Duplex Ultrasonographic Studies on Peripheral Arterjes in Patients Having Coronary Artery Disease

Abstract

Coronary artery disease (CAD) is the disease of arteries inside the heart which supply blood to heart muscle. It is characterized by narrowing of lumen of artery due to deposition of lipid materials inside the arterial wall by a process called atherosclerosis. Atherosclerosis is a systemic disease and once the processes have been started it can affect any arteries of the human body. So, arteries other than coronary arteries may be involved by atherosclerotic process simultaneously with CAD. This study was designed to see the extent of involvement of peripheral arteries with coronary arteries involvement, to see the relation of PAD involvement with severity of CAD, to see the role of common risk factors in synchronous PAD and CAD patients, When peripheral arteries are involved by atherosclerotic process it is called peripheral Arterial disease (PAD). The study was conducted at Inpatient Unit of Cardiology Department of Rajshahi Medical College Hospital. Total 210 patients was included in the study who had definite evidence of CAD, proved by coronary angiogram. Duplex Ultrasonography was performed on both sided major carotid and major lower limb peripheral arteries of each patient to see Haemodynamic status any structural change. Both sided common carotid and internal carotid arteries, femoral arteries, Popliteal arteries anterior tibial arteries and posterior tibial arteries, total 12 segments of peripheral arteries of each patients were examined. Intima Media Thickness of both common carotid arteries and internal carotid arteries were measured. Evidence of plaques or any stenosis was assessed from B mode image and from spectral Doppler analysis by measuring the peak systolic velocity (PSV), end diastolic velocity (EDY), pulsatile index (PI) and resistance index (RI). Data regarding cardiovascular risk factors, physical examination of cardiovascular system, finding in echocardiography, coronary angiography, fasting lipid profile and Duplex ultrasound findings of peripheral arteries were collected. Total 43 (20.4 % ) patients were found having stenosis in peripheral arteries, among which 26 in carotid system, 15 in lower limbs and 2 in both carotid and lower limb arteries. Twenty seven had critical (>50%) stenosis with haemodynamic change and 16 had (<50%) non critical stenosis with no Haemodynamic change. The study revealed that most of the patient of PAD were asymptomatic and were diagnosed for the first time after enrollment in the study. Patients with synchronous PAD and CAD were found older, greater smoking history, were more likely to be diabetic, hypertensive, higher BMI and trend towards high total cholesterol and high serum triglyceride level. Carotid intima media thickness was found had a linear correlation with number of coronary vessels involvement and significantly associated with number of total PAD patient and carotid artery involvement.