The General Prognosis of Patients with Peripheral Arterial Disease Differs According to the Disease Localization

Objectives: The purpose of this study was to assess the general prognosis of patients with peripheral arterial disease (PAD) according to the disease localization.

Background: PAD is associated with poor cardiovascular disease prognosis. However, it is unknown whether the general prognosis could differ according to PAD topography.

Methods: Data for all patients who underwent a first digital subtraction angiography of their lower limbs between January 2000 and December 2005 at our hospital were reviewed. Arterial stenoses > or = 50% were located by 2 experienced vascular physicians. The following events were collected until April 2007: death, nonfatal myocardial infarction or stroke, and coronary or carotid revascularization. The primary outcome combined all these events.

Results: We studied 400 PAD patients (age 68.3 + or - 12.3 years, 77.5% men). Aortoiliac disease (proximal PAD) and infrailiac disease (distal PAD) were noted in 211 (52.8%) and 344 (86.0%) cases, respectively. Male sex and smoking were more prevalent in proximal PAD, whereas older age, diabetes, hypertension, and renal failure were more prevalent in distal PAD (p < 0.05). During the follow-up period (34 + or - 23 months), the event-free survival curves differed according to the PAD localization (p < 0.03). Adjusted for age, sex, cardiovascular disease history and cardiovascular disease risk factors, critical leg ischemia status, and treatments, proximal PAD was significantly associated with a worse prognosis (primary outcome hazard ratio: 3.28; death hazard ratio: 3.18, p < 0.002 vs. distal PAD).

Conclusions: This is the first study to report a poorer general prognosis of patients with proximal (aortoiliac) PAD compared with those with more distal PAD, independent of risk factors and comorbidities.