Abstract T P109: Prediction Of Asymptomatic Cerebrovascular Diseases Before Bypass Surgery For Peripheral Artery Disease

Abstract

Background & Purpose: Cerebrovascular disease (CVD) and peripheral artery disease (PAD) sometimes coexist with each other. We investigated predictive factors for CVD before bypass surgery for PAD. Subjects & Methods: For the present study, 200 consecutive PAD patients who were planned to undergo a bypass surgery for their lower extremity artery were included. Before the surgery, all patients were studied by ankle brachial index (ABI), duplex carotid ultrasonography, magnetic resonance imaging (MRI) including diffusion weighted imaging (DWI), and MR angiography. A stenosis of ≥50% or occlusion of the major intracranial or extracranial cerebral arteries was defined as a significant CVD. We also investigated the predictive factors for significant cerebrovascular lesions. Results: Of the total 200 patients (137 men; 69%, 74±9 years old) studied, a significant CVD of the intracranial or extracranial cerebral arteries was observed in 104 (52%) patients: 57 (29%) in intracranial arteries and 68 (34%) in extracranial arteries. There were asymptomatic ischemic lesions on MRI in 116 (59%) patients. Among them, 13 (7%) patients had asymptomatic high-intense lesions on DWI. In patients with significant CVDs, dyslipidemia (63% vs 47%, p=0.0455), diabetes mellitus (67% vs 37%, p<0.001), prior ischemic stroke (65% vs 48%, p=0.0328), and prior ischemic heart disease (63% vs 46%, p=0.0189) were more frequent, and ABI value was lower (0.34 vs 0.45, p=0.0369) in comparison to patients without CVDs. On ROC curve analysis, the most accurate ABI cut-off value for predicting significant CVDs was 0.46. Prevalence of CVDs tended to increase with the increasing number of risk factors described above (44% in patient with 1, 56% in patient with 2, 71% in patient with 3, 69% in patient with 4, 80% in patient with 5; P<0.0001 for armitage trend). On multivariate analysis, dyslipidemia (OR, 1.93; 95% CI, 1.00-3.81) and diabetes mellitus (OR, 3.06; 95% CI, 1.62-5.86) were independent predictors for significant CVDs. Conclusions: In PAD patients before the bypass surgery, significant CVDs were observed in 52%. Dyslipidemia and diabetes mellitus were independent predictors for significant CVDs. Number of the predictive factors was also important for predicting CVDs.