A comparative study of geometry-based methods and intra-arterial pressure measurements to assess the hemodynamic significance of equivocal iliac artery stenoses

Vascular ◽  
2018 ◽  
Vol 27 (2) ◽  
pp. 119-127
Author(s):  
Stefan GH Heinen ◽  
Wouter Huberts ◽  
Daniel AF van den Heuvel ◽  
Frans N van de Vosse ◽  
Jean-Paul PM de Vries ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Iliac Artery ◽  
Visual Inspection ◽  
Arterial Disease ◽  
Lumen Diameter ◽  
Pressure Measurements ◽  
Rotational Angiography ◽  
3D Rotational Angiography ◽  
Peripheral Arterial ◽  
Diameter Reduction

Objectives To date, the ultimate decision to treat iliac artery stenoses in patients suffering from symptomatic peripheral arterial disease is based on the patient’s symptoms and on visual inspection of angiographical images. The primary aim of this study was to investigate the accuracy of geometry-based methods (i.e. visual inspection and quantitative vascular analysis (Viewforum version R7.2v1 Advanced vessel analysis, Philips Healthcare, Best, The Netherlands) of 3D rotational angiography) to identify the severity of equivocal iliac artery stenosis in peripheral arterial disease patients with intra-arterial hyperemic pressure measurements (gold standard) as a reference. Methods Twenty patients with symptomatic iliac artery stenoses were subjected to 3D rotational angiography. Intra-arterial pressure measurements under hyperemic conditions were performed across 24 visually identified iliac artery stenoses. Three experienced interventional-radiologists retrospectively estimated the lumen diameter reduction by visual inspection. Furthermore, quantitative vascular analysis was performed on the 3D rotational angiography data. Geometry-based estimates were classified into two groups: lumen diameter reduction of <50% (non-significant) and diameter reduction [Formula: see text]50% (significant), and compared to the intra-arterial hyperemic pressure gradients. A stenosis causing a pressure gradient (Δp) ≥10 mmHg was considered hemodynamically significant. Results Visual inspection and quantitative vascular analysis correctly identified hemodynamically significant stenoses in, respectively, 83% and 67% of the 24 iliac artery stenoses. Quantitative vascular analysis-based identification of hemodynamic significant stenoses (Δp ≥ 10 mmHg) could be optimized by lowering the threshold to a 42% lumen diameter reduction which improved the accuracy from 67% to 83%. Conclusions Visual inspection of 3D rotational angiography by experienced interventional-radiologists has an 83% accuracy to identify hemodynamic significant iliac artery stenoses (Δ p ≥10 mmHg). The use of quantitative vascular analysis software did not improve accuracy.

scholarly journals TCTAP C-200 Peripheral Arterial Disease with Chronic Total Occlusion over Right Common Iliac Artery

2016 ◽  
Vol 67 (16) ◽  
pp. S340-S342
Author(s):  
Tzu Chieh Lin ◽  
Chun-Yuan Chu ◽  
Wen-Hsien Lee ◽  
Po-Chao Hsu ◽  
Ho-Ming Su ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Iliac Artery ◽  
Chronic Total Occlusion ◽  
Common Iliac Artery ◽  
Arterial Disease ◽  
Total Occlusion ◽  
Peripheral Arterial

Duplex scanning compared with intra-arterial angiography in diagnosing peripheral arterial disease: three analytical approaches

VASA ◽  
2006 ◽  
Vol 35 (2) ◽  
pp. 86-91 ◽  
Author(s):  
Krnic ◽  
Vucic ◽  
Sucic
Keyword(s):  
Peripheral Arterial Disease ◽  
Digital Subtraction Angiography ◽  
Weighted Kappa ◽  
Arterial Disease ◽  
Lower Limbs ◽  
Arterial Stenosis ◽  
Duplex Scanning ◽  
Digital Subtraction ◽  
Peripheral Arterial ◽  
Diameter Reduction

Background: This study was undertaken to assess the reliability of duplex scanning, as compared with digital subtraction angiography, in diagnosing peripheral arterial disease of the lower limbs. Patients and methods: 60 legs were studied. Each leg was divided in 5 arterial segments, from aortoiliac to popliteal. Duplex scanning and digital subtraction angiography were performed. The disease in each segment was assessed as significant or insignificant or classified into five categories concerning the grade of stenosis (patent vessel or no diameter reduction, mild stenosis, i.e. 1–19% diameter reduction, moderate and severe stenosis, i.e. 20–49% and 50–99% diameter reduction, respectively, and occluded vessel). Three statistical approaches were applied: calculating sensitivity and specificity, Kappa statistics, and weighted Kappa value. Median grades of arterial stenosis across different segments, according to angiography measurements, were also calculated. Results: The duplex sensitivity in detecting significant lesions ranged from 0.46 to 0.88. The Kappa values of agreement between duplex and angiography ranged from 0.35 to 0.64. Weighted Kappa values ranged from 0.45 to 0.72. Median grades of arterial lesions ranged from 2 (interquartile range 1–2) to 4 (3–4) and differed significantly (Kruskal-Wallis H test, p < 0.001). Conclusions: The sensitivities and specificities suggested various duplex reliabilities in detecting significant arterial disease across different lower limbs segments. The Kappa values, in general, testified duplex’s insufficient accuracy in grading the severity of stenosis. However, weighted Kappa values confirmed duplex’s better ability to approximate the grade of stenosis. The arterial segments themselves were unevenly affected with the peripheral arterial disease.

Does kidney transplantation to iliac artery deteriorate ischemia in the ipsilateral lower extremity with peripheral arterial disease?

Vascular ◽  
2014 ◽  
Vol 23 (5) ◽  
pp. 490-493 ◽  
Author(s):  
Ashley Northcutt ◽  
Gazi Zibari ◽  
Tze-Woei Tan ◽  
Amy H Coulter ◽  
Wayne W Zhang
Keyword(s):  
Kidney Transplantation ◽  
Peripheral Arterial Disease ◽  
Lower Extremity ◽  
Iliac Artery ◽  
Wound Care ◽  
Medical Center ◽  
Arterial Disease ◽  
University Teaching ◽  
Post Transplantation ◽  
Peripheral Arterial

Objectives This study was conducted to investigate the progression of lower extremity ischemia following kidney transplantation to iliac artery in patients with peripheral arterial disease. Methods A retrospective chart review of all renal transplant patients completed at a university teaching medical center from January 2006 to December of 2011 was performed. A total of 219 patients underwent successful kidney transplantation to the common, external, or internal iliac artery. Pre- and post-transplantation ischemic changes in the ipsilateral lower extremity were reviewed and analyzed. Results Thirty-eight of the 219 patients had ipsilateral peripheral arterial disease and seven of them were symptomatic. Six of the seven symptomatic patients remained stable and one patient’s rest pain improved, postoperatively. Eight patients developed new symptoms of ischemia 12 months later, including four with claudication, two with ischemic ulcers, and two with gangrene toes. The ulcers were healed following superficial femoral artery stenting and wound care. Toe amputation was performed in two patients with gangrene. No major amputation was required up to 48 months of follow-up. Conclusions Transplanted kidney to iliac artery does not significantly deteriorate ischemia in adults with ipsilateral lower extremity peripheral arterial disease. Late developed ischemic complications may be due to the progression of underlying arterial disease.

Management of Peripheral Arterial Disease

2006 ◽  
Vol 39 (3) ◽  
pp. 44
Author(s):  
WILLIAM E. GOLDEN ◽  
ROBERT H. HOPKINS
Keyword(s):  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Peripheral Arterial
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