Patterns and Severity of PeripheralOpen Access Original Article   Vascular Disease in the Pakistani Population

Athar  Badshah; Anas Bin Saif; Nauman  Imtiaz; Ahsin Manzoor Bhatti; Rizwan  Khan; Azaz Ayubi

doi:10.51253/pafmj.v75i4.12444

Authors

Athar Badshah Department of Vascular Surgery, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Anas Bin Saif Department of Vascular Surgery, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Nauman Imtiaz Department of Vascular Surgery, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Ahsin Manzoor Bhatti Department of Vascular Surgery, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Rizwan Khan Department of Vascular Surgery, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Azaz Ayubi Department of Vascular Surgery, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75i4.12444

Keywords:

Atherosclerosis, Aorto-iliac Computed Tomography Angiography, Diabetes, Peripheral Arterial Disease, Risk Factors

Abstract

Objective: To assess the patterns and severity of peripheral vascular diseases (PVD) in a Pakistani population, using CT angiography.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Department of Vascular Surgery, Combined Military Hospital, Rawalpindi Pakistan, from Aug to Dec 2023.

Methodology: A total of 81 adult patients with clinically suspected lower limb PVD were included. Participants underwent a first routine clinical assessment, arterial Doppler, and then lower limb CTA if required to confirm the diagnosis. Patient characteristics, including demographic data and co-morbid conditions, were recorded. The arterial tree was divided into aorto-illiac, femoro-popliteal, and infra-popliteal segments, and the lesions were graded using the TASC-II classification.

Results: The study included 62 males (76.5%) and 19 females (23.5%), with a mean age of 62.91±8.99 years. Hypertension (66.7%), diabetes (59.3%), and ischemic heart disease (51.9%) were common comorbidities. Smoking was reported in 49.4% of patients. The most affected segments were the femoro-popliteal arteries (55.6%), followed by the aorto-illiac (45.7%) and the infra-popliteal arteries (34.6%). Multiple segment involvement was noted in 34.6% of cases. Circumferential calcification was observed in 67.9% of patients. Diabetes was significantly less associated with infra-popliteal disease (p=0.035).

Conclusion: There is a significant burden of PVD in the Pakistani population, particularly among males and individuals with comorbid conditions such as hypertension, diabetes, and ischemic heart disease. There is a predominance of femoro-popliteal involvement and an advanced nature of atherosclerosis, indicated by prevalent calcification and prevalent type D TASC II disease pattern in different arterial regions.

Downloads

Download data is not yet available.

References

Bukhamseen F, Alradhi A, et al. Anatomical distribution patterns of peripheral arterial disease according to patient characteristics: a unicentral cohort study. Vasc Health Risk Manag 2023: 447-457.

https://doi.org/10.2147/VHRM.S416967

2. Kiss LZ, Bagyura Z, Vadas R. Signs of subclinical atherosclerosis in asymptomatic patients at increased risk of type 2 diabetes mellitus. J Diabetes Complications 2017; 31(8): 1293-1298.

https://doi.org/10.1016/j.jdiacomp.2017.05.007

3. Bennett PC, Silverman S, Gill PS, Lip GY. Ethnicity and peripheral artery disease. Quart J Med 2009; 102(1): 3-16.

https://doi.org/10.1093/qjmed/hcn140

4. Laghari S, Ullah K, Masroor I, Butt G, Kifayat F. Prevalence of peripheral arterial disease diagnosed by ankle brachial index among chronic kidney disease patients in a tertiary care unit. Saudi J Kidney Dis Transpl 2015; 26(5): 924-930.

https://doi.org/10.4103/1319-2442.164572

5. Ali N, Samiullah SM, Ahmed T, Shahzad RK. Frequency of Peripheral Arterial Disease among Diabetic Patients. Pak J Med Health Sci 2022; 16(08): 701.

https://doi.org/10.53350/pjmhs22168701

6. Kumar M, Khan N, Jalbani J, Shar GS, Ishaq H, Shaikh AH. Pattern of vascular involvement in patients with lower extremity peripheral arterial disease. Pak Heart J 2022; 55(2): 166-170.

https://doi.org/10.47144/phj.v55i2.2193

7. Fayyaz A, Bhatti AM, Ghani UF. Pattern of Peripheral Vascular Disease in Troops and Troop Families in Armed Forces: Pattern of Peripheral Vascular Disease. Pak Armed Forces Med J 2018; 68(2): 269-272.

8. Ali Z, Ahmed SM, Bhutto AR, Chaudhry A, Munir SM. Peripheral artery disease in type II diabetes. J Coll Physicians Surg Pak 2012; 22(11): 686-689.

9. Takahara M, Soga Y, Fujihara M, Iida O, Kawasaki D. Association of smoking, diabetes, and dialysis with the presence of popliteal lesions in femoropopliteal artery disease. J Atheroscler Thromb 2022; 64007.

https://doi.org/10.5551/jat.64007

10. Ohtake T, Mitomo A, Yamano M. Impact of arterial calcification of the lower limbs on long-term clinical outcomes in patients on hemodialysis. J Clin Med 2023; 12(4): 1299.

https://doi.org/10.3390/jcm12041299

11. Chhetri PK, Thapa K. CT Angiography in Patients with Peripheral Arterial Disease. J Coll Med Sci-Nepal 2020; 16(2): 78-82.

12. Martinelli O, Alunno A, Drudi FM, Malaj A, Irace L. Duplex ultrasound versus CT angiography for the treatment planning of lower-limb arterial disease. J Ultrasound 2021; 24: 471-479.

https://doi.org/10.1007/s40477-020-00534-y

13. Kannel WB, McGee DL. Update on some epidemiologic features of intermittent claudication: the Framingham Study. J Am Geriatr Soc 1985; 33: 13-18.

https://doi.org/10.1111/j.1532-5415.1985.tb02853.x

14. Pabon M, Cheng S, Alin SE, Sethi SS, Nelson MD, Moreau KL, et al. Sex differences in peripheral artery disease. Circ Res. 2022; 130(4): 496-511.

https://doi.org/10.1161/CIRCRESAHA.121.320702

15. Everhart JE, Pettitt DJ, Knowler WC, Rose FA, Bennett PH. Medial arterial calcification and its association with mortality and complications of diabetes. Diabetologia 1988; 31(1): 16-23.

https://doi.org/10.1007/BF00279127

16. Konijn LC, Takx RA, de Jong PA, Spreen MI, Veger HT, Willem PT, et al. Arterial calcification and long-term outcome in chronic limb-threatening ischemia patients. Eur J Radiol 2020; 132: 109305.

https://doi.org/10.1016/j.ejrad.2020.109305

17. Patel AP, Wang M, Kartoun U, Ng K, Khera AV. Quantifying and understanding the higher risk of atherosclerotic cardiovascular disease among South Asian individuals: results from the UK Biobank prospective cohort study. Circulation 2021; 144(6): 410-422.

https://doi.org/10.1161/CIRCULATIONAHA.120.052430

18. Cainzos-Achirica M, Fedeli U, Sattar N, Agyemang C, Jenum AK, McEvoy JW, et al. Epidemiology, risk factors, and opportunities for prevention of cardiovascular disease in individuals of South Asian ethnicity living in Europe. Atherosclerosis 2019; 286: 105-113.

https://doi.org/10.1016/j.atherosclerosis.2019.05.014