July 14, 2004

Differences In Risk Factors For Proximal and Distal Peripheral Vascular Occlusive Disease

Joseph D Raffetto1, Jana E Montgomery1, Robert T Eberhardt2, Wayne W LaMorte3, James O Menzoian11Boston University Medical Center, Boston, MA;2Boston University Medical Center, Boston, MA;3Boston University Medical Center, Boston, MA

Introduction: Our previous study in patients undergoing lower extremity revascularization suggested that proximal occlusive disease was associated with smoking, and distal disease was associated with diabetes and renal insufficiency. Despite these relative differences among patients with vascular disease, the lack of a comparison group without vascular disease made it impossible to evaluate the true impact of various risk factors on proximal versus distal peripheral occlusive disease. We addressed this by using a control group without known vascular disease to generate risk factor profiles for each of three separate groups undergoing revascularization for different levels of clinically significant occlusive disease: 1) aortoiliac, 2) superficial femoral, and 3) popliteal-tibial disease. Methods: 151 patients undergoing lower extremity revascularization and 229 patients undergoing knee and hip replacement performed between January 2000 and June 2003 were reviewed for cardiovascular risk factors and type of revascularization. Comparisons to controls were analyzed using t-tests or chi squared tests. Results: The table compares risk factors and odds ratios (OR) with 95% confidence interval for the three levels of occlusive disease using orthopedic patients as controls. [ * p<.05, ** p<.001 compared to controls].

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Dyslipidemia was associated with a 3-4 fold increased risk of occlusion at all 3 anatomic levels. Smoking and male gender were strongly associated with aortoiliac and superficial femoral disease, but not popliteal-tibial disease. In contrast, older age, diabetes, chronic renal insufficiency, and dialysis were strong risk factors for popliteal-tibial disease, but not for aortoiliac disease. Conclusions: These data, which use revascularization level as a surrogate marker for disease, suggest that the risk factor profile for proximal disease differs from that of distal disease. Diabetes and chronic renal insufficiency substantially increase the risk of distal (but not proximal) disease, while smoking and male gender is a strong risk factor for proximal (but not distal) occlusive disease.