PhD Defense: Peripheral artery disease. Evaluation of novel biomarkers and adverse events in unexplored subtypes

Peripheral arterial vascular disease (PAV) is a common disorder, but despite this, little is known about the outcomes of the disease within certain subgroups.

Our study shows that patients with non-revascularizable disease have an amputation-free survival of only 43%, largely characterized by mortality or amputation in the first year. Use of the Vascular Quality Initiative score for mortality can be used with reasonable accuracy in this population.
Another rare subgroup, patients with pseudoxanthoma elasticum, have a very elevated risk of PAD and this is manifested at an early age. Nevertheless, vascular interventions are often not necessary and the outcomes of these surgeries should not be the first choice of treatment because of a high risk of reinterventions.
The remainder of our research concerns biomarkers that may predict adverse outcomes. When we compare a palette of biomarkers derived from extracellular vesicles (EV) with the same biomarkers derived from blood plasma, the correlation is very broad and thus there are both similarities and differences between the sources (depending on the biomarker). This could indicate that pathophysiological processes are represented differently by source, and thus have different predictive properties. In patients who underwent femoral endarterectomy, both CD14 and serpinG in EV are associated with limb-related outcomes as well as other cardiovascular outcomes, including myocardial infarction or cerebral infarction. Adding these biomarkers to existing risk models leads to an improvement. Finally, serum lipoprotein(a) appears to be associated with limb-related outcomes in this group of patients, but not with other cardiovascular outcomes such as myocardial infarction or cerebral infarction.