Lower-Extremity Arteries

2018 ◽  
pp. 237-256
Author(s):  
Parag J. Patel ◽  
Diamanto “Amanda” Rigas
Keyword(s):  
Lower Extremity ◽  
Treatment Options ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Incidence Risk ◽  
Peripheral Arterial ◽  
Fontaine Classification ◽  
Patient Presentation

Peripheral arterial disease (PAD) is a common manifestation of atherosclerotic disease affecting circulation in the extremities, which carries significant morbidity and mortality. High morbidity and mortality rates and subsequent healthcare costs are associated with PAD. More than 200 million people worldwide are estimated to suffer from PAD, and an estimated 8.5 million Americans above the age of 40 are affected by it. This chapter on lower-extremity PAD explores the incidence, risk factors, and patient presentation of the disease. It reviews diagnostic studies, including the ankle-brachial index (ABI), toe-brachial index, and pulse volume recordings (PVRs), as well as imaging studies. The spectrum of patient presentations is discussed, including the Rutherford and Fontaine classification schemes. Treatment options, including medical and endovascular and surgical revascularization, are reviewed as well.

PAD screening: Why? Whom? When? How? – a systematic review

VASA ◽  
2020 ◽  
pp. 1-7
Author(s):  
Arne G. Kieback ◽  
Roman Gähwiler ◽  
Christoph Thalhammer
Keyword(s):  
Systematic Review ◽  
Relevant Literature ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Screening Strategy ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Abdominal Aortic ◽  
Screening Guideline ◽  
Peripheral Arterial

Summary: An estimated 237 million people suffer from peripheral arterial disease (PAD), which is associated with high morbidity and mortality, and prevalence is still increasing. Currently, we do not have any randomized trials that compare screening to no screening specifically for PAD in the general population. Presently, PAD screening is not generally established. This systematic review gives an overview of relevant literature and guidelines. Screening usually focuses on ankle-brachial index (ABI)-measurement, which enables detection of asymptomatic and symptomatic PAD, but has limitations in diabetics. There are no sufficient data on PAD screening. Guideline recommendations are heterogeneous. While some advocate no screening until better data are available, most recommend selective screening despite insufficient data on morbidity and mortality reduction in consequence of screening. We support the only evidence-based screening strategy for PAD: combined screening for abdominal aortic aneurysm (AAA), PAD and arterial hypertension in men aged 65–74 according to the VIVA study. We additionally suggest a new simple three-step screening strategy for symptomatic PAD in all individuals aged 40 and older, who see a general practitioner: Asking one question (“Do you have pain or cramps in the legs during normal walking?”) followed by physical examination (normal lower extremity pulse status?) in those, whose answer is “yes”, and ABI measurement unless all pulses are normal.

scholarly journals Increased Elastin Degradation in Pseudoxanthoma Elasticum Is Associated with Peripheral Arterial Disease Independent of Calcification

2020 ◽  
Vol 9 (9) ◽  
pp. 2771
Author(s):  
Jonas W. Bartstra ◽  
Wilko Spiering ◽  
Jody M. W. van den Ouweland ◽  
Willem P. T. M. Mali ◽  
Rob Janssen ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Ankle Brachial Index ◽  
Pseudoxanthoma Elasticum ◽  
Arterial Disease ◽  
Arterial Calcification ◽  
Elastin Degradation ◽  
Liquid Chromatography Tandem Mass ◽  
Peripheral Arterial ◽  
Fontaine Classification

Pseudoxanthoma elasticum (PXE) results in extensive fragmentation and calcification of elastin fibers in the peripheral arteries, which results in peripheral arterial disease (PAD). Current research focuses on the role of calcifications in the pathogenesis of PXE. Elastin degradation and calcification are shown to interact and may amplify each other. This study aims to compare plasma desmosines, a measure of elastin degradation, between PXE patients and controls and to investigate the association between desmosines and (1) arterial calcification, (2) PAD, and (3) PAD independent of arterial calcification in PXE. Plasma desmosines were quantified with liquid chromatography-tandem mass spectrometry in 93 PXE patients and 72 controls. In PXE patients, arterial calcification mass was quantified on CT scans. The ankle brachial index (ABI) after treadmill test was used to analyze PAD, defined as ABI < 0.9, and the Fontaine classification was used to distinguish symptomatic and asymptomatic PAD. Regression models were built to test the association between desmosines and arterial calcification and arterial functioning in PXE. PXE patients had higher desmosines than controls (350 (290–410) ng/L vs. 320 (280–360) ng/L, p = 0.02). After adjustment for age, sex, body mass index, smoking, type 2 diabetes mellitus, and pulmonary abnormalities, desmosines were associated with worse ABI (β (95%CI): −68 (−132; −3) ng/L), more PAD (β (95%CI): 40 (7; 73) ng/L), and higher Fontaine classification (β (95%CI): 30 (6; 53) ng/L), but not with arterial calcification mass. Lower ABI was associated with higher desmosines, independent from arterial calcification mass (β (95%CI): −0.71(−1.39; −0.01)). Elastin degradation is accelerated in PXE patients compared to controls. The association between desmosines and ABI emphasizes the role of elastin degradation in PAD in PXE. Our results suggest that both elastin degradation and arterial calcification independently contribute to PAD in PXE.

scholarly journals Impact of Sex on Morbidity and Mortality Rates After Lower Extremity Interventions for Peripheral Arterial Disease

2014 ◽  
Vol 63 (23) ◽  
pp. 2525-2530 ◽  
Author(s):  
Elizabeth A. Jackson ◽  
Khan Munir ◽  
Theodore Schreiber ◽  
Jeffrey R. Rubin ◽  
Robert Cuff ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Lower Extremity ◽  
Arterial Disease ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Peripheral Arterial

Evaluation of Leg Pain

2015 ◽  
Author(s):  
Martyn Knowles
Keyword(s):  
Lower Extremity ◽  
Ankle Brachial Index ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Cardiac Risk ◽  
Multiple Organ ◽  
Leg Pain ◽  
Acute Limb Ischemia ◽  
Organ Systems ◽  
Peripheral Arterial

Few patient complaints offer such a large range of acuity and differential diagnoses as the complaint of leg pain. This is in part due to the multiple organ systems at play, including cardiac, pulmonary, musculoskeletal, neurologic, vascular, and dermatologic. The surgeon is frequently presented with the challenge of identifying and managing these complaints in a variety of settings. Management involves a spectrum from conservative care to surgical intervention where appropriate. The wide array of symptoms, signs, and often contradictory test results can be confusing and frustrating to patients and physicians alike, leading to delays and errors in diagnosis and ineffective management. This review offers a sequential and ordered approach to the evaluation of leg pain. Tables highlight atherosclerotic risk factors, vascular causes of lower extremity pain, the classification of acute limb ischemia, the ankle-brachial index and corresponding peripheral arterial disease, and the revised cardiac risk score for preoperative risk. Figures show bilateral lower extremity ischemia, chronic ischemic changes to the foot, classic dry gangrene, wet gangrene, acute limb ischemia, Charcot foot, segmental waveform and pulse volume recording analysis of the bilateral lower extremities, and angiographic evaluation of patients with aortoiliac and tibial disease. This review contains 10 figures, 5 tables, and 55 references.

Exercise Stress Testing Is a Useful Adjunct in the Evaluation of Patients With Claudication and Normal Ankle-Brachial Index: A Case Report

2021 ◽  
pp. 154431672199653
Author(s):  
Kim Weaver
Keyword(s):  
Case Report ◽  
Lower Extremity ◽  
Stress Testing ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Significant Drop ◽  
Peripheral Arterial ◽  
Vascular Occlusive Disease

A 45-year-old man presented with bilateral lower extremity claudication and was evaluated for lower extremity peripheral arterial disease. Ankle-brachial indices (ABIs) were performed with exercise stress testing. Resting ABI was normal, with postexercise arterial testing revealing a significant drop in ankle pressures, suggesting moderate proximal atherosclerotic vascular occlusive disease. It is important that sonographers are sufficiently trained to determine true claudication symptoms, and lab protocols should be established to effectively appropriate exercise stress testing when necessary.

High tolerance of progressive elastic compression in peripheral arterial disease

VASA ◽  
2019 ◽  
Vol 48 (5) ◽  
pp. 413-417 ◽  
Author(s):  
Serge Couzan ◽  
Jean-François Pouget ◽  
Claire Le Hello ◽  
Céline Chapelle ◽  
Silvy Laporte ◽  
...  
Keyword(s):  
Venous Insufficiency ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Return Flow ◽  
High Tolerance ◽  
Compression Stockings ◽  
Short Term ◽  
Poor Tolerance ◽  
The Mean ◽  
Peripheral Arterial

Summary. Background: Theoretically progressive compression stockings, which produce a higher compression at the calf than at the ankle level, improve venous return flow without exacerbating peripheral arterial insufficiency (PAD). We aimed to evaluate the short-term tolerance of elastic progressive compression stockings on peripheral arterial vascularisation in patients with symptomatic PAD and associated mild venous insufficiency. Patients and methods: Monocentric, prospective, open pilot study of 18 patients (acceptability study, 6 x 6 plan) evaluating the short-term tolerance of progressive compression stockings (18 ± 2 mmHg at calf and 8 ± 2 mmHg at ankle level) in patients with PAD (ankle brachial index ABI > 0.60 < 0.75) and chronic venous insufficiency (C1s–C4 stages of the CEAP classification). Day 15 tolerance was evaluated by a composite primary criteria comprising: no decrease > 15 % of ABI on each side, no decrease > 15 % of toe brachial index (TBI) on each side and no decrease > 25 % of the number of active plantar flexions performed while standing. Results: The proportion of men was 77.8 %, mean age was 77.3 ± 7.5 years and no patient were diabetic. At inclusion, the mean low ABI was 0.60 ± 0.04 and the mean high ABI was 0.77 ± 0.18. The mean low TBI was 0.32 ± 0.09 and the mean high TBI 0.46 ± 0.15. The mean number of active standing plantar flexions was 33.0 ± 5.0. The majority of the patients were classified in CEAP C2s and C3 classes (class 2: 16.7 %, class C2s: 27.8 %, class C3: 44.4 %, class C4: 5.6 % and class C4s: 5.6 %). Poor tolerance occurred in no patient. By day 30, no patient had worsening of their arterial and venous symptoms. No adverse events occurred during the study. Conclusions: These results suggest a high tolerance of progressive elastic stockings (18 ± 2 mmHg at calf and 8 ± 2 mmHg at ankle level) in symptomatic PAD.

Predictive value of the ankle brachial index in patients with acute ischemic stroke

VASA ◽  
2014 ◽  
Vol 43 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Konstantinos Tziomalos ◽  
Vasilios Giampatzis ◽  
Stella Bouziana ◽  
Athinodoros Pavlidis ◽  
Marianna Spanou ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
National Institutes Of Health ◽  
Limited Data ◽  
Severe Stroke ◽  
Hospital Outcome ◽  
Peripheral Arterial

Background: Peripheral arterial disease (PAD) is frequently present in patients with acute ischemic stroke. However, there are limited data regarding the association between ankle brachial index (ABI) ≤ 0.90 (which is diagnostic of PAD) or > 1.40 (suggesting calcified arteries) and the severity of stroke and in-hospital outcome in this population. We aimed to evaluate these associations in patients with acute ischemic stroke. Patients and methods: We prospectively studied 342 consecutive patients admitted for acute ischemic stroke (37.4 % males, mean age 78.8 ± 6.4 years). The severity of stroke was assessed with the National Institutes of Health Stroke Scale (NIHSS)and the modified Rankin scale (mRS) at admission. The outcome was assessed with the mRS and dependency (mRS 2 - 5) at discharge and in-hospital mortality. Results: An ABI ≤ 0.90 was present in 24.6 % of the patients whereas 68.1 % had ABI 0.91 - 1.40 and 7.3 % had ABI > 1.40. At admission, the NIHSS score did not differ between the 3 groups (10.4 ± 10.6, 8.3 ± 9.3 and 9.3 ± 9.4, respectively). The mRS score was also comparable in the 3 groups (3.6 ± 1.7, 3.1 ± 1.8 and 3.5 ± 2.3, respectively). At discharge, the mRS score did not differ between the 3 groups (2.9 ± 2.2, 2.3 ± 2.1 and 2.7 ± 2.5, respectively) and dependency rates were also comparable (59.5, 47.6 and 53.3 %, respectively). In-hospital mortality was almost two-times higher in patients with ABI ≤ 0.90 than in patients with ABI 0.91 - 1.40 or > 1.40 but this difference was not significant (10.9, 6.6 and 6.3 %, respectively). Conclusions: An ABI ≤ 0.90 or > 1.40 does not appear to be associated with more severe stroke or worse in-hospital outcome in patients with acute ischemic stroke.

Overview of Treatment Options for Critical Limb Ischaemia Patients

2011 ◽  
Vol 7 (1) ◽  
pp. 51 ◽  
Author(s):  
Frederic Baumann ◽  
Nicolas Diehm ◽  
◽  
Keyword(s):  
Treatment Options ◽  
Critical Limb Ischaemia ◽  
Treatment Modalities ◽  
High Morbidity ◽  
Limb Ischaemia ◽  
Arterial Revascularisation ◽  
Planning Treatment ◽  
Treatment Concepts ◽  
Peripheral Arterial ◽  
Renal Origin

Patients with critical limb ischaemia (CLI) constitute a subgroup of patients with particularly severe peripheral arterial occlusive disease (PAD). Treatment modalities for these patients that often exhibit multilevel lesions and severe vascular calcifications are complicated due to multiple comorbidities, i.e. of cardiac and vascular but also of renal origin. These need to be taken into consideration while planning treatment options. Although CLI is associated with considerably high morbidity and mortality rates, the clinical outcome of patients being subjected to revascularisation has improved substantially in recent years. This is mainly due to improved secondary prevention strategies as well as dedicated endovascular innovations for this most challenging patient cohort. The aim of this article is to provide a discussion of the contemporary treatment concepts for CLI patients with a focus on arterial revascularisation.

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