Perspectives on Lower Extremity Peripheral Artery Disease: A Qualitative Study of Early Diagnosis and Treatment and the Impact of Health Disparities

Trends in lower extremity peripheral arterial disease incidence since 1990 and forecasting future statistics using Global Burden of Disease 2021: a time-series analysis

Background

Lower extremity peripheral arterial disease (LEPAD) significantly affects quality of life and is associated with severe cardiovascular risks. Studies on its long-term incidence trends are limited.

Objective

This study aims to analyze global trends in LEPAD incidence from 1990 to 2021 using the Global Burden of Disease (GBD) 2021 database and to forecast future trends between 2022 and 2030, providing insights for healthcare planning and resource allocation.

Methods

Data were extracted from the GBD 2021 database by genders, age groups, continents, and sociodemographic index (SDI) levels. Using Joinpoint regression analysis, annual percentage changes (APC) and average annual percentage changes (AAPC) were calculated to assess age-standardized incidence rates (ASIR) historical trends. Autoregressive integrated moving average (ARIMA) model was applied to predict ASIR between 2022 and 2030.

Results

The global ASIR of LEPAD showed a slight decrease from 1990 to 2021, though regional differences were notable. In 2021, the highest ASIR was in the Americas, while Africa had the lowest. Gender and age disparities were significant, and females and older populations were at higher risk. ARIMA predictions indicate a stable ASIR trend from 2025 onward.

Conclusion

This study provides a comprehensive analysis of LEPAD incidence trends and a forecast through 2030. While global incidence may stabilize, the rising burden in lower-income countries calls for prioritizing early intervention and health education in high-risk regions. These findings emphasize the importance of targeted resource allocation and strategic prevention efforts.

NIR-II imaging-based detection of early changes in lower limb perfusion in type 2 diabetes patients without peripheral artery disease

AIMS

The formation of lower limb arterial plaques, exacerbated by type 2 diabetes (T2D), represents an early stage of lower limb peripheral artery disease (PAD). Second near-infrared region (NIR-II) imaging is an emerging technique with high sensitivity for detecting perfusion levels. This study explores the value of NIR-II imaging in identifying perfusion changes due to lower extremity arterial plaques in T2D patients without PAD.

METHODS

NIR-II imaging with indocyanine green (ICG) was conducted on 120 T2D patients, who were categorized into two groups: plaque and non-plaque. NIR-II parameters and clinical characteristics were analyzed between the two groups to identify significant predictors of lower extremity arterial plaques.

RESULTS

Six NIR-II imaging parameters (T start, T 1/2, Tmax, Ingress rate, Egress, and Egress rate) showed significant differences and diagnostic efficacy between the two groups. Three NIR-II parameters (T start, Egress, and Egress rate) and two clinical characteristics (age and sex) were identified as independent predictors of lower limb artery plaques. The nomogram showed that a combined model with NIR-II parameters and clinical characteristics exhibited higher diagnostic efficacy.

CONCLUSION

NIR-II imaging can effectively detect early perfusion changes in T2D patients, showing great potential for pre-diagnosis of individuals at high risk for PAD.

Emerging trends in nationwide mortality, limb loss, and resource utilization for critical limb ischemia in young adults

BACKGROUND/OBJECTIVES

Recent trends indicate a rise in the incidence of critical limb ischemia (CLI) among younger adults. This study examines trends in CLI hospitalization and outcomes among young adults with peripheral arterial disease (PAD) in the United States.

METHODS

Adult hospitalizations (18-40 years) for PAD/CLI were analyzed from the 2016-2020 nationwide inpatient sample database using ICD-10 codes. Rates were reported per 1000 PAD or 100,000 cardiovascular disease admissions. Outcomes included trends in mortality, major amputations, revascularization, length of hospital stay (LOS), and hospital costs (THC). We used the Jonckheere-Terpstra tests for trend analysis and adjusted costs to the 2020 dollar using the consumer price index.

RESULTS

Approximately 63,045 PAD and 20,455 CLI admissions were analyzed. The mean age of the CLI cohort was 32.7 ± 3 years. The majority (12,907; 63.1 %) were female and white (11,843; 57.9 %). Annual CLI rates showed an uptrend with 3265 hospitalizations (227 per 1000 PAD hospitalizations, 22.7 %) in 2016 to 4474 (252 per 1000 PAD hospitalizations, 25.2 %) in 2020 (Ptrend<0.001), along with an increase in PAD admissions from 14,405 (188 per 100,000, 0.19 %) in 2016 to 17,745 (232 per 100,000, 0.23 %%) in 2020 (Ptrend<0.0001). Annual in-hospital mortality increased from 570 (2.8 %) in 2016 to 803 (3.9 %) in 2020 (Ptrend = 0.001) while amputations increased from 1084 (33.2 %) in 2016 to 1995 (44.6 %) in 2020 (Ptrend<0.001). Mean LOS increased from 5.1 (SD 2.7) days in 2016 to 6.5 (SD 0.9) days in 2020 (Ptrend = 0.002). The mean THC for CLI increased from $50,873 to $69,262 in 2020 (Ptrend<0.001). The endovascular revascularization rates decreased from 11.5 % (525 cases) in 2016 to 10.7 % (635 cases) in 2020 (Ptrend = 0.025). Surgical revascularization rates also increased from 4.9 % (225 cases) in 2016 to 10.4 % (600 cases) in 2020 (Ptrend = 0.041).

CONCLUSION

Hospitalization and outcomes for CLI worsened among young adults during the study period. There is an urgent need to enhance surveillance for risk factors of PAD in this age group.