title: Distal aortic diameter and peripheral arterial occlusive disease.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Julius Center for General Practice and Patient Oriented Research, Department of Radiology, University Medical Center Utrecht, The Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: van den Bosch
authors.forename: Y
authors.initials: Y
authors.lastname: van der Graaf
authors.forename: B C
authors.initials: BC
authors.lastname: Eikelboom
authors.forename: A
authors.initials: A
authors.lastname: Algra
authors.forename: W P
authors.initials: WP
authors.lastname: Mali
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000886:Anthropometry; D001012:Aorta, Abdominal / Q000473:pathology*; D001018:Aortic Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology*; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D001794:Blood Pressure; D016022:Case-Control Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D016491:Peripheral Vascular Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D015995:Prevalence; D012017:Referral and Consultation; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014463:Ultrasonography