Crural Index and extensive atherosclerosis of crural vessels are associated with long-term cardiovascular mortality in patients with symptomatic peripheral artery disease

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dc.contributor.author Wickstrom, Jan-Erik
dc.contributor.author Jalkanen, Juho M.
dc.contributor.author Venermo, Maarit
dc.contributor.author Hakovirta, Harri H.
dc.date.accessioned 2019-01-23T22:36:23Z
dc.date.available 2021-12-17T22:02:36Z
dc.date.issued 2017-09
dc.identifier.citation Wickstrom , J-E , Jalkanen , J M , Venermo , M & Hakovirta , H H 2017 , ' Crural Index and extensive atherosclerosis of crural vessels are associated with long-term cardiovascular mortality in patients with symptomatic peripheral artery disease ' , Atherosclerosis , vol. 264 , pp. 44-50 . https://doi.org/10.1016/j.atherosclerosis.2017.07.023
dc.identifier.other PURE: 90021316
dc.identifier.other PURE UUID: db782d90-ba5f-4a86-aa6e-c761177ecefa
dc.identifier.other WOS: 000408877000006
dc.identifier.other Scopus: 85026425117
dc.identifier.uri http://hdl.handle.net/10138/297952
dc.description.abstract Background and aims: Limited data exist on the association of the anatomical distribution of atherosclerotic lesions and the extent of atherosclerosis at defined arterial segments with life expectancy. We recently presented a new classification of the extent of atherosclerosis in crural vessels and showed that Crural Index (CIx) was associated with mid-term survival of symptomatic peripheral artery disease (PAD) patients. This study evaluates the significance of the extent of crural atherosclerosis on long-term cardiovascular mortality. Methods: 887 consecutive patients with PAD, admitted for digital subtraction angiography (DSA) at Turku University Hospital Department of Vascular Surgery (Turku, Finland) between January 1st, 2009 and July 30th, 2011, were retrospectively analysed. Each crural angiographic image was graded according to CIx criteria. Aorto-iliac and femoro-popliteal arterial segments were similarly graded according to modified TASC II criteria. CIx was used as the categorical variable for the extent of atherosclerosis in crural vessels for survival analysis. Survival was also evaluated with respect to which arterial segment was most severely affected. Causes of death were provided by the Cause of Death Registry of Statistics Finland, updated on January 23rd, 2017. Results: Altogether, 408 (46%) patients died during follow-up. The majority of deaths were due to cardiovascular causes (n = 246, 60%). Cardiovascular mortality was strongly associated with a high CIx (CIx III (Hazard ratio (HR) 2.16, Confidence interval (CI) 95% 1.23-3.80, p = 0.007)) and CIx IV (HR 3.513, 95% CI 1.93-4.565, p <0.001), as compared to CIx 0. In patients having the crural segment as the most severely affected arterial segment, cardiovascular mortality was significantly increased (HR 2.321, 95% CI 1.45-3.73, p <0.001), as was overall mortality (HR 2.177, 95% CI 1.53-3.10, p <0.001). Conclusions: High Crural Index and extensive crural vessel atherosclerosis are associated with long-term cardiovascular mortality, and both may serve as useful indicators of survival among patients with symptomatic PAD. (c) 2017 Elsevier B.V. All rights reserved. en
dc.format.extent 7
dc.language.iso eng
dc.relation.ispartof Atherosclerosis
dc.rights.uri info:eu-repo/semantics/openAccess
dc.subject Atherosclerosis
dc.subject Crural Index
dc.subject Imaging
dc.subject Peripheral artery disease
dc.subject Mortality
dc.subject LIMB CLASSIFICATION-SYSTEM
dc.subject INTER-SOCIETY CONSENSUS
dc.subject ANKLE-BRACHIAL INDEX
dc.subject RISK-FACTORS
dc.subject DISTRIBUTION PATTERN
dc.subject RENAL-INSUFFICIENCY
dc.subject TASC-II
dc.subject ISCHEMIA
dc.subject PREVALENCE
dc.subject REVASCULARIZATION
dc.subject 3121 General medicine, internal medicine and other clinical medicine
dc.subject 3126 Surgery, anesthesiology, intensive care, radiology
dc.title Crural Index and extensive atherosclerosis of crural vessels are associated with long-term cardiovascular mortality in patients with symptomatic peripheral artery disease en
dc.type Article
dc.contributor.organization Clinicum
dc.contributor.organization Verisuonikirurgian yksikkö
dc.contributor.organization HUS Abdominal Center
dc.description.reviewstatus Peer reviewed
dc.relation.doi https://doi.org/10.1016/j.atherosclerosis.2017.07.023
dc.relation.issn 0021-9150
dc.rights.accesslevel openAccess
dc.type.version publishedVersion

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