Disease Location Is Associated With Survival in Patients With Peripheral Arterial Disease

Abstract

BackgroundWe investigated whether disease location influences survival in patients with peripheral arterial disease.Methods and ResultsPatients (n=12 731; mean age, 67.5±12.7 years; 57.4% male) who underwent outpatient noninvasive lower extremity arterial evaluation were followed up for 5.9±3.1 years for all‐cause mortality. Peripheral arterial disease (n=8930) was defined as a resting or postexercise ankle‐brachial index (ABI) ≤0.90, and normal ABI (n=3 801) was defined as a resting and postexercise ABI of 1.00 to 1.30. Presence or absence of disease at the proximal location or distal location was determined on the basis of Doppler signals in leg arteries; 42% had no PD or DD, 45% had proximal (14% postexercise PD only), 30% had distal disease, 17% had both proximal and distal disease, 28% had proximal only and 14% had distal only. We performed multivariable logistic regression to identify factors associated with disease location, and Cox proportional hazard regression to assess the respective effects of proximal or distal disease on survival. Older age, male sex, diabetes, heart failure, and critical limb ischemia were associated with distal disease, whereas female sex, smoking, hypertension, dyslipidemia, coronary heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, and critical limb ischemia were associated with proximal disease. Over a mean follow‐up of 5.9±3.1 years, 3039 patients (23.9%) died. After adjustment for potential confounders, the hazard ratios (HRs) of death associated with PD only and DD only were 1.3 (1.3 to 1.4) and 1.5 (1.4 to 1.6), respectively. After additional adjustment for resting ABI, there was no significant association between proximal disease and death, whereas the association of distal disease with death remained significant (HR, 1.2; 95% CI, 1.1 to 1.3).ConclusionsIn patients with peripheral arterial disease, proximal and distal disease locations were associated with distinctive risk factor and comorbidity profiles. Distal disease was associated with worse survival even after adjustment for risk factors, comorbidities, and resting ABI.

Prediction of Coronary Artery Disease in Patients With Lower Extremity Peripheral Artery Disease

“…Chen, et al demonstrated that patients with distal disease had a poorer prognosis than patients without distal disease, whereas patients with proximal disease showed no difference in prognosis. 17) Similarly, another study showed that multi-level disease was associated with a poorer prognosis in PAD patients. 16) Therefore, previous publications and our data showed that PAD lesion location affects the severity of CAD and prognosis in patients with lower extremity PAD.…”

“…Previous studies showed that the location of the lesion is associated with survival in patients with lower extremity PAD. 16,17) However, there are few studies on the relationship between PAD and CAD lesion location confirmed by angiography. We hypothesized that the location of the PAD lesion can predict the presence and severity of CAD.…”

Long‐Term Prognostic Risk in Lower Extremity Peripheral Arterial Disease as a Function of the Number of Peripheral Arterial Lesions

“…This raises the question whether it is possible that the manifestation of atherosclerosis may present differentially among individual patients’ arteries. More aggressive expression of atherosclerosis has been found in patients with distal versus aortoiliac disease and in patients in whom higher inflammation markers can be found 17, 18, 19. These studies suggested which concomitant factors could be associated with a more aggressive underlying atherosclerotic process but were unable to document whether this could be linked to the number of lower extremity lesions and patient outcomes 17, 18.…”

Patterns of Disease Distribution of Lower Extremity Peripheral Arterial Disease

“…42 Chen et al study found that common femoral was more commonly affected than the distal location (57.6% and 42.9%, respectively). 13 Peripheral arterial disease resulting from atherosclerosis is a multisegmental disease in approximately two-thirds of symptomatic patients. 16 In the study of Haltmayer et al, 25% of patients had stenoses and/or occlusions in 2 segments.…”

“…11,16 However, another clinical study showed that hypertension is significantly associated with proximal disease. 13 Smith study indicated that raised systolic blood pressure appears to be more strongly related to multisegment disease and that a raised diastolic pressure may predispose more to disease in the aortoiliac vessels. 7 Diehm et al found no relationship between hypertension and lesion sites.…”