium ) at a dose of 0.03 mmol/kg ; effectiveness was defined as accuracy relative to the reference st and ard , conventional angiography . MATERIAL S AND METHODS Study was approved by institutional review boards of participating institutions , and required national approvals were obtained . Study protocol conformed to Good Clinical Practice guidelines , and informed patient consent was obtained . Patients with known or suspected peripheral vascular disease received 0.03 mmol/kg MS-325 for aortoiliac MR angiography . They were also examined with conventional angiography . MS-325-enhanced MR was evaluated for safety and effectiveness . Along with unenhanced two-dimensional time-of-flight MR angiography , it was compared with conventional angiography for presence of vascular stenosis . Student t tests were used to identify significant improvement in diagnostic sensitivity , specificity , and accuracy , as well as quantitative characterization of stenoses by three blinded readers . Correlations between readers of conventional angiograms were calculated and compared with MR results . RESULTS In 174 patients , MS-325-enhanced MR angiography showed significant improvement ( P < or = .001 ) in sensitivity , specificity , and accuracy for diagnosis of clinical ly significant ( > or = 50 % ) stenosis , compared with unenhanced MR . For all readers , areas under the receiver operating characteristic curve for both quantitative and qualitative measures of significant disease increased ( P < .001 ) for MS-325-enhanced MR compared with time-of-flight MR . All readers also expressed higher confidence in diagnosis ( P < .001 ) and found fewer images uninterpretable with MS-325 enhancement . All measures of interpretation accuracy approached corresponding measures of correlation between readers of conventional angiograms . Incidence of severe and serious adverse events with MS-325 was low . No patients were withdrawn from study due to adverse events or abnormalities in laboratory results . There were no clinical ly important trends in findings at hematology , blood chemistry , urinalysis , electrocardiography , or physical examination . CONCLUSION MR angiography with MS-325 provides significant improvement in effectiveness over unenhanced MR ( and minimal and transient side effects ) at a dose of 0.03 mmol/kg and was safe and effective for MR evaluation of patients with aortoiliac occlusive disease Background Screening for abdominal aortic aneurysm ( AAA ) of men aged 65 - 74 years reduces the AAA-related mortality and is generally considered cost effective . Despite of this only a few national health care services have implemented permanent programs . Around 10 % of men in this group have peripheral arterial disease ( PAD ) defined by an ankle brachial systolic blood pressure index ( ABI ) below 0.9 result ing in an increased mortality-rate of 25 - 30 % . In addition well-documented health benefits may be achieved through primary prophylaxis by initiating systematic cholesterol-lowering , smoking cessation , low-dose acetylsalicylic acid ( aspirins ) , exercise , a healthy diet and blood-pressure control altogether reducing the increased risks for cardiovascular disease by at least 20 - 25%.The benefits of combining screening for AAA and PAD seem evident ; yet they remain to be established . The objective of this study is to assess the efficacy and the cost-effectiveness of a combined screening program for AAA , PAD and hypertension . Methods The Viborg Vascular ( VIVA ) screening trial is a r and omized , clinical ly controlled study design ed to evaluate the benefits of vascular screening and modern vascular prophylaxis in a population of 50,000 men aged 65 - 74 years . Enrolment started October 2008 and is expected to stop in October 2010 . The primary outcome is all-cause mortality . The secondary outcomes are cardiovascular mortality , AAA-related mortality , hospital services related to cardiovascular conditions , prevalence of AAA , PAD and potentially undiagnosed hypertension , health-related quality of life and cost effectiveness . Data analysis by intention to treat . Results Major follow-up will be performed at 3 , 5 and 10 years and final study result after 15 years . Trial registration Clinical Trials.gov OBJECTIVE To determine the utility of  ankle-brachial index ( ABI )  in screening for unrecognized peripheral arterial disease ( PAD ) . Although PAD is a consistent predictor of cardiovascular morbidity and mortality , it is often under-diagnosed and under-treated . METHODS In this prospect i ve , observational , real-life , epidemiologic study ( ELLIPSE ) the prevalence of  PAD ( ABI < 0.9 )  was calculated in 2146 asymptomatic patients > or = 55 years of age who were at high cardiovascular risk and who were hospitalized in departments of cardiology , diabetology , geriatrics , internal medicine , or neurology in metropolitan France .  Univariate and multivariate analyses were performed to identify PAD risk factors . The discriminatory power of the model was evaluated by calculating the area under the curve ( AUC ) of the receiver operating characteristic curve . RESULTS The ABI was < 0.9 in 41.1 % of patients . In the multivariate analysis , absence of > or = 1 pulse ( odds ratio [ OR ] , 2.18 ; 95 % confidence interval [ CI ] , 1.81 to 2.63 ; P < .0001 ) , arterial bruit ( OR , 1.92 ; 95%CI , 1.34 to 2.75 ; P < .0004 ) , previous non-Q-wave myocardial infa rct ion ( OR , 1.50 ; 95%CI , 1.08 to 2.08 ; P = .02 ) , regular smoking ( OR , 1.49 ; 95%CI , 1.22 to 1.80 ; P < .0001 ) , age > or = 81 years ( OR , 1.45 ; 95%CI , 1.15 to 1.82 ; P = .001 ) , creatinine clearance < 60 mL/min ( OR , 1.33 ; 95%CI , 1.08 to 1.63 ; P = .008 ) , and treated hypertension ( OR , 1.28 ; 95%CI , 1.03 to 1.59 ; P = .03 ) were significantly associated with PAD . Although risk increased with the number of variables , the model , based on clinical symptoms and on medical history parameters , was not discriminatory ( AUC = 0.66 ) . On average , physicians took 15 minutes to perform the ABI test . CONCLUSIONS The high prevalence of asymptomatic PAD in this patient population suggests that ABI should systematic ally be performed in high-risk hospitalized patients to ensure that appropriate secondary prevention programs are initiated Aims : Peripheral arterial disease ( PAD ) can be diagnosed in asymptomatic stage , measuring ankle-brachial index ( ABI ) . Low ABI is an indicator of increased cardiovascular risk and its inclusion to traditional risk factors can improve risk prediction . The objective of the present cross-sectional part of our large-scale , multicenter , observational study was to evaluate the prevalence of PAD in a large cohort of hypertensive patients . Methods and results : A total of 21 892 hypertensive men and women ( 9162 men ; mean age 61.45 years ) were included in our prospect i ve study in hypertension clinics . Clinical history , physical examination , and blood analysis were taken , and the ABI was measured with the Doppler method in all patients . The prevalence of PAD ( ABI ⩽0.9 ) was 14.4 % . In 15.6 % of the patients an ABI of 0.91–0.99 , and in 9.4 % of the patients high ABI ( > 1.3 ) was measured . In the low , moderate , high , and very high Systematic Coronary Risk Evaluation risk groups , the prevalence of low ABI was 8.1 , 11.1 , 16.3 , and 26 % , respectively . The prevalence of PAD was lower in hypertensive patients achieving their blood pressure target ( 9.6 vs. 16.8 % ; P < 0.001 ) . Conclusions : Asymptomatic PAD was highly prevalent in the studied hypertensive population . The use of ABI screening may improve cardiovascular risk prediction . Optimal blood pressure goal values in PAD patients and cardiovascular morbidity/mortality data will be evaluated after the 5-year long prospect i ve phase of the Evaluation of Ankle-Brachial Index in Hungarian Hypertensives program OBJECTIVE This study prospect ively assessed the diagnostic accuracy of a novel bilateral photoplethysmography toe pulse measurement technique for the detection of significant lower limb peripheral arterial disease . METHOD Bilateral photoplethysmography toe pulse measurements were compared with the ankle-brachial pressure index ( ABPI ) gold st and ard reference . Pulse wave analysis techniques extracted timing , amplitude , and shape characteristics for the great toes and their right-to-left side differences . These characteristics were compared with previously obtained normative ranges , and the accuracy was assessed for all significant disease ( ABPI < 0.9 ) and higher- grade disease ( ABPI < 0.5 ) . Measurements were collected in a controlled environment within a tertiary vascular surgical unit for 111 subjects ( age range , 42 - 91 years ) , of whom 48 had significant lower limb peripheral arterial disease and 63 were healthy . Subjects were matched in age , sex , height , body mass index , and heart rate . Diagnostic performance was assessed using diagnostic sensitivity , specificity , accuracy , negative-predictive and positive-predictive value , and the kappa statistic representing agreement between techniques beyond chance . RESULTS The degree that pulse shape fell beyond the normal range of normalized pulse shapes was at the threshold of substantial to almost perfect agreement compared with ABPI for significant disease detection ( diagnostic accuracy , 91 % [ kappa = 0.80 ] ; sensitivity , 93 % ; specificity , 89 % ) , and with 90 % accuracy ( kappa = 0.65 ) for higher- grade disease detection . Pulse transit time differences between right and left toes also had substantial agreement with ABPI , with diagnostic accuracy of 86 % for significant disease detection ( pulse transit time to pulse foot [ kappa = 0.71 ] and to pulse peak [ kappa = 0.70 ] ) and reached at least 90 % for these for the higher- grade disease . The performance ranking for the different pulse features mirrored an earlier pilot study . With the shape and pulse transit time measurements , the negative-predictive values of the 5 % disease population screening-prevalence level were at least 99 % and had positive-predictive values of at least 98 % for the 90 % disease-prevalence level for vascular laboratory referrals . CONCLUSION This simple-to-use technique could offer significant benefits for the diagnosis of peripheral arterial disease in setting s such as primary care where noninvasive , accurate , and diagnostic techniques not requiring specialist training are desirable . Improved diagnosis and screening for peripheral arterial disease has the potential to allow identification and risk factor management for this high-risk group Asymptomatic peripheral arterial disease ( PAD ) can be easily identified using the  ankle – brachial index ( ABI ) . This study was design ed to investigate the benefits of performing ABI in patients aged 50 - 70 years . A r and om sample of 107 patients was chosen and data on gender , age , risk factors and laboratory tests were collected and the ABI measured . Twenty ( 19 % ) patients were found to have PAD . Smoking , high total cholesterol , high triglycerides and diabetes mellitus were shown to be associated with a low ABI and the presence of PAD . Age , diabetes and smoking were identified as the strongest predictors of PAD . Having more risk factors for PAD also predicted a lower ABI . These results suggest that measuring ABI  is not necessary in patients aged 50 - 70 years if they only have one risk factor , with the exception of patients with diabetes and those who smoke . In contrast , measuring ABI seems to be useful for patients with multiple risk factors for PAD , although additional studies are required 
    Output:
    
Therefore , we are unable to determine the effects of screening for PAD in order to guide decision making by healthcare providers and planners .