الفهرس 
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Abstract
Peripheral arterial disease (PAD) is a chronic progressive disorder that results from accumulation of atherosclerotic plaques in the walls of arterial tree especially those of the lower limb leading to gradual narrowing of their lumens with eventual obstruction& limb loss if not treated. (1)
Several factors have been implicated in that process. Along with traditional risk factors of atherosclerosis (DM, Dyslipidemia, Hypertension, CKD), other factors exist as elevated Fibrinogen, D-dimer, hyperhomocysteinemia, CRP…….etc.
Generally Uric Acid (UA) has been accused for the initiation& progression of atherosclerosis in various arterial segments. Moreover, it showed significant correlation with markers of peripheral arterial stiffness in multiple clinical trials. It is thought to accumulate in the arterial wall& induce inflammation& activation of Xanthine Oxidoreductase enzyme. (5)
Symptoms of PAD vary according to the site& degree of obstruction. In the lower limbs symptoms range from a symptomatic, exercise induced Intermittent Claudications(IC), Rest Pain to Critical Limb Ischemia (CLI), Ischemic Ulcers, Gangrene& Amputation. (3)
Carotid stenosis manifests as symptoms of Transient Ischemic Attacks (TIA), Stroke syndromes or a symptomatic silent infarction (33).
Diagnosis of PAD is usually non- invasive, it involves thorough clinical evaluation, provocative& screening tests.
ABI is the best screening test with a sensitivity that reaches 75%& specificity 86% for diagnosis of PAD (25).
So it is recommended by American Diabetes Association (ADA)& European Society of Cardiology (ESC) to be performed in a symptomatic people < 65 years of age, people >65 years who have high CV risk& people>50 years who have family history of PAD. Other screening tests include treadmill exercise test, Transcutaneous Oxygen Pressure measurement (TcPO2), Toe Brachial Index (TBI).
Imaging modalities as duplex ultrasound (DUS), MRA& CT angiography greatly help in diagnosis. Digital Subtraction Angiography (DSA) is the gold standard& the most accurate, but it is retained for interventional procedures after failure of pharmacological therapy.
CIMT has emerged as a marker of early stages of atherosclerosis since early 1990s. Increased thickness was associated with increased total CV risk in some trials (6), however that association was reported to be negligible by others (32). So it could be used as an end point to assess effects of drugs in interventional clinical trials.
Treatment includes addressing risk factors, antiplatelet therapy, vasoactive drugs& intervention either by endovascular techniques or surgical bypass. Newer modalities as angiogenesis is still under trial (43).
Our study aimed to evaluate the correlation between increased serum uric acid levels& PAD indicated by ABI& CIMT in patients diagnosed with PAD.
This study was carried on one hundred subjects visiting El Demerdash hospital during the period between September 2019& October 2020. The subjects were subdivided according to ABI into two groups
group I was the patients group, it included 50 patients diagnosed with PAD, had low ABI>0.9 they were recruited from vascular surgery department.
group II was the control group, it included 50 subjects who matched group I as regards age& sex, they had traditional CV risk factors but they were free from PAD symptoms& signs& had normal ABI≥0.9, they were recruited from outpatient clinics.
In the present study, the patients group were predominantly males, were older, had higher BMI& were smokers. They had significantly higher prevalence of DM, dyslipidemia& hyperuricemia & increased CIMT.
UA was significantly correlated to low ABI(P-value=0.003) regardless its levels. On the other hand CIMT showed non-significant correlation with UA(P-value=0.651), regardless UA levels although subjects in the highest UA tertiles showed higher values of CIMT.
UA showed significant correlation with PAD (OR=1.37, P-value=0.006), however after further adjustment for other risk factors that association became non- significant (OR=2,P-value=0.227). Higher BMI, DM& dyslipidemia showed the highest significant correlations.
In the present study we concluded that UA& CIMT were significantly higher among the patients group. High UA was significantly associated with low ABI among the patients group. UA showed non-significant correlation with increased CIMT. This denotes a probable relation between UA& lower limb atherosclerosis. These findings are consistent with most of the previous studies carried in this field.