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Peripheral Artery Disease (PAD): Risk Factors, Diagnosis and Treatment
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Peripheral Artery Disease (PAD): Risk Factors, Diagnosis and Treatment

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Acquired Cardiovascular Disease".

Deadline for manuscript submissions: closed (30 June 2024) | Viewed by 11272

Special Issue Editor

Dr. Zoltán Ruzsa

E-Mail Website
Guest Editor
2nd Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, 6720 Szeged, Hungary
Interests: angiology; cardiology; invasive cardiology; interventional radiology

Special Issue Information

Dear Colleagues,

Peripheral artery disease (PAD), also called peripheral arterial disease, is a common circulatory problem encompassing a range of atherosclerotic and aneurysmal conditions within the extra-coronary circulation. PAD affects millions of people around the world, and significantly increases the risk of cardiovascular events in affected patients.

The risk factors include, but are not limited to, advanced age, smoking, physical inactivity, diabetes, obesity, thrombosis, dyslipidemia, inflammation, and microvascular disease. PAD can increase the risk of heart attack, stroke, and transient ischemic attack, limb amputation, and even death. Doctors diagnose PAD with a physical exam and different tools depending on the disease stage. Treatments include lifestyle changes, medicines, and occasionally surgery. Lifestyle changes include dietary changes and exercise and the medicines used are antihypertensive drugs, statins, antiplatelet drugs, etc. More advanced PAD may require surgical treatment, including balloon angioplasty, stents, peripheral artery bypass surgery, and atherectomy.

This Special Issue aims to include research related to PAD that addresses risk factor analysis, imaging technologies, diagnostic tools, clinical applications, or treatment strategies.

Dr. Zoltán Ruzsa
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Cardiovascular Development and Disease is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • peripheral artery disease
  • PAD
  • atherosclerosis
  • aneurysm
  • endovascular treatment
  • angioplasty
  • stents
  • dyslipidemia
  • stroke
  • limb ischemia

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Published Papers (6 papers)

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Research

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13 pages, 291 KiB  
Article
Subclinical Atherosclerosis Progression in Low-Risk, Middle-Aged Adults: Carotid Leads Femoral in IMT Increase but Not in Plaque Formation
by Eva Szabóová, Alexandra Lisovszki, Alojz Rajnič, Peter Kolarčik, Peter Szabó, Tomáš Molnár and Lucia Dekanová
J. Cardiovasc. Dev. Dis. 2024, 11(9), 271; https://doi.org/10.3390/jcdd11090271 - 2 Sep 2024
Viewed by 843
Abstract
This study investigated subclinical atherosclerosis progression in low-risk, middle-aged adults (N = 141; a mean age of 49.6 ± 4.7 years) using a 5-year ultrasound follow-up. We compared the involvement of the carotid and femoral arteries. Methods: Clinical data, risk factors, carotid/femoral intima-media [...] Read more.
This study investigated subclinical atherosclerosis progression in low-risk, middle-aged adults (N = 141; a mean age of 49.6 ± 4.7 years) using a 5-year ultrasound follow-up. We compared the involvement of the carotid and femoral arteries. Methods: Clinical data, risk factors, carotid/femoral intima-media thickness (IMT), and plaque presence were analyzed. Results: Cardiovascular risk factors and scores increased significantly at follow-up. Both carotid and femoral mean IMT increased (p < 0.001). While plaque prevalence rose and was similar in both arteries (carotid: 4.8% to 17.9%, femoral: 3.6% to 17.7%, p < 0.001 for both), the progression of plaque burden was greater in femorals. Notably, the carotid mean IMT demonstrated a faster yearly progression rate compared to the mean femoral IMT. The prevalence of pathological nomogram-based mean IMT right or left was higher in the carotids (52.9% to 78.8%, p < 0.001) compared to femorals (23.2% to 44.7%, p < 0.001), with a significant increase at the end of follow-up in both territories. Conclusions: This study demonstrates significant subclinical atherosclerosis progression in low-risk, middle-aged adults over 5 years. Carotid arteries showed a faster progression rate of mean IMT and a higher prevalence of pathological nomogram-based mean IMT compared to the femoral arteries. However, plaque burden was similar in both territories, with greater progression in femorals. Identifying carotid and femoral atherosclerosis burden may be a valuable tool for risk stratification in this population. Full article
(This article belongs to the Special Issue Peripheral Artery Disease (PAD): Risk Factors, Diagnosis and Treatment)
40 pages, 5423 KiB  
Article
Calciprotein Particles Induce Cellular Compartment-Specific Proteome Alterations in Human Arterial Endothelial Cells
by Daria Shishkova, Arseniy Lobov, Egor Repkin, Victoria Markova, Yulia Markova, Anna Sinitskaya, Maxim Sinitsky, Egor Kondratiev, Evgenia Torgunakova and Anton Kutikhin
J. Cardiovasc. Dev. Dis. 2024, 11(1), 5; https://doi.org/10.3390/jcdd11010005 - 22 Dec 2023
Cited by 3 | Viewed by 2256
Abstract
Calciprotein particles (CPPs) are indispensable scavengers of excessive Ca2+ and PO43− ions in blood, being internalised and recycled by liver and spleen macrophages, monocytes, and endothelial cells (ECs). Here, we performed a pathway enrichment analysis of cellular compartment-specific proteomes in [...] Read more.
Calciprotein particles (CPPs) are indispensable scavengers of excessive Ca2+ and PO43− ions in blood, being internalised and recycled by liver and spleen macrophages, monocytes, and endothelial cells (ECs). Here, we performed a pathway enrichment analysis of cellular compartment-specific proteomes in primary human coronary artery ECs (HCAEC) and human internal thoracic artery ECs (HITAEC) treated with primary (amorphous) or secondary (crystalline) CPPs (CPP-P and CPPs, respectively). Exposure to CPP-P and CPP-S induced notable upregulation of: (1) cytokine- and chemokine-mediated signaling, Ca2+-dependent events, and apoptosis in cytosolic and nuclear proteomes; (2) H+ and Ca2+ transmembrane transport, generation of reactive oxygen species, mitochondrial outer membrane permeabilisation, and intrinsic apoptosis in the mitochondrial proteome; (3) oxidative, calcium, and endoplasmic reticulum (ER) stress, unfolded protein binding, and apoptosis in the ER proteome. In contrast, transcription, post-transcriptional regulation, translation, cell cycle, and cell–cell adhesion pathways were underrepresented in cytosol and nuclear compartments, whilst biosynthesis of amino acids, mitochondrial translation, fatty acid oxidation, pyruvate dehydrogenase activity, and energy generation were downregulated in the mitochondrial proteome of CPP-treated ECs. Differentially expressed organelle-specific pathways were coherent in HCAEC and HITAEC and between ECs treated with CPP-P or CPP-S. Proteomic analysis of mitochondrial and nuclear lysates from CPP-treated ECs confirmed bioinformatic filtration findings. Full article
(This article belongs to the Special Issue Peripheral Artery Disease (PAD): Risk Factors, Diagnosis and Treatment)
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9 pages, 739 KiB  
Article
Safety of Retrograde Tibial-Pedal Access and Intervention in Patients with Single Remaining Non-Occluded Infra-Popliteal Runoff Artery
by Henry K. Siu, Emily Schultz, Sandrine LeBrun, Michael Liou and Tak W. Kwan
J. Cardiovasc. Dev. Dis. 2023, 10(11), 463; https://doi.org/10.3390/jcdd10110463 - 15 Nov 2023
Viewed by 1796
Abstract
Background: The adaptation of retrograde tibial-pedal access for peripheral angiogram and intervention is limited by the lack of operator experience and concern for small distal vessel injury. This study evaluates the safety of the retrograde tibial-pedal access for peripheral angiogram and intervention in [...] Read more.
Background: The adaptation of retrograde tibial-pedal access for peripheral angiogram and intervention is limited by the lack of operator experience and concern for small distal vessel injury. This study evaluates the safety of the retrograde tibial-pedal access for peripheral angiogram and intervention in patients with two vessel infra-popliteal artery chronic total occlusions, where the access point is the sole remaining non-occluded infra-popliteal artery. Methods: A retrospective analysis of 5687 consecutive patients who underwent peripheral angiograms by retrograde tibial-pedal access via the single remaining non-occluded infra-popliteal artery was performed. Patients who had retrograde tibial-pedal access at the sole remaining infra-popliteal artery confirmed by angiography were included. Clinical and ultrasound data of the accessed infra-popliteal vessel up to 6 months were collected. Results: The cohort consisted of 314 patients (152 males; mean age 77.9 years). At 6 months, access vessel complications occurred in 15 patients (4.8%). Access vessel occlusion occurred in 9 out of 314 patients (2.9%), arteriovenous fistula in 4 (1.3%), with spontaneous resolution in 2, pseudoaneurysm requiring thrombin injection in 2 (0.6%) and non-cardiovascular death in 1 (0.3%). No uncontrolled bleeding, procedure-related hospitalizations or limb amputations occurred. Conclusions: Routine primary retrograde tibial-pedal access for lower extremity peripheral artery diagnostic angiography and intervention in patients with single infra-popliteal artery runoff can be safety performed in an outpatient setting with infrequent and manageable complications. Full article
(This article belongs to the Special Issue Peripheral Artery Disease (PAD): Risk Factors, Diagnosis and Treatment)
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12 pages, 1137 KiB  
Article
Dynamic Perfusion Computed Tomography for the Assessment of Concomitant Coronary Artery Disease in Patients with a History of Percutaneous Transluminal Angioplasty for Chronic Limb-Threatening Ischemia—A Pilot Study
by Ferenc T. Nagy, Dorottya Olajos, Borbála Vattay, Sarolta Borzsák, Melinda Boussoussou, Mónika Deák, Milán Vecsey-Nagy, Barbara Sipos, Ádám L. Jermendy, Gábor G. Tóth, Balázs Nemes, Béla Merkely, Tamás Szili-Török, Zoltán Ruzsa and Bálint Szilveszter
J. Cardiovasc. Dev. Dis. 2023, 10(11), 443; https://doi.org/10.3390/jcdd10110443 - 25 Oct 2023
Cited by 1 | Viewed by 1914
Abstract
Background: Chronic limb-threatening ischemia (CLTI) is associated with high rates of long-term cardiovascular mortality. Exercise stress testing to detect obstructive coronary artery disease (CAD) can be difficult in this subset of patients due to inability to undergo exercise testing, presence of balanced ischemia [...] Read more.
Background: Chronic limb-threatening ischemia (CLTI) is associated with high rates of long-term cardiovascular mortality. Exercise stress testing to detect obstructive coronary artery disease (CAD) can be difficult in this subset of patients due to inability to undergo exercise testing, presence of balanced ischemia and severe coronary artery calcification (CAC). Aim: To test the feasibility of regadenoson stress dynamic perfusion computed tomography (DPCT) in CLTI patients. Methods: Between 2018 and 2023, coronary computed tomography angiography (CTA) and, in the case of a calcium score higher than 400, DPCT, were performed in 25 CLTI patients with a history of endovascular revascularization. Results: Of the 25 patients, 19 had a calcium score higher than 400, requiring DPCT image acquisition. Obstructive CAD could be ruled out in 10 of the 25 patients. Of the 15 CTA/DPCT+ patients, 13 proceeded to coronary angiography (CAG). Revascularization was necessary in all 13 patients. In these 13 patients, vessel-based sensitivity and specificity of coronary CTA/DPCT as compared to invasive evaluation was 75%, respectively. At follow-up (27 ± 21 months) there was no statistically significant difference in all-cause mortality between CTA/DPCT- positive and -negative patients (p = 0.065). Conclusions: Despite a high prevalence of severe CAC, coronary CTA complemented by DPCT may be a feasible method to detect obstructive and functionally significant CAD in CLTI patients. Full article
(This article belongs to the Special Issue Peripheral Artery Disease (PAD): Risk Factors, Diagnosis and Treatment)
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11 pages, 3063 KiB  
Article
Radiation Exposure Reduction by Digital Variance Angiography in Lower Limb Angiography: A Randomized Controlled Trial
by Péter Sótonyi, Márton Berczeli, Marcell Gyánó, Péter Legeza, Zsuzsanna Mihály, Csaba Csobay-Novák, Ákos Pataki, Viktória Juhász, István Góg, Krisztián Szigeti, Szabolcs Osváth, János P. Kiss and Balázs Nemes
J. Cardiovasc. Dev. Dis. 2023, 10(5), 198; https://doi.org/10.3390/jcdd10050198 - 30 Apr 2023
Cited by 2 | Viewed by 1996
Abstract
Background: digital variance angiography (DVA) provides higher image quality than digital subtraction angiography (DSA). This study investigates whether the quality reserve of DVA allows for radiation dose reduction during lower limb angiography (LLA), and compares the performance of two DVA algorithms. Methods: this [...] Read more.
Background: digital variance angiography (DVA) provides higher image quality than digital subtraction angiography (DSA). This study investigates whether the quality reserve of DVA allows for radiation dose reduction during lower limb angiography (LLA), and compares the performance of two DVA algorithms. Methods: this prospective block-randomized controlled study enrolled 114 peripheral arterial disease patients undergoing LLA into normal dose (ND, 1.2 µGy/frame, n = 57) or low-dose (LD, 0.36 µGy/frame, n = 57) groups. DSA images were generated in both groups, DVA1 and DVA2 images were generated in the LD group. Total and DSA-related radiation dose area product (DAP) were analyzed. Image quality was assessed on a 5-grade Likert scale by six readers. Results: the total and DSA-related DAP were reduced by 38% and 61% in the LD group. The overall visual evaluation scores (median (IQR)) of LD-DSA (3.50 (1.17)) were significantly lower than the ND-DSA scores (3.83 (1.00), p < 0.001). There was no difference between ND-DSA and LD-DVA1 (3.83 (1.17)), but the LD-DVA2 scores were significantly higher (4.00 (0.83), p < 0.01). The difference between LD-DVA2 and LD-DVA1 was also significant (p < 0.001). Conclusions: DVA significantly reduced the total and DSA-related radiation dose in LLA, without affecting the image quality. LD-DVA2 images outperformed LD-DVA1, therefore DVA2 might be especially beneficial in lower limb interventions. Full article
(This article belongs to the Special Issue Peripheral Artery Disease (PAD): Risk Factors, Diagnosis and Treatment)
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Review

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15 pages, 1078 KiB  
Review
Spinal Cord Stimulation for Intractable Chronic Limb Ischemia: A Narrative Review
by Roberto Gazzeri, Tommaso Castrucci, Matteo Luigi Giuseppe Leoni, Marco Mercieri and Felice Occhigrossi
J. Cardiovasc. Dev. Dis. 2024, 11(9), 260; https://doi.org/10.3390/jcdd11090260 - 26 Aug 2024
Viewed by 1558
Abstract
Critical limb ischemia (CLI) is the most severe form of peripheral arterial disease, significantly impacting quality of life, morbidity and mortality. Common complications include severe limb pain, walking difficulties, ulcerations and limb amputations. For cases of CLI where surgical or endovascular reconstruction is [...] Read more.
Critical limb ischemia (CLI) is the most severe form of peripheral arterial disease, significantly impacting quality of life, morbidity and mortality. Common complications include severe limb pain, walking difficulties, ulcerations and limb amputations. For cases of CLI where surgical or endovascular reconstruction is not possible or fails, spinal cord stimulation (SCS) may be a treatment option. Currently, SCS is primarily prescribed as a symptomatic treatment for painful symptoms. It is used to treat intractable pain arising from various disorders, such as neuropathic pain secondary to persistent spinal pain syndrome (PSPS) and painful diabetic neuropathy. Data regarding the effect of SCS in treating CLI are varied, with the mechanism of action of vasodilatation in the peripheral microcirculatory system not yet fully understood. This review focuses on the surgical technique, new modalities of SCS, the mechanisms of action of SCS in vascular diseases and the parameters for selecting CLI patients, along with the clinical outcomes and complications. SCS is a safe and effective surgical option in selected patients with CLI, where surgical or endovascular revascularization is not feasible. Full article
(This article belongs to the Special Issue Peripheral Artery Disease (PAD): Risk Factors, Diagnosis and Treatment)
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