Should incidental asymptomatic angiographic stenoses and occlusions be treated in patients with peripheral arterial disease?

Hdl Handle:
http://hdl.handle.net/10147/127460
Title:
Should incidental asymptomatic angiographic stenoses and occlusions be treated in patients with peripheral arterial disease?
Authors:
Keeling, Aoife N; Naughton, Peter A; Khalidi, Karim; Ayyoub, Alaa S; Kelly, Cathal K; Leahy, Austin L; Bouchier-Hayes, David J; Athanasiou, Thanos; Lee, Michael J
Affiliation:
Department of Academic Radiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
Citation:
Should incidental asymptomatic angiographic stenoses and occlusions be treated in patients with peripheral arterial disease? 2009, 20 (9):1133-40 J Vasc Interv Radiol
Journal:
Journal of vascular and interventional radiology : JVIR
Issue Date:
Sep-2009
URI:
http://hdl.handle.net/10147/127460
DOI:
10.1016/j.jvir.2009.05.035
PubMed ID:
19640739
Abstract:
The clinical importance of angiographically detected asymptomatic lower-limb stenoses and occlusions is unknown. This study aims to (i) assess the clinical outcome of asymptomatic lesions in the lower limb, (ii) identify predictors of clinical deterioration, and (iii) determine which asymptomatic lower-limb lesions should be treated at presentation.; All 918 patients undergoing peripheral angiography with or without angioplasty over a period of 7.5 years (January 1999 through June 2006) at a single institution were retrospectively evaluated. One hundred twenty-two patients (54% men; mean age, 70.3 years; age range, 41-91 y) with angiographic stenoses (> or =50%) or occlusions on the asymptomatic leg were included. The composite endpoint of interest was major adverse clinical outcome (MACO) of the asymptomatic limb at clinical follow-up, which was defined as the development of intermittent claudication (IC), critical limb ischemia (CLI), or need for subsequent endovascular or surgical revascularization. Actuarial freedom from MACO was assessed with Kaplan-Meier curves and multivariable Cox proportional-hazards regression.; During a 4.2-year mean follow-up in 122 patients with significant concomitant asymptomatic disease, 32.8% of patients developed symptoms (13.9% with IC, 18.9% with CLI); 42.5% of these cases required revascularization. Cox regression revealed two independent predictors of MACO on the asymptomatic side: contralateral below-knee amputation (BKA; hazard ratio, 2.93; 95% CI, 1.21-7.10; P = .01) and statin treatment (hazard ratio, 3.56; 95% CI, 1.56-8.13; P = .003).; Asymptomatic peripheral angiographic stenoses and occlusions become symptomatic in one third of patients, necessitating treatment in 13.9% overall. Previous contralateral BKA and statin use were independent predictors of adverse outcome in this population. Close clinical follow-up and appropriate risk factor modification are recommended.
Item Type:
Article
Language:
en
MeSH:
Adult; Aged; Angiography; Comorbidity; Female; Humans; Incidence; Incidental Findings; Intermittent Claudication; Ireland; Male; Middle Aged; Peripheral Vascular Diseases; Retrospective Studies; Risk Assessment; Risk Factors; Survival Analysis; Survival Rate; Vascular Surgical Procedures
ISSN:
1535-7732

Full metadata record

DC FieldValue Language
dc.contributor.authorKeeling, Aoife Nen
dc.contributor.authorNaughton, Peter Aen
dc.contributor.authorKhalidi, Karimen
dc.contributor.authorAyyoub, Alaa Sen
dc.contributor.authorKelly, Cathal Ken
dc.contributor.authorLeahy, Austin Len
dc.contributor.authorBouchier-Hayes, David Jen
dc.contributor.authorAthanasiou, Thanosen
dc.contributor.authorLee, Michael Jen
dc.date.accessioned2011-04-06T14:38:38Z-
dc.date.available2011-04-06T14:38:38Z-
dc.date.issued2009-09-
dc.identifier.citationShould incidental asymptomatic angiographic stenoses and occlusions be treated in patients with peripheral arterial disease? 2009, 20 (9):1133-40 J Vasc Interv Radiolen
dc.identifier.issn1535-7732-
dc.identifier.pmid19640739-
dc.identifier.doi10.1016/j.jvir.2009.05.035-
dc.identifier.urihttp://hdl.handle.net/10147/127460-
dc.description.abstractThe clinical importance of angiographically detected asymptomatic lower-limb stenoses and occlusions is unknown. This study aims to (i) assess the clinical outcome of asymptomatic lesions in the lower limb, (ii) identify predictors of clinical deterioration, and (iii) determine which asymptomatic lower-limb lesions should be treated at presentation.-
dc.description.abstractAll 918 patients undergoing peripheral angiography with or without angioplasty over a period of 7.5 years (January 1999 through June 2006) at a single institution were retrospectively evaluated. One hundred twenty-two patients (54% men; mean age, 70.3 years; age range, 41-91 y) with angiographic stenoses (> or =50%) or occlusions on the asymptomatic leg were included. The composite endpoint of interest was major adverse clinical outcome (MACO) of the asymptomatic limb at clinical follow-up, which was defined as the development of intermittent claudication (IC), critical limb ischemia (CLI), or need for subsequent endovascular or surgical revascularization. Actuarial freedom from MACO was assessed with Kaplan-Meier curves and multivariable Cox proportional-hazards regression.-
dc.description.abstractDuring a 4.2-year mean follow-up in 122 patients with significant concomitant asymptomatic disease, 32.8% of patients developed symptoms (13.9% with IC, 18.9% with CLI); 42.5% of these cases required revascularization. Cox regression revealed two independent predictors of MACO on the asymptomatic side: contralateral below-knee amputation (BKA; hazard ratio, 2.93; 95% CI, 1.21-7.10; P = .01) and statin treatment (hazard ratio, 3.56; 95% CI, 1.56-8.13; P = .003).-
dc.description.abstractAsymptomatic peripheral angiographic stenoses and occlusions become symptomatic in one third of patients, necessitating treatment in 13.9% overall. Previous contralateral BKA and statin use were independent predictors of adverse outcome in this population. Close clinical follow-up and appropriate risk factor modification are recommended.-
dc.language.isoenen
dc.subject.meshAdult-
dc.subject.meshAged-
dc.subject.meshAngiography-
dc.subject.meshComorbidity-
dc.subject.meshFemale-
dc.subject.meshHumans-
dc.subject.meshIncidence-
dc.subject.meshIncidental Findings-
dc.subject.meshIntermittent Claudication-
dc.subject.meshIreland-
dc.subject.meshMale-
dc.subject.meshMiddle Aged-
dc.subject.meshPeripheral Vascular Diseases-
dc.subject.meshRetrospective Studies-
dc.subject.meshRisk Assessment-
dc.subject.meshRisk Factors-
dc.subject.meshSurvival Analysis-
dc.subject.meshSurvival Rate-
dc.subject.meshVascular Surgical Procedures-
dc.titleShould incidental asymptomatic angiographic stenoses and occlusions be treated in patients with peripheral arterial disease?en
dc.typeArticleen
dc.contributor.departmentDepartment of Academic Radiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.en
dc.identifier.journalJournal of vascular and interventional radiology : JVIRen
dc.description.provinceLeinster-

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