Zdenek Novak, Francisco Alcocer, Fernando Ovalle, David Rooney, Bruce G. Lowman, Bart R. Combs, William D. Jordan
Vascular Surgery, University of Alabama at Birmingham, Birmingham, AL.
OBJECTIVES: The prevalence of peripheral artery disease (PAD) in the general population is estimated to be 3-10%. Patients with diabetes mellitus (DM) are known to have greater risk of developing PAD but its contribution is unclear. Prospective screening was initiated for DM patients to determine prevalence, risk factors and outcome for PAD.
METHODS: We enrolled 511 DM patients into a screening study. Lower extremity (LE) vascular screening was completed on 473 participants, including history (subjective symptoms) focusing on pain, LE vascular interventions, walking distance, tissue loss and physical examination (objective symptoms) with LE pulse exam, ankle brachial index, and duplex ultrasound of the superficial femoral artery. A positive screening was defined as symptoms of PAD or abnormal objective findings. SPSS (IBM) was used for statistical analysis.
RESULTS: Of the 473 patients, 188 (39.7%) screened positive; subjective symptoms were positive in 108 (57.4%), objective in 134 (71.2%) and 54 patients (28.7%) were positive on both. The main subjective symptoms were pain (89%) and walking distance (40.1%) and the main objective symptoms were presence of plaque (69%) and absence of pulses (44.7%). Significant difference was reached for mean age (54±13.3 neg vs. 57.9±13 pos [years], p<0.01) and for time from DM diagnosis to screening (9.7±9.2 neg vs. 13.5±10 pos [years], p<0.01). Demographic factors significantly associated with PAD included male sex (OR=1.8, p<0.01), CAD (OR=2, p<0.01), smoking (OR=1.6, p=0.02), dialysis (OR=3.5, p=0.03), obesity (OR=0.5, p<0.01) and insulin treatment (OR=1.7, p<0.01).
CONCLUSIONS: This data suggests that the subjective findings should be augmented by objective examination in order to increase PAD screening sensitivity. DM patients had similar risks but higher PAD prevalence than expected in the general population suggesting potentiating role of DM. Proactive screening using objective methods could help identify subclinical disease that may benefit from earlier treatment.
AUTHOR DISCLOSURES: F. Alcocer: Medtronics, Research grants; B. R. Combs: Nothing to disclose; W. D. Jordan: Medtronic; Aptus, Consulting fees or other remuneration (payment); Abbott; Volcano, Consulting fees or other remuneration (payment); LeMaitre, Research grants; Lombard, Research grants; ev3, Research grants; WL Gore, Research grants; Abbott, Research grants; Medtronic, Research grants; Aptus, Research grants; Maquet, research grants; Terumo, Research grants; Endologix, Research grants; Trivascular, Research grants; Cook Medical, Research grants; B. G. Lowman: Nothing to disclose; Z. Novak: Nothing to disclose; F. Ovalle: Nothing to disclose; D. Rooney: Nothing to disclose.
Posted April 2013