Anatomical Distribution Patterns of Peripheral Arterial Disease According to Patient Characteristics: A Unicentral Cohort Study

Abstract

Purpose

Peripheral arterial disease (PAD) is a common disease with multiple risk factors and affects patients worldwide. Several international studies have established correlations between anatomical topography/distribution of atherosclerosis and comorbidities in patients with PAD. In this cohort study, we aimed to analyze the patterns of atherosclerosis (site, distribution, and degree) in patients who underwent lower limb computed tomography angiography and arterial angiography by identifying the atherosclerotic plaque(s) that were possibly responsible for thrombi. Additionally, we aimed to determine any relationship between comorbidities and identified patterns.

Patients and Methods

Between January 2015 and January 2021, we retrospectively recruited 140 patients at King Fahd Hospital of the University of Saudi Arabia. Data collected included patient characteristics, risk factors, and metabolic disorders, such as hypertension (HTN), diabetes mellitus (DM), dyslipidemia, and chronic kidney disease. Patients with incomplete records or unavailable radiological images were excluded.

Results

The infrapopliteal territory was the most common segment that was affected. HTN, DM, and dyslipidemia were found in 81.4%, 77.9%, and 62.9% of patients, respectively. Correlation analyses revealed that DM was the only independent metabolic disorder associated with a PAD distribution pattern in the femoropopliteal segment (p=0.039), thus denoting distal involvement. No significant association was found between PAD distribution and the severity of stenosis.

Conclusion

Segmental involvement in PAD varies with the risk factors and metabolic comorbidities present in patients. DM is an independent predictor of the anatomical distribution of PAD. The identification of such an anatomical distribution is paramount for screening procedures, early detection of disease, and prevention of complications, particularly limb amputation.

Keywords:

• angiography
• computed tomography
• diabetes mellitus
• peripheral arterial disease
• stenosis

Abbreviations

CT, computed tomography; CTA, computed tomography angiography; DM, diabetes mellitus; HTN, hypertension; CKD, chronic kidney disease; AI, aortoiliac; FP, femoropopliteal; IP, infrapopliteal.

Data Sharing Statement

The datasets generated and/or analyzed during the current study are not publicly available due to restrictions (eg, information that could compromise the privacy of participants). Anonymized data are available from the corresponding author on reasonable request. IAA is the principal investigator and corresponding author for this project. IAA should be contacted for data pertaining to this study ([email protected]).

Ethical Approval and Informed Consent

The non-experimental study protocol was approved by the Imam Abdulrahman Bin Faisal University licensing committee of Institutional Review Board (IRB-UGS-2020-01-367) and granted approval for the study to be conducted at King Fahd Hospital University. This study was performed in accordance with the Helsinki Declaration of 1975 (revised in 1983). Anonymized data were collected, analyzed, and reported only in aggregate form, and no identifiable participant information (image, face, name etc.) was revealed in the study. Informed consent was obtained from all participants and/or their legal guardian(s).

Acknowledgments

The authors gratefully acknowledge Dr. Mohamed Selim (Vascular Surgeon) for his initial assistance with the study proposal.

Author Contributions

All authors made a significant contribution to the work reported in terms of the conception, study design, execution, acquisition of data, analysis and interpretation, or all these areas; drafting, revising or critically reviewing the article; and final approval of the version. The authors have agreed to the submission of the article to the current journal and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no competing interests.

Additional information

Funding

This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.