The risk factors and predictors of the clinically significant progression of atherosclerosis in patients with chronic lower extremity ischemia

Abstract


Aim. To define the risk factors and predictors of atherosclerosis progression leading to clinical worsening in patients with chronic lower extremity ischemia (CLEI).
Subjects and methods: Two hundred and forty patients with lower extremity arterial (LEA) atherosclerosis were examined. All the patients underwent color duplex ultrasound scanning of the great arteries supplying blood to the brain and LEA. Later on an annual observation was made for 11 months to 11 years (mean 45.6 months). To evaluate the influence of various factors on the progression of LEA atherosclerosis, the authors estimated overall survival without progression of CLEI.
Results. The one-year overall CLEI progression-free survival was 93.5% (SE = 0.016); 5- and 7-year survival was 66.9% (SE = 0.040) and 53.7% (SE = 0.054), respectively. Over 5 years, a clinically significant progression of CLEI was noted in 32% of the smokers and in 8% of the non-smokers, also in 26% of the patients with grade 1 or 2 hypertensive disease (HD) and in 43% of those with grade 3 HD. The overall CLEI progression-free survival did not depend on the severity of type 2 diabetes mellitus (patients with the severe course were excluded from the analysis). LEA atherosclerosis showed a significantly rapider progression in patients with increased common carotid intima-media thickness (IMT) (p = 0.004). During 5 years, CLEI progression occurred in 18% of the patients with an IMT of ≤ 1.0 mm and in 38% of those with an IMT of more than 1.0 mm, in 15% of the patients without hemodynamically significant stenosis (HDSS) of brachiocephalic arteries (BCA) and in 52% of those with HDSS of BCA, as well as in 20% of the patients without ischemic heart disease (IHD) and in 36% of those with symptoms of IHD.
Conclusion. Smoking that increases the risk of CLEI progression by 2.1 times and severe hypertension are the most important factor influencing the progression of atherosclerosis. The IMT index is a universal predictor of progressive atherosclerosis. It may be presumed that there is a higher process development rate in the detection of HDSS of one of the arterial beds (LEA, BCA, and symptoms of IHD) at the first examination.

About the authors

Natal'ya Sergeevna Nosenko

Ekaterina Mikhaylovna Nosenko

Larisa Valer'evna Dadova

Boris Alekseevich Sidorenko

N S Nosenko

E M Nosenko

L V Dadova

B A Sidorenko

References

  1. Покровский А. В. Значение оценки состояния микроциркуляции в клинической практике. Ангиол. и сосуд. хир. 2004; 10 (3): 3-4.
  2. Zheng L., Yu J., Li J. et al. Prevalence of and risk factors for peripheral arterial disease among Chinese hypertensive patients with and without known cardiovascular disease. Acta cardiol. 2008; 63 (6): 693-702.
  3. Powell J. T., Edwards R. J., Worrell P. C. et al. Risk factors associated with the development of peripheral arterial disease in smokers: a case control study. Atherosclerosis 1997; 129: 41- 48.
  4. Балахонова Т. В. Ультразвуковое исследование артерий у пациентов с сердечно-сосудистыми заболеваниями: Дис. ... д-ра мед. наук. М.; 2002. 50-55.
  5. Кунцевич Г. И. Окклюзирующие поражения артерий нижних конечностей. В кн.: Кунцевич Г. И. (ред.) Ультразвуковая диагностика в абдоминальной и сосудистой хирургии. Минск: Кавалер паблишерс; 1999. 179-191.
  6. Vogt M. T., Wolfson S. K., Kuller L. H. Lower extremity arterial disease and the aging process: a review. J. Clin. Epidemiol. 1992; 45: 529-542.
  7. Dormandy J. Peripheral vascular disease. Maryland Heights. Medical Clinics of North America. 1994. 353-360.
  8. Faxon D. P., Fuster V., Libby P. et al. Atherosclerotic vascular disease conference: Writing group III: Pathophysiology. Circulation 2004; 109 (21): 2617-2625.
  9. Meijer W. T., Hoes A. W., Rutgers D. M. et al. Peripheral arterial disease in the elderly: the Rotterdam study. Arterioscler. Thromb. Vasc. Biol. 1998; 18: 185-192.
  10. Hiatt W. R., Hoag S., Hamman R. F. Effect of diagnostic criteria on the prevalence of peripheral arterial disease: The San Luis Valley Diabetes Study. Circulation 1995; 91 (5): 1472- 1479.
  11. Luscher T. F., Creager M. A., Beckman J. A., Cosentino F. Diabetes and vascular disease: Pathophysiology, clinical consequences, and medical therapy. Part II. Circulation 2003; 108 (13): 1655-1661.
  12. Российский консенсус. Рекомендуемые стандарты для оценки результатов лечения пациентов с хронической ишемией нижних конечностей, М.: 2001, 9.
  13. Бокерия Л. А., Бухарин В. А., Работников B. C., Алшибая М. М. Хирургическое лечение больных ишемической болезнью сердца с поражением брахиоцефальных артерий. М.: Изд. НЦ ССХ им. А. Н. Бакулева; 1999.

Statistics

Views

Abstract - 50

Cited-By


Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
 

Address of the Editorial Office:

  • Novij Zykovskij proezd, 3, 40, Moscow, 125167

Correspondence address:

  • Novoslobodskaya str 31c4., Moscow, 127005, Russian Federation

Managing Editor:

 

© 2018 "Consilium Medicum" Publishing house

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies