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CLINICAL RESEARCH: VASCULAR DISEASE

The General Prognosis of Patients With Peripheral Arterial Disease Differs According to the Disease Localization

Victor Aboyans, MD, PhD^_*,,_*, Ileana Desormais, MD^_*, Philippe Lacroix, MD^_*,, Johanna Salazar, MD^_*, Michael H. Criqui, MD, MPH and Marc Laskar, MD^_*

^_* Department of Thoracic and Cardiovascular Surgery and Vascular Medicine, Limoges University, Limoges, France
EA3174-IFR 175, Limoges University, Limoges, France
Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, California

Manuscript received March 30, 2009; revised manuscript received July 22, 2009, accepted September 24, 2009.

^_* Reprint requests and correspondence: Dr. Victor Aboyans, Department of Thoracic and Cardiovascular Surgery and Vascular Medicine, Dupuytren University Hospital, 2, Avenue Martin Luther King, 87042 Limoges, France (Email: victor.aboyans{at}unilim.fr).

Objectives: The purpose of this study was to assess the general prognosis of patients with peripheral arterial disease (PAD) according to the disease localization.

Background: PAD is associated with poor cardiovascular disease prognosis. However, it is unknown whether the general prognosis could differ according to PAD topography.

Methods: Data for all patients who underwent a first digital subtraction angiography of their lower limbs between January 2000 and December 2005 at our hospital were reviewed. Arterial stenoses 50% were located by 2 experienced vascular physicians. The following events were collected until April 2007: death, nonfatal myocardial infarction or stroke, and coronary or carotid revascularization. The primary outcome combined all these events.

Results: We studied 400 PAD patients (age 68.3 ± 12.3 years, 77.5% men). Aortoiliac disease (proximal PAD) and infrailiac disease (distal PAD) were noted in 211 (52.8%) and 344 (86.0%) cases, respectively. Male sex and smoking were more prevalent in proximal PAD, whereas older age, diabetes, hypertension, and renal failure were more prevalent in distal PAD (p < 0.05). During the follow-up period (34 ± 23 months), the event-free survival curves differed according to the PAD localization (p < 0.03). Adjusted for age, sex, cardiovascular disease history and cardiovascular disease risk factors, critical leg ischemia status, and treatments, proximal PAD was significantly associated with a worse prognosis (primary outcome hazard ratio: 3.28; death hazard ratio: 3.18, p < 0.002 vs. distal PAD).

Conclusions: This is the first study to report a poorer general prognosis of patients with proximal (aortoiliac) PAD compared with those with more distal PAD, independent of risk factors and comorbidities.

Key Words: mortality • peripheral arterial disease • prognosis

Abbreviations and Acronyms   CVD = cardiovascular disease   DSA = digital subtraction angiography   PAD = peripheral arterial disease

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