Association between critical limb ischemia and arterial stiffness measured by brachial artery oscillometry

Abstract

Background Elevated arterial stiffness is associated with increased cardiovascular mortality. The relationship between arterial stiffness and critical limb ischemia (CLI) is not well established. Objectives The objective of this study is to analyze the relationship between arterial stiffness indices and the degree of limb ischemia measured by the ankle-brachial index (ABI). Methods A cross-sectional study comparing patients with CLI and controls. Arterial stiffness was measured using brachial artery oscillometry. The arterial stiffness indices pulse wave velocity (PWV) and augmentation index normalized to 75 beats/min (AIx@75) were determined. Multiple linear regression was applied to identify predictors of arterial stiffness indices. Results Patients in the CLI group had higher PWV (12.1±1.9 m/s vs. 10.1±1.9 m/s, p < 0.01) and AIx@75 (31.8±7.8% vs. 17.5±10.8%, p < 0.01) than controls. Central systolic pressure was higher in the CLI group (129.2±18.4 mmHg vs. 115.2±13.1 mmHg, p < 0.01). There was an inverse relationship between AIx@75 and ABI (Pearson coefficient = 0.24, p = 0.048), but there was no relationship between ABI and PWV (Pearson coefficient = 0.19, p = 0.12). In multiple regression analysis, reduced ABI was a predictor of elevated levels of AIx@75 (β = -25.02, p < 0.01). Conclusions Patients with CLI have high arterial stiffness measured by brachial artery oscillometry. The degree of limb ischemia, as measured by the ABI, is a predictor of increased AIx@75. The increased AIx@75 observed in CLI may have implications for the prognosis of this group of patients with advanced atherosclerosis.

Combined Evaluation of Arterial Stiffness and Blood Pressure Promotes Risk Stratification of Peripheral Arterial Disease

“… 13 , 34 Moreover, elevated AS may be an indicator of high mortality in patients with PAD with claudication or severe ischemia. 35 On the contrary, a study in middle-aged Japanese men free of PAD reported that decreased AS is related to lower ABI. 19 This could be explained by the fact that AS (eg, baPWV) reflects the stiffening of central and peripheral muscular arteries, 36 which is closely correlated with but different from blood pressure.…”

Mechanoregulation of Vascular Endothelial Growth Factor Receptor 2 in Angiogenesis

“…Studies have shown upregulation of HIF, VEGF, and VEGFR-2 in limb ischemia, especially in acute limb ischemia as opposed to chronic ( 102 , 103 ). Since limb ischemia is so similar to PAD, many of the mechanical changes present in PAD are also in ischemia, such as increased arterial stiffening and increased blood pressure ( 104 ). Studies have explored whether pro-angiogenic factors could promote vascularization in ischemic tissues, although so far these strategies have demonstrated mixed success, with single factors appearing to be less effective than combined treatments ( 93 , 105 , 106 ).…”

Total vascular resistance, augmentation index, and augmentation pressure increase in patients with peripheral artery disease

“…Increase of arterial stiffness is associated with higher risk for the development of arteriosclerosis and recognized as a prognostic marker beyond standard risk factors. Currently, arterial stiffness is able to be measured non-invasively and reproducibly [6–9] …”

“…Currently, arterial stiffness is able to be measured non-invasively and reproducibly. [6][7][8][9] To date, to evaluate vascular dysfunction, an early stage of arteriosclerosis, several devises have been developed. Pulse wave velocity (PWV) is widely used in clinical practice as a parameter for arterial stiffness.…”