scholarly journals CT perfusion in peripheral arterial disease—hemodynamic differences before and after revascularisation

2021 ◽  
Author(s):  
Patrick Veit-Haibach ◽  
Martin W. Huellner ◽  
Martin Banyai ◽  
Sebastian Mafeld ◽  
Johannes Heverhagen ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Ct Perfusion ◽  
Arterial Disease ◽  
Lower Leg ◽  
Therapy Control ◽  
Non Invasive ◽  
Before And After ◽  
Invasive Method ◽  
The Mean ◽  
Peripheral Arterial

Abstract Objectives The purpose of this study was the assessment of volumetric CT perfusion (CTP) of the lower leg musculature in patients with symptomatic peripheral arterial disease (PAD) before and after interventional revascularisation. Methods Twenty-nine consecutive patients with symptomatic PAD of the lower extremities requiring interventional revascularisation were assessed prospectively. All patients underwent a CTP scan of the lower leg, and hemodynamic and angiographic assessment, before and after intervention. Ankle-brachial pressure index (ABI) was determined. CTP parameters were calculated with a perfusion software, acting on a no outflow assumption. A sequential two-compartment model was used. Differences in CTP parameters were assessed with non-parametric tests. Results The cohort consisted of 24 subjects with an occlusion, and five with a high-grade stenosis. The mean blood flow before/after (BFpre and BFpost, respectively) was 7.42 ± 2.66 and 10.95 ± 6.64 ml/100 ml*min−1. The mean blood volume before/after (BVpre and BVpost, respectively) was 0.71 ± 0.35 and 1.25 ± 1.07 ml/100 ml. BFpost and BVpost were significantly higher than BFpre and BVpre in the treated limb (p = 0.003 and 0.02, respectively), but not in the untreated limb (p = 0.641 and 0.719, respectively). Conclusions CTP seems feasible for assessing hemodynamic differences in calf muscles before and after revascularisation in patients with symptomatic PAD. We could show that CTP parameters BF and BV are significantly increased after revascularisation of the symptomatic limb. In the future, this quantitative method might serve as a non-invasive method for surveillance and therapy control of patients with peripheral arterial disease. Key Points • CTP imaging of the lower limb in patients with symptomatic PAD seems feasible for assessing hemodynamic differences before and after revascularisation in PAD patients. • This quantitative method might serve as a non-invasive method, for surveillance and therapy control of patients with PAD.

Markers of arterial stiffness in peripheral arterial disease

VASA ◽  
2015 ◽  
Vol 44 (5) ◽  
pp. 341-348 ◽  
Author(s):  
Marc Husmann ◽  
Vincenzo Jacomella ◽  
Christoph Thalhammer ◽  
Beatrice R. Amann-Vesti
Keyword(s):  
Arterial Stiffness ◽  
Peripheral Arterial Disease ◽  
Pulse Wave ◽  
Augmentation Index ◽  
Arterial Disease ◽  
Care Physician ◽  
Additional Information ◽  
Non Invasive ◽  
Assessment Techniques ◽  
Peripheral Arterial

Abstract. Increased arterial stiffness results from reduced elasticity of the arterial wall and is an independent predictor for cardiovascular risk. The gold standard for assessment of arterial stiffness is the carotid-femoral pulse wave velocity. Other parameters such as central aortic pulse pressure and aortic augmentation index are indirect, surrogate markers of arterial stiffness, but provide additional information on the characteristics of wave reflection. Peripheral arterial disease (PAD) is characterised by its association with systolic hypertension, increased arterial stiffness, disturbed wave reflexion and prognosis depending on ankle-brachial pressure index. This review summarises the physiology of pulse wave propagation and reflection and its changes due to aging and atherosclerosis. We discuss different non-invasive assessment techniques and highlight the importance of the understanding of arterial pulse wave analysis for each vascular specialist and primary care physician alike in the context of PAD.

scholarly journals The relation of anatomical distribution of symptomatic peripheral arterial disease (PAD) with HbA1c level in patients with type 2 diabetes mellitus

2021 ◽  
Vol 12 ◽  
pp. 204201882110005
Author(s):  
Nawaf J. Shatnawi ◽  
Nabil A. Al-Zoubi ◽  
Hassan M. Hawamdeh ◽  
Yousef S. Khader ◽  
Mowafeq Heis ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Peripheral Arterial Disease ◽  
Hba1c Level ◽  
Arterial Disease ◽  
Anatomical Distribution ◽  
The Mean ◽  
Peripheral Arterial

Aims: Increased level of glycated hemoglobin (HbA1c) is associated with an increased prevalence of peripheral arterial disease (PAD). This study aimed to assess the relationship between the anatomical distribution of symptomatic PAD lesions in patients with type 2 diabetes and HbA1c levels at the time of PAD diagnosis. Patients and methods: A retrospective study was conducted at King Abdullah University Hospital during the period August 2011 to December 2015. Consecutive patients with type 2 diabetes presented with symptomatic PAD confirmed by computed tomography-angiography (CTA) were included in this study. CTA images were reviewed. Relevant information including demographic data, PAD symptoms, comorbidities, HbA1c level, lipid profile, C-reactive protein and the mean platelets volume were retrieved from medical records. Results: A total of 332 patients with type 2 diabetes (255 males and 77 females) were included in this study. The mean HbA1c at the time of PAD diagnosis was 8.68% (±2.06%). The prevalence of hemodynamic relevant atherosclerotic lesions of the superficial femoral artery, popliteal artery, leg vessels, femoro-popliteal, and crural segments was significantly higher in patients with HbA1c >7.5% compared with patients with HbA1c ⩽7.5%. Conclusion: The anatomical distribution of symptomatic PAD in patients with type 2 diabetes mellitus differed significantly according to HbA1c level at the time of PAD diagnosis.

Non-Invasive Management of Peripheral Arterial Disease

2015 ◽  
Author(s):  
K. J. Williams ◽  
A. Babber ◽  
R. Ravikumar ◽  
A. H. Davies
Keyword(s):  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Non Invasive ◽  
Peripheral Arterial ◽  
Invasive Management

scholarly journals Quick Evaluation of Lower Leg Ischemia in Patients with Peripheral Arterial Disease by Time Maximum Intensity Projection CT Angiography: A Pilot Study

2020 ◽  
Author(s):  
Daming Zhang ◽  
Xueyan Zhou ◽  
Haiping Zhang ◽  
Xiaobing Fan ◽  
Zehong Lin ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Subjective Evaluation ◽  
Maximum Intensity Projection ◽  
Objective Evaluation ◽  
Arterial Disease ◽  
Lower Leg ◽  
Maximum Intensity ◽  
Ct Attenuation ◽  
Significant Difference ◽  
Peripheral Arterial

Abstract Background: The purpose of this study is to evaluate the new method of time maximum intensity projection (t-MIP) which was postprocessed from dynamic computed tomographic angiography (dyn-CTA) in diagnosing peripheral arterial disease (PAD). Methods: A population of 34 patients with known PAD was examined with a combined CTA protocol consisting of an s-CTA of the lower extremity and a dyn-CTA scan of the calves. For each lower leg, t-MIP images consisting of the MIP0 (sagittal MIP), and MIP+θ (45degree lateral MIP), MIP-θ (-45degree lateral MIP) were automatically generated from dyn-CTA. An objective evaluation of vascular CT attenuation of the best enhancement phase of dyn-CTA and t-MIP was measured; subjective evaluation of vessel stenosis and occlusion with a score was assigned for t-MIP and s-CTA. A comparison between the CT attenuation of t-MIP and dyn-CTA was made, so was the runoff score of t-MIP and s-CTA.Results: The CT attenuation of t-MIP CTA of three vascular segments from 68 lower extremities was higher than that of the best enhancement phase of dyn-CTA and s-CTA, with statistical significant difference at posterior tibial artery and fibular artery (all p＜0.05) . There were strong correlations (r ≥0.75, p < 0.05) of runoff scores between t-MIP and s-CTA. Conclusions: There is potential clinical application of t-MIP for assisting with the diagnosis of lower leg vascular stenosis in dyn-CTA with reliable diagnostic accuracy and convenient immediacy.

scholarly journals Molecular Imaging of Lower Extremity Peripheral Arterial Disease: An Emerging Field in Nuclear Medicine

2022 ◽  
Vol 8 ◽  
Author(s):  
Mitchel R. Stacy
Keyword(s):  
Nuclear Medicine ◽  
Molecular Imaging ◽  
Peripheral Arterial Disease ◽  
Lower Extremity ◽  
Lower Extremities ◽  
Arterial Disease ◽  
Diagnostic Tools ◽  
Non Invasive ◽  
Increased Risk ◽  
Peripheral Arterial

Peripheral arterial disease (PAD) is an atherosclerotic disorder of non-coronary arteries that is associated with vascular stenosis and/or occlusion. PAD affecting the lower extremities is characterized by a variety of health-related consequences, including lifestyle-limiting intermittent claudication, ulceration of the limbs and/or feet, increased risk for lower extremity amputation, and increased mortality. The diagnosis of lower extremity PAD is typically established by using non-invasive tests such as the ankle-brachial index, toe-brachial index, duplex ultrasound, and/or angiography imaging studies. While these common diagnostic tools provide hemodynamic and anatomical vascular assessments, the potential for non-invasive physiological assessment of the lower extremities has more recently emerged through the use of magnetic resonance- and nuclear medicine-based approaches, which can provide insight into the functional consequences of PAD-related limb ischemia. This perspectives article specifically highlights and discusses the emerging applications of clinical nuclear medicine techniques for molecular imaging investigations in the setting of lower extremity PAD.

scholarly journals Role of multidetector computed tomography angiography in evaluation of peripheral arterial disease

2020 ◽  
Vol 8 (7) ◽  
pp. 2437
Author(s):  
Rakesh Kumar ◽  
Anil Taneja
Keyword(s):  
Peripheral Arterial Disease ◽  
Color Doppler ◽  
Arterial Disease ◽  
Cross Sectional ◽  
Non Invasive ◽  
Wall Calcification ◽  
Peripheral Arterial ◽  
Infrapopliteal Arteries ◽  
Ct And Mri

Background: Diagnostic imaging plays an important role in the evaluation of peripheral arterial disease. Many imaging modalities are available ranging from conventional modalities to the cross-sectional modalities like Doppler ultrasound, DSA, CT and MRI. The main principles of imaging are to characterize the all lesions detected including type of plaques, no. of lesions, length of stenosis, diameter of vessel in pre-stenotic and post-stenotic segments, degree of wall calcification, assisting in pretreatment planning with respect to route of access, selection of balloon and demonstrates size, extent, neck dimention, and presence of thrombosis in cases with aneurysm.Methods: A Cross-sectional observational study was done in 30 patients. Clinically suspected patients of peripheral arterial disease based on history, sign and symptoms and patients diagnosed with peripheral arterial disease on color doppler were included in our study. Both modalities were compared for detecting the occlusion and stenotic segments.Results: A total of 476 vessel segments were imaged by both modalities. When all arterial segments were considered, MDCTA detected stenosis or occlusion lesions in 30% of arterial segments, versus 18.8% compared to DUS. MDCTA showed 9.8% (95% CI:[4.3%, 15.3%]) more lesions than DUS when all arterial segments were considered together, 11.2% (95% CI: [2.7%, 22.1%]) more lesions when only the iliac arteries were compared, 9.1% (95% CI: [3.2%, 17.2%]) more lesions when only the femoropopliteal arteries were compared, 8.9% (95% CI: [1.5%, 16.3%]) more lesions when only infrapopliteal arteries were compared and 13% (95% CI: [2.6%, 25.4%]) more lesions when only the upper limb arterial segments were compared, (p <0.05 for all comparisons).Conclusions: MDCTA may be used as a screening tool in patients with peripheral arterial disease as it is a non-invasive and more accurate modality when compared to DUS and plays important role in management.

scholarly journals Acupressure dan Senam Kaki terhadap Tingkat Peripheral Arterial Disease pada Klien DM Tipe 2

2020 ◽  
Vol 3 (2) ◽  
pp. 694-706
Author(s):  
Linda Widiastuti
Keyword(s):  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Smoking History ◽  
Test Results ◽  
Type 2 Dm ◽  
Before And After ◽  
Peripheral Arterial ◽  
Dm Type 2 ◽  
Difference Test

This study aims to determine the effect of acupressure intervention, foot gymnastics, and acupressure combination with foot gymnastics on the level of PAD in type 2 DM clients. The results showed that there was a significant relationship between age (p = 0,000), smoking history (p = 0,000), and duration of DM (p = 0.028) with the level of PAD. Paired difference test results found that there were significant differences in the level of PAD before and after the intervention in the acupressure group (p = 0,000), foot gymnastics (p = 0,000), and the combination of acupressure with foot gymnastics (p = 0,000). The results of the ordinal logistic regression test showed that the combination of acupressure with foot exercises gave the strongest influence on the level of PAD (p = 0,000) with a contribution of 36.4%, acupressure (p = 0.005) with a contribution of 30.2%, and foot exercises ( p = 0.033) with a contribution of 20.6%. Conclusions, acupressure, and foot exercises affect the level of PAD of type 2 DM clients. Keywords: Acupressure, DM type 2, Peripheral Arterial Disease, Foot Gymnastics

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