Atherosclerotic risk factors and segmental distribution in symptomatic peripheral artery disease

To determine the distribution of atherosclerotic peripheral artery disease (PAD) and associated risk factors in patients who have undergone pelvic and lower-limb angiography.

Records of 626 consecutive patients (88 women, 538 men; mean age, 62 years; age range, 31-85 y) with PAD were retrospectively reviewed. Severity of limb ischemia was staged according to Rutherford classification of PAD. The arterial system was divided into three segments including aortoiliac, femoropopliteal, and crural segments. PAD was defined as a greater than 50% stenosis or occlusion of any segment. Univariate and multivariate analyses were used to determine associations between segmental arterial disease and patient demographics, medical history, and angiographic findings.

Of the 626 patients, 400 (64%) had multisegmental disease, the most common form of which was combined femoropopliteal and crural disease (25%). A significant association was found between severity of limb ischemia and distribution of PAD. Intermittent claudication was significantly associated with aortoiliac disease (odds ratio, 2.15; P < .001), whereas critical limb ischemia was associated with crural disease (odds ratio, 2.5; P = .001) on multivariate analysis. Significant associations were found between smoking and aortoiliac, femoropopliteal, and multisegment disease; between diabetes mellitus and crural disease; and between age and femoropopliteal and multisegment disease.

PAD was multisegmental in most of the patients in this study group. Different clinical risk factors predict the involvement of different arterial segments. Severity of limb ischemia was significantly associated with the distribution of PAD.