Markers of arterial stiffness in peripheral arterial disease

Abstract. Increased arterial stiffness results from reduced elasticity of the arterial wall and is an independent predictor for cardiovascular risk. The gold standard for assessment of arterial stiffness is the carotid-femoral pulse wave velocity. Other parameters such as central aortic pulse pressure and aortic augmentation index are indirect, surrogate markers of arterial stiffness, but provide additional information on the characteristics of wave reflection. Peripheral arterial disease (PAD) is characterised by its association with systolic hypertension, increased arterial stiffness, disturbed wave reflexion and prognosis depending on ankle-brachial pressure index. This review summarises the physiology of pulse wave propagation and reflection and its changes due to aging and atherosclerosis. We discuss different non-invasive assessment techniques and highlight the importance of the understanding of arterial pulse wave analysis for each vascular specialist and primary care physician alike in the context of PAD.

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CT perfusion in peripheral arterial disease—hemodynamic differences before and after revascularisation

European Radiology ◽

10.1007/s00330-021-07692-5 ◽

2021 ◽

Author(s):

Patrick Veit-Haibach ◽

Martin W. Huellner ◽

Martin Banyai ◽

Sebastian Mafeld ◽

Johannes Heverhagen ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Ct Perfusion ◽

Arterial Disease ◽

Lower Leg ◽

Therapy Control ◽

Non Invasive ◽

Before And After ◽

Invasive Method ◽

The Mean ◽

Peripheral Arterial

Abstract Objectives The purpose of this study was the assessment of volumetric CT perfusion (CTP) of the lower leg musculature in patients with symptomatic peripheral arterial disease (PAD) before and after interventional revascularisation. Methods Twenty-nine consecutive patients with symptomatic PAD of the lower extremities requiring interventional revascularisation were assessed prospectively. All patients underwent a CTP scan of the lower leg, and hemodynamic and angiographic assessment, before and after intervention. Ankle-brachial pressure index (ABI) was determined. CTP parameters were calculated with a perfusion software, acting on a no outflow assumption. A sequential two-compartment model was used. Differences in CTP parameters were assessed with non-parametric tests. Results The cohort consisted of 24 subjects with an occlusion, and five with a high-grade stenosis. The mean blood flow before/after (BFpre and BFpost, respectively) was 7.42 ± 2.66 and 10.95 ± 6.64 ml/100 ml*min−1. The mean blood volume before/after (BVpre and BVpost, respectively) was 0.71 ± 0.35 and 1.25 ± 1.07 ml/100 ml. BFpost and BVpost were significantly higher than BFpre and BVpre in the treated limb (p = 0.003 and 0.02, respectively), but not in the untreated limb (p = 0.641 and 0.719, respectively). Conclusions CTP seems feasible for assessing hemodynamic differences in calf muscles before and after revascularisation in patients with symptomatic PAD. We could show that CTP parameters BF and BV are significantly increased after revascularisation of the symptomatic limb. In the future, this quantitative method might serve as a non-invasive method for surveillance and therapy control of patients with peripheral arterial disease. Key Points • CTP imaging of the lower limb in patients with symptomatic PAD seems feasible for assessing hemodynamic differences before and after revascularisation in PAD patients. • This quantitative method might serve as a non-invasive method, for surveillance and therapy control of patients with PAD.

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Prognostic Impact of Arterial Stiffness in Patients with Symptomatic Peripheral Arterial Disease

Journal of Vascular Surgery ◽

10.1016/j.jvs.2014.07.029 ◽

2014 ◽

Vol 60 (3) ◽

pp. 808

Author(s):

J. Kals ◽

J. Lieberg ◽

P. Kampus ◽

M. Zagura ◽

J. Eha ◽

...

Keyword(s):

Arterial Stiffness ◽

Peripheral Arterial Disease ◽

Arterial Disease ◽

Prognostic Impact ◽

Peripheral Arterial

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Abstract 3077: Cross-Sectional Associations of Arterial Stiffness Measures and Ankle-Brachial Index: The Multi-Ethnic Study of Atherosclerosis (MESA)

Circulation ◽

10.1161/circ.118.suppl_18.s_810-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

John T Wilkins ◽

Mary M McDermott ◽

Kiang Liu ◽

Cheeling Chan ◽

Michael Criqui ◽

...

Keyword(s):

Arterial Stiffness ◽

Mechanical Characteristics ◽

Pulse Wave ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Cross Sectional ◽

Men And Women ◽

Independent Variables ◽

Vascular Impedance ◽

Peripheral Arterial

The association between tonometry-derived measures of arterial stiffness and peripheral arterial disease (PAD) is unclear. Using baseline data from 2847 female and 2614 male participants of the NHLBI-funded MESA study, we conducted linear regression analyses adjusted for age, demographics and risk factors. Ankle-brachial index (ABI) was the dependent variable and measures of large (C1) and small artery elasticity (C2) and total vascular impedance (TVI), all measured from radial artery tonometry, were the independent variables in separate models. In men and women, lower C1 and C2 values were associated with lower ABI. Higher TVI was associated with lower ABI in men and women [P<0.001]. Significant trends for C1, C2 and TVI were observed across clinical strata of ABI (Table ). In pairwise analyses, compared with participants with a normal ABI (1.1 to <1.3), those with ABI <1.1 tended to have significantly lower C2. Additionally, women with high ABI (1.3–1.5) tended to have significantly higher C2 values. Pairwise comparisons of lower and higher ABI groups compared with normal groups did not yield consistent findings for C1. Significantly higher TVI levels with lower ABI group were noted mostly in women (Table ). We observed a continuum of arterial mechanical characteristics across clinical ABI values, indicating that measures of arterial stiffness are significantly associated with ABI and severity of PAD. These results suggest that changes in C2 occur in patients with advanced lower extremity large-vessel atherosclerotic disease. Of note, female participants with high ABI between 1.3–1.5 had a significantly higher C2, arguing against the accepted “non-compressible” or “calcified arterial disease” explanation for high ABI in women. Associations Between ABI and Pulse Wave Analysis Measurements when adjusted for age, cigarette smoking, diabetes, hypertension, and creatinine level

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