title: Renal insufficiency is independently associated with a distal distribution pattern of symptomatic lower-limb atherosclerosis.
abstract: OBJECTIVE
  The purpose of this study was to assess the impact of renal insufficiency (RI) on the distribution pattern of peripheral arterial disease (PAD). We hypothesised that RI is associated with a distally accentuated involvement of the peripheral arterial tree.
  
  
  METHODS
  This is a retrospective analysis.
  
  
  METHODS
  Analysis was based on a consecutive series of 2709 patients with chronic PAD of atherosclerotic origin undergoing primary endovascular treatment of lower-extremity arteries. Atherosclerotic pattern was grouped into femoropopliteal (n=2085) and infragenicular (n=892) disease according to target lesions treated while using iliac disease (n=1133) as reference. Univariable and multivariable multinomial regression analyses were performed to assess relation with RI. Results are shown as relative risk ratio (RRRs) with 95% confidence intervals (95% CIs). A p<0.05 was considered statistically significant. RI was defined as glomerular filtration rate (GFR)<60 ml min(-1) 1.73 m(-2).
  
  
  RESULTS
  Presence of RI was an independent risk factor for a centrifugal lesion pattern (RRR 1.48, 95% CI: 1.17-1.86, p=0.001). Moreover, a decrease in GFR by 10 ml min(-1) 1.73 m(-2) was associated with an RRR of 1.08 for below-the-knee arterial disease (95% CI: 1.03-1.13, p=0.003).
  
  
  CONCLUSIONS
  Presence and severity of RI are independent predictors of a distal obstructive pattern in patients with symptomatic PAD.
authors.affiliation: University Clinic of Angiology, Swiss Cardiovascular Center, Inselspital, University Hospital of Bern, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Wasmuth
authors.forename: I
authors.initials: I
authors.lastname: Baumgartner
authors.forename: D-D
authors.initials: DD
authors.lastname: Do
authors.forename: T
authors.initials: T
authors.lastname: Willenberg
authors.forename: A
authors.initials: A
authors.lastname: Saguner
authors.forename: M
authors.initials: M
authors.lastname: Zwahlen
authors.forename: N
authors.initials: N
authors.lastname: Diehm
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D051437:Renal Insufficiency / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013557:Switzerland / Q000453:epidemiology