title: Local association between endothelial dysfunction and intimal hyperplasia: relevance in peripheral artery disease.
abstract: BACKGROUND
  Endothelial dysfunction is a key factor in the development of atherosclerosis. Commonly, endothelial function is determined in the brachial artery, whereas patients with peripheral artery disease (PAD) present with lower limb atherosclerosis. We hypothesized that in PAD, a segmental or local association exists between endothelial dysfunction and atherosclerotic structural changes.
  
  
  RESULTS
  We used ultrasound to study endothelial function as flow-mediated vasodilation, intima media thickness, and local stiffness of the superficial femoral artery (SFA) and brachial artery (BA). PAD patients with symptomatic SFA or below-the-knee disease were compared with age-matched patients without PAD and young healthy controls. PAD patients with SFA or below-the-knee disease exhibited endothelial dysfunction of the proximal SFA (flow-mediated vasodilation: 3.9±0.6%, 3.7±0.6%) compared with healthy controls (7.4±1.0%) and patients without PAD (5.4±0.6%). Brachial artery flow-mediated vasodilation values were not different in PAD patients with SFA or below-the-knee disease compared with patients without PAD, but they were significantly lower than those of healthy controls. Endothelial dysfunction correlated with increased intima media thickness or plaque thickness at the site of flow-mediated vasodilation measurement across vascular sites. In PAD patients with SFA disease, SFA flow-mediated vasodilation was further impaired within and distal to stenosis (prestenosis 3.9±0.6%, intrastenosis 2.3±0.7%, poststenosis 2.5±0.6%) and recovered within 24 hours after SFA balloon angioplasty to prestenotic values but not to the brachial artery or SFA values in patients without PAD or controls.
  
  
  CONCLUSIONS
  A close association exists between local endothelial function and atherosclerotic structural remodeling, suggesting that in PAD, local and segmental factors-in addition to systemic factors-influence local endothelial function. Our data point toward a pathophysiological role for lower extremity endothelial dysfunction in PAD.
authors: Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany (Y.H., E.S., R.S., K.B., R.W., J.B., T.R., T.L., M.K., C.H.).
authors: Yvonne
authors: Y
authors: Heinen
authors: Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany (Y.H., E.S., R.S., K.B., R.W., J.B., T.R., T.L., M.K., C.H.).
authors: Emilia
authors: E
authors: Stegemann
authors: Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany (Y.H., E.S., R.S., K.B., R.W., J.B., T.R., T.L., M.K., C.H.).
authors: Roberto
authors: R
authors: Sansone
authors: Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany (Y.H., E.S., R.S., K.B., R.W., J.B., T.R., T.L., M.K., C.H.).
authors: Kolja
authors: K
authors: Benedens
authors: Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany (Y.H., E.S., R.S., K.B., R.W., J.B., T.R., T.L., M.K., C.H.).
authors: Rabea
authors: R
authors: Wagstaff
authors: Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany (Y.H., E.S., R.S., K.B., R.W., J.B., T.R., T.L., M.K., C.H.).
authors: Jan
authors: J
authors: Balzer
authors: Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany (Y.H., E.S., R.S., K.B., R.W., J.B., T.R., T.L., M.K., C.H.).
authors: Tienush
authors: T
authors: Rassaf
authors: Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany (Y.H., E.S., R.S., K.B., R.W., J.B., T.R., T.L., M.K., C.H.).
authors: Thomas
authors: T
authors: Lauer
authors: Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany (Y.H., E.S., R.S., K.B., R.W., J.B., T.R., T.L., M.K., C.H.).
authors: Malte
authors: M
authors: Kelm
authors: Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany (Y.H., E.S., R.S., K.B., R.W., J.B., T.R., T.L., M.K., C.H.).
authors: Christian
authors: C
authors: Heiss
mesh_terms: D000328:Adult; D000368:Aged; D050197:Atherosclerosis / Q000000981:diagnostic imaging* / Q000473:pathology; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000473:pathology*; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000473:pathology; D012039:Regional Blood Flow; D012307:Risk Factors; D059289:Vascular Stiffness; D014664:Vasodilation
keywords: atherosclerosis; endothelial function; peripheral artery disease; vasodilation
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