The extent of atherosclerotic lesions in crural arteries predicts survival of patients with lower limb peripheral artery disease : A new classification of crural atherosclerosis

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Jalkanen , J M , Wickstrom , J-E , Venermo , M & Hakovirta , H H 2016 , ' The extent of atherosclerotic lesions in crural arteries predicts survival of patients with lower limb peripheral artery disease : A new classification of crural atherosclerosis ' , Atherosclerosis , vol. 251 , pp. 328-333 . https://doi.org/10.1016/j.atherosclerosis.2016.04.016

Title: The extent of atherosclerotic lesions in crural arteries predicts survival of patients with lower limb peripheral artery disease : A new classification of crural atherosclerosis
Author: Jalkanen, Juho M.; Wickstrom, Jan-Erik; Venermo, Maarit; Hakovirta, Harri H.
Contributor: University of Helsinki, Clinicum
Date: 2016-08
Language: eng
Number of pages: 6
Belongs to series: Atherosclerosis
ISSN: 0021-9150
URI: http://hdl.handle.net/10138/224537
Abstract: Background and aims: Several studies report correlation of ankle brachial index (ABI) values and mortality. However, no studies exist on the predictive value of anatomical distribution of atherosclerotic lesions and the extent of atherosclerosis at defined arterial segments on life expectancy. The aim of the present study was to evaluate the significance of both extent and localisation of atherosclerotic lesions to mid-term patient survival. Methods: Digital subtraction angiography (DSA) images of 887 consecutive patients admitted to the Department of Vascular Surgery at Turku University Hospital (Turku, Finland) were retrospectively analysed. Each angiography was classified according to the TASC II classification for aorto-iliac and femoro-popliteal segments, and a similar four-grade index was created for crural arteries. Patients were followed until 36-months post DSA. Results: During 36-month follow-up 295 (33%) deaths occurred. Death during follow-up was strongly associated with extensive crural disease, but not with extensive proximal disease (Crural Index p = 0.044 and <0.001, respectively). In a Cox regression analysis incorporating baseline variables, Crural Index IV and most severe atherosclerosis on crural vessels were the strongest predictors of poor prognosis (HR 2.20 95% CI 1.3-3.7, p = 0.003 and HR 2.45 95% CI 1.5-4.0, p <0.001 respectively). Conclusions: The extent of crural atherosclerosis is independently associated with poor mid term life expectancy. Therefore, a classification of the extent of crural atherosclerosis could serve as an indicator of mortality among PAD patients and aid in clinical decision making. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
Subject: Imaging
Peripheral artery disease
Atherosclerosis
Survival
TASC II classification
CARDIOVASCULAR RISK-FACTORS
DISTRIBUTION PATTERN
RENAL-INSUFFICIENCY
MORTALITY
ISCHEMIA
SOCIETY
REVASCULARIZATION
PREVALENCE
PROGNOSIS
SEVERITY
3126 Surgery, anesthesiology, intensive care, radiology
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