Abstract
BackgroundLower extremity peripheral artery disease has become a significant health burden worldwide. Since the treatment strategies can be different if atherosclerotic disease involves different femoral artery segments, it is important to assess plaque distribution among different segments of femoral arteries. We sought to investigate the longitudinal distribution of subclinical femoral artery atherosclerosis in asymptomatic elderly adults using cardiovascular magnetic resonance (CMR) vessel wall imaging.MethodsAsymptomatic elderly subjects underwent three-dimensional (3D) CMR vessel wall imaging for femoral arteries. The 3D motion sensitized-driven equilibrium prepared rapid gradient-echo (3D-MERGE) sequence was acquired from the common femoral artery to the popliteal artery. The femoral artery was divided into 4 segments: common femoral artery (CFA), proximal superficial femoral artery (pSFA), adductor canal (AC) segment of femoral artery, and popliteal artery (PA). The morphological characteristics including lumen area, wall area, maximum and minimum wall thickness, normalized wall index (NWI = wall area / [lumen area + wall area] × 100%), and eccentricity index ([maximum wall thickness - minimum wall thickness] / maximum wall thickness), luminal stenosis, and presence of atherosclerotic plaque were evaluated and compared between bilateral sides and among different femoral artery segments in each side of femoral artery. The associations between ankle-brachial index (ABI) and cardiovascular risk factors and femoral artery plaque characteristics were also determined.ResultsOf 107 recruited subjects (71.9 ± 5.6 years; 48 males), 70 (65.4%) were found to have femoral artery plaques. The atherosclerotic plaques were most frequently found in PA (41.1%) and CFA (40.2%) segments, followed by pSFA (31.8%) and AC (23.4%) segments (p = 0.002). Similarly, PA and CFA segments showed significantly greater maximum wall thickness and eccentricity index compared with pSFA and AC segments (all p < 0.001). Significant differences can be found in NWI among four segments of femoral arteries (p < 0.001) and PA showed the highest NWI (54.8%), followed by AC (54.3%), pSFA (52.4%) and CFA (45.9%) segments. Compared with right femoral artery, left femoral artery had significant smaller lumen area and greater NWI in most of segments (p < 0.002). There were no significant differences in ABI between subjects with and without atherosclerotic plaques (p = 0.161). The presence of subclinical atherosclerotic plaque in femoral arteries was significantly associated with cardiovascular risk factors including age (odds ratio [OR], 1.133; 95% confidence interval [CI], 1.048–1.224, p = 0.002), male gender (OR, 3.914; 95% CI, 1.612–9.501, p = 0.003), and hypertension (OR, 4.000; 95% CI, 1.700–9.411, p = 0.001), respectively.ConclusionsSubclinical femoral artery atherosclerosis is prevalent in the elderly population, particularly in the left femoral artery and segments of CFA and PA, and is associated with age, male gender and hypertension. Our findings suggest that, for screening subclinical atherosclerosis, more attention needs to be paid to the specific side and segments of femoral arteries, particularly older individuals and those with these cardiovascular disease risk factors.
Highlights
Lower extremity peripheral artery disease has become a significant health burden worldwide
The atherosclerotic plaques were most frequently found in popliteal artery (PA) (41.1%) and common femoral artery (CFA) (40.2%) segments, followed by proximal superficial femoral artery (pSFA) (31.8%) and adductor canal (AC) (23.4%) segments (p = 0.002)
For screening subclinical atherosclerosis, more attention needs to be paid to the specific side and segments of femoral arteries, older individuals and those with these cardiovascular disease risk factors
Summary
Lower extremity peripheral artery disease has become a significant health burden worldwide. We sought to investigate the longitudinal distribution of subclinical femoral artery atherosclerosis in asymptomatic elderly adults using cardiovascular magnetic resonance (CMR) vessel wall imaging. It is important to assess the atherosclerotic plaque distribution among different segments of femoral arteries for precise diagnosis, patient management and event prevention. Three-dimensional (3D) cardiovascular magnetic resonance (CMR) vessel wall imaging techniques have been proposed for evaluating atherosclerotic plaques in carotid [8] and femoral arteries [9,10,11]. Benefiting from the iso-tropic high spatial resolution and large longitudinal coverage, 3D vessel wall imaging techniques have been successfully utilized for assessing plaque distribution in intracranial and extracranial carotid arteries [12, 13]. We sought to investigate the distribution of subclinical atherosclerotic diseases among different femoral artery segments in the elderly population using 3D CMR vessel wall imaging
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