Abstract
ObjectiveAlthough lower extremity arterial disease (LEAD) is most often multisegmental, the predominant disease location and risk factors differ between patients. Ankle-brachial index (ABI), toe-brachial index (TBI), and toe pressure (TP) are predictive of outcome in LEAD patients. Previously, we reported a classification method defining the most diseased arterial segment (MDAS); crural (CR), femoropopliteal (FP), or aortoiliac (AOI). Current study aimed to analyze the associations between MDAS, peripheral pressure measurements and cardiovascular mortality.Materials and methodsWe reviewed retrospectively 729 consecutive LEAD patients (Rutherford 2–6) who underwent digital subtraction angiography between January, 2009 to August, 2011 and had standardized peripheral pressure measurements.ResultsIn Cox Regression analyses, cardiovascular mortality was associated with MDAS and non-invasive pressure indices as follows; MDAS AOI, TP <30 mmHg (HR 3.00, 95% CI 1.13–7.99); MDAS FP, TP <30 mmHg (HR 2.31, 95% CI 1.36–3.94), TBI <0.25 (HR 3.20, 95% CI 1.34–7.63), ABI <0.25 (HR 5.45, 95% CI 1.56–19.0) and ≥1.30 (HR 6.71, 95% CI 1.89–23.8), and MDAS CR, TP <30 mmHg (HR 4.26, 95% CI 2.19–8.27), TBI <0.25 (HR 7.71, 95% CI 1.86–32.9), and ABI <0.25 (HR 2.59, 95% CI 1.15–5.85).ConclusionsSymptomatic LEAD appears to be multisegmental with severe infrapopliteal involvement. Because of this, TP and TBI are strongly predictive of cardiovascular mortality and they should be routinely measured despite the predominant disease location or clinical presentation.
Highlights
Lower-extremity arterial disease (LEAD), both symptomatic and asymptomatic, is associated with elevated risk for cardiovascular and all-cause mortality [1]
In Cox Regression analyses, cardiovascular mortality was associated with most diseased arterial segment (MDAS) and noninvasive pressure indices as follows; MDAS AOI, toe pressure (TP)
Symptomatic LEAD appears to be multisegmental with severe infrapopliteal involvement
Summary
Lower extremity arterial disease (LEAD) is most often multisegmental, the predominant disease location and risk factors differ between patients. Ankle-brachial index (ABI), toe-brachial index (TBI), and toe pressure (TP) are predictive of outcome in LEAD patients. We reported a classification method defining the most diseased arterial segment (MDAS); crural (CR), femoropopliteal (FP), or aortoiliac (AOI). Current study aimed to analyze the associations between MDAS, peripheral pressure measurements and cardiovascular mortality
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