Peripheral artery disease and the risk of venous thromboembolism

Daniel Sykora, Christine Firth, Marlene Girardo, Shubhang Bhatt, Andrew Tseng, Alanna Chamberlain, David Liedl, Paul Wennberg, Fadi Elias Shamoun

Research output: Contribution to journalArticlepeer-review


Background: Peripheral artery disease (PAD) impacts 3-12% of patients worldwide and is characterized by endothelial dysfunction and inflammatory pathways which are also common to venous thromboembolism (VTE), but there is a paucity of evidence regarding VTE risk in PAD patients. We investigated whether PAD is an independent risk factor for VTE. Patients and methods: We reviewed medical records of patients undergoing ABI studies at Mayo Clinic from 01/1996-02/2020. We classified patients by ABI (low [<1.0], normal [1.0-1.4], or elevated [>1.4]), as well as by specific low ABI subgroup: severely reduced (ABI: 0.00-0.39), moderately reduced (0.40-0.69), mildly reduced (0.70-0.90), and borderline reduced (0.91-0.99). The primary outcome was incident VTE event (acute lower extremity deep vein thrombosis or pulmonary embolism) after ABI measurement. Multivariable Cox proportional regression was used to calculate hazard ratios (HR) with 95% confidence intervals (CI) after adjusting for age, sex, active smoking, cancer, previous VTE, thrombophilia, anticoagulation, and revascularization. Results: 39,834 unique patients (mean age 66.3±14.3 years, median follow-up 34 months) were identified. 2,305 VTE events occurred in patients without PAD (13.0%), 2,218 in low ABI patients (13.0%), and 751 in elevated ABI patients (14.8%). After risk factor adjustment, VTE risk was modestly increased for PAD overall (HR: 1.12, 95% CI [1.06, 1.18]), including low ABI (HR: 1.11, 95% CI [1.04, 1.18]) and elevated ABI groups (HR: 1.15, 95% CI [1.04, 1.26]), compared to patients without PAD. The greatest VTE risk was in severely low ABI patients (HR: 1.46, 95% CI [1.31, 1.64]). Conclusions: In a large longitudinal cohort, we present strong clinical evidence of PAD, with low and elevated ABI, as an independent VTE risk factor, with the highest risk seen in patients with severely low ABI. Continued research is required to further investigate this relationship and its intersection with functional performance status to optimize VTE risk reduction or anticoagulation strategies in the PAD population.

Original languageEnglish (US)
Pages (from-to)365-371
Number of pages7
JournalVasa - European Journal of Vascular Medicine
Issue number6
StatePublished - Nov 2022


  • Peripheral artery disease
  • atherosclerosis
  • deep vein thrombosis
  • lower extremity artery disease
  • pulmonary embolism
  • venous thromboembolism

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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