BAD transmission and SAD distribution: A new scenario for critical limb ischemia

R. Ferraresi, G. Mauri, F. Losurdo, N. Troisi, D. Brancaccio, C. Caravaggi, L. Neri

Research output: Contribution to journalArticle

Abstract

Background: Most of the studies on peripheral artery disease (PAD) focused on above-the-ankle artery disease, while less is known about foot artery disease. We hypothesize a scenario were two different diseases can be present in PAD patients, big artery disease (BAD) and small artery disease (SAD), overlapping at the foot level; the aim of this study is to evaluate their prevalence and their correlation with risk factors and critical limb ischemia (CLI) in a large cohort of patients with symptomatic PAD. Methods: We retrospectively reviewed 1915 limbs of 1613 patients (502 females, mean age 72.4±10.8 years) who underwent angiography between September 2009 and November 2013. Age, sex, diabetes, smoke history, high blood pressure, dialysis and BMI were considered as risk factors. Logistic regression was performed to test the association of arterial lesions patterns and CLI, and to evaluate the association between risk factors and lesion localization. Results: SAD was present in 414 patients (25.2%). Patients with disease of any of plantar, dorsalis pedis arteries and SAD faced higher risk of CLI (OR=13.25, 95% CI: 1.69-104.16). SAD was associated with diabetes and dialysis (both: OR=4.85; dialysis only: OR=3.60; diabetes only: OR=1.70; none: reference OR; P
Original languageEnglish
Pages (from-to)655-664
Number of pages10
JournalJournal of Cardiovascular Surgery
Volume59
Issue number5
Publication statusPublished - 2018

Fingerprint

Ischemia
Extremities
Arteries
Peripheral Arterial Disease
Dialysis
Foot Diseases
Ankle
Smoke
Foot
Angiography
Logistic Models
History
Hypertension

Keywords

  • Cardiovascular diseases
  • Ischemia
  • Peripheral arterial disease
  • Risk factors
  • aged
  • artery
  • blood flow
  • critical illness
  • diabetes mellitus
  • diagnostic imaging
  • digital subtraction angiography
  • female
  • hemodialysis
  • human
  • ischemia
  • Italy
  • kidney disease
  • lower limb
  • male
  • middle aged
  • odds ratio
  • pathophysiology
  • peripheral occlusive artery disease
  • prevalence
  • retrospective study
  • risk factor
  • statistical model
  • vascularization
  • very elderly
  • Aged
  • Aged, 80 and over
  • Angiography, Digital Subtraction
  • Arteries
  • Critical Illness
  • Diabetes Mellitus
  • Female
  • Humans
  • Kidney Diseases
  • Logistic Models
  • Lower Extremity
  • Male
  • Middle Aged
  • Odds Ratio
  • Peripheral Arterial Disease
  • Prevalence
  • Regional Blood Flow
  • Renal Dialysis
  • Retrospective Studies
  • Risk Factors

Cite this

Ferraresi, R., Mauri, G., Losurdo, F., Troisi, N., Brancaccio, D., Caravaggi, C., & Neri, L. (2018). BAD transmission and SAD distribution: A new scenario for critical limb ischemia. Journal of Cardiovascular Surgery, 59(5), 655-664.

BAD transmission and SAD distribution: A new scenario for critical limb ischemia. / Ferraresi, R.; Mauri, G.; Losurdo, F.; Troisi, N.; Brancaccio, D.; Caravaggi, C.; Neri, L.

In: Journal of Cardiovascular Surgery, Vol. 59, No. 5, 2018, p. 655-664.

Research output: Contribution to journalArticle

Ferraresi, R, Mauri, G, Losurdo, F, Troisi, N, Brancaccio, D, Caravaggi, C & Neri, L 2018, 'BAD transmission and SAD distribution: A new scenario for critical limb ischemia', Journal of Cardiovascular Surgery, vol. 59, no. 5, pp. 655-664.
Ferraresi, R. ; Mauri, G. ; Losurdo, F. ; Troisi, N. ; Brancaccio, D. ; Caravaggi, C. ; Neri, L. / BAD transmission and SAD distribution: A new scenario for critical limb ischemia. In: Journal of Cardiovascular Surgery. 2018 ; Vol. 59, No. 5. pp. 655-664.
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title = "BAD transmission and SAD distribution: A new scenario for critical limb ischemia",
abstract = "Background: Most of the studies on peripheral artery disease (PAD) focused on above-the-ankle artery disease, while less is known about foot artery disease. We hypothesize a scenario were two different diseases can be present in PAD patients, big artery disease (BAD) and small artery disease (SAD), overlapping at the foot level; the aim of this study is to evaluate their prevalence and their correlation with risk factors and critical limb ischemia (CLI) in a large cohort of patients with symptomatic PAD. Methods: We retrospectively reviewed 1915 limbs of 1613 patients (502 females, mean age 72.4±10.8 years) who underwent angiography between September 2009 and November 2013. Age, sex, diabetes, smoke history, high blood pressure, dialysis and BMI were considered as risk factors. Logistic regression was performed to test the association of arterial lesions patterns and CLI, and to evaluate the association between risk factors and lesion localization. Results: SAD was present in 414 patients (25.2{\%}). Patients with disease of any of plantar, dorsalis pedis arteries and SAD faced higher risk of CLI (OR=13.25, 95{\%} CI: 1.69-104.16). SAD was associated with diabetes and dialysis (both: OR=4.85; dialysis only: OR=3.60; diabetes only: OR=1.70; none: reference OR; P",
keywords = "Cardiovascular diseases, Ischemia, Peripheral arterial disease, Risk factors, aged, artery, blood flow, critical illness, diabetes mellitus, diagnostic imaging, digital subtraction angiography, female, hemodialysis, human, ischemia, Italy, kidney disease, lower limb, male, middle aged, odds ratio, pathophysiology, peripheral occlusive artery disease, prevalence, retrospective study, risk factor, statistical model, vascularization, very elderly, Aged, Aged, 80 and over, Angiography, Digital Subtraction, Arteries, Critical Illness, Diabetes Mellitus, Female, Humans, Kidney Diseases, Logistic Models, Lower Extremity, Male, Middle Aged, Odds Ratio, Peripheral Arterial Disease, Prevalence, Regional Blood Flow, Renal Dialysis, Retrospective Studies, Risk Factors",
author = "R. Ferraresi and G. Mauri and F. Losurdo and N. Troisi and D. Brancaccio and C. Caravaggi and L. Neri",
note = "Export Date: 5 February 2019 CODEN: JCVSA Correspondence Address: Ferraresi, R.; Peripheral Interventional Unit, Humanitas Gavazzeni HospitalItaly; email: ferraresi.md@gmail.com References: Hirsch, A.T., Duval, S., The global pandemic of peripheral artery disease (2013) Lancet, 382, pp. 1312-1314; Fowkes, F.G., Rudan, D., Rudan, I., Aboyans, V., Denenberg, J.O., McDermott, M.M., Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: A systematic review and analysis (2013) Lancet, 382, pp. 1329-1340; Norgren, L., Hiatt, W.R., Dormandy, J.A., Nehler, M.R., Harris, K.A., Fowkes, F.G., Inter-society consensus for the management of peripheral arterial disease (TASC II) (2007) J Vasc Surg, 45, pp. S5-S67; Jameson, J.L., Kasper, D., Hauser, S., Longo, D., Fauci, A., Loscalzo, J., (2015) Harrison's Principles of Internal Medicine, , 19th edition. McGraw-Hill Education; Ozkan, U., Oguzkurt, L., Tercan, F., Atherosclerotic risk factors and segmental distribution in symptomatic peripheral artery disease (2009) J Vasc Interv Radiol, 20, pp. 437-441; Diehm, N., Shang, A., Silvestro, A., Do, D.D., Dick, F., Schmidli, J., Association of cardiovascular risk factors with pattern of lower limb atherosclerosis in 2659 patients undergoing angioplasty (2006) Eur J Vasc Endovasc Surg, 31, pp. 59-63; Criqui, M.H., Browner, D., Fronek, A., Klauber, M.R., Coughlin, S.S., Barrett-Connor, E., Peripheral arterial disease in large vessels is epidemiologically distinct from small vessel disease. An analysis of risk factors (1989) Am J Epidemiol, 129, pp. 1110-1119; Aboyans, V., Criqui, M.H., Denenberg, J.O., Knoke, J.D., Ridker, P.M., Fronek, A., Risk factors for progression of peripheral arterial disease in large and small vessels (2006) Circulation, 113, pp. 2623-2629; Haine, A., Haynes, A.G., Limacher, A., Sebastian, T., Saengprakai, W., Fuss, T., Patency of the arterial pedal-plantar arch in patients with chronic kidney disease or diabetes mellitus (2018) Ther Adv Cardiovasc Dis, 12, pp. 145-153; Karacagil, S., Almgren, B., Bowald, S., Eriksson, I., A new method of angiographic runoff evaluation in femorodistal reconstructions. Significant correlation with early graft patency (1990) Arch Surg, 125, pp. 1055-1058; Diehm, N., Rohrer, S., Baumgartner, I., Keo, H., Do, D., Kalka, C., Distribution pattern of infrageniculate arterial obstructions in patients with diabetes mellitus and renal insufficiency - Implications for revascularization (2008) Vasa, 37, pp. 265-273; Higashimori, A., Iida, O., Yamauchi, Y., Kawasaki, D., Nakamura, M., Soga, Y., Outcomes of one straight-line flow with and without pedal arch in patients with critical limb ischemia (2016) Catheter Cardiovasc Interv, 87, pp. 129-133; Troisi, N., Turini, F., Chisci, E., Ercolini, L., Frosini, P., Lombardi, R., Impact of pedal arch patency on tissue loss and time to healing in diabetic patients with foot wounds undergoing infrainguinal endovascular revascularization (2018) Korean J Radiol, 19, pp. 47-53; Criqui, M.H., Fronek, A., Klauber, M.R., Barrett-Connor, E., Gabriel, S., The sensitivity, specificity, and predictive value of traditional clinical evaluation of peripheral arterial disease: Results from noninvasive testing in a defined population (1985) Circulation, 71, pp. 516-522; Manzi, M., Cester, G., Palena, L.M., Alek, J., Candeo, A., Ferraresi, R., Vascular imaging of the foot: The first step toward endovascular recanalization (2011) Radiographics, 31, pp. 1623-1636; Ferraresi, R., Palena, L.M., Mauri, G., Manzi, M., Tips and tricks for a correct {"}endo approach{"} (2013) J Cardiovasc Surg (Torino), 54, pp. 685-711; Diehm, N., Pattynama, P.M., Jaff, M.R., Cremonesi, A., Becker, G.J., Hopkins, L.N., Clinical endpoints in peripheral endovascular revascularization trials: A case for standardized definitions (2008) Eur J Vasc Endovasc Surg, 36, pp. 409-419; Rueda, C.A., Nehler, M.R., Perry, D.J., McLafferty, R.B., Casserly, I.P., Hiatt, W.R., Patterns of artery disease in 450 patients undergoing revascularization for critical limb ischemia: Implications for clinical trial design (2008) J Vasc Surg, 47, pp. 995-999; Gray, B.H., Grant, A.A., Kalbaugh, C.A., Blackhurst, D.W., Langan, E.M., III, Taylor, S.A., The impact of isolated tibial disease on outcomes in the critical limb ischemic population (2010) Ann Vasc Surg, 24, pp. 349-359; Graziani, L., Silvestro, A., Bertone, V., Manara, E., Andreini, R., Sigala, A., Vascular involvement in diabetic subjects with ischemic foot ulcer: A new morphologic categorization of disease severity (2007) Eur J Vasc Endovasc Surg, 33, pp. 453-460; Aboyans, V., Criqui, M.H., Abraham, P., Allison, M.A., Creager, M.A., Diehm, C., Measurement and interpretation of the ankle-brachial index: A scientific statement from the American Heart Association (2012) Circulation, 126, pp. 2890-2909; Jens, S., Koelemay, M.J., Reekers, J.A., Bipat, S., Diagnostic performance of computed tomography angiography and contrast-enhanced magnetic resonance angiography in patients with critical limb ischaemia and intermittent claudication: Systematic review and meta-analysis (2013) Eur Radiol, 23, pp. 3104-3114; Pomposelli, F.B., Jr., Jepsen, S.J., Gibbons, G.W., Campbell, D.R., Freeman, D.V., Miller, A., Efficacy of the dorsal pedal bypass for limb salvage in diabetic patients: Short-term observations (1990) J Vasc Surg, 11, pp. 745-751; Karacagil, S., Almgren, B., L{\"o}relius, L.E., Bowald, S., Eriksson, I., Angiographic runoff patterns in patients undergoing lower limb revascularization (1989) Acta Chir Scand, 155, pp. 19-24; Rashid, H., Slim, H., Zayed, H., Huang, D.Y., Wilkins, C.J., Evans, D.R., The impact of arterial pedal arch quality and angiosome revascularization on foot tissue loss healing and infrapopliteal bypass outcome (2013) J Vasc Surg, 57, pp. 1219-1226; Biancari, F., Juvonen, T., Angiosome-targeted lower limb revascularization for ischemic foot wounds: Systematic review and meta-analysis (2014) Eur J Vasc Endovasc Surg, 47, pp. 517-522; Bosanquet, D.C., Glasbey, J.C., Williams, I.M., Twine, C.P., Systematic review and meta-analysis of direct versus indirect angiosomal revascularisation of infrapopliteal arteries (2014) Eur J Vasc Endovasc Surg, 48, pp. 88-97; Khor, B.Y., Price, P., The comparative efficacy of angiosome-directed and indirect revascularisation strategies to aid healing of chronic foot wounds in patients with co-morbid diabetes mellitus and critical limb ischaemia: A literature review (2017) J Foot Ankle Res, 10, p. 26; Varela, C., Ac{\'i}n, F., De Haro, J., Bleda, S., Esparza, L., March, J.R., The role of foot collateral vessels on ulcer healing and limb salvage after successful endovascular and surgical distal procedures according to an angiosome model (2010) Vasc Endovascular Surg, 44, pp. 654-660; Kawarada, O., Yasuda, S., Nishimura, K., Sakamoto, S., Noguchi, M., Takahi, Y., Effect of single tibial artery revascularization on microcirculation in the setting of critical limb ischemia (2014) Circ Cardiovasc Interv, 7, pp. 684-691; Manzi, M., Fusaro, M., Ceccacci, T., Erente, G., Dalla Paola, L., Brocco, E., Clinical results of below-The knee intervention using pedal-plantar loop technique for the revascularization of foot arteries (2009) J Cardiovasc Surg (Torino), 50, pp. 331-337; Zhu, Y.Q., Zhao, J.G., Liu, F., Wang, J.B., Cheng, Y.S., Li, M.H., Subintimal angioplasty for below-the-ankle arterial occlusions in diabetic patients with chronic critical limb ischemia (2009) J Endovasc Ther, 16, pp. 604-612; Abdelhamid, M.F., Davies, R.S., Rai, S., Hopkins, J.D., Duddy, M.J., Vohra, R.K., Below-the-ankle angioplasty is a feasible and effective intervention for critical leg ischaemia (2010) Eur J Vasc Endovasc Surg, 39, pp. 762-768; Katsanos, K., Diamantopoulos, A., Spiliopoulos, S., Karnabatidis, D., Siablis, D., Below-the-ankle angioplasty and stenting for limb salvage: Anatomical considerations and long-term outcomes (2013) Cardiovasc Intervent Radiol, 36, pp. 926-935; Nakama, T., Watanabe, N., Haraguchi, T., Sakamoto, H., Kamoi, D., Tsubakimoto, Y., Clinical outcomes of pedal artery angioplasty for patients with ischemic wounds: Results from the multicenter RENDEZVOUS registry (2017) JACC Cardiovasc Interv, 10, pp. 79-90; Tokuda, T., Hirano, K., Sakamoto, Y., Takimura, H., Kobayashi, N., Araki, M., Incidence and clinical outcomes of the slow-flow phenomenon after infrapopliteal balloon angioplasty (2017) J Vasc Surg, 65, pp. 1047-1054; Ciavarella, A., Silletti, A., Mustacchio, A., Gargiulo, M., Galaverni, M.C., Stella, A., Angiographic evaluation of the anatomic pattern of arterial obstructions in diabetic patients with critical limb ischaemia (1993) Diabete Metab, 19, pp. 586-589; Lozano, R., Naghavi, M., Foreman, K., Lim, S., Shibuya, K., Aboyans, V., Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the Global Burden of Disease Study 2010 (2012) Lancet, 380, pp. 2095-2128",
year = "2018",
language = "English",
volume = "59",
pages = "655--664",
journal = "Journal of Cardiovascular Surgery",
issn = "0021-9509",
publisher = "Edizioni Minerva Medica S.p.A.",
number = "5",

}

TY - JOUR

T1 - BAD transmission and SAD distribution: A new scenario for critical limb ischemia

AU - Ferraresi, R.

AU - Mauri, G.

AU - Losurdo, F.

AU - Troisi, N.

AU - Brancaccio, D.

AU - Caravaggi, C.

AU - Neri, L.

N1 - Export Date: 5 February 2019 CODEN: JCVSA Correspondence Address: Ferraresi, R.; Peripheral Interventional Unit, Humanitas Gavazzeni HospitalItaly; email: ferraresi.md@gmail.com References: Hirsch, A.T., Duval, S., The global pandemic of peripheral artery disease (2013) Lancet, 382, pp. 1312-1314; Fowkes, F.G., Rudan, D., Rudan, I., Aboyans, V., Denenberg, J.O., McDermott, M.M., Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: A systematic review and analysis (2013) Lancet, 382, pp. 1329-1340; Norgren, L., Hiatt, W.R., Dormandy, J.A., Nehler, M.R., Harris, K.A., Fowkes, F.G., Inter-society consensus for the management of peripheral arterial disease (TASC II) (2007) J Vasc Surg, 45, pp. S5-S67; Jameson, J.L., Kasper, D., Hauser, S., Longo, D., Fauci, A., Loscalzo, J., (2015) Harrison's Principles of Internal Medicine, , 19th edition. McGraw-Hill Education; Ozkan, U., Oguzkurt, L., Tercan, F., Atherosclerotic risk factors and segmental distribution in symptomatic peripheral artery disease (2009) J Vasc Interv Radiol, 20, pp. 437-441; Diehm, N., Shang, A., Silvestro, A., Do, D.D., Dick, F., Schmidli, J., Association of cardiovascular risk factors with pattern of lower limb atherosclerosis in 2659 patients undergoing angioplasty (2006) Eur J Vasc Endovasc Surg, 31, pp. 59-63; Criqui, M.H., Browner, D., Fronek, A., Klauber, M.R., Coughlin, S.S., Barrett-Connor, E., Peripheral arterial disease in large vessels is epidemiologically distinct from small vessel disease. An analysis of risk factors (1989) Am J Epidemiol, 129, pp. 1110-1119; Aboyans, V., Criqui, M.H., Denenberg, J.O., Knoke, J.D., Ridker, P.M., Fronek, A., Risk factors for progression of peripheral arterial disease in large and small vessels (2006) Circulation, 113, pp. 2623-2629; Haine, A., Haynes, A.G., Limacher, A., Sebastian, T., Saengprakai, W., Fuss, T., Patency of the arterial pedal-plantar arch in patients with chronic kidney disease or diabetes mellitus (2018) Ther Adv Cardiovasc Dis, 12, pp. 145-153; Karacagil, S., Almgren, B., Bowald, S., Eriksson, I., A new method of angiographic runoff evaluation in femorodistal reconstructions. Significant correlation with early graft patency (1990) Arch Surg, 125, pp. 1055-1058; Diehm, N., Rohrer, S., Baumgartner, I., Keo, H., Do, D., Kalka, C., Distribution pattern of infrageniculate arterial obstructions in patients with diabetes mellitus and renal insufficiency - Implications for revascularization (2008) Vasa, 37, pp. 265-273; Higashimori, A., Iida, O., Yamauchi, Y., Kawasaki, D., Nakamura, M., Soga, Y., Outcomes of one straight-line flow with and without pedal arch in patients with critical limb ischemia (2016) Catheter Cardiovasc Interv, 87, pp. 129-133; Troisi, N., Turini, F., Chisci, E., Ercolini, L., Frosini, P., Lombardi, R., Impact of pedal arch patency on tissue loss and time to healing in diabetic patients with foot wounds undergoing infrainguinal endovascular revascularization (2018) Korean J Radiol, 19, pp. 47-53; Criqui, M.H., Fronek, A., Klauber, M.R., Barrett-Connor, E., Gabriel, S., The sensitivity, specificity, and predictive value of traditional clinical evaluation of peripheral arterial disease: Results from noninvasive testing in a defined population (1985) Circulation, 71, pp. 516-522; Manzi, M., Cester, G., Palena, L.M., Alek, J., Candeo, A., Ferraresi, R., Vascular imaging of the foot: The first step toward endovascular recanalization (2011) Radiographics, 31, pp. 1623-1636; Ferraresi, R., Palena, L.M., Mauri, G., Manzi, M., Tips and tricks for a correct "endo approach" (2013) J Cardiovasc Surg (Torino), 54, pp. 685-711; Diehm, N., Pattynama, P.M., Jaff, M.R., Cremonesi, A., Becker, G.J., Hopkins, L.N., Clinical endpoints in peripheral endovascular revascularization trials: A case for standardized definitions (2008) Eur J Vasc Endovasc Surg, 36, pp. 409-419; Rueda, C.A., Nehler, M.R., Perry, D.J., McLafferty, R.B., Casserly, I.P., Hiatt, W.R., Patterns of artery disease in 450 patients undergoing revascularization for critical limb ischemia: Implications for clinical trial design (2008) J Vasc Surg, 47, pp. 995-999; Gray, B.H., Grant, A.A., Kalbaugh, C.A., Blackhurst, D.W., Langan, E.M., III, Taylor, S.A., The impact of isolated tibial disease on outcomes in the critical limb ischemic population (2010) Ann Vasc Surg, 24, pp. 349-359; Graziani, L., Silvestro, A., Bertone, V., Manara, E., Andreini, R., Sigala, A., Vascular involvement in diabetic subjects with ischemic foot ulcer: A new morphologic categorization of disease severity (2007) Eur J Vasc Endovasc Surg, 33, pp. 453-460; Aboyans, V., Criqui, M.H., Abraham, P., Allison, M.A., Creager, M.A., Diehm, C., Measurement and interpretation of the ankle-brachial index: A scientific statement from the American Heart Association (2012) Circulation, 126, pp. 2890-2909; Jens, S., Koelemay, M.J., Reekers, J.A., Bipat, S., Diagnostic performance of computed tomography angiography and contrast-enhanced magnetic resonance angiography in patients with critical limb ischaemia and intermittent claudication: Systematic review and meta-analysis (2013) Eur Radiol, 23, pp. 3104-3114; Pomposelli, F.B., Jr., Jepsen, S.J., Gibbons, G.W., Campbell, D.R., Freeman, D.V., Miller, A., Efficacy of the dorsal pedal bypass for limb salvage in diabetic patients: Short-term observations (1990) J Vasc Surg, 11, pp. 745-751; Karacagil, S., Almgren, B., Lörelius, L.E., Bowald, S., Eriksson, I., Angiographic runoff patterns in patients undergoing lower limb revascularization (1989) Acta Chir Scand, 155, pp. 19-24; Rashid, H., Slim, H., Zayed, H., Huang, D.Y., Wilkins, C.J., Evans, D.R., The impact of arterial pedal arch quality and angiosome revascularization on foot tissue loss healing and infrapopliteal bypass outcome (2013) J Vasc Surg, 57, pp. 1219-1226; Biancari, F., Juvonen, T., Angiosome-targeted lower limb revascularization for ischemic foot wounds: Systematic review and meta-analysis (2014) Eur J Vasc Endovasc Surg, 47, pp. 517-522; Bosanquet, D.C., Glasbey, J.C., Williams, I.M., Twine, C.P., Systematic review and meta-analysis of direct versus indirect angiosomal revascularisation of infrapopliteal arteries (2014) Eur J Vasc Endovasc Surg, 48, pp. 88-97; Khor, B.Y., Price, P., The comparative efficacy of angiosome-directed and indirect revascularisation strategies to aid healing of chronic foot wounds in patients with co-morbid diabetes mellitus and critical limb ischaemia: A literature review (2017) J Foot Ankle Res, 10, p. 26; Varela, C., Acín, F., De Haro, J., Bleda, S., Esparza, L., March, J.R., The role of foot collateral vessels on ulcer healing and limb salvage after successful endovascular and surgical distal procedures according to an angiosome model (2010) Vasc Endovascular Surg, 44, pp. 654-660; Kawarada, O., Yasuda, S., Nishimura, K., Sakamoto, S., Noguchi, M., Takahi, Y., Effect of single tibial artery revascularization on microcirculation in the setting of critical limb ischemia (2014) Circ Cardiovasc Interv, 7, pp. 684-691; Manzi, M., Fusaro, M., Ceccacci, T., Erente, G., Dalla Paola, L., Brocco, E., Clinical results of below-The knee intervention using pedal-plantar loop technique for the revascularization of foot arteries (2009) J Cardiovasc Surg (Torino), 50, pp. 331-337; Zhu, Y.Q., Zhao, J.G., Liu, F., Wang, J.B., Cheng, Y.S., Li, M.H., Subintimal angioplasty for below-the-ankle arterial occlusions in diabetic patients with chronic critical limb ischemia (2009) J Endovasc Ther, 16, pp. 604-612; Abdelhamid, M.F., Davies, R.S., Rai, S., Hopkins, J.D., Duddy, M.J., Vohra, R.K., Below-the-ankle angioplasty is a feasible and effective intervention for critical leg ischaemia (2010) Eur J Vasc Endovasc Surg, 39, pp. 762-768; Katsanos, K., Diamantopoulos, A., Spiliopoulos, S., Karnabatidis, D., Siablis, D., Below-the-ankle angioplasty and stenting for limb salvage: Anatomical considerations and long-term outcomes (2013) Cardiovasc Intervent Radiol, 36, pp. 926-935; Nakama, T., Watanabe, N., Haraguchi, T., Sakamoto, H., Kamoi, D., Tsubakimoto, Y., Clinical outcomes of pedal artery angioplasty for patients with ischemic wounds: Results from the multicenter RENDEZVOUS registry (2017) JACC Cardiovasc Interv, 10, pp. 79-90; Tokuda, T., Hirano, K., Sakamoto, Y., Takimura, H., Kobayashi, N., Araki, M., Incidence and clinical outcomes of the slow-flow phenomenon after infrapopliteal balloon angioplasty (2017) J Vasc Surg, 65, pp. 1047-1054; Ciavarella, A., Silletti, A., Mustacchio, A., Gargiulo, M., Galaverni, M.C., Stella, A., Angiographic evaluation of the anatomic pattern of arterial obstructions in diabetic patients with critical limb ischaemia (1993) Diabete Metab, 19, pp. 586-589; Lozano, R., Naghavi, M., Foreman, K., Lim, S., Shibuya, K., Aboyans, V., Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the Global Burden of Disease Study 2010 (2012) Lancet, 380, pp. 2095-2128

PY - 2018

Y1 - 2018

N2 - Background: Most of the studies on peripheral artery disease (PAD) focused on above-the-ankle artery disease, while less is known about foot artery disease. We hypothesize a scenario were two different diseases can be present in PAD patients, big artery disease (BAD) and small artery disease (SAD), overlapping at the foot level; the aim of this study is to evaluate their prevalence and their correlation with risk factors and critical limb ischemia (CLI) in a large cohort of patients with symptomatic PAD. Methods: We retrospectively reviewed 1915 limbs of 1613 patients (502 females, mean age 72.4±10.8 years) who underwent angiography between September 2009 and November 2013. Age, sex, diabetes, smoke history, high blood pressure, dialysis and BMI were considered as risk factors. Logistic regression was performed to test the association of arterial lesions patterns and CLI, and to evaluate the association between risk factors and lesion localization. Results: SAD was present in 414 patients (25.2%). Patients with disease of any of plantar, dorsalis pedis arteries and SAD faced higher risk of CLI (OR=13.25, 95% CI: 1.69-104.16). SAD was associated with diabetes and dialysis (both: OR=4.85; dialysis only: OR=3.60; diabetes only: OR=1.70; none: reference OR; P

AB - Background: Most of the studies on peripheral artery disease (PAD) focused on above-the-ankle artery disease, while less is known about foot artery disease. We hypothesize a scenario were two different diseases can be present in PAD patients, big artery disease (BAD) and small artery disease (SAD), overlapping at the foot level; the aim of this study is to evaluate their prevalence and their correlation with risk factors and critical limb ischemia (CLI) in a large cohort of patients with symptomatic PAD. Methods: We retrospectively reviewed 1915 limbs of 1613 patients (502 females, mean age 72.4±10.8 years) who underwent angiography between September 2009 and November 2013. Age, sex, diabetes, smoke history, high blood pressure, dialysis and BMI were considered as risk factors. Logistic regression was performed to test the association of arterial lesions patterns and CLI, and to evaluate the association between risk factors and lesion localization. Results: SAD was present in 414 patients (25.2%). Patients with disease of any of plantar, dorsalis pedis arteries and SAD faced higher risk of CLI (OR=13.25, 95% CI: 1.69-104.16). SAD was associated with diabetes and dialysis (both: OR=4.85; dialysis only: OR=3.60; diabetes only: OR=1.70; none: reference OR; P

KW - Cardiovascular diseases

KW - Ischemia

KW - Peripheral arterial disease

KW - Risk factors

KW - aged

KW - artery

KW - blood flow

KW - critical illness

KW - diabetes mellitus

KW - diagnostic imaging

KW - digital subtraction angiography

KW - female

KW - hemodialysis

KW - human

KW - ischemia

KW - Italy

KW - kidney disease

KW - lower limb

KW - male

KW - middle aged

KW - odds ratio

KW - pathophysiology

KW - peripheral occlusive artery disease

KW - prevalence

KW - retrospective study

KW - risk factor

KW - statistical model

KW - vascularization

KW - very elderly

KW - Aged

KW - Aged, 80 and over

KW - Angiography, Digital Subtraction

KW - Arteries

KW - Critical Illness

KW - Diabetes Mellitus

KW - Female

KW - Humans

KW - Kidney Diseases

KW - Logistic Models

KW - Lower Extremity

KW - Male

KW - Middle Aged

KW - Odds Ratio

KW - Peripheral Arterial Disease

KW - Prevalence

KW - Regional Blood Flow

KW - Renal Dialysis

KW - Retrospective Studies

KW - Risk Factors

M3 - Article

VL - 59

SP - 655

EP - 664

JO - Journal of Cardiovascular Surgery

JF - Journal of Cardiovascular Surgery

SN - 0021-9509

IS - 5

ER -