The distribution of atherosclerosis in the lower limbs

Aston, N. O.; Thomas, Mariam; Burnand, K. G.

doi:10.1016/s0950-821x(05)80098-2

Cited by 12 publications

(5 citation statements)

References 20 publications

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“…10,14 Lower extremity atherosclerosis is considered to be strongly related to smoking and diabetes mellitus. 4,7,9,15 However, there are striking dissimilarities between arterial regions of the lower extremities [16][17][18][19][20][21] with the predominant below knee involvement in diabetic patients most obvious. 17 The aim of this cohort study of patients undergoing primary endovascular treatment of lower limb arteries is to analyse risk factor association with distribution pattern of peripheral atherosclerotic target lesions.…”

Section: Introductionmentioning

confidence: 99%

Association of Cardiovascular Risk Factors with Pattern of Lower Limb Atherosclerosis in 2659 Patients Undergoing Angioplasty

Diehm

Shang

Silvestro

et al. 2006

European Journal of Vascular and Endovascular Surgery

201

181

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Section: Introductionmentioning

confidence: 99%

Association of Cardiovascular Risk Factors with Pattern of Lower Limb Atherosclerosis in 2659 Patients Undergoing Angioplasty

Diehm

Shang

Silvestro

et al. 2006

European Journal of Vascular and Endovascular Surgery

201

181

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“…For example, the consequences of arterial occlusions are less severe in the aortoiliac than in the femoropopliteal segment, which in turn are better tolerated than an infrapopliteal occlusion. 6,7 The number and capacity of collateral vessels may also have an impact on the severity of symptoms and disease prognosis and may be influenced by comorbidities, such as diabetes or smoking habits. If the significance of arteriogenesis on PAD progression were known, this information could be used to develop new treatment methods aiming to stimulate collateral growth.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Poor Collateral Development in Claudication

Vivo¹,

Palmer-Kazen

Kalin

et al. 2005

Vasc Endovascular Surg

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The objective of this retrospective, cross-sectional study was to determine risk factors for poor collateral development in patients with claudication. The authors listed all patients with calf claudication who had undergone angiography in this hospital between 1999 and 2001 and extracted those with superficial femoral artery (SFA) occlusion, a popliteal artery without major lesions, and at least 1 patent calf artery. Forty-five patients met the criteria, and concomitant disease and claudication characteristics, ankle/brachial index (ABI) and number of outflow vessels were recorded. Three blinded observers calculated the number of collaterals on the angiograms, and the collateral count was related to the other factors by use of regression analysis. The mean patient age was 69 years (SD 11), and 62% were women. Their walking distance was 90 m (77) and ABI 0.47 (0.15). Thirty-three percent had diabetes and 50% had duration of symptoms longer than 5 years. The mean number of collaterals bypassing the occlusion was 15.1 (SD 4.8). Univariate regression analysis indicated an association (p <0.08) between few collateral vessels and diabetes, short duration of symptoms, current smoking habits, and old age. In the multivariate analysis only diabetes and short duration of symptoms were related to having few collaterals. In patients with claudication and SFA occlusion, few collaterals from the deep femoral artery appear to be associated with having diabetes and a short duration of symptoms.

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“…Aston and colleagues have observed that even symptomless patients have occlusions in the tibial and fibular vessels, and they postulate that the extent of previous distal occlusions determines the severity of the symptoms at the time of proximal occlusion. 6 Additionally, mental or neurological disorders, such as deterioration of the memory due to dementia, may be the cause of patient histories not revealing any symptoms of claudication. Naturally, more than one of these mechanisms may coexist.…”

Section: Discussionmentioning

confidence: 99%

“…5 Critical leg ischemia (CLI) is mostly caused by occlusive lesions that are more severe and extended than the vascular changes found in claudication. 6 It seems logical to assume that all critically ischemic patients should have had symptoms of claudication at an earlier stage of the disease. This would mean that these patients could approach a doctor before critical ischemia develops with the opportunity to intercept the progression of the disease at an earlier stage.…”

Section: Introductionmentioning

confidence: 99%

Claudication does not always precede critical leg ischemia

Mätzke

Lepäntalo

2001

Vasc Med

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Prevalence of intermittent claudication is often used to calculate the prevalence of critical leg ischemia (CLI), a more severe form of peripheral arterial disease (PAD). Although this logical course of the disease is intellectually appealing, not all patients with CLI have experienced any symptoms of previous claudication. A total of 100 consecutive patients with objective evidence of critical ischemia, as evaluated by non-invasive testing in the authors' vascular laboratory, were subjected to a structured interview to evaluate how often peripheral arterial disease is presented with symptoms of CLI as the initial complaint. In all, 37 patients had never experienced claudication prior to the development of CLI. Furthermore, 12 of 63 patients who suffered from previous claudication did not have any claudication symptoms at the time of the development of CLI. Of the 37 patients with CLI as the first sign of PAD, 20 had diabetes -four of whom with manifest diagnosed neuropathy. The patients without previous claudication more frequently had ulcers as the initial symptom of CLI (89%) than those with claudication (59%), whose disease first progressed to rest pain. Altogether, 25 patients did not walk enough to develop symptoms of claudication. In conclusion, every patient presenting with symptoms potentially related to CLI should undergo vascular laboratory measurements regardless of whether he/she has a history of claudication or not. This is especially true in limbs with unhealed skin lesions.

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The distribution of atherosclerosis in the lower limbs

Cited by 12 publications

References 20 publications

Association of Cardiovascular Risk Factors with Pattern of Lower Limb Atherosclerosis in 2659 Patients Undergoing Angioplasty

Association of Cardiovascular Risk Factors with Pattern of Lower Limb Atherosclerosis in 2659 Patients Undergoing Angioplasty

Risk Factors for Poor Collateral Development in Claudication

Claudication does not always precede critical leg ischemia

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