PAD Prognosis Linked to Stenotic Lesion Location


MUNICH — For peripheral arteial disease, like real estate, it's all about location.

In a review of 400 patients, those with proximally located peripheral arterial disease (PAD) within aortoiliac vessels, were more than twice as likely to die or have a cardiovascular disease event during follow-up as patients with PAD lesions located exclusively in distal, infrailiac arteries, Dr. Victor Aboyans reported at the annual meeting of the European Society of Cardiology.

“This is the first study showing general prognosis differences in PAD patients according to disease location, independent of associated risk factors,” said Dr. Aboyans, a senior physician at Dupuytren University Hospital in Limoges, France.

The study reviewed all 400 patients who underwent an initial, lower-limb angiography examination at the hospital during 2000–2005. Their average age was 68 years, and 78% were men. Arterial stenoses of 50% or more were located by two experienced vascular physicians.

Aortoiliac lesions were found in 211 patients. Many of these patients had lesions in distal arteries, too, although 56 of these patients only had aortoiliac stenoses. The other 189 patients in the study had stenotic lesions confined to distal parts of the lower vasculature, including femoro-popliteal disease and infragenicular disease.

During follow-up through April 2007, the rate of total death in the patients with aortoiliac stenoses was about 2.5-fold higher than those PAD patients who only had distal lesions in an analysis that adjusted for differences in patient age, gender, smoking status, diabetes, heart failure, and several other comorbidities and variables, Dr. Aboyans said. A second 2.5-fold increased risk was calculated for the incidence of cardiovascular disease events in the patients with proximal disease, compared with those who only had infra-iliac stenoses.

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