Is Duplex Ultrasound Scanning for Peripheral Arterial Disease of the Lower Limb a Non-invasive Alternative or an Adjunct to Angiography?

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.

Download Full-text

Transpedal Approach in Failed Antegrade Attempt of Lower Limb Peripheral Arterial Disease—A Review with Different Treatment Strategies

International Journal of Angiology ◽

10.1055/s-0040-1709504 ◽

2020 ◽

Vol 29 (03) ◽

pp. 143-148

Author(s):

Ranjit Kumar Nath ◽

Siva Subramaniyan ◽

Neeraj Pandit ◽

Deepankar Vatsa

Keyword(s):

High Risk ◽

Peripheral Arterial Disease ◽

Femoral Artery ◽

Lower Limb ◽

Treatment Strategies ◽

Arterial Disease ◽

Retrograde Approach ◽

Femoral Access ◽

Antegrade Approach ◽

Peripheral Arterial

AbstractTranspedal access is an evolving technique primarily used in patients after failed femoral antegrade approach to revascularize complex tibiopedal lesions. In patients who are at high risk for surgery the transpedal access may be the only option in failed antegrade femoral access to avoid amputation of the limbs. In recent years transpedal access is used routinely to revascularize supra-popliteal lesions due to more success and less complications over femoral artery approach. Retrograde approach parse will not give success in all cases and importantly success depends on techniques used. There are different techniques that need to be used depending on lesion characteristics, comorbidities, and hardware available to improve success with less complications. This review provides different strategies for successful treatment of iliac and femoral artery lesions by transpedal approach after failed antegrade femoral attempt.

Download Full-text

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

European Radiology ◽

10.1007/s00330-021-07692-5 ◽

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.

Download Full-text

The Role of Circulating Biomarkers in Peripheral Arterial Disease

International Journal of Molecular Sciences ◽

10.3390/ijms22073601 ◽

2021 ◽

Vol 22 (7) ◽

pp. 3601

Author(s):

Goren Saenz-Pipaon ◽

Esther Martinez-Aguilar ◽

Josune Orbe ◽

Arantxa González Miqueo ◽

Leopoldo Fernandez-Alonso ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Lower Limb ◽

Prediction Models ◽

Arterial Disease ◽

Cardiac Damage ◽

Thrombotic Occlusion ◽

Medical Treatments ◽

Peripheral Arterial ◽

Inflammatory Molecules

Peripheral arterial disease (PAD) of the lower extremities is a chronic illness predominantly of atherosclerotic aetiology, associated to traditional cardiovascular (CV) risk factors. It is one of the most prevalent CV conditions worldwide in subjects >65 years, estimated to increase greatly with the aging of the population, becoming a severe socioeconomic problem in the future. The narrowing and thrombotic occlusion of the lower limb arteries impairs the walking function as the disease progresses, increasing the risk of CV events (myocardial infarction and stroke), amputation and death. Despite its poor prognosis, PAD patients are scarcely identified until the disease is advanced, highlighting the need for reliable biomarkers for PAD patient stratification, that might also contribute to define more personalized medical treatments. In this review, we will discuss the usefulness of inflammatory molecules, matrix metalloproteinases (MMPs), and cardiac damage markers, as well as novel components of the liquid biopsy, extracellular vesicles (EVs), and non-coding RNAs for lower limb PAD identification, stratification, and outcome assessment. We will also explore the potential of machine learning methods to build prediction models to refine PAD assessment. In this line, the usefulness of multimarker approaches to evaluate this complex multifactorial disease will be also discussed.

Download Full-text