Severity Of Peripheral Arterial Disease Research Articles

An association between the blood perfusion parameters in foot tissues and the severity of arterial occlusion and stenosis in the lower extremities

Rationale: Peripheral artery disease (PAD) is common among the elderly and increases the risk of cardiovascular events, disability and death. PAD course and outcomes depend not only on the condition of macrovasculature but also on the tissue perfusion. We have previously shown that Type 2 diabetic patients with lower extremity ischemia have significantly lower perfusion than healthy volunteers, and the ratio of basal perfusion in the arm and leg (BP1/BP3) measured by incoherent optical fluctuation flowmetry (IOFF) allows to identify hemodynamically significant stenoses. Aim: To analyze associations between perfusion parameters registered by IOFF and the severity of vascular involvement in PAD patients. Methods: This single center cross-sectional study included 38 PAD patients admitted to the Department of Vascular Surgery and Coronary Artery Disease. The arteries were assessed with duplex Doppler ultrasonography (DDU), according to the results of which the PAD severity score and ankle-brachial index (ABI) were calculated. Skin microhemodynamic parameters were recorded by IOFF. The basal perfusion on the arm (BP1), the dorsal foot surface and the toe (BP2 and BP3), the ratio BP1/BP3, local thermal hyperemia (LTH2 and LTH3) and an increase in perfusion after heating on two leg zones (LTH2-BP2, LTH3-BP3) were evaluated and expressed in perfusion units (PU). BP1, BP3, and BP1/BP3 values were additionally measured with laser Doppler flowmetry (LDF). The analysis was performed depending on the degree of arterial involvement determined by DDU for each limb separately (n = 73). There were ≥ 50% stenoses in 15 extremities (Group 1), occlusion of one of the major arteries in 42 (Group 2) and ≥ 2 occlusions in 16 lower extremities (Group 3). Results: In the groups 1, 2 and 3, the values of most parameters estimated by IOFF decreased with an increase in severity of limb lesions. As an example, the respective perfusion parameters for the big toe in the study groups were as follows: BP3 4.0 [2.0; 9.8], 2.2 [0.9; 3.7] and 1.1 [0.7; 2.6] PU (p = 0.007); LTH3 10.0 [6.4; 14.9], 5.0 [1.5; 7.8] and 2.5 [1.4; 4.5] PU (p 0.001), and LTH3-BP3 3.8 [2.6; 7.8], 2.4 [0.6; 4.3] and 1.2 [0.4; 1.5] PU (p = 0.001). The BP1/BP3 ratio in the above mentioned group increased: 1.8 [0.8; 7.7], 7.2 [3.4; 21.3] and 14.2 [6.6; 18.3] (p = 0.004), respectively. No similar trend was found for this parameter registered by LDF. There were significant correlations between the lower extremities perfusion parameters measured by IOFF and ABI, with the correlation coefficients ranging from 0.365 to 0.717 (p 0.05). Conclusion: The functional parameters of the skin microhemodynamics vary with different PAD severity. In addition, they correlate with clinical indicators of atherosclerosis. The IOFF technique can be promising as an additional quantitative method for assessment of microvascular blood flow in patients with PAD.

"The medicine is not something that interests me at all." Beliefs, health-related behaviors, and medication adherence in patients with symptomatic peripheral arterial disease

Abstract Background Despite evidence-based guidelines recommending secondary prevention with antithrombotics and lipid-lowering therapies, adherence to optimal pharmacological therapies remains suboptimal in patients with symptomatic lower extremity peripheral arterial disease (PAD), potentially contributing to excess morbidity and mortality. However, the behavioral factors and health beliefs underlying this behavior are still poorly understood. Purpose To explore the health-related behaviors and beliefs of patients with symptomatic PAD regarding secondary preventive therapy. Methods Using a qualitative design, we conducted individual semi-structured interviews with patients diagnosed with symptomatic PAD. Participants were recruited from four departments of vascular surgery in Denmark from December 2022 to January 2024. Data analysis was performed using framework analysis based on the six domains of the Health Belief Models1 (HBM) as analytical framework: perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy. The HBM is widely used for conceptualizing individual’s attitudes and beliefs to explain and predict health behaviours. Results Sixteen patients participated in the study: seven adherent and nine non-adherent patients. Based on the HBM components, the following findings emerged (Figure 1). Patients expressed low perceived awareness of the severity of PAD and its potential consequences, not recognizing PAD as a systemic condition associated with broader cardiovascular risk. The perception of PAD centered around the experience of excruciating leg pain and its impact on everyday life. This focus on symptoms affected the perceived benefits of secondary preventive therapies. Patients lacked knowledge about the importance and goal of treatment and did not link the secondary preventive therapy to PAD, often associating it only with other cardiovascular diseases. Barriers included inadequate understanding of the chronic progressive nature of PAD and its severity, experience and fear of side-effects, prescription confusion, pill burden, financial constraints, and allergies. Fear of recurring pain, complications, and early death served as strong internal adherence triggers. Paradoxically, despite expressing fear, some patients were only adherent to antithrombotic therapy, not assigning the same importance to statins. Other cues to action included practical arrangements as well as establishing a trusting patient-provider relationship and receiving comprehensive and logical explanations. Conclusions This study provided new perspectives on the multifaceted challenges hindering adherence to secondary preventive therapy among patients with symptomatic PAD. Notably, the insufficient knowledge regarding the chronic progressive nature of PAD and its cardiovascular implications, underscores the need for enhanced patient education and tailored interventions to ensure optimal secondary preventive therapy.Figure 1

Lipid-associated GWAS loci as important markers of the risk, severity, and clinical course of peripheral artery disease

ABSTRACT Background This study investigated the relationship between lipid-associated loci identified through genome-wide association studies (GWAS) and the risk of peripheral artery disease (PAD), its severity, as well as clinical and laboratory features. Research design and methods A study included 1263 unrelated Russian subjects, consisting of 620 patients diagnosed with PAD and 643 healthy controls. Thirteen single nucleotide polymorphisms (SNP) were genotyped using the MassArray-4 system. Results Polymorphisms rs1689800, rs55730499 and rs881844 were found to be associated with an increased risk of PAD, whereas SNPs rs1883025, rs3136441, rs3764261 and rs6065906 showed protective effects against disease (Pperm ≤ 0.05). SNPs rs1689800, rs217406, rs1883025, and rs3136441 exhibited combined effects with cigarette smoking on the PAD risk (Pperm ≤ 0.05). Polymorphisms rs55730499 (beta = 0.124, Pperm = 0.04), rs9987289 (beta = 0.558, Pperm = 0.03), and rs881844 beta = −0.171, Pperm = 0.03) correlated with the ankle-brachial index. Multiple associations have been found between the SNPs and clinically significant characteristics, including disease severity, risk of gangrene, early disease onset, plasma procoagulant and atherogenic lipid changes (Pperm ≤ 0.05). Conclusions We identified novel genetic markers associated with PAD susceptibility and disease-related clinical and laboratory features. The identified biomarkers enhance the potential for predictive genetic testing related to the risk and progression of PAD, facilitating the integration of molecular diagnostics into clinical decision-making processes.

Genetic Variation Associated With Progression and Severity of Peripheral Artery Disease

Genetic Variation Associated With Progression and Severity of Peripheral Artery Disease

Relationship of the modified Glasgow Prognostic Score with peripheral artery disease severity and procedure success in patients who had undergone endovascular treatment.

The modified Glasgow Prognostic Score (mGPS) is one type of inflammation-based index; it includes data on elevated C-reactive protein and reduced albumin content. The predictive value of mGPS for outcomes is investigated in various diseases such as cancer, heart failure, myocardial infarction, acute pulmonary embolism, and inflammatory bowel diseases. This study aimed to evaluate the link between mGPS and the severity and complexity of peripheral arterial disease (PAD) as determined by the Transatlantic Intercommunal Consensus Document (TASC-II) classification and the prediction value of mGPS for procedural success in patients undergoing endovascular treatment (EVT). Our study included 203 consecutive patients receiving EVT for atherosclerotic obstruction of aortoiliac, femoro-popliteal, and below-knee arteries between January 2019 and February 2020. The lesion characteristics were determined according to categories in the TASC-II. Operational failure is the inability to position the guidewire through the occluded lesion following percutaneous intervention or achieve distal perfusion following EVT. In our study, we observed 136 patients (%6) with TASC A-B lesions and 67 patients (%33) with TASC C-D lesions. EVT was performed on the femoro-popliteal artery in 59.4% of the patients, on the aortoiliac artery in 30.7%, and on the below-the-knee artery in 9.9%. mGPS was an independent predictor of severe PAD (OR: 17.943, 95% CI: 5.120-62.882; p < .001) and procedural success (odds ratio: 0.004; 95% CI: 0.001-0.099; p < .001). Additionally, we identified age and the presence of a TASC D lesion as independent predictors of interventional success (OR: 0.938, 95% CI: 0.819-0.979; p: .034; OR: 0.104, 95% CI: 0.107-0.643; p: .015, respectively). We determined that mGPS independently predicts PAD complexity and severity based on TASC-II classification; the EVT success rate is lower in patients with high mGPS.

Influence of pseudoxanthoma elasticum on the lipid profile and prognostic implications.

Background: Pseudoxanthoma elasticum (PXE) is a rare, inherited disease characterised by specific skin lesions, progressive loss of vision and early onset atherosclerosis. Atherosclerosis in PXE leads to an increased rate of vascular occlusion and severe intermittent claudication. Although genetically determined, the individual course of PXE is highly variable. Up to now, there is no sufficient parameter to identify individuals at risk of rapid disease progression. This present study focused the lipid profile of patients with PXE and its possible influence on the clinical severity of peripheral artery disease (PAD). Patients and methods: 112 patients with PXE were retrospectively screened. Patients without a complete lipid profile consisting of total cholesterol (TC), triglycerides (TGC), high-density lipoprotein (HDL), low-density lipoprotein (LDL) and Lipoprotein(a) (Lp[a]) where excluded as well as patients with already initiated lipid-lowering therapy. 52 patients met the inclusion criteria. An age-adjusted ordinal regression model was applied to determine the association of each lipid fraction with the severity of PAD assessed as Fontaine classification. Results: The lipid profile of patients with PXE was unremarkable (TGC: 135.8±105.8 mg/dl; TC: 172.5±44.4 mg/dl; HDL: 63.0±18.2 mg/dl; Lp[a]: 64.7±93.5 nmol/l). Ordinal regression showed a significant association of Lp(a) with the severity of PAD with an odds ratio of 1.01 (1.00-1.02; p = 0.004), whereas the other fractions of the lipid profile had no significant influence. Conclusions: This study provides the largest evaluation of blood lipids up to now and the first characterization of Lp(a) levels in patients with PXE. We were able to provide first evidence of a correlation between elevated levels of Lp(a) and the severity of PAD. The present results suggest that determination of Lp(a) in early stages of PXE could help to identify patients at risk of rapid disease progression and with the need of intensified walking exercise training.

Association of endothelial function and lower extremity perfusion in peripheral artery disease.

Background: The current study aims to investigate the association between endothelial function and lower extremity perfusion in patients with peripheral artery disease (PAD). Patients and methods: In total 229 patients with PAD (Rutherford stage 0-3) were enrolled in the current study. Endothelial function was assessed by measuring flow-mediated dilation (FMD) and endothelial cell proliferation capacity (ECPC). Lower extremity perfusion was assessed by measuring oscillometry-based ankle brachial index (oABI) and pulse wave index (PWI). In addition, carotid intima-media-thickness (cIMT) was also measured as a surrogate marker for atherosclerosis. Correlations between FMD, ECPC, oABI, PWI, and cIMT were analysed using Pearson correlation coefficient. The relationship between the above variables and the severity of PAD was investigated using ordinal logistic regression analysis. Results: Correlation analysis showed that FMD negatively associated with PWI (r = -0.183, p = 0.005), ECPC positively associated with oABI (r = 0.162, p = 0.014), and oABI negatively associated with PWI (r = -0.264, p < 0.001). Ordinal logistic regression analysis showed that ECPC (β = -0.009, p = 0.048), oABI (β = -5.290, p < 0.001), and age (β = -0.058, p = 0.002) negatively associated with the PAD Rutherford stages. In addition, PWI (β = 0.006, p < 0.001), cIMT (β = 18.363, p = 0.043) positively associated with the PAD Rutherford stages. Conclusions: Endothelial function significantly associates with lower extremity perfusion in patients with PAD, and both are related to the severity of PAD.

Examining Psychological Factors in Peripheral Artery Disease: Affective Temperament, Anxiety, and Depression in Patients Undergoing Revascularization Procedures.

This study aimed to assess the prevalence of depressive and anxiety symptoms in peripheral artery disease (PAD) patients, correlating these symptoms with clinical parameters and examining affective temperaments within the study group. A total of 159 PAD patients, predominantly male, admitted for vascular surgery due to lower limb atherosclerosis, participated in this cross-sectional study. Various assessments were conducted, including the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A) for affective temperaments, the Hospital Anxiety and Depression Scale (HADS) for anxiety and depression symptoms, and the Numerical Rating Scale (NRS) for pain intensity. Additionally, the Ankle-Brachial Index (ABI) was measured to assess circulation in the legs. The findings revealed a higher prevalence of depressive and anxiety symptoms in the PAD patient group compared to the control group. Notably, depressive and anxiety symptoms correlated with the severity of PAD, as indicated by lower ABI values in the operated leg. Patients undergoing surgical revascularizations exhibited higher depressive symptoms than those undergoing endovascular procedures. Furthermore, correlations were observed between depressive symptoms and the number of previous vascular procedures and amputations, alongside increased pain levels at admission. Clinical factors such as diabetes, hypertension, heart failure, ischemic heart disease, previous revascularization procedures, amputations, and the intensity of affective temperaments did not correlate with HADS scores. The study highlighted the intricate relationship between mood disorders and PAD severity, emphasizing the potential prognostic implications of untreated depression and anxiety in PAD patients. These findings suggest the importance of closely monitoring and addressing psychological well-being in PAD management. However, the study encountered limitations such as varying assessment timing and sample size discrepancies among comorbidities, impacting the observation of associations between mood disorders and certain conditions. In conclusion, depressive and anxiety symptoms are often in PAD. Further research is needed to explore therapeutic interventions targeting mental health and pain management to improve the course and outcomes of PAD.

Effect of interval training and electromagnetic field therapy on functional balance and peripheral arterial disease severity in patients with diabetic polyneuropathy: randomised controlled trial

Effect of interval training and electromagnetic field therapy on functional balance and peripheral arterial disease severity in patients with diabetic polyneuropathy: randomised controlled trial

Progression of Peripheral Artery Disease Severity After Interventions for Intermittent Claudication

Progression of Peripheral Artery Disease Severity After Interventions for Intermittent Claudication

Pedal Acceleration Time An Alternative Tool To Ankle-Brachial Index In Peripheral Arterial Disease.

Ankle-Brachial Index (ABI) is a well-established diagnostic tool for evaluating peripheral arterial disease (PAD). Limitations in its application led to the development of alternative diagnostic methods, including Toe-Brachial Index (TBI) and Transcutaneous Pressure of Oxygen (TcPO2), yet these are not as widely available as ABI. Recently, Pedal Acceleration Time (PAT), has gained popularity as a new tool to assess PAD, requiring only an ultrasound. This study seeks to further establish the correlation between ABI and PAT, determining whether PAT can be a reliable alternative for diagnosing and assessing the severity of PAD. ABI and PAT were measured in patients attending our consult with no history of vascular or endovascular surgery. Limbs with unmeasurable ABI were excluded. Patients were categorized into groups based on their PAD stage according to the Fontaine classification. Patient demographics, comorbidities and respective ABI and PAT were analysed. Sixty-nine patients (114 limbs) were included in the study. Mean age 68 ± 11.7 years, 78.3% male and 33.3% diabetic patients. Fifty-three claudicant limbs (46.5%) and 26 limbs (22.8%) with chronic limb threatening ischemia. Pearson correlation coefficient between ABI and PAT, showed a strong negative correlation (r= -0.78; p<0.01). Mean ABI and PAT for limbs in Fontaine stage I were 0.94 ± 0.17 and 82.0 ± 27.4 ms; Fontaine stage IIa 0.69 ± 0.21 and 141.3 ± 57.8 ms; Fontaine stage IIb 0.54 ± 0.14 and 173.4 ± 65.1 ms; Fontaine stage III 0.43 ± 0.15 and 216 ± 33.2 ms; Fontaine stage IV 0.49 ± 0.17 and 206.7 ± 78.1 ms, respectively. Our study suggests an inverse correlation between ABI and PAT, in accordance with the findings published in the literature, thus supporting the use of PAT as an easily reproducible and efficient alternative to ABI for evaluating the severity of PAD.

Abstract 2124: Genetic Variation Associated With Progression And Severity Of Peripheral Artery Disease

Background: Peripheral Artery Disease (PAD) is a major source of cardiovascular morbidity and mortality, affecting &gt;230 million individuals worldwide. While PAD may initially cause exertional limb pain (claudication), progression leads to chronic limb threatening ischemia (CLTI; rest pain and/or tissue loss) and amputation, which are associated with high rates of hospitalization and death. Genetic variants associated with PAD susceptibility have been identified using genome-wide association studies (GWAS). However, the role of genetic variation in the progression of PAD and disease severity remains poorly understood. Methods: GWAS of progression to CLTI were performed among individuals with PAD in the VA Million Veteran Program (MVP) and Copenhagen Hospital Biobank (CHB), accounting for age, sex, and genetic principal components. GWAS were first performed among genetically inferred ancestry subpopulations (EUR: European; AFR: African; AMR: admixed American), and combined using fixed-effects meta-analysis. SlopeHunter was used to account for index-event bias using a GWAS of prevalent PAD. Genetic associations with PAD severity (claudication, CLTI, amputation) were evaluated using multinomial logistic regression. Results: Up to 21.1 million genetic variants were tested for association with CLTI (17,641 individuals) in comparison to PAD (75,133 individuals). A total of 3 genetic loci were associated with progression to CLTI (p &lt; 5x10 -8 ). The strongest association with CLTI was rs6025 (OR 1.25, 95% CI 1.18 to 1.34, p = 4.62x10 -12 ), a common missense variant (p.Arg534Gln) encoding Factor V Leiden, with consistent effects accounting for index-event bias. Compared to 489,538 individuals without PAD in MVP, rs6025 was associated with increased risk of non-specific PAD (OR 1.15, 95% CI 1.1 to 1.2, p = 5x10 -8 ), claudication (OR 1.14, 95% CI 1.1 to 1.2, p = 1x10 -4 ), CLTI (OR 1.42, 95% CI 1.3 to 1.6, p = 7x10 -23 ), and amputation (OR 1.54, 95% CI 1.4 to 1.8, p = 2x10 -10 ). Conclusion: Our results implicate F5 p.Arg534Gln as a risk factor for PAD progression and severe PAD manifestations including CLTI and amputation. This result provides genetic support for a potential role of anticoagulation as a treatment to prevent PAD progression and severe outcomes.

Clinical Outcomes and Resource Utilization in Patients With Peripheral Arterial Disease Hospitalized for Acute Coronary Syndrome

Previous studies have shown an association between acute limb ischemia and higher mortality in patients with Acute Myocardial Infarction. Although Peripheral Artery Disease is a well-known risk factor for development of macrovascular pathology, the effect of its severity is not well investigated in patients hospitalized for Acute Coronary Syndrome (ACS). Using a national cohort of patients with various degrees of Peripheral Arterial Disease, we investigated in-hospital outcomes in patients who were admitted for ACS. Using the 2016-2020 Nationwide Readmissions Database, we queried all patients who were hospitalized for ACS (Unstable Angina, Non ST-Elevation Myocardial Infarction, and ST-Elevation Myocardial Infarction). Patients were further divided into three groups, either No Peripheral Arterial Disease (Non-PAD), Peripheral Arterial Disease (PAD) or Critical Limb Ischemia (CLI). Multivariable models were designed to adjust for patient and hospital factors and examine the association between ACS and PAD severity. Of an approximately 3,834,181 hospitalizations for ACS, 6.4% had PAD, 0.2% had CLI and all other were Non-PAD. Following risk adjustment, in hospital mortality was higher by 24% in PAD (AOR 1.24, 95%CI 1.21-1.28) and 86% in CLI (AOR 1.86, 95%CI 1.62-2.09) compared to Non-PAD. Furthermore, PAD and CLI were linked to 1.23-fold (95%CI 1.20-1.26) and 1.67-fold (95%CI 1.45-1.86) greater odds of cardiogenic shock compared to Non-PAD. Additionally, PAD and CLI were linked with higher odds of mechanical circulatory support usage, cardiac arrest and acute kidney injury compared to Non-PAD. Lastly, duration of hospital stay, hospitalization costs and odds of non-home discharge and 30-day readmissions were greater in patients with PAD and CLI compared to Non-PAD. PAD severity was associated with worse clinical outcomes in patients with ACS, including in hospital mortality and resource utilization.

Abstract 3023: Association Of Lipoprotein(a) With Adverse Events Following Revascularization For Chronic Limb Threatening Ischemia: A Subgroup Analysis Of The BEST-CLI Trial

Background: Elevated lipoprotein(a) (Lp[a]) levels are implicated in the development of peripheral artery disease (PAD) and in major adverse limb events (MALE) across a range of PAD severity. The association between Lp(a) level and adverse events in patients with chronic limb threatening ischemia (CLTI) remains uncertain. Research Questions: Does Lp(a) level associate with MALE and death in patients with CLTI undergoing revascularization? Goals/Aims: To assess the association of Lp(a) level with MALE and death in patients with CLTI undergoing revascularization. Methods: The BEST-CLI trial was a randomized trial assessing the optimal revascularization strategy in patients with CLTI. A subgroup of patients underwent lipid and Lp(a) assessment during the study period and were included. The primary outcome was the first death or MALE event (above-ankle amputation or major reintervention). Hazard ratios were calculated using Cox proportional hazards models, adjusting for age, sex, statin use, and glomerular filtration rate. Results: A total of 192 patients (median [IQR] age, 67.5 [62.1, 74.2] years; 139 men [72.4%]) were included in the cohort. Median Lp(a) level was 26.8 [10.8, 65.1] with normal Lp(a) levels (&lt;30 mg/dL) observed in 104 patients, high levels (30-111 [the 90 th percentile] mg/dL) in 68 patients, and very high levels (&gt;111 mg/dL) in 20 patients. The primary outcome occurred in 75 (39.1%) patients, including 42 (40.4%), 25 (36.8%), and 8 (40.0%) patients with normal, high, and very high Lp(a) levels. There was no association between Lp(a) and the primary outcome (HR 1.00, 95% CI 0.99-1.02, Figure 1). A significant association between Lp(a) and death (HR 1.03, 95% CI 1.01-1.05) was noted. Results did not vary by randomized revascularization procedure. Conclusion: In this cohort, Lp(a) predicts death but not limb events in patients with CLTI. Larger studies are needed to understand the role of Lp(a) in patients with CLTI undergoing revascularization.

Association of lower extremity peripheral arterial disease with quantitative muscle features from computed tomography angiography

ObjectivesTo explore the association between lower extremity muscle features from CTA and peripheral arterial disease (PAD) severity using digital subtraction angiography (DSA) as reference standard.MethodsInformed consent was waived for this Institutional Review Board approved retrospective study. PAD patients were recruited from July 2016 to September 2020. Two radiologists evaluated PAD severity on DSA and CTA using runoff score. The patients were divided into two groups: mild PAD (DSA score ≤ 7) vs. severe PAD (DSA score > 7). After segmenting lower extremity muscles from CTA, 95 features were extracted for univariable analysis, logistic regression model (LRM) analysis, and sub-dataset analysis (PAD prediction based on only part of the images). AUC of CTA score and LRMs for PAD prediction were calculated. Features were analyzed using Student’s t test and chi-squared test. p < 0.05 was considered statistically significant.ResultsA total of 56 patients (69 ± 11 years; 38 men) with 56 lower legs were enrolled in this study. The lower leg muscles of mild PAD group (36 patients) showed higher CT values (44.6 vs. 39.5, p < 0.001) with smaller dispersion (35.6 vs. 41.0, p < 0.001) than the severe group (20 patients). The AUC of CTA score, LRM-I (constructed with muscle features), and LRM-II (constructed with muscle features and CTA score) for PAD severity prediction were 0.81, 0.84, and 0.89, respectively. The highest predictive performance was observed in the image subset of the middle and inferior segments of lower extremity (LRM-I, 0.83; LRM-II, 0.90).ConclusionsLower extremity muscle features are associated with PAD severity and can be used for PAD prediction.Critical relevance statementQuantitative image features of lower extremity muscles are associated with the degree of lower leg arterial stenosis/occlusion and can be a beneficial supplement to the current imaging methods of vascular stenosis evaluation for the prediction of peripheral arterial disease severity.Key points• Compared with severe PAD, lower leg muscles of mild PAD showed higher CT values (39.5 vs. 44.6, p < 0.001).• Models developed with muscle CT features had AUC = 0.89 for predicting PAD.• PAD severity prediction can be realized through the middle and inferior segment of images (AUC = 0.90).Graphical

Correlation of Coronary Artery Disease in Patients with Peripheral Artery Disease: Cross-Sectional Study

Background Peripheral Artery Disease (PAD) and Coronary Artery Disease (CAD) represent two facets of atherosclerotic cardiovascular disease, significantly impacting global health. Despite their high morbidity and mortality rates, the epidemiological and clinical nexus between PAD and CAD remains underexplored. Understanding the interrelation of these conditions is paramount for optimizing diagnostic and therapeutic strategies. Objective This study aimed to delineate the incidence and clinical correlation of CAD in patients diagnosed with PAD, thereby providing insights into the epidemiological characteristics and enhancing the clinical management of these conditions. Methods A cross-sectional analysis was conducted at Afridi Medical Complex's departments of vascular surgery and cardiology from 2021 to 2023. One hundred PAD patients referred for peripheral angiography were enrolled. Demographic data, Ankle Brachial Index (ABI) readings, ejection fraction percentages, and the presence of multivessel disease were evaluated. Statistical analyses were performed using SPSS version 25, focusing on mean, median, range, and significance levels to elucidate the prevalence of CAD among PAD patients. Results The study revealed a median age of 58 years among participants, with a significant male predominance (84%). ABI analysis showed that 74% and 108% of patients had mild and moderate PAD severity, respectively. The incidence of CAD in the PAD population was 56%, with angiographic assessments indicating single, double, and triple vessel disease in 23.21%, 39.29%, and 37.5% of patients, respectively. Notably, diabetes and dyslipidemia were prominent predictors of CAD presence in PAD patients. Conclusion The high prevalence of CAD in PAD patients underscores the critical need for comprehensive cardiovascular risk assessment and suggests the potential benefit of routine coronary angiography in symptomatic PAD cases, particularly among those with diabetes and dyslipidemia. This study reinforces the intertwined nature of PAD and CAD, advocating for an integrated approach to the diagnosis and management of these atherosclerotic conditions.

Association of Hyperemia With Severity of Peripheral Artery Disease

Association of Hyperemia With Severity of Peripheral Artery Disease

Serum Trefoil Factor-3 Predicts Survival in Peripheral Artery Disease.

Trefoil factor 3 (TFF3) has been studied in processes leading to atherosclerosis. Data are scarce in manifest disease and missing in peripheral artery disease (PAD). This study aims to elucidate TFF3 with disease stages, degrees of atherosclerosis, and outcomes. TFF3 was measured in serum in 364 PAD patients without critical limb ischemia and mild to moderate chronic kidney disease (CKD). Mortality data were retrieved from the Austrian central death registry (median observation 9.6years). Survival analyses were performed using Cox regression and the Kaplan-Meier method. A negative association between ankle-brachial index and TFF3 (P < .001) was observed, while levels were similar in asymptomatic and symptomatic PAD. TFF3 increased with history of cardiovascular and cerebrovascular disease (P < .001). TTF3 was associated with the estimated glomerular filtration rate (R = -0.617, P < .001) and urinary albumin-creatinine ratio (R = 0.229, P < .001). One SD increase in TFF3 showed a worsening in all-cause mortality (hazard ratio 1.68, CI 1.37-2.05) which persisted after multiple adjustment for cardiovascular risk, inflammatory, and angiogenetic markers (hazard ratio 1.35, CI 1.01-1.81). This study is the first to link TFF3 with both disease markers and outcomes in PAD. TFF3 demonstrated associations with renal function, PAD severity measured by ankle-brachial index, and additional atherosclerotic burden in PAD.

Effect of a standalone rehabilitation programme for patients with peripheral arterial disease on claudication, cardiovascular risk factors and quality of life

Background/Aims There have been calls to make rehabilitation programmes more accessible to patients with peripheral arterial disease. This study aimed to evaluate the effectiveness of a standalone peripheral arterial disease rehabilitation programme on walking outcomes, quality of life and cardiovascular risk factors as primary outcomes. Secondary outcomes relating to the characteristics that may have influenced change in walking outcomes and reasons for non-attendance or non-completion were also explored. Methods In this prospective, observational, one-site study, new patients were offered a 10-week programme, consisting of exercise, education and intervention for uncontrolled cardiovascular risk factors, in line with international peripheral arterial disease guidelines. Claudication times were measured using the Gardner-Skinner protocol and quality of life was measured using VascuQol. Pre- and post-intervention data were analysed using the SPSS version 23, with Pearson's Rho, Spearman's Rho and t tests being performed as appropriate. Statistical significance was set at P&lt;0.05. Results Of the 160 referrals received, 114 patients were enrolled in the programme and 89 (78%) completed it. Reasons for non-completion were mainly either logistical (domestic commitments or return to work) or perceptions of insuitability relating to age, infirmity or severity of peripheral arterial disease. Of those who completed the programme, the median age was 66 years, 81% were men, 71% had a history of hypertension, 25% had diabetes and 37% smoked. There were significant pre–post improvements (P&lt;0.05) in initial and maximum claudication time and distance, systolic and diastolic blood pressure, total cholesterol, low-density lipoprotein and quality of life scores. Improvements in maximum claudication times were associated with lower baseline initial claudication times, lower body mass index, some quality of life scores and male gender. Conclusions The peripheral arterial disease rehabilitation programme was effective in improving functional capacity, quality of life and some cardiovascular risk factors. Factors found to influence improvements in claudication times could be discussed with patients before and during the programme to address misperceptions, provide encouragement and improve compliance and recruitment. The safe environment of supervised exercise may have contributed to these results, prompting efforts to make exercise accessible to all patients with peripheral arterial disease.

Galectin-3 and peripheral artery disease: a Mendelian randomization study.

Multiple clinical studies have found a significant correlation between elevated galectin-3 (Gal-3) in circulation and the diagnosis and severity of peripheral arterial disease (PAD). The current study used the Mendelian randomization (MR) technique to evaluate the possible causal relationship between Gal-3 and PAD. Genome-wide association study (GWAS) data of Gal-3 and PAD were obtained through the MR-Base platform. Then, using Gal-3 as the exposure and PAD as the outcome, a two-sample MR analysis was performed utilizing several regression techniques, including MR-Egger regression, inverse variance weighted (IVW), weighted median, and weighted mode. Six single-nucleotide polymorphisms (SNPs) were identified and designated as instrumental variables (IVs) that exhibited significant correlations with Gal-3 (linkage disequilibrium r2 < 0.001; P < 5 × 10-8). Various statistical methods showed that there was an absence of a significant link between Gal-3 and PAD (IVW: odds ratio (OR) = 0.9869, 95% confidence interval (CI) = 0.8792-1.1078, P = 0.8232). In addition, the presence of genetic pleiotropy did impact the putative causal relationship between PAD and Gal-3 (MR-Egger intercept = 0.0099, P = 0.659). There is no current evidence to establish a causal relationship between the level of Gal-3 in circulation and PAD.