Influence of diabetes on diagnostic performance of computed tomography angiography of the calf arteries in acute limb ischemia

2021 ◽  
pp. 028418512110069
Author(s):  
Talha Butt ◽  
Leena Lehti ◽  
Jan Apelqvist ◽  
Anders Gottsäter ◽  
Stefan Acosta
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Diagnostic Performance ◽  
Intraclass Correlation ◽  
Arterial Occlusion ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Diabetic Patients ◽  
Acute Limb Ischemia ◽  
Below The Knee

Background Patients with diabetes mellitus (DM) have a more extensive distal arterial occlusive disease compared to non-diabetic patients. Diagnostic imaging is a necessity to identify the location and extent of the arterial occlusion in acute limb ischemia (ALI). Computed tomography angiography (CTA) is the most commonly used modality and the diagnostic performance with CTA of calf arteries may be questioned. Purpose To evaluate diagnostic performance of CTA of calf arteries in ALI and to compare patients with and without DM. Material and Methods All thrombolytic treatments performed during 2001–2008 in patients with ALI were included. Initial digital subtraction angiography (DSA) and CTA of all patients were classified according to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) below-the-knee arteries and compared to CTA. Two raters assessed the CTA images independently. Inter-rater reliability was expressed as intraclass correlation (ICC) with 95% confidence intervals (CI). Results Patients with (n = 23) and without (n = 85) DM had lower ( P = 0.006) glomerular filtration rate. ICC between CTA and DSA was 0.33 (95% CI –0.22 to 0.56) and 0.71 (95% CI 0.38–0.68) in patients with and without DM, respectively. Sensitivity with CTA for TASC D lesions in patients with and without DM was 0.14 (95% CI –0.12 to 0.40) and 0.64 (95% CI 0.48–0.80), respectively. Conclusion The sensitivity of CTA for assessment of infra-popliteal TASC D lesions in patients with ALI was not acceptable in patients with DM in contrast to those without DM. Another imaging option at present times should be considered for patients with DM.

scholarly journals Successful limb salvage by endovascular treatment for critical limb ischemia subsequent to acute limb ischemia

2019 ◽  
Vol 2019 (10) ◽  
Author(s):  
Tetsuya Nomura ◽  
Satoshi Tasaka ◽  
Kenshi Ono ◽  
Yu Sakaue ◽  
Naotoshi Wada ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Major Amputation ◽  
Sudden Onset ◽  
Acute Limb Ischemia ◽  
Below The Knee ◽  
Tibial Arteries ◽  
Chronic Critical Limb Ischemia ◽  
Peripheral Arterial

Abstract Recently, there have been increasing opportunities to treat patients with peripheral arterial disease. Of those patients, both pathological conditions, such as acute limb ischemia (ALI) and chronic critical limb ischemia (CLI), are closely associated with high risks of major amputation, disability and death. We encountered a very rare case of CLI subsequent to ALI. An 83-year-old male showed the sudden onset of ALI, probably due to thromboembolism from an abdominal aortic aneurysm during an operation for gastric cancer. The patient was referred to another hospital for Fogarty thrombectomy. About 1 month after ALI onset, necrosis of the left first toe gradually progressed. On angiography of the left lower limb, we noted occlusions of both anterior and posterior tibial arteries. Then, we successfully conducted balloon angioplasty for the below-the-knee arteries. Thereby, favorable blood flow was achieved, which led to successful wound healing without amputations.

scholarly journals Simultaneous acute limb ischemia related to acute Leriche syndrome and pulmonary embolism without existing patent foramen ovale: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ying-Sheng Li ◽  
Ying-Ching Li
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Computed Tomography Angiography ◽  
Patent Foramen Ovale ◽  
Pulmonary Arteries ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Foramen Ovale ◽  
Leriche Syndrome ◽  
History Of

Abstract Background Aortoiliac occlusion disease, also called Leriche syndrome, is characterized by atherothrombotic obliteration of the aortic bifurcation and bilateral common iliac arteries; typically, it has a chronic presentation. Pulmonary embolism is more related to venous thromboembolism rather than arterial thromboembolic events. Therefore, cases of simultaneous acute Leriche syndrome and pulmonary embolism are rare. Existing intracardiac right-to-left shunt were detected in most previous cases. Herein, we present the first likely documented case wherein acute Leriche syndrome and pulmonary embolism occurred simultaneously without a patent foramen ovale. Case presentation A 58-year-old man with hyperlipidemia and coronary artery disease presented with a 4-h history of bilateral lower limb numbness. He was a heavy smoker with a history of stroke. Computed tomography angiography revealed pulmonary embolism and aortoiliac artery occlusion. Although a massive thrombus straddled the bilateral pulmonary arteries, orthopnea was his only presentation, without right ventricle failure. Cyanosis of the affected limbs was noted, and muscle strength in both limbs had regressed to grade 1. Owing to acute limb ischemia, he underwent an emergency operation to salvage the limbs. On postoperative day 5, the general condition of both the legs improved; the muscle strength improved to grade 4. He was then transferred to the general ward and enoxaparin was continued. Computed tomography angiography was repeated to evaluate the pulmonary embolism on postoperative day 8; the thrombus remained lodged in the bilateral main pulmonary arteries. Owing to persistent orthopnea and chest tightness with intermittent tachycardia, he underwent a staged operation for the pulmonary embolism on postoperative day 13. During the surgery, intraoperative transesophageal echocardiography showed no patent foramen ovale or an existing right-to-left shunt. Postoperatively, he was closely monitored in the intensive care unit for 3 days and then transferred to the general ward for 10 days. A final computed tomography angiography performed on postoperative day 18 revealed thrombus resolution. He was then discharged on postoperative day 30 without any in-hospital complications. Conclusion We present a case that might be the first documented report of acute Leriche syndrome co-occurring with pulmonary embolism without an existing patent foramen ovale.

Computed tomography angiography evaluation of acute limb ischemia

VASA ◽  
2019 ◽  
Vol 48 (1) ◽  
pp. 57-64
Author(s):  
Alex Wallace ◽  
Yash Pershad ◽  
Aman Saini ◽  
Sadeer Alzubaidi ◽  
Sailendra Naidu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Magnetic Resonance ◽  
Computed Tomography Angiography ◽  
Vascular Anatomy ◽  
Limb Ischemia ◽  
Medical Emergency ◽  
Acute Limb Ischemia ◽  
Surgical Interventions ◽  
Presenting Symptoms ◽  
Time Treatment

Abstract. Acute limb ischemia (ALI), a subclass of critical limb ischemia, is a medical emergency. The cause of ALI is usually thrombotic or embolic in nature, and the specific etiology often dictates the appropriate therapy. While the diagnosis is a clinical with common presenting symptoms, advances in ultrasound, computed tomography, and magnetic resonance technology have impacted the diagnosis and subsequent therapy. In ALI, the time to revascularization is critical and computed tomography angiography (CTA) provides a highly sensitive and specific technique for rapidly identifying occlusions and precisely defining vascular anatomy prior to interventions. In patients with significant renal disease, magnetic resonance angiography with or without contrast provides effective alternatives at the expense of imaging time. Treatment can include a variety of endovascular or surgical interventions, including thromboembolectomy, angioplasty, or bypass. Proper evaluation of the etiology of the ischemia, affected vasculature, and medical history is critical to select appropriate treatment and improve patient outcomes. Here, we examine the presentation, evaluation, and treatment of ALI and the role of CTA in diagnosis and therapy.

scholarly journals Comparison of Color Doppler and computed tomography angiography (CTA) in arterial disease in patients with lower limb ischemia.

2021 ◽  
Vol 28 (10) ◽  
pp. 1381-1391
Author(s):  
Muhammad Zakir ◽  
Anjum Tazeen ◽  
Faisal Nadeem Khan ◽  
Mehreen Fatima ◽  
Javed Tauqir ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Peripheral Arterial Disease ◽  
Computed Tomography Angiography ◽  
Lower Limb ◽  
Color Doppler ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Cross Sectional ◽  
Lower Limb Ischemia ◽  
Peripheral Arterial

Objective: To compare the diagnostic accuracy of color Doppler ultrasound with computed tomography angiography in patients with lower limb ischemia and to assess the severity of stenosis. Study Design: Cross Sectional Analytical study. Setting: Shalamar Hospital, Lahore. Period: May 2020 to October 2020. Material & Methods: Data were collected according to the Age, Height, Weight, BMI, Duration of diabetes, Total Cholesterol, LDL, HDL, Triglyceride, Gender, Socioeconomic status, Diabetes, Hypertension, Stenosis, Collateral, calcification. Sample size of46 patients were included in this research comprising 32 males (69.6%) and 14 females (30.4%).Data entry and analysis will be done by using SPSS version-23. Results: Total numbers of 46 patients were included in this research comprising 32 males (69.6%) and 14 females (30.4%). According to the result analysis 34 patients had shown peripheral arterial disease at color Doppler and 12 patients had not shown peripheral arterial disease at color doppler. 38 patients had shown peripheral arterial disease at CTA and 8 patients had not shown peripheral arterial disease at CTA. Conclusion: This study concludes that computed tomography angiography for detection of peripheral arterial disease as the gold standard, MDCT angiography shows higher sensitivity (82.6%) than color-coded Doppler ultrasonography (73.9%) in the assessment of peripheral arterial disease.

scholarly journals Diagnostic Performance of Computed Tomography Angiography in Peripheral Arterial Disease

JAMA ◽  
2009 ◽  
Vol 301 (4) ◽  
pp. 415 ◽  
Author(s):  
Rosemarie Met ◽  
Shandra Bipat ◽  
Dink A. Legemate ◽  
Jim A. Reekers ◽  
Mark J. W. Koelemay
Keyword(s):  
Computed Tomography ◽  
Peripheral Arterial Disease ◽  
Computed Tomography Angiography ◽  
Diagnostic Performance ◽  
Arterial Disease ◽  
Peripheral Arterial
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