Proximal Superficial Femoral Artery Occlusion, Collateral Vessels, and Walking Performance in Peripheral Artery Disease

Abstract

Objective We studied associations of MRI-measured SFA occlusions with functional performance, leg symptoms, and collateral vessel number in PAD. We studied associations of collateral vessel number with functional performance in PAD. Background Associations of magnetic resonance imaging (MRI)-detected superficial femoral artery (SFA) occlusion and collateral vessel number with functional performance among individuals with peripheral artery disease (PAD) have not been reported. Methods 457 participants with an ankle brachial index (ABI) < 1.00 had MRI measurement of the proximal SFA with twelve consecutive 2.5 millimeter cross-sectional images. An occluded SFA was defined as an SFA in which at least one segment was occluded. A non-occluded SFA was defined as absence of any occluded slices. Collateral vessels were visualized with magnetic resonance angiography (MRA). Lower extremity functional performance was measured with the six-minute walk, four-meter walking velocity at usual and fastest pace, and the short physical performance battery (SPPB) (0-12 scale, 12=best). Results Adjusting for age, sex, race, comorbidities, and other confounders, the presence of an SFA occlusion was associated with poorer six-minute walk performance (1,031 vs. 1,169 feet, P=0.006), slower fast-paced walking velocity (1.15 vs. 1.22 meters/second, P =0.042), and lower SPPB score (9.07 vs. 9.75, P=0.038) compared to the absence of an SFA occlusion. More numerous collateral vessels were associated with better six-minute walk performance (0-3 collaterals-1,064 feet, 4-7 collaterals-1,165 feet, ≥ 8 collaterals-1,246 feet, P trend=0.007), faster usual-paced walking speed (0-3 collaterals-0.84 meters/second, 4-7 collaterals-0.88 meters/second, ≥ 8 collaterals-0.91 meters/second, P trend=0.029), and faster rapid-paced walking speed (0-3 collaterals-1.17 meters/second, 4-7 collaterals-1.22 meters/second, ≥ 8 collaterals-1.29 meters/second, P trend=0.002), adjusting for age, sex, race, comorbidities, ABI, and other confounders. Conclusions Among PAD participants, MRI-visualized occlusions in the proximal SFA are associated with poorer functional performance, while more numerous collaterals are associated with better functional performance. Clinical Trial ID NCT00520412

Incidence and Prognostic Significance of Depressive Symptoms in Peripheral Artery Disease

“…Similar recruitment methods were used for all 3 studies . In all 3 cohorts, PAD participants were identified from among consecutive patients with PAD in Chicago‐area vascular surgery and noninvasive vascular laboratories . Participants were also identified from among lists of consecutive PAD patients in cardiology, general medicine, endocrinology, and geriatric clinics at Northwestern.…”

“…[7][8][9][10] In all 3 cohorts, PAD participants were identified from among consecutive patients with PAD in Chicago-area vascular surgery and noninvasive vascular laboratories. [7][8][9][10] Participants were also identified from among lists of consecutive PAD patients in cardiology, general medicine, endocrinology, and geriatric clinics at Northwestern. In the WALCS and WALCS II cohorts, participants without PAD were identified from among consecutive patients in a general internal medicine practice who were screened with the ankle-brachial index (ABI) and found to have an ABI of 0.90 to 1.50.…”

Functional Impairment in Peripheral Artery Disease and How to Improve It in 2013

“…Preliminary evidence also suggests that PAD is associated with mitochondrial dysfunction, and that this association is not fully reversible with lower extremity revascularization (43,44). Larger and more numerous collateral vessels may be associated with better functional performance in PAD, but further study is needed to better characterize these associations (45). An improved understanding of mechanisms of functional impairment and decline in PAD is needed in order to identify new therapies to improve functional performance in PAD.…”

High-risk plaque in the superficial femoral artery of people with peripheral artery disease: Prevalence and associated clinical characteristics

“…18, 19 However, to our knowledge, a more detailed assessment of plaque composition to describe the prevalence and associated clinical characteristics of MRI-measured LRNC and intra-plaque hemorrhage in the femoral arteries has not been reported previously. We used MRI of plaque in the superficial femoral artery (SFA) to determine the prevalence of LRNC and intra-plaque hemorrhage among adults with peripheral arterial disease (PAD).…”