Peripheral artery disease (PAD) causes increased all-cause and cardiovascular (CV)
mortality. These increases have been associated with abnormal ankle-brachial
indices and the extent of atherosclerotic lesions as measured by radiological imaging.
Reported associations of outcome in regard to systolic toe pressure (TP) are scarce,
and those associations in regard to lesion distribution have been ambiguous. This
thesis has two aims. First, to clarify the relationship of TP with outcome in patients
with symptomatic PAD. Second, to clarify the association of anatomical distribution
and extensiveness of angiographically detected lower extremity atherosclerotic
lesions with outcome in the same patients.

This thesis retrospectively reviews 887 patients whom underwent digital
subtraction angiography (DSA) for the following: peripheral pressure
measurements, DSA images and causes of death. Within a median 4.6 years followup,
almost half of the patients had died, and of these deaths 60% had been due to CV
causes. Angiographic lesion distribution, severity and TP were independently
associated with increased all-cause and CV mortality.

A predominantly or exclusively crural distribution of atherosclerotic lesions in
the lower extremities and widespread lesions in the crural arteries predicted
increased CV and all-cause mortality in symptomatic PAD patients undergoing
DSA. Estimated cumulative survival and freedom from CV death could be stratified
according to TP categories < 30 mmHg, 30–49 mmHg and ≥ 50 mmHg in the
affected lower extremity. TP < 30 mmHg was independently associated with
increased all-cause and CV mortality and decreased amputation-free survival.
Bilaterally low TP was associated with a particularly poor outcome.