Anatomical Distribution Patterns of Peripheral Arterial Disease in the Upper Extremities According to Patient Characteristics: A Retrospective Cohort Study

Abdulaziz Mohammad Al-Sharydah; Khaled Saud AlZahrani; Ibrahim Abobaker Alghanimi; Maha Mukhlef AlAnazi; Razan Essam AlHarbi

doi:10.2147/VHRM.S440408

Anatomical Distribution Patterns of Peripheral Arterial Disease in the Upper Extremities According to Patient Characteristics: A Retrospective Cohort Study

Vasc Health Risk Manag. 2023 Dec 29:19:871-883. doi: 10.2147/VHRM.S440408. eCollection 2023.

Authors

Abdulaziz Mohammad Al-Sharydah¹, Khaled Saud AlZahrani², Ibrahim Abobaker Alghanimi¹, Maha Mukhlef AlAnazi¹, Razan Essam AlHarbi¹

Affiliations

¹ Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar City, Eastern Province, Saudi Arabia.
² Radiology Department, King Fahad General Hospital-Jeddah, Ministry of Health, Al Andalus, Jeddah, 23325, Saudi Arabia.

Abstract

Purpose: Peripheral arterial disease (PAD) greatly affects the patients' quality of life. We aimed to investigate the affected anatomical sites and distribution patterns in upper extremity PAD using computed tomography angiography (CTA). Furthermore, we sought to identify the correlations between patient characteristics and the identified patterns.

Patients and methods: This was a retrospective chart review of upper limb CTA findings from patients with symptomatic PAD aged >18 years. Significant variables from univariate logistic regression analysis were further tested using multivariate logistic regression analysis. Statistical significance was set at p < 0.05, with confidence intervals of 95%.

Results: The mean age of the 102 included patients with upper extremity PAD was 55.45 years. Laterality analysis revealed that the upper left limb segments were more affected than the upper right limb segments (42 vs 63; left-to-right ratio, 3:2). The forearm was the segment most affected by stenotic PAD (62 segments, 3.37%). The arm was the segment most affected by occlusive PAD (14 segments, 0.76%). Diabetes mellitus (DM) and hypertension (HTN) were significant predictors of PAD (p = 0.046). In patients with DM, the occlusive form of PAD was dominant in the arm (18.18%); however, the stenotic form prevailed in the forearm (72.72%). In patients with HTN, the occlusive form of PAD was predominant in the arm (45.45%); however, the stenotic form tended to occur in the arm and forearm (90.90%).

Conclusion: The distribution patterns of upper extremity PAD are linked to its underlying pathophysiology. HTN and DM are the most frequent comorbidities in patients with upper extremity PAD. Angiographically, PAD in these patients is likely to present as stenosis rather than as occlusion. This is vital for interventionists who deviate from radial arterial access in patients with PAD. Therefore, targeted screening standards are required, and further studies on PAD are warranted.

Keywords: angiography; computed tomography; diabetes mellitus; hypertension; stenosis.

MeSH terms

Angiography / methods
Constriction, Pathologic
Diabetes Mellitus*
Humans
Lower Extremity
Middle Aged
Peripheral Arterial Disease* / diagnostic imaging
Peripheral Arterial Disease* / epidemiology
Quality of Life
Retrospective Studies
Risk Factors
Upper Extremity

Grants and funding

This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.