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International Angiology 2003 March;22(1):83-7


lingua: Inglese

Interrelationship between peripheral arterial occlusive disease, carotid atherosclerosis and flow mediated dilation of the brachial artery

Poredos P., Golob M., Jensterle M.

Department of Vascular Disease, University Medical Centre, Ljubljana, Slovenia


Aim. Ath­ero­scler­o­sis is con­sid­ered a system­ic dis­ease. There­fore, in ­patients with ath­e­ros­cle­rot­ic dis­ease ­effects on var­i­ous sec­tions of the arte­ri­al ­system are expect­ed. The aim of our study was to deter­mine wheth­er ­patients with evi­dent periph­er­al arte­ri­al occlu­sive dis­ease (PAOD) of the lower limbs have any sub­clin­i­cal func­tion­al or struc­tu­ral arte­ri­al wall chang­es in other sec­tions of the arte­ri­al ­system.
Meth­ods. The study includ­ed 54 ­patients with PAOD, Fon­taine stage II and a claud­i­ca­tion dis­tance from 50 to 500 ­m (aver­age 250±170 m). Their mean age was 64. None of them had any symp­toms or signs of cor­o­nary or cereb­ro­vas­cu­lar ath­ero­scler­o­sis (CVD). The con­trol group con­sist­ed of 50 ­healthy vol­un­teers with a mean age of 64 years with­out any risk fac­tors of ath­ero­scler­o­sis. In all sub­jects the carot­id inti­ma-media thick­ness (IMT), was meas­ured, the pres­ence of ath­e­ros­cle­rot­ic ­plaques in the carot­id ­artery (CA) was reg­is­tered and the endo­the­li­um-depen­dent dila­tion capa­bil­ity of the bra­chi­al ­artery (BA) dur­ing reac­tive hyper­emia was meas­ured using the B-mode ultra­sound tech­nique.
­Results. The aver­age IMT was sig­nif­i­cant­ly great­er in PAOD ­patients than in con­trols (0.8±0.2 mm vs 0.6±0.1 mm, p<0.001). In ­patients ath­e­ros­cle­rot­ic ­plaques in the CA were also more numer­ous than in con­trols (38 vs 4, p<0.001). The IMT of ­patients was relat­ed to body mass index (BMI), ankle-bra­chi­al pres­sure index (ABI), LDL cho­les­te­rol and to the num­ber of ath­e­ros­cle­rot­ic ­plaques. In PAOD ­patients flow-medi­at­ed dila­tion of the BA was sig­nif­i­cant­ly lower than in con­trols (7.2±4.9% vs 12.3±2.1%, p<0.001). The dila­tion capa­bil­ity of the BA was lin­e­ar­ly relat­ed to the BMI, ABI and IMT.
Con­clu­sion. The ­results of our study show that PAOD ­patients with­out clin­i­cal evi­dence of CVD have mor­pho­log­i­cal chang­es of the CA, ­increased IMT and numer­ous ath­e­ros­cle­rot­ic ­plaques. Fur­ther­more, in PAOD ­patients flow-medi­at­ed endo­the­li­um-depen­dent dila­tion of the periph­er­al arter­ies is ­decreased. These ­results sup­port the hypoth­e­sis that ath­ero­scler­o­sis is a gen­er­al­ized dis­ease, lead­ing to func­tion­al and struc­tu­ral chang­es in sev­er­al seg­ments of the arte­ri­al ­system.

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