Jung Hyuk Jae, Lee Sang Su, Kim Hyun Yul, Park Byung Soo, Kim Dong Il, Nam Kyoung Jin, Roh Ji Eun, Choo Ki Seok
Department of Surgery.
Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si, Gyeongsangnam-do, South Korea.
Medicine (Baltimore). 2019 Feb;98(6):e14163. doi: 10.1097/MD.0000000000014163.
We aimed to investigate the association between carotid artery stenosis and peripheral artery disease (PAD) by screening carotid ultrasonography (CUS).From January 2012 to December 2015, 231 consecutive patients who had undergone preoperative CUS for PAD were included in this study. A radiologist assessed the degree of internal carotid artery (ICA) stenosis by using the North American Symptomatic Carotid Endarterectomy Trial (NASCET). Severe (>70%) ICA stenosis was evaluated based on the type of vascular surgery, PAD lesion, and ankle-brachial index (ABI). Data were analyzed using multiple logistic regression analysis and the χ test.Among 231 PAD patients, multilevel lesions revealed significantly higher incidence of severe ICA stenosis than iliac and infrainguinal lesion (22.5% vs 9.4% vs 8%: P = .016). Age (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.00-1.12: P = .035), chronic kidney disease (CKD, OR: 6.19, 95% CI: 2.04-45.04: P = .013), and cerebral vascular disease (CVD, OR: 4.08, 95% CI: 1.13-16.46: P = .037) were significant risk factors of severe ICA stenosis in multivariate analysis. Prevalence of severe ICA stenosis according to ABI in PAD was not significant.Preoperative screening by CUS provides valuable information onasymptomatic carotid artery stenosis (ACAS) that can identify severe ACAS patients who are at high risk of stroke and to consider more intensive management of carotid disease in PAD patients. CUS can be a useful noninvasive preoperative screening imaging tool for PAD patients with multilevel lesions, aged > 65 years old, with CKD and CVD.
我们旨在通过颈动脉超声检查（CUS）来研究颈动脉狭窄与外周动脉疾病（PAD）之间的关联。2012年1月至2015年12月，本研究纳入了231例因PAD接受术前CUS检查的连续患者。一名放射科医生采用北美症状性颈动脉内膜切除术试验（NASCET）评估颈内动脉（ICA）狭窄程度。基于血管手术类型、PAD病变和踝臂指数（ABI）对重度（>70%）ICA狭窄进行评估。使用多元逻辑回归分析和χ检验对数据进行分析。在231例PAD患者中，多级病变患者的重度ICA狭窄发生率显著高于髂动脉和腹股沟下病变患者（22.5%对9.4%对8%：P = 0.016）。年龄（比值比[OR]：1.05，95%置信区间[CI]：1.00 - 1.12：P = 0.035）、慢性肾脏病（CKD，OR：6.19，95% CI：2.04 - 45.04：P = 0.013）和脑血管疾病（CVD，OR：4.08，95% CI：1.13 - 16.46：P = 0.037）在多变量分析中是重度ICA狭窄的显著危险因素。根据PAD患者的ABI得出的重度ICA狭窄患病率无显著差异。术前通过CUS筛查可提供关于无症状性颈动脉狭窄（ACAS）的有价值信息，能够识别出有中风高风险的重度ACAS患者，并考虑对PAD患者的颈动脉疾病进行更强化的管理。对于患有多级病变、年龄>65岁、患有CKD和CVD的PAD患者，CUS可作为一种有用的无创术前筛查成像工具。
