Antegrade flow and peripheral resistance determine the level of endogenous arteriogenesis in patients with superficial femoral artery occlusion.
OBJECTIVE
Occlusion in a limb artery leads to impaired blood supply and ischaemia. Collateral artery growth (arteriogenesis) is one of the most effective natural response mechanisms to compensate this pathologic situation. However, it is unknown if clinically important features, like poor run-off, have an impact on compensatory vessel growth.


METHODS
Study population of this retrospective study consisted of 70 patients who suffered from lower limb ischaemia and underwent bypass surgery because of an occlusion of the superficial femoral artery. Clinical data were collected and pre- and postoperative angiograms were reviewed. Number of collateral vessels bypassing the occluded segment was counted. Features of inflow and outflow vessels were recorded.


RESULTS
The mean number of collaterals was 13 + or - 0.5 per patient. In univariate analysis, short daily walking distance, chronic critical leg ischaemia, low ankle brachial index, low number of patent calf arteries and stenosed inflow arteries predicted low number of collateral arteries. In the multivariate analysis, only the quality of inflow and the number of patent calf vessels demonstrated an independent association (P < 0.05) with the number of collaterals.


CONCLUSIONS
Ankle-brachial index, grade of symptoms and daily walking capacity could be used to predict collateral density. Importantly, a good antegrade flow and peripheral runoff seem to have a significant effect on collateral density, implying an impact on the activation of arteriogenesis.
Vajanto
I
I
Department of Cardiothoracic Surgery, Kuopio University Hospital, Kuopio, Finland.
Korpisalo
P
P
Karjalainen
J
J
Hakala
T
T
Mäkinen
K
K
Ylä-Herttuala
S
S
D000368:Aged; D000792:Angiography; D055109:Ankle Brachial Index; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D001158:Arteries / Q000254:growth & development; D001161:Arteriosclerosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D003097:Collateral Circulation / Q000502:physiology*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D015999:Multivariate Analysis; D018919:Neovascularization, Physiologic / Q000502:physiology*; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011237:Predictive Value of Tests; D012039:Regional Blood Flow / Q000502:physiology; D012189:Retrospective Studies; D014655:Vascular Resistance / Q000502:physiology*; D016138:Walking