The Increase of The Relative Amount of Nodular Calcification In Femoral Plaques is Associated With Milder Lower Extremity Arterial Disease

Abstract Vascular calcification exists in different forms that reflect variable clinical and histological implications. Categories of calcification have not been quantified in relation to the clinical presentation of lower extremity arterial disease. The study analyzed 51 femoral plaques collected during femoral endarterectomy, characterized by > 90% stenosis. The plaques were longitudinally sectioned, stained with Hematoxylin and Eosin and digitized for a deep learning platform for quantification of the relative area of nodular calcification to the plaque section area. Vessel measurements and quantity of each calcification category was compared to the clinical risk factors and outcomes. nodular calcification area proportion is associated with reduced risk of severely lowered toe pressure (< 30mmHg) (OR=0.910, 95%CI =0.835-0992, p<0.05), severely lowered ankle brachial index (<0.4), (OR=0.912, 95%CI=0.84-0.986, p<0.05), and semi-urgent operation (OR=0.882, 95%CI=0.797-0.976, p<0.05). The analysis was adjusted by age, gender, hypertension, diabetes and dyslipidaemia. Increase of the relative amount of nodular calcification in femoral plaques with over 90% stenosis is associated with protection against severe LEAD, identified by severely lowered toe pressure and ankle brachial index and semi-urgent operations. Nodular calcification may contribute to a slower obstruction, hence milder obstructive ischaemic presentation.

Download Full-text

Sensitivity, Specificity and Predictive Value of the Edinburgh Claudication Questionnaire versus Ankle-Brachial Index for the Diagnosis of Lower Extremity Arterial Disease in Turkish Adults

Gulhane Medical Journal ◽

10.5455/gulhane.173585 ◽

2017 ◽

pp. 1

Author(s):

Bilgin BASGOZ ◽

Ilker TASCI ◽

Birol YILDIZ ◽

Cengizhan ACIKEL ◽

Seref DEMIRBAS ◽

...

Keyword(s):

Lower Extremity ◽

Predictive Value ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Lower Extremity Arterial Disease ◽

Sensitivity Specificity

Download Full-text

Hybrid Endarterectomy and Endovascular Therapy in Multilevel Lower Extremity Arterial Disease Involving the Femoral Artery Bifurcation

International Surgery ◽

10.9738/0020-8868-97.1.56 ◽

2012 ◽

Vol 97 (1) ◽

pp. 56-64 ◽

Cited By ~ 9

Author(s):

Junjie Zou ◽

Yongxiang Xia ◽

Hongyu Yang ◽

Hao Ma ◽

Xiwei Zhang

Keyword(s):

Lower Extremity ◽

Femoral Artery ◽

Ankle Brachial Index ◽

Common Femoral Artery ◽

Arterial Disease ◽

Primary Patency ◽

Secondary Patency ◽

Hybrid Procedures ◽

Lower Extremity Arterial Disease ◽

Group 3

Abstract The objective of this study was to evaluate the feasibility and efficacy of hybrid therapy (combined endarterectomy-endovascular) in patients with complex peripheral multifocal steno-obstructive vascular disease involving the femoral artery bifurcation. Forty-one combined procedures were performed on 40 patients. Although the common femoral artery was usually treated with endarterectomy, endoluminal procedures were performed proximally in 12 patients (group 1), distally in 18 patients (group 2), and both upward and downward in 11 patients (group 3). Patients underwent clinical assessment and ankle-brachial index measurement thereafter. Primary, assisted-primary, and secondary patency rates at 24 months were 59%, 66%, and 72%, respectively. Primary patency rates were lower in group 3 compared with groups 1 and 2 (P = 0.015). The limb salvage rate was 86.4% at the end of the follow-up period. Hybrid procedures provide feasible and effective treatment management of selected patients with multilevel lower extremity arterial disease involving the femoral artery bifurcation.

Download Full-text

Toe pressure and toe brachial index are predictive of cardiovascular mortality regardless of the most diseased arterial segment in symptomatic lower-extremity artery disease—A retrospective cohort study

PLoS ONE ◽

10.1371/journal.pone.0259122 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0259122

Author(s):

V. Koivunen ◽

M. Juonala ◽

M. Venermo ◽

M. Laivuori ◽

J. M. Jalkanen ◽

...

Keyword(s):

Lower Extremity ◽

Cardiovascular Mortality ◽

Cox Regression ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Pressure Measurements ◽

Arterial Segment ◽

Toe Brachial Index ◽

Disease Location ◽

Toe Pressure

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

Download Full-text

Association of Circulating Osteopontin Levels With Lower Extremity Arterial Disease in Subjects With Type 2 Diabetes Mellitus: A Cross-Sectional Observational Study

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734619898097 ◽

2020 ◽

Vol 19 (2) ◽

pp. 180-189

Author(s):

Ioanna Eleftheriadou ◽

Dimitrios Tsilingiris ◽

Anastasios Tentolouris ◽

Iordanis Mourouzis ◽

Pinelopi Grigoropoulou ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Lower Extremity ◽

Geometric Mean ◽

Multivariable Analysis ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Lower Extremity Arterial Disease

Osteopontin (OPN) is involved in the atherosclerotic and inflammatory process. In this article, we examined the relationship between circulating OPN levels with lower extremity arterial disease (LEAD) in individuals with type 2 diabetes mellitus (T2DM). Seventy individuals with T2DM and 66 individuals without T2DM were recruited. Diagnosis of LEAD was based on the absence of triphasic waveform on the pedal arteries. Plasma OPN levels were determined by Luminex Multiplex immunoassay. LEAD was present in 34 (48.6%) patients with T2DM. In the diabetes cohort, individuals with LEAD had higher plasma OPN concentrations than those without LEAD (geometric mean [95% confidence intervals]; 43.4 [37.5-50.4] vs 26.1 [22.9-29.8] ng/mL, respectively, P < .001). Multivariable analysis showed that presence of LEAD independently associated with higher OPN levels in subjects with T2DM, with marginal statistical significance ( P = .049). In both cohorts, plasma OPN concentrations were negatively associated with ankle-brachial index values ( P < .05). In the total sample, there was a gradual increase of OPN levels across subgroups with triphasic, biphasic, and monophasic/blunted waveforms ( P < .001). In conclusion, plasma OPN levels are associated with the presence and severity of LEAD in subjects with T2DM. Further studies are needed to investigate the role of OPN in the pathogenesis and progression of LEAD.

Download Full-text

HIV clinical stages and lower extremity arterial disease among HIV infected outpatients in Burundi

Scientific Reports ◽

10.1038/s41598-021-87862-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ileana Desormais ◽

Deo Harimenshi ◽

Théodore Niyongabo ◽

Philippe Lacroix ◽

Victor Aboyans ◽

...

Keyword(s):

Lower Extremity ◽

Hiv Infection ◽

Multivariable Analysis ◽

Ankle Brachial Index ◽

Central Africa ◽

Arterial Disease ◽

Cross Sectional ◽

Lower Extremity Arterial Disease ◽

Clinical Stages

AbstractChronic disease of people living with human immunodeficiency virus (HIV) infection are now approaching those of the general population. Previous, in vitro studies shown that HIV causes arterial injuries resulting in inflammation and atherosclerosis but direct relationship between HIV infection clinical stages and lower extremity arterial disease (LEAD) remain controversial. No study assessed, with an accurate method, both the prevalence of LEAD and the influence of HIV severity on LEAD in HIV outpatients in Central Africa. A cross-sectional study was conducted among 300 HIV-infected outpatients, aged ≥ 40 years in Bujumbura, Burundi. All patients underwent ankle-brachial index (ABI) measurement and LEAD was diagnosed by ABI ≤ 0.9. The prevalence of LEAD was 17.3% (CI 95% 13.2–22.1). The mean age was 49.6 ± 7.1 years. On multivariable analysis, factors associated with LEAD were hypertension (OR = 2.42; 95% CI 1.10–5.80), and stage IV HIV clinical infection (OR = 4.92, 95% CI 1.19–20.36). This is the first study performed on a large HIV population in Central Africa, reporting high LEAD prevalence. It underlines the influence of HIV infection on peripheral atherosclerosis at latest clinical stages and the need for LEAD screening in HIV-infected patients.

Download Full-text

Lower Extremity Arterial Disease Assessed by Ankle-Brachial Index in a Middle-Aged Population of African Americans and Whites

American Journal of Preventive Medicine ◽

10.1016/j.amepre.2005.07.019 ◽

2005 ◽

Vol 29 (5) ◽

pp. 42-49 ◽

Cited By ~ 56

Author(s):

Zhi-Jie Zheng ◽

Wayne D. Rosamond ◽

Lloyd E. Chambless ◽

F. Javier Nieto ◽

Ralph W. Barnes ◽

...

Keyword(s):

African Americans ◽

Lower Extremity ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Middle Aged ◽

Lower Extremity Arterial Disease ◽

Aged Population

Download Full-text

Short-term outcomes of endovascular therapy for chronic lower extremity arterial disease

Tạp chí Phẫu thuật Tim mạch và Lồng ngực Việt Nam ◽

10.47972/vjcts.v35i.702 ◽

2022 ◽

Vol 35 ◽

pp. 212-219

Author(s):

Hoang Van

Keyword(s):

Surgical Treatment ◽

Lower Extremity ◽

Balloon Angioplasty ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Endovascular Intervention ◽

Short Term ◽

Lower Extremity Arterial Disease ◽

Before And After ◽

Artery Disease

Background: Chronic lower extremity arterial disease, mostly caused by atherosclerotic etiology, has been increasing in recent years. Currently, there has been a shift in the treatment chronic lower extremity arterial disease from open surgical treatment to endovascular intervention. According to the TASC classification, surgical treatment is preferred for patients with complex lesions of TASC C, D but recent studies have shown that endovascular intervention has had good results for high-grade lesions. Objective: To determine the efficacy, short-term results of endovascular intervention in patients with symptomatic lower extremity artery disease Methods: From January to December 2021, the cross sectional, descriptive study was carried out on 38 patients with lower limb artery disease, treated by endovascular intervetion in Interventional Department, Hanoi Heart hospital. All patients were evaluated by clinical symptoms, ankle- brachial index and lesion characteristic before and after the intervention to determine the initial success Results: Majority of lesions belong to TASC II C and D (78,9%). Injured arteries can be isolated in the aortoiliac (21,1%), femoropopliteal (21,1%), below-knee artery (21,1%) or combine aortoiliac and femoropopliteal (10,5%), femoropopliteal and BTK (15,8%). The ankle- brachial index before and after the intervention respectively 0,57 and 0.83 (p<0,001). The technical successful rate was 94,7%. Balloon angioplasty and stent placement were in 21 patients (55,3%) and balloon angioplasty in 17 patients (44,7%). Post-procedural complications included stent thrombosis (2.6%), amputation (2.6%), pseudoaneurysm at the puncture site (2.6%). Conclusion: Endovascular intervention is a safe, effective, minimally invasive method in the treatment of chronic lower extremity arterial disease

Download Full-text