The correlation between the severity of peripheral arterial disease and carotid occlusive disease

Abstract

Peripheral arterial disease (PAD) and carotid occlusive disease (COD) are both known to be specific manifestations of atherosclerosis. Because they both have a common cause, it is reasonable to hypothesize that they should correlate with each other to a certain extent, and previous studies have shown that there is a correlation between the prevalence of PAD and COD. The purpose of this study was to determine whether a correlation exists between the severity of PAD and the severity of COD by retrospectively looking at a group of 203 patients who underwent non-invasive testing for suspicion of PAD at the San Diego VA Hospital or UCSD Medical Center, and who also had a non-invasive duplex carotid scan. The severity of PAD was assessed by segmental blood pressure ratios (leg segment/arm ratio) in each leg taken at the toe, ankle, and below the knee, as well as the peak flow velocity of the posterior tibial artery. The severity of COD was assessed by duplex ultrasound scans of six distinct segments of the carotid artery system: the right and left common, internal, and external carotid arteries. Correlation analysis showed r = 0.23 (p = 0.001) when comparing a PAD aggregate standard score with the number of diseased carotid arteries (Ͼ50% stenosis), and r = 0.23 (p = 0.001) when comparing a PAD aggregate standard score with an average COD score. Because about 50% of the patients had undergone surgical intervention on their leg or carotid arteries, another correlation analysis restricted to patients with no surgical interventions (n = 97) was performed. The above correlations were slightly attenuated in this analysis, r = 0.21 (p = 0.043) and r = 0.17 (p = 0.092), respectively. The results indicate that there is a modest but significant correlation between the severity of PAD and the severity of COD in a population with a high prevalence of both.

Epidemiology of Peripheral Artery Disease

“…125 Subjects with PAD have also been shown to have an elevated prevalence of carotid artery stenosis, 126,127 and a similarly modest but significant correlation between the severities of the 2 diseases has been demonstrated. 128 The global REduction of Atherothrombosis for Continued Health registry has highlighted the high prevalence of patients with PAD who also have concomitant coronary or cerebrovascular disease (Figure 4). …”

Type-2 diabetes and carotid stenosis: a proposal for a screening strategy in asymptomatic patients

“…Presently, there is no consensus on the actual thresholds of ABI, 29 and our thresholds correspond to another report on the probability of carotid stenosis according to ABI values in a different population. 9 As the prevalence of carotid disease is proportional to PAD severity, 9,30 it is plausible that by choosing a more lenient criteria we would weaken the predictive value of ABI to determine Ն60% carotid stenosis.…”

Pheochromocytoma with the Renovascular Hyperreninemia Attendant on Renal Artery Stenosis

“…In one study, approximately one third of individuals with significant carotid artery stenosis had symptoms of cerebrovascular ischemia (100). The severity of lower extremity PAD correlates with the severity and extent of significant carotid artery stenosis (102).…”