Vol. 21 No. 3 (2017)
VASCULAR SURGERY

Features of manifestation and progression for critical lower limb ischemia in subjects with abdominal aortic calcification: a pilot study

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  • M. Melynikov,
  • V. Zelinskiy
M. Melynikov
North-Western State Medical University named after I.I. Mechnikov, Ministry of Health of Russian Federation, Saint-Petersburg, Russian Federation
V. Zelinskiy
North-Western State Medical University named after I.I. Mechnikov, Ministry of Health of Russian Federation, Saint-Petersburg, Russian Federation
Bio
DOI: https://doi.org/10.21688/1681-3472-2017-3-58-64

Published 2017-11-22

Keywords

  • peripheral arterial disease,
  • abdominal aortic calcification,
  • critical lower limb ischemia,
  • atherosclerotic plaque rupture

How to Cite

Melynikov, M., & Zelinskiy, V. (2017). Features of manifestation and progression for critical lower limb ischemia in subjects with abdominal aortic calcification: a pilot study. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 21(3), 58–64. https://doi.org/10.21688/1681-3472-2017-3-58-64

Copyright (c) 2017 Zelinskiy V.A., Melynikov M.V.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Aim. The study was designed to assess the specific features of manifestation and progression for critical low limb ischemia in patients with abdominal aortic calcification.
Methods. The total of 151 patients with low limb critical ischemia due to peripheral arterial disease were enrolled to the study cohort: 79 patients (study group) with abdominal aortic calcification and 72 patients (control group) without any signs of abdominal aortic wall calcification. Abdominal aortic calcification was detected by CT-imaging. The patients with diabetes mellitus and with chronic renal insufficiency were excluded from the study cohort.
Results. Critical lower limb ischemia in subjects with abdominal aortic calcification manifested itself in the following features: predominant localization of lesions in the aorto-iliac position (68.4% vs. 33.3% in patients without abdominal aortic calcification; р<0.05), rapid progression of lower limb ischemia (its prevalence in the study group was 77.7% vs. 37.3% in the control group; р<0.01), expressed hypercoagulation combined with a decrease in the level of natural anticoagulants concentration (mean activity of antithrombin III in individuals with abdominal aortic calcification was 56.5±10.4% vs. 98.7±16.4% in patients without abdominal aortic calcification; р<0.001).
Conclusion. The study findings have shown that critical lower limb ischemia in subjects with abdominal aortic calcification has specific futures of manifestation and clinical course that need to be considered when choosing the best treatment strategy.

Received 24 April 2017. Revised 7 June 2017. Accepted 19 June 2017.

Funding: The study did not have sponsorship.

Conflict of interest: The authors declare no conflict of interest.

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References

  1. Norgren L., Hiatt W.R., Dormandy J.A., Nehler M.R., Harris K.A., Fowkes F.G. and TASC II Working Group. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) // Eur. J. Vasc. Endovasc. Surg. 2007. Vol. 45 (Suppl.). P. S5-S67. doi:10.1016/j.jvs.2006.12.037 [Norgren L., Hiatt W.R., Dormandy J.A., Nehler M.R., Harris K.A., Fowkes F.G. and TASC II Working Group. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur. J. Vasc. Endovasc. Surg. 2007;45 (Suppl):S5-S67. doi:10.1016/j.jvs.2006.12.037].
  2. Society for Vascular Surgery Lower Extremity Guidelines Writing Group, Conte M.S., Pomposelli F.B., Clair D.G., Geraghty P.J., McKinsey J.F., Mills J.L., Moneta G.L., Murad M.H., Powell R.J., Reed A.B., Schanzer A., Sidawy A.N.; Society for Vascular Surgery. Society for Vascular Surgery. Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication // J. Vasc. Surg. 2015. Vol. 61 (3 Suppl.). P. 2S-41S. doi:10.1016/j.jvs.2014.12.009. [Society for Vascular Surgery Lower Extremity Guidelines Writing Group, Conte M.S., Pomposelli F.B., Clair D.G., Geraghty P.J., McKinsey J.F., Mills J.L., Moneta G.L., Murad M.H., Powell R.J., Reed A.B., Schanzer A., Sidawy A.N.; Society for Vascular Surgery. Society for Vascular Surgery. Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication. J. Vasc. Surg. 2015; 61(3 Suppl): 2S-41S. doi: doi:10.1016/j.jvs.2014.12.009].
  3. Becker F., Robert-Ebadi H., Ricco J.B., Setacci C., Cao P., de Donato G., Eckstein H.H., De Rango P., Diehm N., Schmidli J., Teraa M., Moll F.L., Dick F., Davies A.H., Lepäntalo M., Apelqvist J. Management of Critical Limb Ischaemia and Diabetic Foot. Clinical Practice Guidelines of the European Society for Vascular Surgery. Chapter I: Definitions, epidemiology, clinical presentation and prognosis // Eur. J. Vasc. Endovasc. Surg. 2011. Vol. 42 (Suppl. 2). P. S4-12. doi: 10.1016/S1078-5884(11)60009-9. [Becker F., Robert-Ebadi H., Ricco J.B., Setacci C., Cao P., de Donato G., Eckstein H.H., De Rango P., Diehm N., Schmidli J., Teraa M., Moll F.L., Dick F., Davies A.H., Lepäntalo M., Apelqvist J. Management of Critical Limb Ischaemia and Diabetic Foot. Clinical Practice Guidelines of the European Society for Vascular Surgery. Chapter I: Definitions, epidemiology, clinical presentation and prognosis. Eur. J. Vasc. Endovasc. Surg. 2011;42 Suppl 2:S4-12. doi: 10.1016/S1078-5884(11)60009-9].
  4. Criqui M.H., Aboyans V. Epidemiology of peripheral artery disease // Circ. Res. 2015. Vol. 24. № 116(9). P.1509-1526. doi: 10.1161/CIRCRESAHA.116.303849. [Criqui M.H., Aboyans V. Epidemiology of peripheral artery disease. Circ. Res. 2015; 24;116(9):1509-1526. doi: 10.1161/CIRCRESAHA.116.303849].
  5. Huang C.L., Wu I.H., Wu Y.W., Hwang J.J., Wang S.S., Chen W.J., Lee W.J., Yang W.S. Association of lower extremity arterial calcification with amputation and mortality in patients with symptomatic peripheral artery disease // PLoS One. 2014. Vol. 26. № 9(2). P.e90201. doi:10.1371/journal.pone.0090201. [Huang C.L., Wu I.H., Wu Y.W., Hwang J.J., Wang S.S., Chen W.J., Lee W.J., Yang W.S. Association of lower extremity arterial calcification with amputation and mortality in patients with symptomatic peripheral artery disease. PLoS One. 2014; 26; 9(2):e90201. doi: 10.1371/journal.pone.0090201].
  6. Ohtake T., Oka M., Ikee R., Mochida Y., Ishioka K., Moriya H., Hidaka S., Kobayashi S. Impact of lower limbs' arterial calcification on the prevalence and severity of PAD in patients on hemodialysis // J. Vasc. Surg. 2011. Vol. 53. № 3. P. 676-683. doi: 10.1016/j.jvs.2010.09.070. [Ohtake T., Oka M., Ikee R., Mochida Y., Ishioka K., Moriya H., Hidaka S., Kobayashi S. Impact of lower limbs' arterial calcification on the prevalence and severity of PAD in patients on hemodialysis. J Vasc Surg. 2011;53(3):676-683. doi: 10.1016/j.jvs.2010.09.070].
  7. Harbaugh C.M., Terjimanian M.N., Lee J.S., Alawieh A.Z., Kowalsky D.B., Tishberg L.M., Krell R.W., Holcombe S.A., Wang S.C., Campbell D.A. Jr., Englesbe M.J. Abdominal aortic calcification and surgical outcomes in patients with no known cardiovascular risk factors // Ann. Surg. 2013. Vol. 257. P. 774-781. doi: 10.1097/SLA.0b013e31826ddd5f. [Harbaugh C.M., Terjimanian M.N., Lee J.S., Alawieh A.Z., Kowalsky D.B., Tishberg L.M., Krell R.W., Holcombe S.A., Wang S.C., Campbell D.A. Jr., Englesbe M.J. Abdominal aortic calcification and surgical outcomes in patients with no known cardiovascular risk factors. Ann. Surg. 2013;257: 774-812. doi: 10.1097/SLA.0b013e31826ddd5f].
  8. Iida O., Soga Y., Yamauchi Y., Hirano K., Kawasaki D., Tazaki J., Yamaoka T., Suematsu N., Suzuki K., Shintani Y., Miyashita Y., Takahara M., Uematsu M. Anatomical predictors of major adverse limb events after infrapopliteal angioplasty for patients with critical limb ischaemia due to pure isolated infrapopliteal lesions // Eur. J. Vasc. Endovasc. Surg. 2012. Vol. 44. № 3. P. 318-324. doi: 10.1016/j.ejvs.2012.05.011. [Iida O., Soga Y., Yamauchi Y., Hirano K., Kawasaki D., Tazaki J., Yamaoka T., Suematsu N., Suzuki K., Shintani Y., Miyashita Y., Takahara M., Uematsu M. Anatomical predictors of major adverse limb events after infrapopliteal angioplasty for patients with critical limb ischaemia due to pure isolated infrapopliteal lesions. Eur. J. Vasc. Endovasc. Surg. 2012; 44(3):318-324. doi: 10.1016/j.ejvs.2012.05.011].
  9. Feldman D.N. Atherectomy for calcified femoropopliteal disease: are we making progress? // J. Invasive. Cardiol. 2014. Vol. 26. № 8. P.304-306. [Feldman D.N. Atherectomy for calcified femoropopliteal disease: are we making progress? J. Invasive. Cardiol. 2014;26(8):304-306].
  10. Jayalath R.W., Mangan S.H., Golledge J. Aortic calcification // Eur. J. Vasc. Endovasc. Surg. 2005. Vol.30. № 5. P.476-488. doi: 10.1016/j.ejvs.2005.04.030. [Jayalath R.W., Mangan S.H., Golledge J. Aortic calcification. Eur. J. Vasc. Endovasc. Surg. 2005;30(5):476-488. doi: 10.1016/j.ejvs.2005.04.030].
  11. Fleckenstein-Grün G, Frey M, Thimm F, Luley C, Czirfusz A, Fleckenstein A. Differentiation between calcium- and cholesterol-dominated types of arteriosclerotic lesions: antiarteriosclerotic aspects of calcium antagonists // J. Cardiovasc. Pharmacol. 1991. Vol.18. № 6 (Suppl). P.S1-S9. [Fleckenstein-Grün G., Frey M., Thimm F., Luley C., Czirfusz A., Fleckenstein A. Differentiation between calcium- and cholesterol-dominated types of arteriosclerotic lesions: antiarteriosclerotic aspects of calcium antagonists. J. Cardiovasc. Pharmacol. 1991;18; Suppl 6:S1-S9].
  12. Fleckenstein-Grün G., Thimm F., Frey M., Czirfusz A. Role of calcium in arteriosclerosis--experimental evaluation of antiarteriosclerotic potencies of Ca++ antagonists. Study Group for Calcium Antagonism // Basic. Res. Cardiol. 1994. Vol. 89. Suppl. 1. P.145-159. [Fleckenstein-Grün G., Thimm F., Frey M., Czirfusz A. Role of calcium in arteriosclerosis--experimental evaluation of antiarteriosclerotic potencies of Ca++ antagonists. Study Group for Calcium Antagonism. Basic. Res. Cardiol. 1994;89; Suppl. 1:145-159].
  13. Cao P., Eckstein H.H., De Rango P., Setacci C., Ricco J.B., de Donato G., Becker F., Robert-Ebadi H., Diehm N., Schmidli J., Teraa M., Moll F.L., Dick F., Davies A.H., Lepäntalo M., Apelqvist J. Chapter II: Diagnostic methods // Eur. J. Vasc. Endovasc. Surg. 2011. Vol. 42. Suppl 2. P. S13-S32. doi: 10.1016/S1078-5884(11)60010-5. [Cao P., Eckstein H.H., De Rango P., Setacci C., Ricco J.B., de Donato G., Becker F., Robert-Ebadi H., Diehm N., Schmidli J., Teraa M., Moll F.L., Dick F., Davies A.H., Lepäntalo M., Apelqvist J. Chapter II: Diagnostic methods. Eur. J. Vasc. Endovasc. Surg. 2011;42; Suppl 2:S13-32. doi: 10.1016/S1078-5884(11)60010-5].
  14. Harrison P., Mackie I., Mumford A., Briggs C., Liesner R., Winter M., Machin S; British Committee for Standards in Haematology. Guidelines for the laboratory investigation of heritable disorders of platelet function // Br. J. Haematol. 2011. Vol. 155. № 1. P. 30-44. doi: 10.1111/j.1365-2141.2011.08793.x. [Harrison P., Mackie I., Mumford A., Briggs C., Liesner R., Winter M., Machin S.; British Committee for Standards in Haematology. Guidelines for the laboratory investigation of heritable disorders of platelet function. Br. J. Haematol. 2011;155(1):30-44. doi: 10.1111/j.1365-2141.2011.08793.x.].
  15. Marlar R.A., Gausman J.N., Engel J.W. Validation of hemostasis and coagulation assays: recommendations and guidelines // Semin. Thromb. Hemost. 2014. Vol. 40. № 2. P. 186-194. doi: 10.1055/s-0033-1364186. [Marlar R.A., Gausman J.N., Engel J.W. Validation of hemostasis and coagulation assays: recommendations and guidelines. Semin. Thromb. Hemost. 2014;40(2):186-194. doi: 10.1055/s-0033-1364186].
  16. Allison M.A., Budoff M.J., Nasir K., Wong N.D., Detrano R., Kronmal R., Takasu J., Criqui M.H. Ethnic-specific risks for atherosclerotic calcification of the thoracic and abdominal aorta (from the multi-ethnic study of atherosclerosis) // Am. J. Cardiol. 2009. Vol. 104. № 6. Р. 812–817. doi: 10.1016/j.amjcard.2009.05.004. [Allison M.A., Budoff M.J., Nasir K., Wong N.D., Detrano R., Kronmal R., Takasu J., Criqui M.H. Ethnic-specific risks for atherosclerotic calcification of the thoracic and abdominal aorta (from the multi-ethnic study of atherosclerosis). Am. J. Cardiol. 2009;104 (6):812–817. doi: 10.1016/j.amjcard.2009.05.004].
  17. Wong N.D., Lopez V.A., Allison M., Detrano R.C., Blumenthal R.S., Folsom A.R., Ouyang P., Criqui M.H. Abdominal aortic calcium and multi–site atherosclerosis: The multiethnic study of atherosclerosis // Atherosclerosis. 2011. Vol. 214. № 2. Р. 436–440. doi: 10.1016/j.atherosclerosis. [Wong N.D., Lopez V.A., Allison M., Detrano R.C., Blumenthal R.S., Folsom A.R., Ouyang P., Criqui M.H. Abdominal aortic calcium and multi–site atherosclerosis: The multiethnic study of atherosclerosis. Atherosclerosis. 2011; 214 (2): 436–440. doi: 10.1016/j.atherosclerosis].
  18. Aboyans V., Desormais I., Lacroix P., Salazar J., Criqui M.H., Laskar M. The general prognosis of patients with peripheral arterial disease differs according to the disease localization // J. Am. Coll. Cardiol. 2010. Vol. 55. № 9. P. 898-903. doi: 10.1016/j.jacc.2009.09.055. [Aboyans V., Desormais I., Lacroix P., Salazar J., Criqui M.H., Laskar M. The general prognosis of patients with peripheral arterial disease differs according to the disease localization. J. Am. Coll. Cardiol. 2010;55(9):898-903. doi: 10.1016/j.jacc.2009.09.055].
  19. Мельников М.В., Зелинский В.А. Особенности течения атеросклероза периферических артерий у больных с кальцинозом брюшной аорты // Ангиология и сосудистая хирургия. 2016. Т. 22. № 3. С.42-47. [Mel'nikov M.V., Zelinskiĭ V.A. Clinical peculiarities of atherosclerosis of peripheral arteries in patients with abdominal aortic calcification. Angiol. Sosud. Khir. 2016;22(3):42-47. (In Russ.)].
  20. Forbang N.I., Ix J.H., Allison M.A., Criqui M.H. Associations of cardiovascular disease risk factors and calcified atherosclerosis with aortoiliac bifurcation position: the MultiEthnic Study of Atherosclerosis //Angiology. 2015. Vol. 66. № 1. P. 90-95. doi: 10.1177/0003319713516669. [Forbang N.I., Ix J.H., Allison M.A., Criqui M.H. Associations of cardiovascular disease risk factors and calcified atherosclerosis with aortoiliac bifurcation position: the MultiEthnic Study of Atherosclerosis. Angiology. 2015; 66(1):90-95. doi: 10.1177/0003319713516669].
  21. Hoshino T., Chow L.A., Hsu J.J., Perlowski A.A., Abedin M., Tobis J., Tintut Y., Mal A.K., Klug W.S., Demer L.L. Mechanical stress analysis of a rigid inclusion in distensible material: a model of atherosclerotic calcification and plaque vulnerability // Am. J. Physiol. Heart. Circ. Physiol. 2009. Vol. 297. № 2. P. H802-H810. doi: 10.1152/ajpheart.00318.2009. [Hoshino T., Chow L.A., Hsu J.J., Perlowski A.A., Abedin M., Tobis J., Tintut Y., Mal A.K., Klug W.S., Demer L.L. Mechanical stress analysis of a rigid inclusion in distensible material: a model of atherosclerotic calcification and plaque vulnerability. Am. J. Physiol. Heart. Circ. Physiol. 2009;297(2):H802-H810. doi: 10.1152/ajpheart.00318.2009].
  22. Zheng B., Mintz G.S., McPherson J.A., De Bruyne B., Farhat N.Z., Marso S.P., Serruys P.W., Stone G.W., Maehara A. Predictors of Plaque Rupture Within Nonculprit Fibroatheromas in Patients With Acute Coronary Syndromes: The PROSPECT Study // JACC. Cardiovasc. Imaging. 2015. Vol. 8. № 10. P. 1180-1187. doi: 10.1016/j.jcmg.2015.06.014. [Zheng B., Mintz G.S., McPherson J.A., De Bruyne B., Farhat N.Z., Marso S.P., Serruys P.W., Stone G.W., Maehara A. Predictors of Plaque Rupture Within Nonculprit Fibroatheromas in Patients With Acute Coronary Syndromes: The PROSPECT Study. JACC. Cardiovasc. Imaging. 2015;8(10):1180-1187. doi: 10.1016/j.jcmg.2015.06.014].