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.

scholarly journals Blunt vascular trauma in a patient with peripheral arterial disease: a case report and review of the literature

2020 ◽  
Vol 2020 (10) ◽  
Author(s):  
Sergiy Karachentsev
Keyword(s):  
Case Report ◽  
Life Expectancy ◽  
Clinical Outcome ◽  
Peripheral Arterial Disease ◽  
Lower Extremity ◽  
Femoral Artery ◽  
Arterial Disease ◽  
Vascular Trauma ◽  
Review Of The Literature ◽  
Peripheral Arterial

Abstract Blunt vascular trauma is rare and challenging in management. Trauma victims who are elderly and have medical comorbidities are still uncommon, but their proportion is expected to increase, as life expectancy has been rising worldwide. A case of blunt vascular trauma to the lower extremity in a 70-year-old patient is reported. During the procedure, a contusion of the superficial femoral artery with thrombosis was identified. Besides, the artery was found to be affected by atherosclerosis. Thrombectomy with resection of the artery and end-to-end anastomosis was performed. Good early clinical outcome was achieved. Nonsystematic review of the available literature is also presented.

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.

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.

Abstract 1776: Peripheral Arterial Disease Determined by Screening Ankle Brachial Index Testing Predicts High Risk Findings On Stress Myocardial Perfusion SPECT Imaging

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
R Parker Ward ◽  
Linda A Taillon ◽  
Justin Weiner ◽  
Kim A Williams
Keyword(s):  
Coronary Artery Disease ◽  
Stress Testing ◽  
Independent Predictor ◽  
Ankle Brachial Index ◽  
Myocardial Perfusion Spect ◽  
Arterial Disease ◽  
Stress Myocardial Perfusion ◽  
Perfusion Spect ◽  
Artery Disease ◽  
Peripheral Arterial

Background: Peripheral arterial disease (PAD) as determined by ankle brachial index (ABI) testing is a potent marker of adverse cardiovascular prognosis. Stress myocardial perfusion SPECT (MPS) testing allows diagnosis of coronary artery disease (CAD) and stratification of cardiovascular risk. The stress MPS findings in patients (pts) with occult PAD are unknown. Accordingly, our goal was to determine the prevalence high risk (HR) MPS findings in pts with occult PAD diagnosed by screening ABI who are referred for MPS testing. Methods: As part of a prospective data collection, 679 male pts referred for MPS were screened for PAD with ABI evaluation. Pts with non-diagnostic ABIs (>1.3) or prior known PAD were excluded. PAD was defined as an ABI ≤ 0.9. PAD severity (mild [ABI 0.8 – 0.9], moderate [ABI 0.4 – 0.8], severe [<0.4]) and symptoms of PAD were also noted. CAD was defined as mild (summed stress score (SSS) ≥ 4) or severe (SSS>8), and the composite of any HR finding (SSS>8, left ventricular ejection fraction [LVEF] < 40%, or TID) was recorded. Results: PAD was present in 28%. Of pts found to have PAD, 65% reported no lower extremity symptoms. Compared to no PAD, pts with PAD were found to have significantly more mild or greater CAD (51% vs. 36%, p<0.01), severe CAD (35% vs. 19%, p<0.01), LV dysfunction [LVEF < 40%] (14% vs 7%, p < 0.01), and composite HR MPS findings (40% vs. 22%, p<0.01). On multivariate logistic regression analysis considering age, HTN, diabetes, tobacco use, hypercholesterolemia, and prior coronary artery disease, PAD was found to be an independent predictor of mild or greater CAD (OR 1.6, 95% CI 1.1–2.4, p<0.01), severe CAD (OR 1.9 95% CI 1.3–3.0, p<0.01), and any HR MPS finding (OR 2.0 95% CI 1.3–3.0, p<0.01). Conclusions: Among men referred for stress testing, occult PAD is common, and is an independent predictor of significant CAD and HR findings on MPS testing. Further study is needed to determine if PAD in pts without an indication for stress testing may benefit from screening MPS.

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