title: The extent of atherosclerotic lesions in crural arteries predicts survival of patients with lower limb peripheral artery disease: A new classification of crural atherosclerosis.
abstract: Several studies report correlation of ankle brachial index (ABI) values and mortality. However, no studies exist on the predictive value of anatomical distribution of atherosclerotic lesions and the extent of atherosclerosis at defined arterial segments on life expectancy. The aim of the present study was to evaluate the significance of both extent and localisation of atherosclerotic lesions to mid-term patient survival.
  
  
  
  Digital subtraction angiography (DSA) images of 887 consecutive patients admitted to the Department of Vascular Surgery at Turku University Hospital (Turku, Finland) were retrospectively analysed. Each angiography was classified according to the TASC II classification for aorto-iliac and femoro-popliteal segments, and a similar four-grade index was created for crural arteries. Patients were followed until 36-months post DSA.
  
  
  
  During 36-month follow-up 295 (33%) deaths occurred. Death during follow-up was strongly associated with extensive crural disease, but not with extensive proximal disease (Crural Index III-IV, p = 0.044 and < 0.001, respectively). In a Cox regression analysis incorporating baseline variables, Crural Index IV and most severe atherosclerosis on crural vessels were the strongest predictors of poor prognosis (HR 2.20 95% CI 1.3-3.7, p = 0.003 and HR 2.45 95% CI 1.5-4.0, p < 0.001 respectively).
  
  
  
  The extent of crural atherosclerosis is independently associated with poor mid term life expectancy. Therefore, a classification of the extent of crural atherosclerosis could serve as an indicator of mortality among PAD patients and aid in clinical decision making.
authors.affiliation: Department of Vascular Surgery, Turku University Hospital and University of Turku, Finland. Electronic address: juho.jalkanen@utu.fi.
authors.forename: Juho M
authors.initials: JM
authors.lastname: Jalkanen
authors.affiliation: Department of Vascular Surgery, Turku University Hospital and University of Turku, Finland. Electronic address: jan-erik.wickstrom@tyks.fi.
authors.forename: Jan-Erik
authors.initials: JE
authors.lastname: Wickström
authors.affiliation: Department of Vascular Surgery, University Hospital of Helsinki, Finland. Electronic address: maarit.venermo@hus.fi.
authors.forename: Maarit
authors.initials: M
authors.lastname: Venermo
authors.affiliation: Department of Vascular Surgery, Turku University Hospital and University of Turku, Finland. Electronic address: haheha@utu.fi.
authors.forename: Harri H
authors.initials: HH
authors.lastname: Hakovirta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D055109:Ankle Brachial Index; D050197:Atherosclerosis / Q000150:complications / Q000401:mortality*; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000150:complications / Q000401:mortality*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
keywords: Atherosclerosis; Imaging; Peripheral artery disease; Survival; TASC II classification