Peripheral Arterial Disease Research Articles

Ulnar-Basilic Arteriovenous Fistula for Hemodialysis: A 15-Year Overview.

Distal forearm arteriovenous fistulas (AVFs) for hemodialysis (HD) include radiocephalic fistulas (RCFs) and ulnar-basilic fistulas (UBFs). However, due to the unique anatomical peculiarities of the latter approach, UBFs are only established in a limited subset of patients undergoing vascular access procedures. This study aimed to present a retrospective case series detailing the creation of UBFs, emphasizing both the technical challenges and clinical outcomes associated with this approach. We conducted a retrospective review of UBFs created between 2008 and 2023. Data collected included patient demographics, comorbidities, patency, functionality, and outcomes. Adequate blood flow and personalized Kt/Vurea levels were prerequisites for defining UBF functionality for HD. Among 253 patients receiving HD, 82.2% had an AVF, with only 3.3% (n = 5) of the 150 distal AVFs functional for HD being UBFs. In this series, a total of 11 UBF fistulas were created, with nine patients experiencing an immediate thrill. Among those with UBF failure, three patients were aged > 85 years, and three had concurrent diabetes mellitus, peripheral vascular disease, and ischemic heart disease. The survival rate in the UBF group correlated with the duration of dialysis in the three patients for whom the UBF was the sole AVF, with one patient achieving a remarkably prolonged period of > 10 years. No incidences of ischemia, hand edema, or ulnar nerve lesions were noted. While the difficulties experienced in achieving functional UBFs for HD are highlighted in this long-term perspective, its safety and durability make it a viable option in managing an increasingly comorbid patient population.

Peripheral Arterial Disease Management: Insights From the SerbVasc Registry.

This report contributes to VASCUNET data on treating peripheral artery disease (PAD) in Serbia, addressing sex differences, revascularization types, procedure characteristics, and morbidity and mortality. SerbVasc, part of the VASCUNET collaboration, includes vascular procedures from 27 Serbian hospitals. Data from 1681 PAD patients were analyzed, focusing on sex disparities, diabetes prevalence, previous procedures, infection and tissue loss, and morbidity and mortality rates. Males formed the majority, comprising 1169 (69.5%) of the patients. Men were significantly more often treated open surgically compared to women (77.6% vs 68.0%; p=0.000). Diabetes stood at 40.2% prevalence. Smoking history was noted in 61.9% of patients, predominantly males. Complication rates stood at 7.5%, with diabetic patients more prone to reinterventions and graft restenosis. The in-hospital mortality rate was 1.6%, with significant predictors of mortality including urgent procedures and recent myocardial infarction. The severity of the infection was correlated with diabetes (r=0.250, p=0.000) and previous amputations (r=0.186, p=0.000). Patients undergoing revascularization followed by minor amputations had a significantly lower incidence of major amputation (0.1% vs 2.9%, p=0.000). SerbVasc data provides a comprehensive overview of PAD management, highlighting the significant impact of diabetes and smoking on disease progression and outcomes. This study highlights critical aspects of PAD management in developing countries, emphasizing sex differences, risk factors, and outcomes. Males predominated and are more likely to undergo open surgery. Diabetes and smoking significantly influenc disease progression, with diabetic patients experiencing higher rates of graft restenosis and reinterventions. Urgent procedures and recent myocardial infarctions are key predictors of in-hospital mortality. Combining revascularization with minor amputations reduced major amputation rates. These findings provide valuable data for tailoring treatment strategies, optimizing resource allocation, and improving outcomes for PAD patients, with implications extending beyond Serbia to similar healthcare systems.

Oral Health, Inflammation, and Cardiometabolic Factors in the VA Million Veteran Program.

Associations between cardiometabolic comorbidities and self-reported oral health (OH) are often underexplored in large biobank datasets. While these associations are unaffected by dental care access, they could be mediated by immune responses and inflammation. This study assessed the associations between cardiometabolic comorbidities and self-reported OH, periodontitis, and tooth loss using the International Classification of Diseases (ICD) codes in participants from the U.S. Veterans Affairs Million Veteran Program (MVP), adjusting for immune and inflammatory covariates. Data from 154,167 MVP participants were extracted from January 2011 to September 2021, including lifetime cardiometabolic comorbidities, self-reported OH, ICD-coded periodontitis and tooth loss, and laboratory measurements. Multivariate logistic regression analysis was used to calculate the odds ratios of cardiometabolic comorbidities for self-reported OH, periodontitis, and tooth loss, adjusting for demographic, socioeconomic, cardiovascular, and inflammatory (neutrophil and lymphocyte cell counts) risk factors. A separate dataset was used for additional sensitivity analyses, adjusting for serum levels of C-reactive protein and albumin. Complete data were analyzed for 154,167 participants (19%). Most participants (92%) were male and from European ancestry (94%). The mean age was 65.5 y (SD 11.4 y). Ten percent of participants had excellent self-reported OH. Fourteen percent had any periodontitis, and 17% had any tooth loss. Significant associations were found between tooth loss and congestive heart failure (odds ratio [OR], 1.74, P < 0.001) and peripheral vascular diseases (OR, 1.82, P < 0.001). There were also significant associations between congestive heart failure and self-reported OH (excellent versus "poor/fair/good/very good"), with increasing odds as self-reported OH declined (P < 0.001 for trend). These associations remained significant even after sensitivity analyses, albeit with slight attenuation. This study of veterans underscores the important cardiometabolic links of self-reported poor OH and tooth loss, akin to those observed with periodontitis, even after adjusting for potential confounders related to demographics, lifestyle, and inflammation. Exploring cardiometabolic associations with self-reported OH, clinically diagnosed periodontitis, and tooth loss using the ICD in the Veterans Affairs Million Veteran Program, we found significant associations. These associations persisted after adjustment for inflammatory confounders. These findings emphasized the benefit of assessing OH as a vital indicator of overall cardiometabolic health in large-scale biobank studies.

Response to the Letter to the Editor: Rare Endocrine Disorders and Peripheral Arterial Disease.

Response to the Letter to the Editor: Rare Endocrine Disorders and Peripheral Arterial Disease.

Clinical and economic implications of focal dissection treatment following percutaneous transluminal angioplasty of the superficial femoral artery: an exploratory analysis based on the TOBA II Study

Aim: Percutaneous transluminal angioplasty (PTA) for peripheral artery disease (PAD) commonly leads to dissections which are associated with higher target lesion revascularization (TLR) rates. Clinical and economic consequences of dissection management in the femoropopliteal artery following PTA, and specifically the potential economic benefit of focal dissection repair using the novel Tack Endovascular System, remain unknown. Methods: A decision-analytic model was used to estimate 24-month clinical events, costs and quality-adjusted life year (QALY) gain for a Tack-supported versus status-quo PTA strategy. Patient and lesion characteristics and TLR rates were derived from the PTA cohort of the TOBA II clinical trial, an observational cohort, and literature. Cost–effectiveness was determined from a US payer and provider perspective separately for the non-severe (grade A or B), severe (grade C and higher) and the entire dissection cohort. Results: TLR rates were lower for the Tack-supported strategy compared with PTA (7.7 vs 27.4% in the non-severe, 13.9 vs 25.8% in the severe and 12.0 vs 26.3% in the entire dissection cohort). Cost and QALY differences were +$297/ + 0.0110 in the non-severe dissection cohort and -$1602/ + 0.0067 in the severe dissection cohort, resulting in an incremental cost–effectiveness ratio (ICER) of $25,622 in the non-severe cohort and dominance in the severe cohort and the entire cohort. Conclusion: Compared with a ‘status-quo’ approach, proactive focal stenting may lead to fewer reinterventions and improved quality of life. There appears to be a graded economic benefit of focal dissection treatment, being cost-effective in non-severe dissections and even cost saving in severe dissections.

Reliability of a portable toe pressure photoplethysmography device compared to a stationary laser doppler flowmeter.

The study aimed to investigate the reliability of a portable toe pressure (TP) photoplethysmography device (PPG) by comparing it to a stationary laser Doppler flowmeter (LD) used in the Helsinki University Hospital. The study evaluated if lower limb arterial circulation could be reliably evaluated with the portable PPG which is more affordable and mobile than the stationary LD. TPs were measured from 102 toes of 54 patients in the vascular surgery outpatient clinic, vascular surgery ward and interventional radiology recovery ward of Helsinki University Hospital. According to the study protocol TPs were measured twice with the PPG device. If the difference between the values was over 10 mmHg, a third measurement was done and two of the closest values were selected for the final analysis. The lowest value displayed by the PPG device was 30 mmHg. Lower than 30 mmHg values were reported as 25 mmHg in the analysis. The repeatability and reliability of the PPG measurements were compared to the LD with Bland Altman plots. Most patients had rest pain (n = 29) or claudication (n = 9). Prior to TP measurement, 24 patients had undergone lower limb revascularization through either a hybrid (n = 3), open (n = 10) or endovascular (n = 11) procedure. The mean absolute difference between PPG and LD measurement values was 15 mmHg (95% confidence interval 12-18 mmHg). 87.5% of lower limbs with significant arterial insufficiency (TP <60 mmHg with LD, n = 49) had a PPG measurement value of <60 mmHg. Conversely, 84.8% of lower limbs that did not exceed the ischemia criterion of TP ≥60 mmHg with LD had a PPG measurement value of ≥60 mmHg. Mean absolute difference of two consecutive PPG measurement values was 4 mmHg (95% CI 3-5 mmHg). The PPG device is a light and affordable option for the assessment of lower limb arterial circulation in primary health care. It is moderately reliable to exclude significant lower limb arterial insufficiency and may reduce unnecessary referrals to the vascular surgery clinic. The repeatability of the PPG device is satisfactory. However, it requires training to use, and the results must always be interpreted with consideration for the patient's clinical status.

Evaluation of Peripheral Circulatory Changes Following Hydrotherapy and Controlled Physical Training in Patients with Atherosclerotic Lower Limb Ischemia

Numerous studies highlight the significant role of exercise therapy in patients with peripheral artery disease (PAD), emphasizing how regular physical exercise enhances vascular endothelial function and promotes metabolic adaptations in skeletal muscles, ultimately improving walking performance. There are currently discussions in the medical world on optimizing noninvasive therapy to prevent the development of lower limb ischemia. This study aimed to assess the impact of a supervised training program combined with whirlpool massage treatment on improving peripheral circulation and physical performance in patients suffering from peripheral artery disease. Methods: One hundred participants (both male and female) aged between 39 and 79 years old (60.0 ± 11.6) were included in the analysis, all diagnosed with peripheral circulation disorders. The participants were assigned to two groups. The study group received 10 whirlpool treatments of the lower limbs and a personalized training program. The control group only participated in the training sessions. Pre- and post-intervention evaluations included impedance plethysmography and the six-minute walk test (6MWT). Results: Assessing the results of local flow parameters, after the procedures, a statistically significant increase in the pulse wave amplitude (PAmpl, p &lt; 0.001) and systolic slope (PSlope, p &lt; 0.001) values was found, as well as a statistically significant decrease in the crest time (CT, p &lt; 0.001) and propagation time (PT, p = 0.007) values in the study group, which indicates an improvement in blood flow in the peripheral circulation. Also, in the 6 min walk test, a statistically significant increase in the walking distance was noted in the study group after the procedures. Conclusions: Physical training, combined with whirlpool massage treatment, has a beneficial effect on improving peripheral blood flow assessed by impedance plethysmography, as well as patients’ tolerance to physical exercise. The inclusion of hydrotherapy as part of cardiovascular rehabilitation protocols in patients with peripheral ischemia is a promising form of conservative treatment.

Rationale for Enhancing Micro and Macrocirculation in the Lower Limbs of Patients with Arterial Insufficiency and Type 2 Diabetes Mellitus

Rationale for Enhancing Micro and Macrocirculation in the Lower Limbs of Patients with Arterial Insufficiency and Type 2 Diabetes Mellitus

European guidelines for the management of peripheral arterial and aortic diseases: what's new?

European guidelines for the management of peripheral arterial and aortic diseases: what's new?

Application of biogenic silver nanoparticle incorporated nanofibers in biomedical science

The applications of nanotechnology are expanding into medical science for designing new medical devices related products. These products can deliver targeted therapies to diseases such as cancer and peripheral artery treatment. Therefore, with the goal to treat peripheral artery disease, we integrated biogenic silver nanoparticles (AgNPs) into polyethylene glycol-polycaprolactone (PEG-PCL) nanofibrous (NFs). The AgNPs-NFs mats were successfully fabricated using a blended electrospinning process. AgNPs with average sizes of 35–55 nm were produced and characterized using multiple techniques such as UV–Vis spectroscopy, TEM, SEM and FTIR. Nanofibrous membranes containing 1 %, 2 %, and 3 % AgNPs by weight were developed, showing a reduction in fiber diameter from 473 nm to 179 nm due to the introduction of charged particles. The scaffold’s suitability and drug release profile were critically analyzed, revealing results consistent with optimal biomedical applications. Preliminary studies indicated that AgNPs dose-dependent inhibition of human umbilical vein endothelial cells (HUVECs) may potentially help prevent atherosclerosis. These findings underscore the potential of AgNPs integrated PEG-PCL NFs mats for advanced biomedical applications.

Cardiovascular Disease & Diabetes Statistics in Korea: Nationwide Data 2010 to 2019.

This study aimed to provide updated insights into the incidence and management of cardiovascular disease (CVD) in Korean adults with diabetes. Using data from the Korean National Health Insurance Service and Korea National Health and Nutrition Examination Survey, we analyzed the representative national estimates of CVD in adults with diabetes. The age- and sex-standardized incidence rate of ischemic heart disease (IHD), ischemic stroke, and peripheral artery disease (PAD) decreased from 2010 to 2019 in individuals with type 2 diabetes mellitus (T2DM). However, an increase in the incidence of heart failure (HF) was observed during the same period. Only 4.96% of adults with diabetes and CVD achieved optimal control of all three risk factors (glycemic levels, blood pressure, and lipid control). Additionally, high-intensity statin treatment rates were 8.84% and 9.15% in individuals with IHD and ischemic stroke, respectively. Treatment with a sodium-glucose cotransporter-2 inhibitor (SGLT2i) or a glucagon-like peptide-1 receptor agonist (GLP-1RA) was relatively low in 2019, with only 11.87%, 7.10%, and 11.05% of individuals with IHD, ischemic stroke, and HF, respectively, receiving SGLT2i treatment. Furthermore, only 1.08%, 0.79%, and 1.06% of patients with IHD, ischemic stroke, and HF, respectively, were treated with GLP-1RA. The incidence of most CVD (IHD, ischemic stroke, and PAD) decreased between 2010 and 2019, whereas the incidence of HF increased. The overall use of high-intensity statins, SGLT2i, and GLP-1RA remained low among individuals with T2DM and CVD.

Prognostic value of preoperative echocardiography in predicting myocardial injury after open abdominal aortic surgery.

Abdominal aortic aneurysms (AAAs) and peripheral arterial and aortic diseases (PAAD) are associated with increased risk of myocardial injury after noncardiac surgery (MINS). To evaluate whether preoperative transthoracic echocardiography (TTE) abnormalities are linked to MINS in patients undergoing open vascular surgeries involving the abdominal aorta due to AAA and / or PAAD. This is a retrospective cohort that analyzed consecutive patients who underwent open abdominal aortic surgery due to infrarenal AAA and / or aortoiliac occlusive disease in a single tertiary center. In each patient, TTE was performed within 1-3 months before the surgery and at least two postoperative high-sensitive troponins were measured (on the first and the second postoperative day) as per the standard of care at the participating center. The study group comprised 336 patients. The median age was 67 years, and 82.7% of patients were male. MINS was diagnosed in 122 (36.3%) patients. Multivariable analysis revealed that myocardial hypokinesis compared to normal contractility was associated with a higher risk of MINS (OR 3.23, 95% CI 1.30 to 8.03). A similar association was not found for left ventricular ejection fraction (OR 1.08, 95% CI 0.78 to 1.48), left ventricular septum hypertrophy (OR 1.58, 95% CI 0.91 to 2.75), increased left atrium surface (OR 0.95, 95% CI 0.54 to 1.70) and mitral insufficiency (OR 0.89, 95% CI 0.50 to 1.58). Our study suggests that routine preoperative TTE may have a low but possible value in the prediction of MINS among patients undergoing high-risk vascular surgery.

2024 European Society of Cardiology Guidelines on Peripheral Arterial and Aortic Diseases

2024 European Society of Cardiology Guidelines on Peripheral Arterial and Aortic Diseases

Efficacy and Safety of Static Stretching and Daily Walking on the Cardio-Ankle Vascular Index in a Patient With Type 2 Diabetes Mellitus, Proliferative Retinopathy, and Lower-Extremity Peripheral Arterial Disease: A Case Report

Efficacy and Safety of Static Stretching and Daily Walking on the Cardio-Ankle Vascular Index in a Patient With Type 2 Diabetes Mellitus, Proliferative Retinopathy, and Lower-Extremity Peripheral Arterial Disease: A Case Report

Preliminary evidence on the diagnostic value of apolipoprotein B and A-I in peripheral artery disease among Vietnamese patients with diabetes

Preliminary evidence on the diagnostic value of apolipoprotein B and A-I in peripheral artery disease among Vietnamese patients with diabetes

Angiosome-Guided Revascularization in Local Flap Reconstruction of the Foot and Ankle: Comparable Outcomes With Both Direct and Indirect Revascularization.

Among patients with critical limb ischemia and tissue loss, revascularization is an essential component for limb salvage. Local flaps of the foot and ankle remain a versatile tool in reconstructive limb salvage but is dependent on adequate arterial flow. In patients with arterial occlusive disease requiring revascularization, there is a lack of evidence in the current literature investigating on the necessity of direct arterial flow to the respective angiosome for local flaps reconstruction. Our study thereby compares the outcomes of direct (DR) and indirect (IR) revascularization for local flap success. Patients who received endovascular revascularization (ER) prior to local flap reconstruction for chronic wounds in the foot and ankle were retrospectively reviewed. IR was performed in patients where DR could not be performed. DR was defined as an intervention on the same pedicle used for the local flap. IR was defined as an intervention performed on a different angiosome than the pedicle used for the local flap. Patient demographics, Charlson Comorbidity Index (CCI), angiographic details, postoperative complications, and long-term outcomes were collected. A total of 33 patients underwent 43 local flap reconstruction with preoperative ER: 58.1% (n = 25) received DR and 41.2% (n = 18) received IR. Patients had a mean CCI of 6.7 ± 1.8, with a high prevalence of diabetes mellitus (93.9%), peripheral arterial disease (90.9%), and end-stage renal disease (33.3%) with no significant differences between groups. In the immediate postoperative period (postoperative day 0 to 12), there were no significant differences in immediate flap success (DR: 100% vs IR: 88.9%, P = 0.169) or partial flap necrosis between (DR: 0.0% vs IR: 16.7%, P = 0.066). Rates of major complications from infection (DR: 28.2% vs IR: 22.2%, P = 0.736), ischemia (DR: 4.0% vs IR: 11.1%, P = 0.562), or dehiscence (DR: 8.0% vs IR: 16.7%, P = 0.634) requiring reoperation were similar between 2 groups. Overall limb salvage rate was 84.9%, and comparable between groups (DR: 78.6% vs IR: 89.5%, P = 0.628). DR and IR achieve similar rates of limb salvage and flap success after local flap reconstruction. A multidisciplinary vasculo-plastic approach that incorporates preoperative arteriogram and revascularization should be utilized for this highly comorbid patient population to achieve optimal success and limb salvage.

A Preliminary Assessment of Barriers and Facilitators to Accessing Footcare in Homeless Shelters: A Scoping Review

ObjectiveBy examining the scientific literature, this scoping review aims to explore the most common foot problems people experiencing homelessness (PEH) experience, as well as to explore the potential strategies for addressing foot problems in PEH, such as foot clinics, foot screening and foot care for adults experiencing homelessness. MethodsA scoping review of the literature from MEDLINE (Ovid), CINAHL (EBSCOhost), Cochrane Register of Controlled Trials (Ovid), EMBASE (Ovid), PubMed, clinicaltrials.gov, Google Scholar and Web of Science was conducted to identify relevant articles published from inception to April 14, 2023. Literature discussing foot problems, foot care and intervention in PEH were included. 61 articles were retained after screening by two independent reviewers. Data were extracted by three independent reviewers and disagreements were resolved by a fourth reviewer. Outcomes were determined after data extraction given the nature of the scoping review. Primary outcomes include foot problems, their severity, and their prevalence. The quality of studies included for data extraction was assessed using the Newcastle-Ottawa quality assessment scale and the National Institute of Health Quality Assessment Tool when applicable. ResultsWe present a summary of the prevalence of foot pain and foot problems along with gender differences when data was available. Frostbites, foot ulcers, peripheral arterial disease, foot infections (including diabetic foot infection), and related amputations were also found to be prevalent in PEH, with data suggesting that homelessness is an independent risk factor for these foot problems. Strategies and interventions to address foot health for PEH were divided into: 1) direct interventions in the field, such as wound care, moisturization, or education of PEH during clinical encounters, and 2) organizational interventions, such as expanding outreach efforts, coordinating resources to avoid interfering with shelter hours, or improving the timeliness of interventions by first responders. The literature shows that foot exams, appropriate footwear and education, which can be provided in the context of mobile clinics, play a critical role in the detection and prevention of foot pathologies. Barriers to care were broken down into four categories: accessing and receiving care, comorbid health issues or substance use, emotional barriers and social inequalities. ConclusionFoot problems in PEH, which have been reported in the literature for decades, remain unchanged. Interventions and strategies to address this issue include provision of holistic care, enrollment in insurance programs, provision of supplies and education, and development of outreach services. Indeed, mobile clinics have been shown to eliminate multiple barriers to care for PEH. Although some screening tools were reported, their relevance and reliability have yet to be defined in further studies. While remaining gaps and barriers such as stigma, lack of follow-up care and gratuity of services have been identified, alternative methods other than the aforementioned outreach efforts have yet to be described.

Guidelines at a Crossroad: Comparing European and ACC/AHA Guidelines regarding the Use of Imaging in Peripheral Vascular Arterial Disease and Aortic Disease

Abstract This review examines the differences and similarities between the European and the American guidelines concerning the use of imaging in the diagnosis and management of Peripheral Arterial Disease and Aortic Disease. PAD and aortic conditions contribute significantly to global cardiovascular morbidity and mortality, yet are often underdiagnosed and undertreated. Imaging plays a critical role in addressing this gap, with the ESC and American offering different approaches to diagnostic and interventional imaging modalities. The review highlights that while both guidelines endorse duplex ultrasound as the first-line imaging method for PAD, discrepancies arise in the use of advanced modalities such as computed tomography angiography and magnetic resonance angiography. The European Guidelines adopts a more conservative approach, reserving these advanced techniques for specific clinical scenarios, whereas the American guidelines places a stronger emphasis on comprehensive imaging for all patients with suspected PAD. The review also compares the guidelines on aortic disease, noting consensus on the role of CTA and MRA for aortic aneurysm diagnosis, but with differences in the emphasis on transoesophageal echocardiography, which is more strongly recommended by the American Guidelines for acute cases. The manuscript calls for harmonization of these guidelines to streamline clinical practice and improve patient outcomes.

What is new in the management of peripheral arterial occlusive disease and diseases of the aorta? : Highlights of the ESC guidelines 2024

The European Society of Cardiology (ESC) guidelines on peripheral arterial disease (PAD) and diseases of the aorta published in September 2024 for the first time combine recommendations for both diseases in a joint guideline document. The consolidation of PAD and aorta guidelines follows aholistic approach, which underlines the entirety of the arterial vascular system. This aim is underlined by a specifically introduced recommendation to take the entirety of the circulatory system into account in patients with vascular diseases. The focus in the current ESC guideline document is on amultidisciplinary, patient-centered management of PAD and diseases of the aorta, whereby the prevention and follow-up of patients after therapeutic interventions are emphasized. In PAD the document highlights exercise training and the procedure for patients with chronic wounds as well as risk stratification and hereditary diseases of the aorta.

Association between atherogenic index of plasma and peripheral arterial disease.

Background: Growing body of evidence suggests that the atherogenic dyslipidemia phenotype is a precursor to Peripheral Arterial Disease (PAD). Nonetheless, there is limited research regarding the association between Atherogenic Index of Plasma (AIP) and PAD which utilized a community population-based database in the United States. We sought to fill this knowledge gap. Methods: A total of 3,517 participants from the National Health and Nutrition Examination Survey 1999-2004 cycles were enrolled in our study. AIP was calculated as log10 (triglycerides/high-density lipoprotein cholesterol). Logistic regression models were adopted to reveal the relationship of AIP and PAD. Additionally, stratified and interaction analyses were also undertaken to see if the relationship was stable in different subgroups. Results: Participants in the higher tertile of AIP tended to have higher prevalence of PAD. A positive correlation was identified between AIP increase and PAD after fully multivariate adjustment (OR=1.30, 95% CI: 1.06-1.59). The multivariable-adjusted OR and 95% CI of the highest AIP tertile compared with the lowest tertile was 1.50 (1.07-2.1). Subgroup analysis demonstrated that the positive association between AIP and PAD was persistent across population subgroups. Conclusions: Our findings demonstrate a positive association between AIP and the incidence of PAD among adults in American adults. Specifically, 1 unit increase in AIP led to a 30% greater risk of PAD.