Duplex screening for carotid artery stenosis in patients with peripheral arterial disease in Assiut University Hospital

Abstract EN

Introduction Carotid atherosclerosis is one of the several etiological factors for stroke and is considered an important health problem with a high burden of disease in the western world and in developing countries.

Aim This study is aimed at investigating the prevalence of asymptomatic carotid artery stenosis (ACAS) in patients with peripheral arterial disease (PAD) and identifying the predictive factors of ACAS in patients with PAD.

Patients and methods Between September 2016 and August 2017, 750 patients with PAD (Fontaine IIb–IV) underwent percutaneous transluminal angioplasty in the Department of Vascular Surgery.

Patients aged less than 50 years old and those who had a previous cerebrovascular event or carotid artery intervention were excluded (n = 105).

The remaining 645 patients underwent preoperative screening for ACAS using carotid duplex ultrasonography examination.

The degree of internal carotid artery (ICA) stenosis was determined by the criteria of Society of Radiologists in Ultrasound Consensus Conference.

Results We found that 302 (46.8%) patients had patent carotid arteries without any evidence of atherosclerotic plaque, whereas 343 (53.2%) patients had ACAS.

The prevalence of significant ICA stenosis (≥70% stenosis) was 2.8%.

ICA occlusion was detected in 0.6%.

Univariate analysis revealed that age older than 65 years (P = 0.013), male sex (P = 0.022), hypertension (P < 0.001), and ischemic heart disease (P = 0.016) are predictive factors of critical carotid artery stenosis, which is defined as peak systolic velocity more than 230 cm/s with diameter reduction of at least 50%.

Discussion and conclusion Patients with chronic lower extremity PAD with either ischemic rest pain or tissue loss (nonhealing ulcers or gangrene), which is defined as critical limb ischemia, and patients with disabling claudication who need revascularization, particularly, males older than 65 years, who have a concomitant hypertension and ischemic heart disease, can be good candidates for carotid screening with carotid duplex ultrasonography.