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Segmental arterial disease in the lower extremities: correlates of disease and relationship to mortality
M T Vogt1, S K Wolfson, L H Kuller
1Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA 15261.
Insights
Current smoking and high blood pressure are key risks for lower limb arterial disease. While aortoiliac and femoropopliteal stenosis increase mortality, tibioperoneal disease does not significantly impact survival.
Area of Science:
- Vascular Medicine
- Cardiovascular Epidemiology
- Peripheral Arterial Disease
Background:
- Peripheral arterial disease (PAD) affects major lower limb arteries.
- Stenosis in these arteries is linked to significant health risks.
- Understanding risk factors and mortality is crucial for patient management.
Purpose of the Study:
- To identify correlates of disease and mortality risk in lower limb arterial stenosis.
- To analyze risk factors across different arterial segments (aortoiliac, femoropopliteal, tibioperoneal).
- To differentiate risks between men and women.
Main Methods:
- Retrospective analysis of patients evaluated in a peripheral vascular laboratory.
- Inclusion of 326 men and 249 women with unisegmental stenosis; 312 men and 275 women with multisegmental disease.
- Multivariate analysis to determine key risk factors and mortality correlations.
Main Results:
- Current smoking and elevated systolic blood pressure are primary risk factors for aortoiliac and femoropopliteal disease in both sexes.
- Diabetes history correlates with tibioperoneal disease in men; elevated systolic blood pressure correlates with distal disease in women.
- Mortality risk increased 2- to 7-fold with aortoiliac/femoropopliteal multi- and unisegmental disease; tibioperoneal disease showed no significant mortality increase.
Conclusions:
- Atherosclerosis in the lower extremity has varying etiology and mortality risks based on lesion site and severity.
- Smoking and hypertension are critical modifiable risk factors for significant PAD.
- Distinguishing disease location is important for risk stratification and patient outcomes.
Abstract:
The purpose of this study was to identify the correlates of disease and mortality risk associated with the presence of stenosis in the major arterial segments of the lower limb in men and women evaluated in a peripheral vascular laboratory. A total of 326 men and 249 women had unisegmental stenosis; 312 men and 275 women had multisegmental disease; 132 men and 111 women had no apparent disease. Multivariate analysis indicated that current smoking and elevated systolic blood pressure were the key risk factors associated with isolated aortoiliac and femoropopliteal arterial disease in both men and women. A history of diabetes was significantly associated with tibioperoneal disease in men while elevated systolic blood pressure was the major correlate of distal disease in women in this patient population. The relative risk of mortality was elevated 2- to 7-fold in men and women with multi- and unisegmental disease involving the aortoiliac and femoropopliteal segments; presence of tibioperoneal disease did not significantly increase mortality relative to those who were free of disease. These results suggest that the etiology and mortality risk associated with atherosclerosis in the lower extremity may vary with the anatomic site and/or severity of the lesion.