Risk Factors for Poor Collateral Development in Claudication

Abstract

The objective of this retrospective, cross-sectional study was to determine risk factors for poor collateral development in patients with claudication. The authors listed all patients with calf claudication who had undergone angiography in this hospital between 1999 and 2001 and extracted those with superficial femoral artery (SFA) occlusion, a popliteal artery without major lesions, and at least 1 patent calf artery. Forty-five patients met the criteria, and concomitant disease and claudication characteristics, ankle/brachial index (ABI) and number of outflow vessels were recorded. Three blinded observers calculated the number of collaterals on the angiograms, and the collateral count was related to the other factors by use of regression analysis. The mean patient age was 69 years (SD 11), and 62% were women. Their walking distance was 90 m (77) and ABI 0.47 (0.15). Thirty-three percent had diabetes and 50% had duration of symptoms longer than 5 years. The mean number of collaterals bypassing the occlusion was 15.1 (SD 4.8). Univariate regression analysis indicated an association (p <0.08) between few collateral vessels and diabetes, short duration of symptoms, current smoking habits, and old age. In the multivariate analysis only diabetes and short duration of symptoms were related to having few collaterals. In patients with claudication and SFA occlusion, few collaterals from the deep femoral artery appear to be associated with having diabetes and a short duration of symptoms.

Metformin stimulates ischemia-induced revascularization through an eNOS dependent pathway in the ischemic hindlimb mice model

“…33,34 There is greater vulnerability to ischemic injury as well impairment of wound healing in the presence of these circulatory changes, ultimately yielding a more frequent occurrence of lower-limb amputation. In the present study, daily oral administration of metformin fostered revascularization in the presence of tissue ischemia.…”

Direct Quantitative Assessment of the Peripheral Artery Collateral Circulation in Patients Undergoing Angiography

“…17 Alternatively, a transverse line marking the inferior border of the obliteration can be drawn, and all vessels that cross the line at the inferior border can be counted as collaterals. 7 Although this method has been used successfully in a clinical study identifying risk factors for poor collateral development in PAD, 7 its use may lead to a rather arbitrary classification of collaterals. Importantly, digital angiography is limited by a low resolution (>0.2 mm), 9,18 and therefore, it lacks the precision and reproducibility needed to study small collaterals.…”

“…3,7,8 In contrast to peripheral arteries, collaterals of the heart can be assessed quantitatively by coronary flow velocity or pressure measurements, which have become the gold standard. [9][10][11] The theoretical basis of this method relates to the fact that perfusion pressure (minus the central venous back pressure) or flow velocity signals obtained distal to an occluded stenosis originate from collaterals (during a brief coronary balloon occlusion or in case of a chronic total occlusion).…”

“…In contrast to the coronary circulation, there is currently no reference method available to document successful promotion of collateral growth in patients with PAD. 3,7,8 Therefore, the purpose of the present study was to evaluate a new invasive method to quantify arterial collateral function in the lower extremity in patients undergoing elective coronary angiography.…”

Pulse volume recording for peripheral vascular disease diagnosis in diabetes patients

“…12 This is also due to poor collateral blood flow as DM targets the microvasculature that leads to an incomplete pedal arch resulting in more severe and acute ischemic conditions in the lower extremities. 13 Patients with DM frequently have calcification of the tunica media of blood vessels as well as noncompressibility due to medial sclerosis of arteries. These qualities of the disease process in DM cause lower extremity blood pressure measurement such as ABI (Table 1) to be inaccurate for diagnosis and surveillance as they are often falsely elevated .1.3 due to incompressibility of vessels.…”