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Carotid and Lower Extremity Arterial Disease in Patients With Renal Artery Atherosclerosis
R. Eugene Zierler, MD;
Robert O. Bergelin, MS;
Nayak L. Polissar, PhD;
Kirk W. Beach, PhD, MD;
Michael T. Caps, MD;
Kim Cantwell-Gab, BSN, RVT, RDMS;
Robert C. Davidson, MD;
D. Eugene Strandness, Jr, MD
Arch Intern Med. 1998;158:761-767.
Background: Atherosclerotic lesions of the carotid and lower extremity arteries may be associated with renal artery stenosis and influence the management of patients with renal artery disease.
Objective To document the prevalence and clinical features of carotid and lower extremity arterial disease in patients with renal artery atherosclerosis.
Methods An analysis of baseline data on 149 patients enrolled in a prospective natural history study of atherosclerotic renal artery stenosis. Patients with at least 1 abnormal renal artery by duplex scanning were eligible. Carotid artery disease was evaluated by duplex scanning, and ankle/brachial indices were used to assess the lower extremity arteries. Disease at each of the 3 arterial sites was classified as mild, moderate, or severe based on the extent of involvement on both sides. Serum urea nitrogen, creatinine, and lipid levels were also measured.
Results Severe renal, carotid, or lower extremity arterial disease was present in 44%, 19%, and 21% of the patients, respectively. There was a trend for patients with increasing degrees of renal artery disease to have increasing degrees of carotid and lower extremity arterial disease. The prevalence of severe carotid artery disease increased from 7% in the mild renal artery group to 28% in the severe renal artery group. Clinical factors that were most predictive of severe disease were elevated apolipoprotein B levels for the renal arteries, high serum urea nitrogen or creatinine levels for the carotid arteries, and smoking for the lower extremity arteries.
Conclusions There was a strong association between severe renal artery atherosclerosis and severe carotid artery disease. Patients with renal artery disease also had a high prevalence of lower extremity arterial disease. In this patient population, screening for lower extremity arterial disease can be reserved for those with signs or symptoms of peripheral ischemia. Noninvasive carotid screening is justified in patients with renal artery disease to detect asymptomatic lesions that require either immediate surgical treatment or serial follow-up for disease progression.
From the Department of Surgery, Division of Vascular Surgery (Drs Zierler, Beach, Caps, and Strandness, Mr Bergelin, and Ms Cantwell-Gab), and the Department of Medicine, Division of Nephrology (Dr Davidson), University of Washington, and The Mountain-Whisper-Light Statistical Consulting (Dr Polissar), Seattle, Wash.
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