Prevalence of Significant Asymptomatic Carotid Artery Disease in Patients with Peripheral Vascular Disease: A Meta-Analysis

Objectives: To determine the prevalence of asymptomatic carotid artery stenosis (ACAS) in patients with peripheral vascular disease (PVD). Methods: Literature search was carried out through Pubmed, Medline and Cochrane Library. Prospective studies published on prevalence of significant carotid stenosis in patients with PVD and used a duplex scan for screenings were included. Results: Nineteen studies with a total of 4573 patients were included. A prevalence of 28% (fixed effect model) and 25% (random effect model) was seen for >50% stenosis, and 14% (in both fixed and random effect models) for 70% stenosis. Significant statistical heterogeneity existed between studies (I-2 = 82.7%, >50% group) (I-2 = 77.5%, >70% group). Larger studies revealed a higher prevalence of carotid stenosis. Conclusion: High prevalence of ACAS exists in patients with PVD. A large multi centre prospective study may help to combat heterogeneity and identify subgroups of PVD patients with higher prevalence. Clinicians who believe in the benefits of carotid endarterectomy for asymptomatic carotid stenosis would gain a greater yield by targeting this group for routine screening rather than a healthy population. (C) 2008 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.