Evaluation Of Peripheral Arterial And Left Ventricular Alterations In Patients With Atherosclerotic Lower Extremity Peripheral Arterial Disease

Peripheral arterial disease (peripheral artery disease, PAD) is pathologicallydefined as stenotic or occlusive disease of the upper-or lower-extemity arteries. It isused to be known as peripheral vascular disease (PVD), peripheral arterial occlusivedisease (PAOD), and arterial sclerosis obliterans (ASO), etc. PAD is considerablycommon in cardiovascular high-risk populations.prevalence. Lower extremity PAD isone of the main types of PAD, in which disorders maily affects the lower extremityarteries, with atherosclerosis as the major and the most common cause. Inatherosclerotic lower extremity PAD, atherosclerotic changes of the aterial wall leadto stenosis or occlusion of the arteries, resulting in chroic or acute ischemicmanifestations of the lower extremity. The walls of the lower extremity arteriesundergo a seies of pathophysiological changes of lipid stripes, fibrous plaques,atheromatous plaques and composite plaques with the progress of atherosclerosis.Thepresence of foam cells, increased amount of collagen fibers,destruction of the mediallayer elastic fibers, and plaque calcification lead to the reconstruction of the bloodvessels, with alterations of the vescular wall thickness and inner diameter, and finallyresulting in arterial stenosis or occlusion and limb manifestations. This disease can beeither acute or chronic. Patients with lower extremity PAD may not experiencerecognizable symptoms in the early stage of the disease. Howerver, as the diseaseprogresses, different sympoms and signs of limb ischemia can be observed, limited limb function, intermittent claudication, ischemic rest pain, limb ulcerations andgangrene. The all-cause and cardiovascular mortality of the patients with lowerextremity PAD are rather high.Since atherosclerosis is a systemic disease, the atherosclerotic changes are notrestricted to lower extremity arteries. Other sites of the arterial tree, such as theconronary arteries and carotid arteries can also be involved, which have beencomfirmed by many studies. Risk factors for PAD, such as hypertension and cigarettesmoking, also have influences on the heart. On the other hand, as the heart andarteries act together to maintain the continuous circulation from the heart to theperipherals, they also have effects on each other though hemodynamic machnisms.Diseases of the peripheral arteries can cause hemodynamic changes, which may alterthe structure and function of the heart. Numerous studies have shown that PAD wasassociated with a higher risk of cardiovascular events and mortality, which is evenmore prominent in patients already present with limb ischemia. Some studies havedemonstrated that PAD patients with coronary heart disease tend to higher prevalenceof abnormal left ventricular geometric patterns. At present, there are few researchesfocusing on the left ventricular structure and functions in patients witharteryatherosclerotic lower extremity PAD without cardiac symptoms. The purpose ofthe present study is to evaluate the structural and functional changes of peripheralarteries and the left ventricule in patients with atherosclerotic lower extremity PAD,and to investigate the correlated factors of the alterations of the arterial stiffness andleft ventricule by using ultrasound techneques, which may provide some informationfor the clinicians so that more appropriate and sufficent clinical interventions can beapplied to these patients. The present study was divided into two parts as follows.Part1. Evaluation of Peripheral Arterial Alterations in Patients withAtherosclerotic Lower Extremity Peripheral Arterial DiseaseThe aim of this part was to evaluate the structural and elastic changes of the peripheral arteries, as well as the factors correlated with arterial stiffness in patientswith atherosclerotic lower extremity PAD. The carotid and femoral arteries wereassessed by high-resolution ultrasound. The intima-media thickness, diameter andarterial stiffness indexes were automatically measured with the QIMT and QAStechneques.These indexes were compared between a group of atherosclerotic lowerextremity PAD patients and a group of age-sex matched control objects. Factorscorrelated with the arterial stiffness indexes were evaluated.RESULTS①The SBP, PP, smoking packyear and smoking extent(nonsmoker, smoker with...