Crural Index and extensive atherosclerosis of crural vessels are associated with long-term cardiovascular mortality in patients with symptomatic peripheral artery disease

Wickström, Jan-Erik; Venermo, Maarit

doi:10.1016/j.atherosclerosis.2017.07.023

Cited by 20 publications

(16 citation statements)

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“…Based on our earlier studies, crural PAD is associated with increased risk of mortality and amputation. 19,20 The present study indicates that this cohort of patients presents also an increased risk of cerebrovascular disease.…”

Section: Discussionsupporting

confidence: 63%

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Association between anatomical distribution of symptomatic peripheral artery disease and cerebrovascular disease

et al. 2020

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Aim Peripheral arterial disease is frequently associated with significant atherosclerosis of other vascular beds. The aim of the present study was to investigate a possible association between peripheral arterial disease segment-specific disease burden and cerebrovascular disease. Methods Two-hundred and twenty-six patients with clinically symptomatic peripheral arterial disease from the prospective PureASO registry were followed up after revascularization. The breadth of peripheral arterial disease was quantified at the time patients entered the study. The segment-specific peripheral arterial disease burden was correlated to cerebrovascular disease and imaging findings during a five-year follow-up. Results At five years, cerebrovascular disease-free survival after lower limb revascularization was 31%. Patients with peripheral arterial disease involving the crural arteries had significantly more ischemic degenerative changes at brain imaging ( p = 0.031), whereas patients with aorto-iliac and femoropopliteal segment peripheral arterial disease had more significant (>50% uni- or bilaterally) internal carotid artery stenosis compared to patients with crural peripheral arterial disease ( p = 0.006). According to Cox regression analyses, crural arteries burden was associated with a significantly increased risk of mortality (adjusted HR 2.07, CI 95% 1.12–3.28, p = 0.021) and cerebrovascular events (adjusted HR 1.97, CI 95% 1.19–3.26, p = 0.008). Conclusions Present results suggest that atherosclerosis burden at different lower limb artery segments is associated with defined cerebrovascular disease. This further suggests that risk factors and pathophysiological mechanisms are congruent across particular vascular beds.

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Section: Discussionsupporting

confidence: 63%

“…The PAD burden at defined lower limb artery segments was analysed according to our recent classification. 19,20 Methods…”

Section: Introductionmentioning

confidence: 99%

Association between anatomical distribution of symptomatic peripheral artery disease and cerebrovascular disease

et al. 2020

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“…Although the chosen primary revascularization method did not correlate with mortality, extensive atherosclerosis was associated with mortality both insulin and non-insulin diabetic. Wickström et al (10) found that CIx III and IV score was associated with mortality, although their analysis did not focus particularly on diabetics or its subgroups as defined by medication. Accelerated alterations in the metabolic state, inflammation, endothelial dysfunction, and other proatherogenic changes that accompany diabetes might be an explanation for worse OS (38).…”

Section: Mortalitymentioning

confidence: 99%

“…In the previous literature, atherosclerosis of the tibial vessels has not only been linked to diabetes but also linked to particularly poor AFS and OS (9,10). Several different classification systems for lower extremity PAD have been created, but none of them have been able to prognosticate the survival of infrapopliteal PAD patients (9).…”

Section: Introductionmentioning

confidence: 99%

Chronic limb threatening ischemia and diabetes mellitus: the severity of tibial atherosclerosis and outcome after infrapopliteal revascularization

et al. 2020

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Background and Aims: Diabetes mellitus associates with poor outcomes in chronic limb threatening ischemia but data on different hypoglycemic regimens and outcomes are lacking. We analyzed insulin-treated diabetes mellitus, non-insulin-treated diabetes mellitus, and patients without diabetes mellitus. Materials and Methods: All patients with peripheral artery disease and/or diabetes mellitus and infrapopliteal revascularization in the Department of Vascular Surgery, Turku University Hospital during 2007–2015 were included. Tibial atherosclerosis was categorized into crural index classes of I–IV. Results: Of the 497 patients, 180 were insulin-treated diabetes mellitus, 94 non-insulin-treated diabetes mellitus, and 223 patients without diabetes mellitus groups (diabetes mellitus 55.1%). Insulin-treated diabetes mellitus was the most ill, youngest (insulin-treated diabetes mellitus—median: 72.4, interquartile range: 64.0–79.5 versus non-insulin-treated diabetes mellitus—76.0, interquartile range: 67.9–83.6 versus patients without diabetes mellitus—77.3, interquartile range: 68.5–83.7, p < 0.001), had the highest body mass index (insulin-treated diabetes mellitus—median: 27.7, interquartile range: 24.0–31.8 versus non-insulin-treated diabetes mellitus—26.3, interquartile range: 23.2–30.3 versus patients without diabetes mellitus—23.9, interquartile range: 21.5–26.9, p < 0.001), and Charlson comorbidity index (insulin-treated diabetes mellitus—65.6% versus non-insulin-treated diabetes mellitus—46.8% versus patients without diabetes mellitus—10.8%, p < 0.001). After endovascular revascularization, limb salvage was poorer for insulin-treated diabetes mellitus ( p = 0.046) and non-insulin-treated diabetes mellitus groups ( p = 0.011) compared to surgery, but not for patients without diabetes mellitus ( p = 0.15). Patients with crural index IV in insulin-treated diabetes mellitus ( p = 0.001) and non-insulin-treated diabetes mellitus ( p = 0.013) had higher mortality after revascularization. Crural index IV was a risk factor for limb loss (hazard ratio: 1.37, 95% confidence interval: 1.08–1.74, p = 0.008). Conclusion: Limb salvage after bypass is better for insulin and non-insulin diabetics, compared to the endovascular approach. Extensive tibial atherosclerosis is an independent risk factor for limb loss. It associates with increased mortality in both insulin and non-insulin diabetics.

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“…При этом тяжелое поражение артерий бедренно-подколенного сегмента и артерий берцового сегмента также независимо ассоциировались с увеличением ОР смерти от всех причин -в 1,34 раза (95% ДИ 1,11-1,08) и 1,03 раза (95% ДИ 1,01-1,03), соответственно. В ряде исследований, оценивающих прогностическую значимость локализации атеросклеротического поражения АНК, было установлено, что поражение главным образом артерий берцового сегмента связано с увеличением риска кардиоваскулярных событий [12,13]. По доступным нам данным, независимая предиктивная ценность АСБ в подколенных артериях продемонстрирована впервые.…”

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The prognostic value of various markers of lower limb atherosclerotic lesions in patients with high and very high cardiovascular risk

Генкель

Шапошник

2019

Russ J Cardiol

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Aim. To study the prognostic significance of various markers of atherosclerosis of lower limb arteries (LLA) in patients at high and very high cardiovascular risk (CVR).Methods. The study included 108 patients at high and very high CVR, the median age of which was 62.0 (55.7; 67.0) years. All patients underwent duplex scanning of the LLA, as well as measurement of the ankle-brachial index (ABI) by the Doppler method. The combined end point was cardiovascular death, nonfatal myocardial infarction or unstable angina, requiring hospitalization, nonfatal stroke, coronary revascularization.Results. Atherosclerotic plaques in LLA were detected in 69.4% of cases, while a decrease in ABI was detected in 22.2% of patients, and LLA stenosis more than 50% in 36.1%. The follow-up duration was 25.0 (14.5; 35.5) months. The adverse cardiovascular events occurred in 41 (37.9%) patients. According to the Cox regression results, the following indicators had an independent predictive value in relation to the development of adverse cardiovascular events: a decrease in ABI ≤0.9 (RR 2.23; 95% CI 1.01-4.94; p=0.048), LLA stenosis ≥40% (RR 3.17; 95% CI 1.27–7.92; p=0.013) and the presence of plaque in the popliteal arteries (RR 2.49; 95% CI 1.27–7.92; p=0.013).Conclusion. In the group of patients at high and very high CVR, among ultrasonographic markers of lower limb arteriosclerosis, independent predictive value regarding the development of adverse cardiovascular events had a decrease in ABI ≤0.9, the presence of plaque in the popliteal arteries and LLA stenosis more than 40%.

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Crural Index and extensive atherosclerosis of crural vessels are associated with long-term cardiovascular mortality in patients with symptomatic peripheral artery disease

Abstract: High Crural Index and extensive crural vessel atherosclerosis are associated with long-term cardiovascular mortality, and both may serve as useful indicators of survival among patients with symptomatic PAD.

Cited by 20 publications

References 30 publications

Association between anatomical distribution of symptomatic peripheral artery disease and cerebrovascular disease

Association between anatomical distribution of symptomatic peripheral artery disease and cerebrovascular disease

Chronic limb threatening ischemia and diabetes mellitus: the severity of tibial atherosclerosis and outcome after infrapopliteal revascularization

The prognostic value of various markers of lower limb atherosclerotic lesions in patients with high and very high cardiovascular risk

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