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International Angiology 2001 September;20(3):200-7


lingua: Inglese

Impact of atherosclerotic risk factors on the anatomical distribution of peripheral arterial disease

Haltmayer M., Mueller T., Horvath W. *, Luft C. *, Poelz W. **, Haidinger D. ***

From the Departments of Laboratory Medicine, * Radiology and *** Surgery (Division of Vascular Surgery), Konventhospital Barmherzige Brueder Linz, ** Department of Applied System Sciences and Statistics, University of Linz, Linz, Austria


Background. The aim of the study was to deter­mine pre­dic­tors of hemo­dy­nam­i­cal­ly rel­e­vant ath­ero­scler­o­sis (HRA) in dif­fer­ent seg­ments of lower limb arter­ies in ­patients with periph­er­al arte­ri­al dis­ease (PAD).
Methods. In a ret­ro­spec­tive case-con­trol study 106 hos­pi­tal­ized con­sec­u­tive ­patients with symp­to­mat­ic PAD and 52 asymp­to­mat­ic con­trol sub­jects were stud­ied. All ­patients under­went dis­tal aor­tof­e­mo­ral angio­gra­phy. The arter­ies of the lower limbs were divid­ed into three sec­tions: in the aorto-iliac and femo­ro-pop­li­teal seg­ments HRA was ­defined as one or more sten­o­sis of over 50%. In the cru­ral seg­ment it was con­sid­ered if at least two arter­ies of one lower leg had occlu­sions/ste­nos­es of over 50%.
Results. In 106 ­patients, there were 132 cases of hemo­dy­nam­i­cal­ly rel­e­vant ­lesions, and in 26 ­patients in two seg­ments. We sep­ar­ate­ly com­pared 23 cases with aorto-iliac, 82 with femo­ro-pop­li­teal and 27 with cru­ral man­i­fes­ta­tion to the 52 con­trol sub­jects. Calculating age- and sex-adjust­ed odds ­ratios, we found that cur­rent smok­ing stat­us and plas­mi­no­gen lev­els were sig­nif­i­cant­ly asso­ciat­ed with HRA in the aorto-iliac and femo­ro-pop­li­teal seg­ments, where­as in dia­betes mel­lit­us the asso­ci­a­tion was found to be in the cru­ral and femo­ro-pop­li­teal seg­ments. However, there was no such asso­ci­a­tion for lipid pro­files and fibrino­gen.
Conclusions. We con­clude that the ana­tom­ic dis­tri­bu­tion of HRA in ­patients with PAD is dif­fer­ent accord­ing to the risk fac­tor pro­file. The aorto-iliac and cru­ral seg­ments show spe­cif­ic risk pro­files while the femo­ro-pop­li­teal seg­ment seems to be a tran­si­tion zone. Smoking and high plas­mi­no­gen lev­els may be relat­ed to ath­ero­scler­o­sis of prox­i­mal seg­ments, dia­betes to that of the distal segments.

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