Factors For Peripheral Arterial Disease Research Articles

Global disease burden and its attributable risk factors of peripheral arterial disease

Peripheral arterial disease (PAD) is a prevalent subtype of atherosclerotic cardiovascular diseases. It is crucial to assess the PAD-related burden and its attributable risk factors. We use the Global Burden of Disease study 2019 database to calculate the incidence, prevalence, mortality, disability-adjusted life years (DALY), attributable risk factors and estimated annual percentage change. The disease burden of PAD grows significantly with age accompanied by prominent heterogeneity between male and female. Despite the increase in the absolute numbers of disease burden from 1990 to 2019, the global PAD-related age-standardized death rate (ASDR) and age-standardized disability-adjusted life years rate (ASDALYR) have a mild downward trend from 1990 to 2019, which negatively correlated with sociodemographic index (SDI). Smoking and high systolic blood pressure (SBP) were the primary attributable risk factors for males (ASDR: 33.4%; ASDALYR: 43.4%) and females (ASDR: 25.3%; ASDALYR: 27.6%), respectively. High fasting plasma glucose (FPG) had become the second risk factor for ASDR (males: 28.5%; females: 25.2%) and ASDALYR (males: 29.3%; females: 26.3%) with an upward tendency. Low-middle SDI regions were predicted to have the most remarkable upward trend of PAD-related burden caused by high FPG. Smoking caused more disease burden in males before 85–90 years old and females before 65–70 years old, while high FPG and high SBP caused more burden after that. The patterns of PAD-related burden and its attributable risk factors are heterogeneous across ages, genders, and SDI regions. To reduce disease burden, tailored strategies should be implemented.

The prevalence and risk factors of peripheral arterial disease in diabetics

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Lower extremity arterial disease

Abstract: Lower Limbs Arterial Disease (LEAD) affects over 40 million people in Europe and appears to be 2-4 times more prevalent in people with type 2 diabetes (PWT2D) than in the general population. LEAD patients need intensive prevention and management of risk factors. Cigarette smoking is one of the most important risk factors for peripheral arterial disease as well as hyperlipoproteinemia and hypertension. Diabetic metabolic disorders are the most important risk factors for LEAD progression. The antiplatelet drugs represent one of the basic options for the management of patients with various atherosclerotic diseases. Aspirin is the oldest and most often prescribed antiplatelet drug. Lifestyle management remains the cornerstones of LEAD patients management.

Atherosclerosis

For the past decade, cardiovascular disease (CVD) has been the leading cause of death and disability worldwide, and in most cases, atherosclerosis is the dominant underlying pathologic process. Atherosclerosis is characterized by subendothelial accumulation of lymphocytes, lipid-filled macrophages, and inflammation-induced migration of vascular smooth muscle cells slowly forming a fibroinflammatory lipid plaque. Over time, the plaque progressively weakens and occludes the vessel; however, with continued inflammation and hemodynamic changes, atheromas can dangerously manifest as ischemia (acute or chronic) or aneurysmal disease. This review discusses the economic impact, historical background, and pathogenesis of atherosclerosis, as well as normal arterial biology, risk factors, and screening. Tables outline physiologic properties of nitric oxide in native vessels, selected cellular and chemical mediators and their role in atherogenesis, current risk factors for peripheral arterial disease (PAD) development, and diagnosis criteria for diseases that confer increased PAD risk. Graphs demonstrate mortality due to PAD, PAD prevalence, and the economic impact of CVD. Illustrations depict normal vessel anatomy, blood flow with plaque at carotid bifurcation, the superficial femoral artery (SFA) with plaque, and the progression of atherosclerotic changes. A flow chart for atherogenesis, photograph of a human carotid endarterectomy specimen, and angiogram showing the classic occluding lesion of the SFA are also provided. This review contains 9 figures, 5 tables, and 91 references.

Prevalence and risk factors for peripheral arterial disease in adults with systemic hypertension in Southern Nigeria

Aims: Atherosclerotic peripheral arterial disease affects quality of life and is used as a marker for atherosclerosis in the coronary and cerebral arteries. The ankle brachial pressure index can be used for identifying persons with peripheral arterial disease. This study aims to determine the prevalence of peripheral arterial disease in a cohort of hypertensive patients using the ankle brachial pressure index as well as identify the risk factors associated with PAD. Methods: One hundred and sixty hypertensive subjects and a commensurate number of age and sex matched apparently healthy controls were evaluated. Assessment of PAD was made using the history, physical examination and measurement of the ankle brachial pressure index. Chi square (χ2) and Student t tests were used to assess statistically differences between categorical and continuous variables respectively. Correlation and regression analysis was used to assess the risk factors for PAD in hypertension. Results: The mean age of the cases with systemic hypertension was 56.3 ± 8.2 years with a range of 42-72 years. There was a female preponderance with a female: male ratio of 1.8:1 as 64.4% of the cases were females and 35.6% were males. The prevalence of PAD using the ABPI was 11% in hypertensives and risk factors were determined to be increasing age (p=0.026), duration of hypertension (p=0.011), and BMI (p=0.008). Conclusion: This study highlights the presence of PAD in adult hypertensive patients and identifies the risk factors associated with PAD.

Prevalence and risk factors for peripheral arterial disease in adults with systemic hypertension in Southern Nigeria

Prevalence and risk factors for peripheral arterial disease in adults with systemic hypertension in Southern Nigeria

Prevalence and related factors of peripheral arterial disease in diabetes mellitus inpatients: a cross-sectional study in China.

Peripheral arterialdisease (PAD) can result in diabetic foot ulcers, gangrene, and even amputation. Since most cases of PAD in diabetic patients are associated with peripheral neuropathy, the symptoms of vascular disease are easily concealed by the symptoms of neuropathy and are ignored by people, so it is critical for health care providers to screen PAD for the diabetes patients. This study was carried out to identify theprevalence and related factors of PAD in diabetes mellitus inpatients. This was a cross-sectional observational study. A total of 855 patients were enrolled in the study from December 2018 to December 2019. The patients were divided into a non-PAD group (ABI = 0.9-1.3) and a PAD group (ABI <0.9). Logistic multivariate regression analysis showed that age, LDL-C, dorsalis pedis artery pulsation (left foot), and sensory-current threshold (right foot) were related factors for peripheral arterial disease. Patients who are older and have a higher LDL-C level, abnormal dorsal foot pulse, and abnormal sensory-current threshold must be vigilant, and receive early screening for PAD diagnosis and treatment to avoid a malignant outcome. In clinical work, medical staff should actively apply PAD screening to diabetic patients, identify risk factors as early as possible, conduct early interventions, reduce the risk of PAD in patients, and avoid the occurrence of adverse outcomes.

Prevalence and Risk Factors of Peripheral Arterial Disease in type 2 Diabets Mellitus in Yogyakarta, Indonesia

Aim:&#x0D; Diabetes mellitus increases the risk of peripheral artery disease (PAD) 2 times. PAD is diagnosed by ABI (Ankle Brachial Index). PAD increases mortality and morbidity of patient with Diabetes Mellitus (DM) Type 2. This study aims to determine the prevalence and risk factors of PAD in the population of type 2 diabetes mellitus (DM) in Yogyakarta, Indonesia.&#x0D; &#x0D; Methods:&#x0D; This study was a community-based descriptive and analytic observational study that examines the prevalence and risk factors of PAD in type 2 diabetes mellitus. Diagnosis of PAD was detected by ABI examination using VaSera VS-1500N. All patients with type 2 diabetes mellitus in Yogyakarta who meet the inclusion criteria will be enrolled in this study. The research subjects were taken in multi-stage, cluster-random sampling in Yogyakarta. The patient will undergo an interview of demographic data which were assessed by one assessor. Data from interviews and ABI examinations were analysed statistically.&#x0D; &#x0D; Results:&#x0D; Two hundred and fifty-six (256) patients with type 2 DM consisted of 188 patients (73.4%) women and 68 patients (26.6%) men. Prevalence of PAD diagnosed by abnormal ABI was found in 41 (16%) of 256 patients. Subjects with age more than 67 years old was significantly associated with PAD occurrence (P=0,001) in type 2 DM population.&#x0D; &#x0D; Conclusion:&#x0D; The prevalence of PAD was 16% of 256 type 2 DM patients. Age more than 67 years old was the strong risk factor of PAD in type 2 DM.&#x0D; &#x0D; Key words: Ankle Brachial Index, Peripheral Arterial Disease, Diabetes mellitus, Prevalence, Risk Factor

Comprehensive management of risk factors in peripheral vascular disease. Expert consensus

IntroductionThere is currently a degree of divergence among the main clinical practice guidelines on the management of risk factors for peripheral arterial disease (PAD). This project aims to gain understanding of the management of PAD risk factors in clinical practice and to reach a multidisciplinary consensus on the strategies to be followed in order to optimize its identification, treatment, and follow-up. MethodologyA multidisciplinary consensus following the Delphi methodology. ResultsProfessionals (n = 130) with extensive experience in PAD participated in this consultation. The results suggest that in order to optimize the control of risk factors, efforts should be aimed at: (1) promoting the involvement and awareness of all specialists in the identification of and screening for the disease; (2) guaranteeing the possibility of evaluating the ankle-brachial index (ABI) in all the medical specialties involved; (3) promoting strategies for patients to quit smoking through the use of drugs, programs, or referrals to specialized units; (4) promoting an appropriate Mediterranean-based diet and the prescription of daily exercise; (5) raising awareness of the importance of ensuring LDL cholesterol values below 70 mg/dL, especially in symptomatic but also in asymptomatic patients (<55 mg/dL following the publication of the ESC/EAS guide); (6) recommending the use of antiplatelet therapy in asymptomatic patients with diabetes mellitus (DM) and/or a pathological ABI; and (7) protocolizing the annual evaluation of ABI in high-risk patients. ConclusionThis document presents the 22 agreed-upon strategies which are intended to help professionals optimize multidisciplinary management of PAD risk factors.

Prevalence and Risk Factors for Peripheral Arterial Disease in Type 2 Diabetic Out Patients in A Care Center in Cotonou

Aim: To determine the prevalence of peripheral arterial disease and its risk factors in type 2 diabetic outpatients. Materials and Methods: It was a descriptive and analytical cross-sectional study, which included 146 diabetic out patients seen. Peripheral arterial disease (PAD) has been accessed using Ankle-Brachial Index and Arterial Doppler Ultrasound . PAD was defined by an ABI value ≤ 0.9 in either of the legs Data management and analysis were performed using Epi-Info software. A p value &lt;0.05 was considered significant. Results: The overall prevalence of peripheral arterial disease was 62.3%. Factors statistically associated with peripheral arterial disease were age (p=0.009), duration of diabetes greater than 10 years (p=0.006) and presence of peripheral neuropathy (p=0.0005). Conclusion: The prevalence of peripheral arterial disease is high in type 2 diabetic outpatients. A systematic screening and suitable management should be done in order to prevent cardiovascular events often associated.

Association between modified ankle-brachial pressure index and indices of adiposity

Objectives: Obesity is one of the important risk factors for peripheral arterial disease (PAD). Ankle-brachial pressure index (ABPI) is a non-invasive test, which may be used for earlier detection of PAD. ABPI in healthy obese/overweight subjects has not been studied. In present study, we investigated correlation of adiposity indices with ABPI. We have also compared ABPI by three different methods in healthy obese/overweight subjects. Materials and Methods: Weight, height, body mass index (BMI), waist circumference, hip circumference (HC), waist height ratio, waist hip ratio, skin fold thickness, and body fat percentage were measured in 45 healthy overweight/obese males. Ankle and brachial pressures were measured by Doppler ultrasound based method. ABPI was calculated using high ankle pressure (ABPI-HIGH), mean ankle pressure (ABPI-MEAN), and low ankle pressure (ABPI-LOW) methods. Results: BMI and HC show positive significant correlation with ABPI-LOW (P = 0.028, P = 0.046, respectively). Significant difference was observed between ABPI-LOW and ABPI-HIGH (P = 0.003). ABPI-MEAN and ABPILOW were also significantly different (P &lt; 0.001). Conclusion: There is a correlation of obesity indices with ABPI-LOW. ABPI-LOW methods could be more appropriate method and contrastingly HC may have direct correlation with PAD detection by ABPI in apparently healthy obese.

Abstract #1003750: Risk Factors of Peripheral Arterial Disease in Type 2 Diabetes Patients: A Systematic Review and Meta-analysis

Peripheral arterial disease (PAD) is one of the macrovascular complications of type 2 diabetes mellitus (T2DM), which cause serious rate of morbidities and mortality. To date, there have not been any systematic and comprehensive review regarding the risk factors of incidence of PAD in T2DM populations. Our study aims to analyze the pooled effect estimates of each risk factors of PAD incidence in T2DM populations.

The Prevalence and Risk Factors for Peripheral Arterial Disease in Adults Living With Human Immunodeficiency Virus.

Adult patients with human immunodeficiency virus (HIV) appear to be at high risk of cardiovascular disease (CVD). Peripheral arterial disease (PAD) is particularly concerning as it is associated with myocardial infarction and stroke. Nevertheless, the incidence of PAD is still unknown. The authors prospectively recruited HIV-infected patients from the outpatient clinic of the Department of Internal Medicine in our center. We assessed ankle-brachial index (ABI) using the VaSera system™ (Fukuda Denshi Co., Ltd). Patients were grouped into 3 ABI levels: an ABI ≤0.90 was considered abnormal and evidence of PAD, an ABI 1.0 to 1.40 was considered normal, and 0.91 to 0.99 was considered borderline. Cardiovascular risk factors were compared across all 3 levels of ABI and were analyzed using multivariate ordinal logistic regression. Eight hundred ninety-two patients were recruited. The mean age was 42.9 ± 10.0 years and 458 (51.4%) were males. There were 704, 149, and 39 patients in the normal, borderline, and abnormal ABI groups, respectively. The latter group of 39 patients was considered to have PAD, yielding a prevalence of 4.37% (95% confidence interval [CI] 3.21-5.93). Sex ratio, age, education levels, smoking rate, body mass index (BMI), blood pressure, prevalence of comorbidities with hypertension and coronary heart disease, median triglyceride level, reduced kidney function and HIV-1 RNA undetectable ratio, duration of HIV diagnosis, and duration on antiretroviral treatment were significantly different among 3 ABI subgroups. Independent risk factors associated with PAD were being female (odds ratio [OR]: 2.86; 95% CI: 1.94-4.22), being <30 years of age (OR: 4.66; 95% CI: 2.78-7.81), being overweight (BMI 25-25.9; OR: 0.39; 95% CI: 0.20-0.76), being obese (BMI: 30; OR: 3.53; 95% CI: 1.51-8.22), having a diastolic blood pressure ≥80 mmHg (OR: 0.50; 95% CI: 0.35-0.71), and having detectable HIV-1 RNA ≥20 copies/mL (OR: 1.85; 95% CI: 1.13-3.03). In conclusion, the prevalence of PAD in HIV-infected Thais was 4.37% in infected patients on therapy attending outpatient clinics. For this population, PAD appears to be relatively poorly correlated with traditional risk factors of CVD.

Manejo integral de los factores de riesgo en enfermedad arterial periférica. Consenso de expertos

IntroductionThere is currently a degree of divergence among the main clinical practice guidelines on the management of risk factors for peripheral arterial disease (PAD). This project aims to gain understanding of the management of PAD risk factors in clinical practice and to reach a multidisciplinary consensus on the strategies to be followed in order to optimize its identification, treatment, and follow-up. MethodologyA multidisciplinary consensus following the Delphi methodology. ResultsProfessionals (n = 130) with extensive experience in PAD participated in this consultation. The results suggest that in order to optimize the control of risk factors, efforts should be aimed at: (1) promoting the involvement and awareness of all specialists in the identification of and screening for the disease; (2) guaranteeing the possibility of evaluating the ankle-brachial index (ABI) in all the medical specialties involved; (3) promoting strategies for patients to quit smoking through the use of drugs, programs, or referrals to specialized units; (4) promoting an appropriate Mediterranean-based diet and the prescription of daily exercise; (5) raising awareness of the importance of ensuring LDL cholesterol values below 70 mg/dL, especially in symptomatic but also in asymptomatic patients (< 55 mg/dL following the publication of the ESC/EAS guide); (6) recommending the use of antiplatelet therapy in asymptomatic patients with diabetes mellitus (DM) and/or a pathological ABI; and (7) protocolizing the annual evaluation of ABI in high-risk patients. ConclusionThis document presents the 22 agreed-upon strategies which are intended to help professionals optimize multidisciplinary management of PAD risk factors.

Low serum vitamin C correlates with an increased risk of peripheral arterial disease in current smokers: Results from NHANES 2003–2004

BackgroundCigarette smoking is one of the most critical risk factors for peripheral arterial disease (PAD) and inversely correlated Vitamin C. Here we determine whether serum vitamin C correlates with the risk of PAD, especially among current smokers. MethodsA cross-sectional analysis of 2383 individuals ≥40 y was performed from the U.S. National Health and Nutrition Examination Survey (NHANES 2003–2004), including measurement of ankle-brachial index (ABI), smoking status and serum vitamin C. We examined the interactions between plasma vitamin C and exposure to smoking on the risk of PAD. Results912 (38.2%) were current smokers while 207 participants were diagnosed with PAD based on ABI(ABI≤0.9). Current smokers in the lowest vitamin C quartile had the highest prevalence of PAD (14.1%) compared to other quartiles. However, this trend was not significant in nonsmokers. Current smokers in the lowest quartile had a 2.32-fold risk (95% CI, 1.03–5.32; P = 0.04) for PAD after weighted adjustment for potential confounders, including vitamin D and C-reactive protein. In contrast, non-smokers did not have a differing risk of PAD as a function of vitamin C (P for interaction = 0.019). ConclusionsAs an anti-oxidant and anti-inflammatory, low serum vitamin C appears to associates with the risk of PAD in smokers. A relationship between PAD and vitamin C in non-current smokers is not apparent. Modulating vitamin C in current smokers may help mitigate the risk of PAD and should be a target of mechanistic study.

Serum Homocysteine Level and Ankle-Brachial Index in Peripheral Arterial Disease

Patients with peripheral arterial disease have a higher risk of death compared to normal populations. There are several relatively new risk factors significantly increase the vulnerability to suffering from peripheral arterial disease, one of which is homocysteine. Studies investigating the role of serum homocysteine level as a biomarker of the severity of peripheral arterial disease based on an ankle-brachial index (ABI) in the different populations were still limited and it was never been studied in Mataram. This was a cross-sectional study aimed to investigate the correlation between serum homocysteine level and ABI in 77 peripheral artery disease (PAD) outpatients in Siti Hajar Hospital, Mataram. The diagnosis of PAD was based on ABI&lt;0.9. Fasting serum homocysteine level was examined using the ELISA technique. Characteristic data collected were gender, age, hypertension, diabetes mellitus, and body mass index (BMI) category. There was a significant correlation between the increase of serum homocysteine levels and the decrease of ABI. The main risk factors for peripheral arterial disease in the subjects are hypertension, diabetes mellitus, and overweight/obesity. Serum homocysteine level is a predictor of peripheral arterial disease severity measured using ABI.

Peripheral Arterial Disease and Its Associated Factors among Type 2 Diabetes Mellitus Patients at Debre Tabor General Hospital, Northwest Ethiopia.

Background Peripheral arterial disease (PAD), one of the major macrovascular complications of diabetes, is associated with cardiovascular mortality and a high rate of disability following the amputation of an extremity in diabetes patients. However, there is no data on the prevalence of PAD among type 2 diabetes patients in Ethiopia. Therefore, the current study is aimed at determining the prevalence and associated factors of PAD among type 2 diabetes patients at Debre Tabor General Hospital, Debre Tabor, Northwest Ethiopia. Methods An institution-based cross-sectional study was conducted among type 2 diabetes mellitus patients from February 1 to August 30, 2019. A pretested interviewer-administered questionnaire was used to collect the data. The presence of stenosis and its grading were determined by color Doppler ultrasonography. Data were entered using EpiData-V.4.6 and analyzed by STATA-14. Bivariable and multivariable logistic regression was performed to identify associated factors of peripheral arterial disease. Adjusted odds ratio (AOR) and its confidence interval were estimated for potential predictors included in the final model. P ≤ 0.05 was used to declare statistical significance. Results The mean age of the study participants was 61.2 ± 7.3 years. One hundred seventy-two (61.4%) patients were males. The prevalence of PAD in this study was 30.7% (95% CI (25.3-36.2%)). Of these, 37 (43%) were symptomatic. Age (AOR = 1.09, 95% CI (1.03-1.16)), higher HbA1c (AOR = 1.97, 95% CI (1.03-3.40)), being an ex-smoker (AOR = 4.68, 95% CI (1.93-11.30)), and current cigarette smoking (AOR = 5.84, 95% CI (1.79-19.04)) were significantly associated with PAD. Conclusion The prevalence of peripheral arterial disease among type 2 diabetes patients was high. Increasing age, high HbA1c, and being cigarette smokers increase the likelihood of developing peripheral arterial disease. Clinicians should prevent PAD; screen T2DM patients who are aged, with high HbA1c, and cigarette smokers; and treat them timely.

Correlation Between Ankle Brachial Index and Lower Limbs Digital Pulse Oximetry: A Referral Center Experience, Prevalence Study

ObjectiveAnkle-brachial index (ABI) is widely recommended and used to evaluate peripheral arterial disease. The oxygen saturation (SpO2) has been associated with ABI, showing a promising clinical practice utility; however, little literature regarding this matter has been reported. This study aims to assess the correlation between pulse oximetry and ABI. MethodsA cross-sectional study was conducted using ABI measuring devices, such as the MESI® Ankle Brachial Pressure Index (ABPI) (MESI, Ltd., Slovenia, EU) and pulse oximetry. We compared the SpO2 distribution by using the Wilcoxon test and evaluated its correlation by using logistic regression. ResultsFrom a total of 86 patients, 54 were males (62.8%) and the median age was 54 years old (interquartile range (IQR) = 37 - 65 yrs.). Regarding ABI measurements of the right lower limb (RLL), a total of 20 patients (22.3%) had an abnormal classification. On the other hand, a total of 21 patients (22.1%) had an abnormal classification of the left lower limb (LLL) ABI measurements. The distribution of SpO2 in relation to ABI categories was not statistically different (RLL p = 0.2433; LLL p = 0.1242). The SpO2 classification of ABI and abnormal pulse oximetry for the RLL was at 76.7% and at 77.9% in the LLL (Pearson’s goodness-of-fit test: RLL = p < 0.001 and LLL = p < 0.001). ConclusionAlthough we didn’t observe any statistical differences in the SpO2 distribution regarding ABI measurements, in their correlation, there seems to be a different tendency. The SpO2 might be a useful non-invasive tool to assess asymptomatic patients with risk factors for peripheral arterial disease (PAD).

Risk factors for peripheral arterial disease in elderly patients with Type-2 diabetes mellitus: A clinical study.

Objectives:To determine risk factors for peripheral arterial disease (PAD) in elderly patients with Type-2 diabetes mellitus.Methods:The elderly patients with Type-2 diabetes treated in the Central Hospital of Cangzhou were enrolled and divided into PAD group and non-PAD group between October 2016 and November 2019, The data of the patients including age, gender, body mass index, blood pressure, hemoglobin A1c, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, total cholesterol, triglyceride, white cell count, lymphocyte count, high-sensitivity C-reactive protein, uric acid as well as living habits and complications of Type-2 diabetes mellitus were recorded to determine the risk factors for PAD.Results:One thousand four hundred seventy six (1476) patients were enrolled, in which 465 patients were included in group of PAD, and 1011 in non-PAD group. The univariate analysis revealed that the two groups significantly differed in age (p=0.003), course of T2DM (p=0.001), hypertension (p=0.006), smoking habits (p<0.001), hyperuricemia (p<0.01), high-sensitivity C-reactive protein (p<0.01), white cell count (p<0.001), lymphocyte count (p<0.001) and diabetic neuropathy (p<0.001). In the multivariate analysis, age (OR: 1.56, 95% CI: 1.21-1.89), smoking habit (OR: 1.37, 95% CI: 1.19-1.68), hypertension (OR: 1.44, 95% CI: 1.15-1.98), diabetic neuropathy (OR: 3.55, 95% CI: 2.14-4.29), high-sensitivity C-reactive protein (OR: 1.74, 95% CI: 1.39-2.61) and hyperuricemia (OR: 2.71, 95% CI: 1.66-3.87) were significant risk factors for PAD.Conclusions:Age, smoking habit, hypertension, diabetic neuropathy, high-sensitivity C-reactive protein and hyperuricemia were independent risk factors for peripheral arterial disease in elderly patients with Type-2 diabetes mellitus.

Prevalence and Risk Factors of Peripheral Arterial Disease in Patients with Lumbar Spinal Stenosis and Intermittent Claudication: CT Angiography Study.

BackgroundIt can be difficult to differentiate between vascular and neurogenic intermittent claudication. The exact diagnosis often cannot be made on clinical evidence and ultimately requires imaging. Perioperative screening for peripheral arterial disease (PAD) in lumbar spinal stenosis (LSS) patients is important because untreated PAD increases the risk of severe vascular events. The aims of this study were to study the prevalence of PAD in LSS patients with symptoms of intermittent claudication, and to study the independent risk factors for PAD. We specified the cases where it was necessary to perform computed tomography angiography (CTA) as a preoperative screening tool in surgery for spinal stenosis.MethodsThis study involved a retrospective analysis of 186 consecutive subjects with radiographic evidence of LSS and symptoms of intermittent claudication, who underwent 3D CTA of the lower extremities at our institution during a three-year period. More than 50% luminal narrowing on CT angiograms was determined to be clinically significant and placed in the PAD group.ResultsThirty-two subjects were diagnosed with PAD and referred to the general vascular team in our hospital, where they received treatment for PAD. In the non-PAD group (154 subjects), 117 underwent definitive surgery for spinal stenosis such as posterior lumbar interbody fusion and a further 37 underwent conservative treatment. Only hypertension, diabetes, and men gender were found to be statistically significant predictors of PAD.ConclusionThe current study showed that man gender, diabetes and hypertension were the greatest risk factors for PAD. We conclude that man patients with diabetes and/or hypertension should be put under serious consideration for routine CTA examination when under evaluation for LSS and intermittent claudication.