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

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.

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

Body Fat Distribution, Cardiometabolic Traits, and Risk of Major Lower-Extremity Arterial Disease in Postmenopausal Women

<b>OBJECTIVE </b> <p>To assess the relationship between body fat distribution and incident lower-extremity arterial disease (LEAD). </p> <p><b>RESEARCH DESIGN AND METHODS </b></p> <p>We included 155,925 postmenopausal women with anthropometric measures from the Women’s Health Initiative who had no known LEAD at recruitment. A subset of 10,894 participants had body composition data quantified by dual energy X-ray absorptiometry (DXA). Incident cases of symptomatic LEAD were ascertained and adjudicated via medical record review.</p> <p><b>RESULTS </b></p> <p>We identified 1152 incident LEAD cases during a median 18.8 years follow-up. After multivariable adjustment and mutual adjustment, waist and hip circumference was positively and inversely associated with risk of LEAD, respectively (both P-trend values <0.0001). In a subset (n = 22,561) where various cardiometabolic biomarkers were quantified, a similar positive association of waist circumference with risk of LEAD was eliminated after adjustment for diabetes and HOMA-IR (P-trend = 0.89), whereas hip circumference remained inversely associated with the risk after adjustment for major cardiometabolic traits (P-trend = 0.0031). In the DXA subset, higher trunk fat (P-trend = 0.0081) and higher leg fat (P-trend <0.0001) was associated with higher and lower risk of LEAD, respectively. Further adjustment for diabetes, dyslipidemia, and blood pressure diminished the association for trunk fat (P-trend = 0.49), yet the inverse association for leg fat persisted (P-trend = 0.0082).</p> <p><b>CONCLUSIONS</b></p> <p>Among US postmenopausal women, a positive association of upper-body fat with risk of LEAD appeared to be attributable to traditional risk factors especially insulin resistance. Lower-body fat was inversely associated with risk of LEAD beyond known risk factors. </p>

Body Fat Distribution, Cardiometabolic Traits, and Risk of Major Lower-Extremity Arterial Disease in Postmenopausal Women

<b>OBJECTIVE </b> <p>To assess the relationship between body fat distribution and incident lower-extremity arterial disease (LEAD). </p> <p><b>RESEARCH DESIGN AND METHODS </b></p> <p>We included 155,925 postmenopausal women with anthropometric measures from the Women’s Health Initiative who had no known LEAD at recruitment. A subset of 10,894 participants had body composition data quantified by dual energy X-ray absorptiometry (DXA). Incident cases of symptomatic LEAD were ascertained and adjudicated via medical record review.</p> <p><b>RESULTS </b></p> <p>We identified 1152 incident LEAD cases during a median 18.8 years follow-up. After multivariable adjustment and mutual adjustment, waist and hip circumference was positively and inversely associated with risk of LEAD, respectively (both P-trend values <0.0001). In a subset (n = 22,561) where various cardiometabolic biomarkers were quantified, a similar positive association of waist circumference with risk of LEAD was eliminated after adjustment for diabetes and HOMA-IR (P-trend = 0.89), whereas hip circumference remained inversely associated with the risk after adjustment for major cardiometabolic traits (P-trend = 0.0031). In the DXA subset, higher trunk fat (P-trend = 0.0081) and higher leg fat (P-trend <0.0001) was associated with higher and lower risk of LEAD, respectively. Further adjustment for diabetes, dyslipidemia, and blood pressure diminished the association for trunk fat (P-trend = 0.49), yet the inverse association for leg fat persisted (P-trend = 0.0082).</p> <p><b>CONCLUSIONS</b></p> <p>Among US postmenopausal women, a positive association of upper-body fat with risk of LEAD appeared to be attributable to traditional risk factors especially insulin resistance. Lower-body fat was inversely associated with risk of LEAD beyond known risk factors. </p>

Development and validation of a risk score model for prediction of lower extremity arterial disease in Chinese with type 2 diabetes aged over 50 years

Background Lower extremity arterial disease (LEAD) is highly prevalent in people with diabetes in China, but half of cases are underdiagnosed due to diversities of clinical presentations and complexities of diagnosis approaches. The purpose of this study was to develop a risk score model for LEAD to facilitate early screening among type 2 diabetes (T2DM) patients. Methods A total of 8313 participants with T2DM from the China DIA-LEAD study, a multicenter, cross-sectional epidemiological study, were selected as the training dataset to develop a risk score model for LEAD by logistic regression. The area under receiver operating characteristic curve (AUC) and bootstrapping were utilized for internal validation. A dataset of 287 participants consecutively enrolled from a teaching hospital between July 2017 and November 2017 was used as external validation for the risk score model. Results A total of 931 (11.2%) participants were diagnosed as LEAD in the training dataset. Factors including age, current smoking, duration of diabetes, blood pressure control, low density lipoprotein cholesterol, estimated glomerular filtration rate, and coexistence of cardio and/or cerebrovascular disease correlated with LEAD in logistic regression analysis and resulted in a weighed risk score model of 0–13. A score of ≥5 was found to be the optimal cut-off for discriminating moderate–high risk participants with AUC of 0.786 (95% CI: 0.778–0.795). The bootstrapping validation showed that the AUC was 0.784. Similar performance of the risk score model was observed in the validation dataset with AUC of 0.731 (95% CI: 0.651–0.811). The prevalence of LEAD was 3.4, 12.1, and 27.6% in the low risk (total score 0–4), moderate risk (total score 5–8), and high risk (total score 9–13) groups of LEAD in the training dataset, respectively, which were 4.3, 19.6, and 30.2% in the validation dataset. Conclusion The weighed risk score model for LEAD could reliably discriminate the presence of LEAD in Chinese with T2DM aged over 50 years, which may be helpful for a precise risk assessment and early diagnosis of LEAD.