Anatomical Distribution Patterns of Peripheral Arterial Disease in the Upper Extremities According to Patient Characteristics: A Retrospective Cohort Study

Abstract

Purpose

Peripheral arterial disease (PAD) greatly affects the patients’ quality of life. We aimed to investigate the affected anatomical sites and distribution patterns in upper extremity PAD using computed tomography angiography (CTA). Furthermore, we sought to identify the correlations between patient characteristics and the identified patterns.

Patients and Methods

This was a retrospective chart review of upper limb CTA findings from patients with symptomatic PAD aged >18 years. Significant variables from univariate logistic regression analysis were further tested using multivariate logistic regression analysis. Statistical significance was set at p < 0.05, with confidence intervals of 95%.

Results

The mean age of the 102 included patients with upper extremity PAD was 55.45 years. Laterality analysis revealed that the upper left limb segments were more affected than the upper right limb segments (42 vs 63; left-to-right ratio, 3:2). The forearm was the segment most affected by stenotic PAD (62 segments, 3.37%). The arm was the segment most affected by occlusive PAD (14 segments, 0.76%). Diabetes mellitus (DM) and hypertension (HTN) were significant predictors of PAD (p = 0.046). In patients with DM, the occlusive form of PAD was dominant in the arm (18.18%); however, the stenotic form prevailed in the forearm (72.72%). In patients with HTN, the occlusive form of PAD was predominant in the arm (45.45%); however, the stenotic form tended to occur in the arm and forearm (90.90%).

Conclusion

The distribution patterns of upper extremity PAD are linked to its underlying pathophysiology. HTN and DM are the most frequent comorbidities in patients with upper extremity PAD. Angiographically, PAD in these patients is likely to present as stenosis rather than as occlusion. This is vital for interventionists who deviate from radial arterial access in patients with PAD. Therefore, targeted screening standards are required, and further studies on PAD are warranted.

Plain Language Summary

In this study, we focused on discovering the link between site selectivity in upper extremity peripheral arterial disease (PAD) and the associated risk factors. This is one of the few studies, particularly from Saudi Arabia, that has provided the best available evidence on the topographical distribution patterns of PAD in the upper extremities according to variable heritable patient characteristics and associated comorbidities. Among the segments studied, the upper left limb segments were the most affected by PAD. Existing evidence indicates that angiographically, (whether with cross-sectional imaging or catheterized contrast-enhanced fluoroscopy imaging), PAD in patients with hypertension and in those with diabetes mellitus is probably observed as stenosis rather than as occlusion. Hypertension and diabetes mellitus were identified as the independent predictors of PAD in the arms and forearms, respectively. This is an important finding for interventionalists who opt for upper extremity access (eg, radial artery access) in patients with upper extremity PAD. To prevent complications, particularly upper limb amputation, screening procedures for and early detection of PAD require the identification of its distribution patterns.

Keywords:

• angiography
• computed tomography
• diabetes mellitus
• hypertension
• stenosis

Abbreviations

BMI, body mass index; CI, confidence interval; CKD, chronic kidney disease; CT, computed tomography; CTA, computed tomography angiography; DM, diabetes mellitus; HTN, hypertension; OR, odds ratio.

Data Sharing Statement

Data supporting the results reported in the manuscript are not publicly available because of institutional restrictions (eg, patient privacy policies). However, anonymized unpublished data are available from the principal investigator and the corresponding author (A.M.A.; [email protected]) upon reasonable request.

Ethics Approval and Informed Consent

The non-experimental study protocol was approved by the Imam Abdulrahman Bin Faisal University licensing committee of the Institutional Review Board (approval no.: IRB-2023-01-325), who further granted approval for the study to be conducted at the King Fahd Hospital of the University. Informed consent was obtained from all the participants and/or their legal guardians.

Author Contributions

All authors made a significant contribution to the work reported, whether that was in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; agreed on the journal to which the article has been submitted; and agreed to be accountable for all aspects of the work.

Disclosure

The authors declare that they have 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.