Impact of atherosclerotic risk factors on the anatomical distribution of peripheral arterial disease

Background. The aim of the study was to determine predictors of hemodynamic ally relevant atherosclerosis (HRA) in different segments of lower limb art eries in patients with peripheral arterial disease (PAD). Methods. In a retrospective ca e-control study 106 hospitalized consecutive patients with symptomatic PAD and 52 asymptomatic control subjects were st udied. All patients underwent distal aortofemoral angiography. The arteries of the lower limbs were divided into three sections: in the aorto-iliac an d femoro-popliteal segments HRA was defined as one or more stenosis of over 50%. In the crural segment it was considered if at least two arteries of o ne lower leg had occlusions/stenoses of over 50%. Results. In 106 patients, there were 132 cases of hemodynamically relevant lesions, and in 26 patients in two segments. We separately compared 23 case s with aortoiliac, 82 with femoro-popliteal and 27 with crural manifestatio n to the 52 control subjects. Calculating age- and sex-adjusted odds ratios , we found that current smoking status and plasminogen levels were signific antly associated with HRA in the aorto-iliac and femoro-popliteal segments, whereas in diabetes mellitus the association was found to be in the crural and femoropopliteal segments. However, there was no such association for l ipid profiles and fibrinogen. Conclusions. We conclude that the anatomic distribution of HRA in patients with PAD is different according to the risk factor profile. The aorto-iliac and crural segments show specific risk profiles while the femoro-popliteal segment seems to be a transition zone. Smoking and high plasminogen levels may be related to atherosclerosis of proximal segments, diabetes to that o f the distal segments.