The Most Accurate Ultrasonographic Finding for Diagnosis of Lower-Extremity Arterial Disease in Patients with Critical Limb Ischemia

Abstract Background Patients with peripheral arterial disease (PAD) have a higher mortality rate than age-matched patients without PAD. Also more than half of patients with symptomatic PAD have polyvascuar disorder including coronary artery disease (CAD). Purpose This study aimed to identify the predictors of mortality outcomes in patients with peripheral artery disease undergoing lower extremity endovascular intervention. Methods We studied 300 consecutive patients admitted for symptomatic low extremity arterial disease. A total of 196 patients without angina and prior coronary revascularization (72±10 years, 156 men) who underwent lower extremity endovascular intervention (claudication, n=74; critical limb ischemia, n=122) were retrospectively analyzed. All patients underwent coronary angiography but not simultaneous coronary revascularization. CAD was defined as angiographically significant (≥50%) stenosis of coronary arteries and severity was classified as none, 1-, 2-, or 3-vessel disease (VD). All-cause mortality and major adverse cardiac and cerebrovascular event (MACCE) rate were compared between the patients with CAD and those without CAD. MACCE included any of the following adverse events: cardiac death, cerebrovascular death, acute myocardial infarction, stroke, and congestive heart failure. Results Mean duration of follow-up was 3 years. All-cause mortality and MACCE were 16.3% and 19.8%, respectively. The independent risk factors for all-cause mortality were old age (HR=1.05, P=0.043), lower body mass index (HR=0.83, P=0.016), critical limb ischemia (HR=3.74, P=0.033) and the presence of CAD (HR=2.85, P=0.027). This variable surpassed all classical risk factors (including smoking and history of hypertension or diabetes mellitus). Of the 196 patients, 101 patients (52%) had asymptomatic CAD; 1-VD (n=35, 18%); 2-VD (n=32, 16%); 3-VD (n=28, 14%). Patients with CAD had significantly higher all-cause mortality (19% vs. 11%, P=0.018) and higher MACCE rate (26% vs. 8%, P=0.001) compared to those without CAD. Furthermore, the severity of CAD had graded associations with the all-cause mortality and MACCE rate (Figure). Independent predictors of CAD were critical limb ischemia (CLI) (OR = 2.43, P=0.018) and presence of the below-the-knee lesions (OR = 2.04, P=0.019). In addition, CAD was more prevalent in the patients with lower BMI (61% vs. 41%, p=0.007). Conclusion Asymptomatic coronary artery disease (CAD) was found in half of the patients undergoing endovascular intervention for lower extremity arterial disease and associated with higher mortality and MACCE rate. Therefore, detection of CAD might be important for risk stratification for these patients, especially with lower body mass index or critical limb ischemia. Funding Acknowledgement Type of funding source: None

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Retraction Note: Association of severity of coronary artery disease by SYNTAX score (SS) and lower extremity arterial disease by duplex ultrasound (DUS) study—an Indian perspective

The Egyptian Heart Journal ◽

10.1186/s43044-020-00130-9 ◽

2020 ◽

Vol 72 (1) ◽

Author(s):

Saumen Nandi ◽

Anindya Mukherjee ◽

Dibbendhu Khanra ◽

Kaushik Biswas

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Lower Extremity ◽

Duplex Ultrasound ◽

Arterial Disease ◽

Syntax Score ◽

Lower Extremity Arterial Disease ◽

Retraction Notice ◽

Artery Disease ◽

Indian Perspective

This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1186/s43044-020-00091-z.

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Omega-3 Polyunsaturated Fatty Acid Supplementation in Patients with Lower Extremity Arterial Disease

Journal of the American College of Nutrition ◽

10.1080/07315724.2021.1891155 ◽

2021 ◽

pp. 1-9

Author(s):

Min-I Su ◽

Ying-Chih Cheng ◽

Yu-Chen Huang ◽

Cheng-Wei Liu

Keyword(s):

Fatty Acid ◽

Lower Extremity ◽

Polyunsaturated Fatty Acid ◽

Arterial Disease ◽

Omega 3 ◽

Lower Extremity Arterial Disease ◽

Fatty Acid Supplementation ◽

Acid Supplementation

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Diagnostic Performance of Ankle-Brachial Pressure Index in Lower Extremity Arterial Disease

The Surgery Journal ◽

10.1055/s-0041-1731444 ◽

2021 ◽

Vol 07 (03) ◽

pp. e132-e137

Author(s):

Mohammed Alagha ◽

Thomas M. Aherne ◽

Ahmed Hassanin ◽

Adeel S. Zafar ◽

Doireann P. Joyce ◽

...

Keyword(s):

Lower Extremity ◽

Sensitivity And Specificity ◽

False Negative ◽

Arterial Disease ◽

Initial Assessment ◽

Reference Standard ◽

Lower Extremity Arterial Disease ◽

Negative Results ◽

Positive Results ◽

Arterial Imaging

Abstract Introduction Ankle-brachial pressure indices (ABIs) continue to form the basis of diagnostics for lower extremity arterial disease (LEAD). However, there remains a paucity of data to support its accuracy. This study aims to evaluate its diagnostic sensitivity and specificity using established arterial-imaging modalities as a benchmark. Methods In this retrospective study, a regional, prospectively maintained, vascular laboratory database was interrogated to identify referred patients with arterial disease who underwent concomitant assessment with ABI and lower limb arterial duplex ultrasound (DUS). Duplex acted as the reference standard. Those who had peripheral computed tomography angiogram (CTA) within 3 months of initial assessment were included in a subgroup analysis to correlate ABI with CTA. The primary end point was the sensitivity and specificity of ABI compared with DUS as the reference standard. Results Concomitant assessment was performed in 438 limbs (250 patients) over a 27-month period. The ABI was normal (0.9 to 1.4) in 196 limbs (44.9%) and abnormal in the remaining 241 limbs (55.1%). False-positive results occurred in 83 out of 241 limbs (34.4%), and false-negative results occurred in 54 limbs out of 196 (27.5%). True-positive results were 158 out of 241 limbs (65.6%), whereas true-negative results were 142 out of 196 limbs (72.4%). ABI using DUS as a benchmark identified a sensitivity for peripheral artery disease of 72.3% and a specificity of 69.3%. Concomitant CTA imaging was available in 200 limbs. The sensitivity and specificity of ABI correlated with CTA were 65.5 and 68.8%, respectively. Conclusion ABIs have a moderate predictive value in the diagnosis of LEAD. Normal range outcomes cannot be taken to infer the absence of LEAD and, as such, further arterial imaging in the form of DUS or angiography should be strongly considered in those with suspected underlying disease requiring intervention. Further noninvasive tests such as exercise studies or pulse volume waveforms should be considered, if diagnostic uncertainty exists, in those requiring nonoperative intervention and risk factor control.

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