Relationship between ankle brachial index and arterial remodeling in pseudoxanthoma elasticum

Objectives: Pseudoxanthoma elasticum (PXE) is an inherited metabolic disease characterized by elastic fiber fragmentation and calcification in the cutaneous, ophthalmologic, and vascular tissues. Cardiovascular manifestations such as peripheral arterial disease (PAD) are frequent in PXE. Because of the changes in the elastic properties and medial calcification of the arterial wall in PXE, the impact of the arterial remodeling on the ankle brachial index (ABI), a well-established diagnostic method for the detection and follow-up of PAD, remains to be determined in this disease. Methods: This was a cross-sectional, comparative, open study, which took place at the ME Consultation Center, University Hospital of Angers. The subjects were 53 patients (mean age, 49 14 years; 35 females) with PXE clinically proven on the basis of established criteria (skin changes, angioid streaks, and skin biopsy). The ABI at rest, symptoms of intermittent claudication (IC), carotid intima-media thickness (IMT), carotid-femoral pulse wave velocity (c-f PWV), compliance (CC), and 13 stiffness index were measured in a single-center cohort. Results: Forty-five percent of the PXE patients had an ABI <= 0.90, but only one patient had an ART >1.40. IC was found in 23% of the patients with an ART <= 0.90. There were no significant differences between the patients with a low and normal ABI in terms of BIT (P = .566) or 13 stiffness index (P = .194), but differences were significant for c-f PWV (P = .010) and CC (P = .011). Adjusted multivariate linear regression for the Framingham-Laurier score showed that patients with a low ABI had less compliant carotid arteries (B = 0.318, P = .039). Conclusions: PAD detected by a low ART is very frequent in PXE, although with limited prevalence of symptomatic claudication. Unexpectedly, ART was low in such calcifying PAD and associated with lower CC, independently of atherosclerosis risk factors. These findings demonstrate that ME represents a unique monogenic model of PAD in which the specific arterial wall remodeling could change the diagnostic value of the ART to detect PAD. (J Vase Surg 2011;54: 1390-4.)