van den Bosch M A, van der Graaf Y, Eikelboom B C, Algra A, Mali W P
Julius Center for General Practice and Patient Oriented Research, Department of Radiology, University Medical Center Utrecht, The Netherlands.
J Vasc Surg. 2001 Dec;34(6):1085-9. doi: 10.1067/mva.2001.118809.
Several studies have reported an association between abdominal aortic dilatation and peripheral arterial occlusive disease. Narrowing of aortic diameter, also called abdominal aortic hypoplasia, and peripheral arterial occlusive disease have received insufficient attention. Precise estimates of the relationship between aortic hypoplasia and peripheral arterial occlusive disease are lacking. In this study, we assessed the relationship between abdominal aortic diameter and peripheral arterial occlusive disease.
In this cross-sectional study, we analyzed 1572 patients 18 to 79 years of age, newly referred to the vascular center of our hospital with clinically manifest atherosclerotic arterial disease or for treatment of cardiovascular risk factors. Diameter measurements were used to subdivide patients according to tertiles of abdominal aortic diameter. Peripheral arterial occlusive disease was assessed by adjusted Rose questionnaire, ankle-brachial pressure index, and the presence of gangrene or leg ulcers.
Compared with patients with normal aortic diameter, peripheral arterial occlusive disease was twice as prevalent in patients at both ends of the aortic diameter spectrum. When the lowest tertile was compared with the middle tertile in male patients, the adjusted odds ratio was 1.7 (95% CI, 1.0-3.1). When the highest tertile was compared with the middle tertile, the adjusted odds ratio was 2.1 (95% CI, 1.2-3.4). Similar results were found in female patients. The adjusted odds ratio of lowest versus middle tertile was 2.4 (95% CI, 1.1-5.0) and 1.8 (95% CI, 0.8-4.0) when the highest tertile was compared with the middle tertile.
The risk of peripheral arterial occlusive disease was increased in the lower and upper distribution of aortic diameter. Apparently, both patients with an aortic diameter too large and patients with an aortic diameter too small are prone to peripheral arterial occlusive disease. This is the first large study that shows that small aortic diameter is associated with peripheral arterial occlusive disease.
多项研究报告了腹主动脉扩张与外周动脉闭塞性疾病之间的关联。主动脉直径变窄，也称为腹主动脉发育不全，与外周动脉闭塞性疾病受到的关注不足。目前缺乏对主动脉发育不全与外周动脉闭塞性疾病之间关系的精确评估。在本研究中，我们评估了腹主动脉直径与外周动脉闭塞性疾病之间的关系。
在这项横断面研究中，我们分析了1572例年龄在18至79岁之间的患者，这些患者因临床表现为动脉粥样硬化性动脉疾病或为治疗心血管危险因素而新转诊至我院血管中心。根据腹主动脉直径三分位数对患者进行分组，并测量直径。通过调整后的罗斯问卷、踝臂压力指数以及坏疽或腿部溃疡的存在情况来评估外周动脉闭塞性疾病。
与主动脉直径正常的患者相比，外周动脉闭塞性疾病在主动脉直径范围两端的患者中患病率是其两倍。在男性患者中，当将最低三分位数与中间三分位数进行比较时，调整后的优势比为1.7（95%可信区间，1.0 - 3.1）。当将最高三分位数与中间三分位数进行比较时，调整后的优势比为2.1（95%可信区间，1.2 - 3.4）。在女性患者中也发现了类似结果。当将最高三分位数与中间三分位数进行比较时，最低三分位数与中间三分位数的调整后优势比分别为2.4（95%可信区间，1.1 - 5.0）和1.8（95%可信区间，0.8 - 4.0）。
外周动脉闭塞性疾病的风险在主动脉直径的较低和较高分布中均增加。显然，主动脉直径过大和过小的患者都容易患外周动脉闭塞性疾病。这是第一项表明小主动脉直径与外周动脉闭塞性疾病相关的大型研究。
