Factors Affecting the Thrombolytic-Treatment-Related Outcomes in Patients with Acute Lower Limb Ischaemia

Akuutti alaraajaiskemia (AAI) on tilanne, joka vaati kiireellistä tai välitöntä kirurgista tai suonensisäistä hoitoa, ja on yhteydessä lisääntyneeseen amputaatio- ja kuoleman riskiin. AAI:n etiopatogeneesi on muuttunut viime vuosikymmenien aikana. Nykyään suurin osa iskemiasta johtuu ateroskleroosin aiheuttamista valtimoahtaumista. Viimeaikaiset tutkimukset ovat osoittaneet, että bakteeritulehdus saattaa vaikuttaa tromboosiin, varsinkin potilailla, joilla on ateroskleroottisia muutoksia. AAI-potilaat ovat usein iäkkäitä ja monisairaita, jolloin liuotushoitoa pidetään hyvänä vaihtoehtona avokirurgialle. Siitä huolimatta katetriohjattu trombolyysi saattaa epäonnistua, ja tämä voi liittyä lisääntyneisiin amputaatioihin. Onnistuneenkin liuotushoidon jälkeen joillekin potilaille kehittyy uusintaiskemia, johon liittyy uusintatoimenpiteitä. Hoidon pitkäaikaistulokset AAI-potilailla jäävät usein epäselviksi. Väitöstutkimuksen aiheena oli selvittää AAI:n taustatekijöitä mukaan lukien uusia etiologisia tekijöitä, hoidon pitkäaikaistuloksia ja niihin vaikuttavia tekijöitä. Tutkimuksen retrospektiivisissa töissä aineistona käytettiin Tampereen ja Turun yliopistollisissa sairaaloissa hoidettujen potilaiden tietoja. Prospektiivisessa osiossa kerättiin AAI-potilaiden trombiaspiraatteja bakteeri-DNA:n tunnistamiseksi. Yhteensä 303 AAI-tapausta (159 miestä [52,5 %]) rekisteröitiin tutkimuksiin. Potilaiden keski-ikä oli 71 vuotta. Lähes 60 % natiivivaltimoista ja 75 % ohitteista olivat bakteeri-DNA-positiivisia. Synteettiset ohitteet olivat positiivisia lähes 80 %:lla potilaista. Kaikista positiivisista valtimonäytteistä 90 % sisälsi Streptococus mitis ryhmän DNA:ta. Trombolyysillä hoidetuilla potilailla varhainen hoidon epäonnistuminen oli todettavissa 23 %:ssa tapauksista. Hyperkolesterolemia, aikaisempi ohituskirurgia ja hoidon aloituksen viivästyminen liittyivät itsenäisinä tekijöinä epäonnistumiseen, joka oli yhteydessä melkein 40 %:n amputaatioriskiin ensimmäisen kuukauden kuluessa. Uusintaiskemia ilmaantui melkein 43 %:lle potilaista 40 kk:n mediaaniseurannan aikana. Ohitteiden uusintatukoksia esiintyi merkitsevästi useammin natiivivaltimotapahtumiin verrattuna. Asianmukaisen verenohennus- tai antiaggregatorisen lääkityksen puute sekä säärivaltimoiden ulosvirtauksen heikkous ennustivat itsenäisesti uusintaiskemian kehittymistä. Yhden vuoden kohdalla lähes 80 % potilaista oli elossa. Primaarinen aukipysyvyys natiivivaltimoissa oli 87 %. Ohitteiden aukipysyvyys tällä ajankohdalla oli 31 %–62 %. Amputaatiovapaa elossaolo oli 66 %. Pitkäaikaistulokset olivat epäsuotuisia. Kymmenen vuoden kohdalla noin 30 % potilaista oli elossa. Eteisvärinä ja korkea ikä (yli 83 vuotta) ennustivat itsenäisesti huonoa eloonjäämistä. Primaarinen aukipysyvyys oli natiivivaltimoissa 18,7 % ja ohitteissa 15,2 %. Yli 75 vuoden ikä vaikutti itsenäisesti amputaatiovapaaseen elossaoloon ollen 24 % kymmenen vuoden kohdalla. Huolimatta siitä, että bakteereiden DNA:ta löydettiin trombiaspiraateista, tietoon täytyisi suhtautua varovaisesti, sillä syy-yhteyksien osoittaminen vaatii lisätutkimuksia. Katetriohjatun trombolyysin tulokset lyhyellä aikavälillä ovat pitkäaikaistuloksia paremmat. Uusintatapahtumat ovat yleisiä, ja pitkäaikaisennuste on epäsuotuisa. Vain osaan hoidon tuloksiin vaikuttavista tekijöistä voidaan vaikuttaa. Nämä tekijät tulisi huomioida sekä kliinisessä työssä että tulevissa tutkimuksissa.Acute lower limb ischaemia (ALLI) is a condition that often requires urgent or emergent surgical or endovascular treatment. This disorder is associated with major amputations and mortality. The aetiopathogenesis of ALLI has changed within the last decades. Currently, it mainly presents with atherosclerosis-associated thrombotic occlusions. An increasing volume of data has been published in favour of a possible bacterial inflammation that can contribute to the pathogenesis of thrombotic events, particularly in patients with atherosclerotic changes. The patients who present with ALLI are often elderly individuals with multiple comorbidities. Therefore, mini-invasive treatment modalities are preferred. Nonetheless, catheter-directed thrombolysis occasionally fails and leads to amputations. Even after successful fibrinolysis, some patients develop recurrent ischaemia and require new interventions. The aim of this work was to study the possible aetiological issues related to ALLI from the viewpoint of bacterial deoxyribonucleic acid (DNA) presence in the thrombi. Further aims were to evaluate possible reasons behind thrombolytic treatment failure and recurrent ALLI, and to assess the long-term outcome of thrombolytic treatment. The thrombus aspirates were obtained aseptically and examined for the presence of bacterial DNA with a quantitative polymerase chain reaction from September 2014 to October 2016. A retrospective analysis of the ALLI patients treated at Tampere and Turku University Hospitals from January 2002 to December 2015 was performed to address the other aforementioned questions. A total of 303 cases of ALLI (159 men [52.5%]) were registered in the studies. The mean age of the patients was 71 years. A total of 58% of the native arterial and 75% of the bypass graft thrombi were identified as positive for bacterial DNA. Synthetic graft thrombi demonstrated positivity for bacterial DNA in 77.8% of the cases. Of the positive samples, 90% contained the Streptococcus mitis group DNA. In patients managed with thrombolysis, an early treatment failure occurred in 23%. A delay in treatment initiation increased the risk of failure by 5% per day. Hyperlipidaemia and previous bypass grafting were also independently associated with failure. This resulted in an almost 40% risk of major amputations within the first month. Nearly 43% of the patients developed recurrent ischaemia within a median of 40 months. Bypass graft reocclusions were predominant (65%). The absence of appropriate antiplatelet or anticoagulant treatment in native arteries and worsened tibial runoff in bypass grafts were independently associated with the risk of recurrent ALLI. At one year, almost 80% of the patients were alive. The primary patency rate at this point for native arteries was 87%. The primary patency rates for bypass grafts ranged from 31% to 62%, with the lowest rates found in autologous vein grafts. The amputation-free survival rate was 66%. The long-term outcomes were unfavourable. At five and ten years, 56% and approximately 30% of the patients, respectively, were alive. The survival was independently associated with the presence of atrial fibrillation and an age of over 83 years. The 10-year primary patency rates for native arteries and conduits were 18.7% and 15.2%, respectively. The amputation- free survival was independently affected by an age of over 75 years and represented a rate of 24% at 10 years. The information on the presence of bacterial DNA in the thrombi must be interpreted with caution. Additional studies are needed to establish whether these findings are involved in the actual thrombotic process. The short-term post-thrombolytic outcomes are superior to the long-term outcomes, which are poor. Recurrent ischaemia is frequent and affects the results. Both modifiable and non-modifiable factors have an impact on the treatment outcome. They should be taken into consideration in the clinical work and further investigations

The Cardiovascular-Mortality-Based Estimate for Normal Range of the Ankle–Brachial Index (ABI)

Background: The ankle–brachial index (ABI) is a first-line examination in cardiovascular risk evaluation. Since cut-off values for normal ABI vary, the aim of the present study was to identify the cardiovascular-mortality-based estimate for the normal range of the ABI. After determining the reference range for the ABI, the corresponding toe–brachial index (TBI) and toe pressure for normal ABI were analyzed. Methods: All consecutive non-invasive pressure measurements in the vascular laboratory of a large university hospital 2011–2013 inclusive were collected and combined with patient characteristics and official dates and causes of death. Patients with an ABI range of 0.8–1.4 on both lower limbs were included in this study. Results: From 2751 patients, 868 had bilateral ABI values within the inclusion. Both ABI category ranges 0.80–0.89 and 0.90–0.99 had poorer survival compared to ABI categories 1.00–1.29 (p < 0.05). The 1-, 3-, and 5-year cardiovascular-death-free survival for respective ABI categories 0.80–0.99 vs. 1.00–1.29 were 90% vs. 96%, 84% vs. 92%, and 60% vs. 87%. The 1-, 3-, and 5-year overall survival for ABI categories 0.80–0.99 vs. 1.00–1.29 were 85% vs. 92%, 75% vs. 83%, and 42% vs. 74%. Conclusions: Borderline ABI (0.90–0.99) associates with higher overall and cardiovascular mortality compared to ABI values 1.00–1.29

The Cardiovascular-Mortality-Based Estimate for Normal Range of the Ankle–Brachial Index (ABI)

Background: The ankle–brachial index (ABI) is a first-line examination in cardiovascular risk evaluation. Since cut-off values for normal ABI vary, the aim of the present study was to identify the cardiovascular-mortality-based estimate for the normal range of the ABI. After determining the reference range for the ABI, the corresponding toe–brachial index (TBI) and toe pressure for normal ABI were analyzed. Methods: All consecutive non-invasive pressure measurements in the vascular laboratory of a large university hospital 2011–2013 inclusive were collected and combined with patient characteristics and official dates and causes of death. Patients with an ABI range of 0.8–1.4 on both lower limbs were included in this study. Results: From 2751 patients, 868 had bilateral ABI values within the inclusion. Both ABI category ranges 0.80–0.89 and 0.90–0.99 had poorer survival compared to ABI categories 1.00–1.29 (p < 0.05). The 1-, 3-, and 5-year cardiovascular-death-free survival for respective ABI categories 0.80–0.99 vs. 1.00–1.29 were 90% vs. 96%, 84% vs. 92%, and 60% vs. 87%. The 1-, 3-, and 5-year overall survival for ABI categories 0.80–0.99 vs. 1.00–1.29 were 85% vs. 92%, 75% vs. 83%, and 42% vs. 74%. Conclusions: Borderline ABI (0.90–0.99) associates with higher overall and cardiovascular mortality compared to ABI values 1.00–1.29

The Cardiovascular-Mortality-Based Estimate for Normal Range of the Ankle-Brachial Index (ABI)

Background: The ankle-brachial index (ABI) is a first-line examination in cardiovascular risk evaluation. Since cut-off values for normal ABI vary, the aim of the present study was to identify the cardiovascular-mortality-based estimate for the normal range of the ABI. After determining the reference range for the ABI, the corresponding toe-brachial index (TBI) and toe pressure for normal ABI were analyzed. Methods: All consecutive non-invasive pressure measurements in the vascular laboratory of a large university hospital 2011-2013 inclusive were collected and combined with patient characteristics and official dates and causes of death. Patients with an ABI range of 0.8-1.4 on both lower limbs were included in this study. Results: From 2751 patients, 868 had bilateral ABI values within the inclusion. Both ABI category ranges 0.80-0.89 and 0.90-0.99 had poorer survival compared to ABI categories 1.00-1.29 (p < 0.05). The 1-, 3-, and 5-year cardiovascular-death-free survival for respective ABI categories 0.80-0.99 vs. 1.00-1.29 were 90% vs. 96%, 84% vs. 92%, and 60% vs. 87%. The 1-, 3-, and 5-year overall survival for ABI categories 0.80-0.99 vs. 1.00-1.29 were 85% vs. 92%, 75% vs. 83%, and 42% vs. 74%. Conclusions: Borderline ABI (0.90-0.99) associates with higher overall and cardiovascular mortality compared to ABI values 1.00-1.29.Peer reviewe

The Cardiovascular-Mortality-Based Estimate for Normal Range of the Ankle-Brachial Index (ABI)

Background: The ankle-brachial index (ABI) is a first-line examination in cardiovascular risk evaluation. Since cut-off values for normal ABI vary, the aim of the present study was to identify the cardiovascular-mortality-based estimate for the normal range of the ABI. After determining the reference range for the ABI, the corresponding toe-brachial index (TBI) and toe pressure for normal ABI were analyzed. Methods: All consecutive non-invasive pressure measurements in the vascular laboratory of a large university hospital 2011-2013 inclusive were collected and combined with patient characteristics and official dates and causes of death. Patients with an ABI range of 0.8-1.4 on both lower limbs were included in this study. Results: From 2751 patients, 868 had bilateral ABI values within the inclusion. Both ABI category ranges 0.80-0.89 and 0.90-0.99 had poorer survival compared to ABI categories 1.00-1.29 (p < 0.05). The 1-, 3-, and 5-year cardiovascular-death-free survival for respective ABI categories 0.80-0.99 vs. 1.00-1.29 were 90% vs. 96%, 84% vs. 92%, and 60% vs. 87%. The 1-, 3-, and 5-year overall survival for ABI categories 0.80-0.99 vs. 1.00-1.29 were 85% vs. 92%, 75% vs. 83%, and 42% vs. 74%. Conclusions: Borderline ABI (0.90-0.99) associates with higher overall and cardiovascular mortality compared to ABI values 1.00-1.29

The effect of percutaneous transluminal angioplasty of superficial femoral artery on pulse wave features

We aimed to analyze the effects of percutaneous transluminal angioplasty (PTA) of the superficial femoral artery (SFA) on arterial pulse waves (PWs). Altogether 24 subjects i.e. 48 lower limbs were examined including 26 treated lower limbs having abnormal ankle-to-brachial pressure index (ABI) (ABI1.3) and 22 non-treated lower limbs. The measurements were conducted in pre-, peri- and post-treatment phases as well as in follow-up visit after 1 month. Both ABI and toe pressures measured by standard equipment were used as reference values. PW-derived parameters include ratios of different peaks of the PW and time differences between them as well as aging index. Both treated and non-treated limbs were compared in pre- and post-treatment as well as follow-up visit conditions. The results were evaluated in terms of statistical tests, Bland-Altman-plots, free-marginal multirater κ-analysis and multiple linear regression analysis. PTA was found to cause small changes to the studied PW-derived parameters of the treated limb which were observed immediately after the treatment, but the changes were more pronounced in the follow-up visit. In addition, we observed that the endovascular instrumentation itself does not cause significant changes to the PW-derived parameters. The results show that PW-analysis could be a useful tool for monitoring the treatment-effect of the PTA. However, because the pre-treatment differences of the treated and non-treated limb were small, further studies with subjects having no arterial diseases are required. The study demonstrates the potential of the PW analysis in monitoring vascular abnormalities.acceptedVersionPeer reviewe

Factors Affecting the Thrombolytic-Treatment-Related Outcomes in Patients with Acute Lower Limb Ischaemia

Akuutti alaraajaiskemia (AAI) on tilanne, joka vaati kiireellistä tai välitöntä kirurgista tai suonensisäistä hoitoa, ja on yhteydessä lisääntyneeseen amputaatio- ja kuoleman riskiin. AAI:n etiopatogeneesi on muuttunut viime vuosikymmenien aikana. Nykyään suurin osa iskemiasta johtuu ateroskleroosin aiheuttamista valtimoahtaumista. Viimeaikaiset tutkimukset ovat osoittaneet, että bakteeritulehdus saattaa vaikuttaa tromboosiin, varsinkin potilailla, joilla on ateroskleroottisia muutoksia. AAI-potilaat ovat usein iäkkäitä ja monisairaita, jolloin liuotushoitoa pidetään hyvänä vaihtoehtona avokirurgialle. Siitä huolimatta katetriohjattu trombolyysi saattaa epäonnistua, ja tämä voi liittyä lisääntyneisiin amputaatioihin. Onnistuneenkin liuotushoidon jälkeen joillekin potilaille kehittyy uusintaiskemia, johon liittyy uusintatoimenpiteitä. Hoidon pitkäaikaistulokset AAI-potilailla jäävät usein epäselviksi. Väitöstutkimuksen aiheena oli selvittää AAI:n taustatekijöitä mukaan lukien uusia etiologisia tekijöitä, hoidon pitkäaikaistuloksia ja niihin vaikuttavia tekijöitä. Tutkimuksen retrospektiivisissa töissä aineistona käytettiin Tampereen ja Turun yliopistollisissa sairaaloissa hoidettujen potilaiden tietoja. Prospektiivisessa osiossa kerättiin AAI-potilaiden trombiaspiraatteja bakteeri-DNA:n tunnistamiseksi. Yhteensä 303 AAI-tapausta (159 miestä [52,5 %]) rekisteröitiin tutkimuksiin. Potilaiden keski-ikä oli 71 vuotta. Lähes 60 % natiivivaltimoista ja 75 % ohitteista olivat bakteeri-DNA-positiivisia. Synteettiset ohitteet olivat positiivisia lähes 80 %:lla potilaista. Kaikista positiivisista valtimonäytteistä 90 % sisälsi Streptococus mitis ryhmän DNA:ta. Trombolyysillä hoidetuilla potilailla varhainen hoidon epäonnistuminen oli todettavissa 23 %:ssa tapauksista. Hyperkolesterolemia, aikaisempi ohituskirurgia ja hoidon aloituksen viivästyminen liittyivät itsenäisinä tekijöinä epäonnistumiseen, joka oli yhteydessä melkein 40 %:n amputaatioriskiin ensimmäisen kuukauden kuluessa. Uusintaiskemia ilmaantui melkein 43 %:lle potilaista 40 kk:n mediaaniseurannan aikana. Ohitteiden uusintatukoksia esiintyi merkitsevästi useammin natiivivaltimotapahtumiin verrattuna. Asianmukaisen verenohennus- tai antiaggregatorisen lääkityksen puute sekä säärivaltimoiden ulosvirtauksen heikkous ennustivat itsenäisesti uusintaiskemian kehittymistä. Yhden vuoden kohdalla lähes 80 % potilaista oli elossa. Primaarinen aukipysyvyys natiivivaltimoissa oli 87 %. Ohitteiden aukipysyvyys tällä ajankohdalla oli 31 %–62 %. Amputaatiovapaa elossaolo oli 66 %. Pitkäaikaistulokset olivat epäsuotuisia. Kymmenen vuoden kohdalla noin 30 % potilaista oli elossa. Eteisvärinä ja korkea ikä (yli 83 vuotta) ennustivat itsenäisesti huonoa eloonjäämistä. Primaarinen aukipysyvyys oli natiivivaltimoissa 18,7 % ja ohitteissa 15,2 %. Yli 75 vuoden ikä vaikutti itsenäisesti amputaatiovapaaseen elossaoloon ollen 24 % kymmenen vuoden kohdalla. Huolimatta siitä, että bakteereiden DNA:ta löydettiin trombiaspiraateista, tietoon täytyisi suhtautua varovaisesti, sillä syy-yhteyksien osoittaminen vaatii lisätutkimuksia. Katetriohjatun trombolyysin tulokset lyhyellä aikavälillä ovat pitkäaikaistuloksia paremmat. Uusintatapahtumat ovat yleisiä, ja pitkäaikaisennuste on epäsuotuisa. Vain osaan hoidon tuloksiin vaikuttavista tekijöistä voidaan vaikuttaa. Nämä tekijät tulisi huomioida sekä kliinisessä työssä että tulevissa tutkimuksissa.Acute lower limb ischaemia (ALLI) is a condition that often requires urgent or emergent surgical or endovascular treatment. This disorder is associated with major amputations and mortality. The aetiopathogenesis of ALLI has changed within the last decades. Currently, it mainly presents with atherosclerosis-associated thrombotic occlusions. An increasing volume of data has been published in favour of a possible bacterial inflammation that can contribute to the pathogenesis of thrombotic events, particularly in patients with atherosclerotic changes. The patients who present with ALLI are often elderly individuals with multiple comorbidities. Therefore, mini-invasive treatment modalities are preferred. Nonetheless, catheter-directed thrombolysis occasionally fails and leads to amputations. Even after successful fibrinolysis, some patients develop recurrent ischaemia and require new interventions. The aim of this work was to study the possible aetiological issues related to ALLI from the viewpoint of bacterial deoxyribonucleic acid (DNA) presence in the thrombi. Further aims were to evaluate possible reasons behind thrombolytic treatment failure and recurrent ALLI, and to assess the long-term outcome of thrombolytic treatment. The thrombus aspirates were obtained aseptically and examined for the presence of bacterial DNA with a quantitative polymerase chain reaction from September 2014 to October 2016. A retrospective analysis of the ALLI patients treated at Tampere and Turku University Hospitals from January 2002 to December 2015 was performed to address the other aforementioned questions. A total of 303 cases of ALLI (159 men [52.5%]) were registered in the studies. The mean age of the patients was 71 years. A total of 58% of the native arterial and 75% of the bypass graft thrombi were identified as positive for bacterial DNA. Synthetic graft thrombi demonstrated positivity for bacterial DNA in 77.8% of the cases. Of the positive samples, 90% contained the Streptococcus mitis group DNA. In patients managed with thrombolysis, an early treatment failure occurred in 23%. A delay in treatment initiation increased the risk of failure by 5% per day. Hyperlipidaemia and previous bypass grafting were also independently associated with failure. This resulted in an almost 40% risk of major amputations within the first month. Nearly 43% of the patients developed recurrent ischaemia within a median of 40 months. Bypass graft reocclusions were predominant (65%). The absence of appropriate antiplatelet or anticoagulant treatment in native arteries and worsened tibial runoff in bypass grafts were independently associated with the risk of recurrent ALLI. At one year, almost 80% of the patients were alive. The primary patency rate at this point for native arteries was 87%. The primary patency rates for bypass grafts ranged from 31% to 62%, with the lowest rates found in autologous vein grafts. The amputation-free survival rate was 66%. The long-term outcomes were unfavourable. At five and ten years, 56% and approximately 30% of the patients, respectively, were alive. The survival was independently associated with the presence of atrial fibrillation and an age of over 83 years. The 10-year primary patency rates for native arteries and conduits were 18.7% and 15.2%, respectively. The amputation- free survival was independently affected by an age of over 75 years and represented a rate of 24% at 10 years. The information on the presence of bacterial DNA in the thrombi must be interpreted with caution. Additional studies are needed to establish whether these findings are involved in the actual thrombotic process. The short-term post-thrombolytic outcomes are superior to the long-term outcomes, which are poor. Recurrent ischaemia is frequent and affects the results. Both modifiable and non-modifiable factors have an impact on the treatment outcome. They should be taken into consideration in the clinical work and further investigations

What We Know From Reports on Type III Endoleak in the Literature

Objective: To analyse case reports published on the latest generations of endograft (EG) and understand the mechanisms of type III endoleak (EL) development. Methods: A literature review was undertaken of English language case reports and series that concerned modular junction or component disconnection (type IIIa EL) and fabric perforations (type IIIb EL) after endovascular aneurysm repair. Results: Of the 2 785 studies, 56 full texts were chosen to review 73 cases. Type III EL was diagnosed with computed tomography angiography in 67.1% and digital subtraction angiography in 12.3%; the rest were identified during surgery. Of the 73 EG, 65 (89.0%) were made of polyethylene terephthalate and seven (9.6%) were polytetrafluoroethylene. The type of material was not mentioned in one (1.4%) case report. There were 25 (34.2%) type IIIa and 48 (65.8%) type IIIb EL. The most frequent were trunk–trunk in nine (12.3%) and trunk–limb overlap separations in 14 (19.2%). Type IIIb EL in the trunk area was identified in 27 (37.0%) cases, while 21 (28.8%) defects were found in the limbs. Stent fractures were recognised as an underlying mechanism of type IIIb EL development in one report. A combination of fabric lesions in the trunk and limb area was found in one case. Seven type IIIb EL were related to suture disruption or suture–fabric abrasions. Four cases were related to stent–fabric abrasions, and two developed as a result of fabric fatigue owing to kinking. Information on the mechanisms of degradation was only occasionally and scarcely presented. Given the small number of reports and lack of detailed analysis, no definitive conclusions could be drawn. Conclusion: The available information is scarce and does not allow any definitive conclusions to be drawn on the mechanisms that lead to the development of type III EL. Further explant analyses would be beneficial

Risk of Symptomatic Venous Thromboembolism After Abdominal Aortic Aneurysm Repair in Long-Term Follow-Up of 1021 Consecutive Patients

acceptedVersionPeer reviewe

Lower limb pulse rise time as a marker of peripheral arterial disease

Abstract Objective: The aim of the study was to show if pulse rise times (PRTs) extracted from photoplethysmographic (PPG) pulse waves (PWs) have an association with peripheral arterial disease (PAD) or its endovascular treatment, percutanoeus transluminal angioplasty (PTA) of the superficial femoral artery. Methods: Lower and upper limb PPG PWs were recorded and analyzed from 24 patients who suffered from PAD. The measurements were conducted before and after the treatment, and one month later by using transmission-mode PPG-probes placed in the index finger and second toe. Ankle-to-brachial pressure index and toe pressures were used as references in clinical patient measurements. PRTs, i.e., the time from the foot point to the peak point of the PW, were extracted from the PWs and compared bilaterally. The results from the PAD patients were also compared with 31 same-aged and 34 younger control subjects. Results: Statistically significant differences were found between the pretreatment PRTs of the treated limb of the PAD patients and the same-aged control subjects (p &lt; 10⁻⁹, Mann–Whitney U-test). The changes in the PRT of the treated lower limb were observed immediately after the PTA (p &lt; 0.001, Student’s t -test), and after one month (p &lt; 0.0005), whereas the PRTs of the non-treated lower limb and upper limb did not indicate changes between different examinations. Conclusion: Results show that a PRT greater than 240 ms indicates PAD-lesions in the lower limb. Significance: This proof-of-concept study suggests that the PRT could be an effective and easy-to-use indicator for PAD and monitoring the effectiveness of its treatment