scholarly journals Infrared Thermography as a Diagnostic Tool for the Assessment of Patients with Symptomatic Peripheral Arterial Disease Undergoing Infrafemoral Endovascular Revascularisations

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1701
Author(s):  
Gladiol Zenunaj ◽  
Nicola Lamberti ◽  
Fabio Manfredini ◽  
Luca Traina ◽  
Pierfilippo Acciarri ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Infrared Thermography ◽  
Ankle Brachial Index ◽  
Blood Perfusion ◽  
Arterial Disease ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Technical Success ◽  
Technical Success Rate ◽  
Peripheral Arterial

Aim: The aim of this study was to evaluate the utility and reliability of temperature foot changes measured by infrared thermography (IRT) for the evaluation of patients with atherosclerotic peripheral arterial disease (PAD) before and after endovascular revascularisation. Methods: This is an observational prospective study carried out on symptomatic PAD patients. Evaluations consisted of a clinical examination, duplex scan with ankle–brachial index calculation (ABI) and IRT measurements with infrared camera FLIR-ONE connected to a smartphone with android technology. Locations on the foot sampled with IRT were the anterior tibial, pedal, posterior and arcuate arteries. Results obtained with IRT on the symptomatic foot were compared to the contralateral foot and with the ABI values obtained bilaterally before and 24 h after revascularisation. Results: Within one year, 40 patients were enrolled, among whom 87,5% suffered from critical limb ischaemia. In three patients, it was impossible to obtain ABI measurements because of ulcerations on the limb. Skin temperature changes obtained by IRT between the symptomatic limb and the contralateral limb had a mean difference of 1.7 °C (range: 1.1–2.2 °C), p < 0.001. There was a positive correlation between ABI and temperature values of the limb needed for treatment before revascularisation (p = 0.025; r = 0.36) and after revascularisation (p = 0.024, r = 0.31). The technical success rate was 100% in all cases, achieving a significant increase in temperature at all points of the foot analysed, with a median change of 2 °C (p < 0.001). Conclusion: IRT is a safe, reliable and simple application. It could be a valuable tool for the assessment of the clinical presentation and severity of foot blood perfusion in symptomatic PAD patients and the evaluation of the technical success of endovascular revascularisation. IRT might have a role in follow-up of revascularisation procedures.

scholarly journals Predictors of post-operative outcomes in patients with peripheral arterial disease and critical limb ischaemia: a systematic review and meta-analysis

2021 ◽  
Vol 55 (1) ◽  
pp. 69-76
Author(s):  
Lily P. Wu ◽  
Nadraj G. Naidoo ◽  
Olatunji O. Adetokunboh
Keyword(s):  
Peripheral Arterial Disease ◽  
Limb Salvage ◽  
Graft Patency ◽  
Arterial Disease ◽  
Critical Limb Ischaemia ◽  
Wound Complications ◽  
Limb Ischaemia ◽  
Operative Outcomes ◽  
One Year ◽  
Peripheral Arterial

Background: A very small proportion (1%) of patients with peripheral artery disease (PAD) present with critical limb threatening ischaemia (CLTI) with poor prognosis. The present review showcased several pre-operative predictors and key post-operative outcomes. Identification of any modifiable predictors may impact positively on surgical outcomes.Design: PubMed/Medline, Google scholar and Cochrane databases were searched using terms such as “peripheral arterial disease” AND “critical limb ischemia,” “post-operative outcome,” AND “predictors of post-operative outcomes”. Search was for relevant English-language articles published between January 1997 and December 2007 Selected articles were screened first by title and abstract, and selection of full articles was based on relevance using our inclusion and exclusion criteria and quality ratings performed with the MINORS score.Results: The included studies were published between 1997 and 2007. Only six (6) articles out of a total of 2,114 were deemed suitable for analysis. Ambulatory recovery was >70% at six months, 86.7% and 70.0% at one year and five years respectively. Rate of local wound complications was between 12% and 24%. Reported limb salvage rates were >90% at six months, >70% at one year and 70.0-90.0% at five years. Primary graft patency rate at one year ranged from 63% and 76.6%. Gangrene, diabetes and impaired pre-operative ambulatory function are associated with more wound complications, low limb salvage, reduced graft patency and poor functional outcome.Conclusion: Pre-operative ambulatory status was the most important predictor of post-operative ambulatory recovery. Diabetes mellitus was an important risk factor for prolonged wound healing, local wound complications and major amputation.

Thrombophilic risk factors and peripheral arterial disease severity

2010 ◽  
Vol 104 (07) ◽  
pp. 71-77 ◽  
Author(s):  
Elisabetta Favaretto ◽  
Cristina Legnani ◽  
Michela Cini ◽  
Eleonora Conti ◽  
Alfio Amato ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Cross Sectional Study ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Cross Sectional ◽  
G20210a Mutation ◽  
Peripheral Arterial ◽  
Few Data

SummaryFew data are available on thrombophilic risk factors and progression of atherosclerotic peripheral arterial disease (PAD). Thrombophilic alterations can be an aggravating factor when arterial stenoses are present. In a cross-sectional study, we evaluated the presence of the thrombophilic factors fibrinogen, homocysteine, factor (F)VIII, lupus anticoagulant (LAC), FII G20210A, and FV R506Q mutations in 181 patients with PAD at Fontaine’s stage II (claudication), in 110 patients with critical limb ischaemia (CLI), and in 210 controls. Fibrinogen was higher in patients with CLI vs. those with claudication and controls (427.9 ± 10.5 vs. 373.1 ± 5.2 vs. 348.9 ± 7.0 p=0.001, respectively). Homocysteine and FVIII were higher in patients with PAD than in controls, but were similar in patients with CLI and claudication. The prevalence of LAC increased in patients with CLI vs. those with claudication and controls (21.4% vs. 7.8% vs. 5.2% p<0.001, respectively). The prevalence of FII 20210A allele was higher in patients with CLI vs. those with claudication and controls. Using a logistic model, FII G20210A mutation (odds ratio [OR] 19.8, confidence interval [CI] 4.5–87.1, p=0.001), LAC (OR 2.7, CI1.1–6.5, p=0.032), and fibrinogen (OR 1.01, CI 1.00–1.01, p=0.001) were associated with CLI, whereas homocysteine, FVIII, and FV R506Q mutation were not. CLI risk increased according to the number of thrombophilic alterations. In conclusion, altered levels of some important thrombophilic risk factors are independently associated with PAD severity. These data suggest that the presence of two or more thrombophilic risk factors raise the likelihood of PAD being more severe, justifying the need for larger longitudinal studies.

Are there predictors for the outcome of a PGE1 treatment in peripheral arterial disease with critical limb ischaemia?

VASA ◽  
2005 ◽  
Vol 34 (2) ◽  
pp. 101-107 ◽  
Author(s):  
Heidrich ◽  
Schmidt ◽  
Fahrig
Keyword(s):  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Vascular Reconstruction ◽  
Clinical Analysis ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Prior Therapy ◽  
Predictors Of Response ◽  
Peripheral Arterial ◽  
Vascular Occlusions

Background: In a multivariate retrospective analysis was conducted to examine whether and to what extent PGE1 is therapeutically effective and whether there are predictors of response. Patients and methods: The examination included 767 patients (448 women, 319 men) of a mean age of 71.2 years and with peripheral arterial disease (PAD) having existed for 44.7 months on the average. They suffered from critical limb ischaemia (Fontaine’s stages III/IV) and showed average tcpO2 values at the instep of 2 mmHg (0 to 15) and average systolic malleolar artery pressures of 18 mmHg (0 to 35 mmHg). Between 1989 and 2001, the patients had received treatments in hospital with i.v. PGE1 doses (2 x 20 mug or 1 x 60 mug/day) for an average of 34.2 days (mean of responder- and non-responder group). Patients were called responders when pain had markedly decreased or disappeared, necroses had been reduced or healed completely, and vascular reconstruction, PTA or amputations were not necessary. Results: The clinical analysis showed 82.4% of the patients to be responders and 17.6% to be non-responders. It was demonstrated that the outcome of the therapy was not dependent on the supine or sitting tcpO2, the malleolar artery pressure, the patient’s age or sex, the duration of PAD, the number or kind of concomitant diseases, the patient’s general condition, the localization and number of vascular occlusions, the kind of prior therapy, or the number of previous amputations, although differences in some of the parameters, while clinically irrelevant, were found to be statistically significant. They are not predictors of the outcome of a PGE1 therapy. Conclusions: Even in extremely bad haemodynamic situations at the beginning of a therapy (malleolar artery pressures from 0 to 35 mmHg, tcpO2 0 to 15 mmHg, multilevel occlusive disease, multiple previous operations and concomitant diseases), PGE1 therapies of more than 20 days – on the average 35.6 days (mean of responder group) – duration allow clinically relevant positive results to be achieved.

Antiphospholipid antibodies and lower extremity peripheral arterial disease - a systematic review and meta-analysis

VASA ◽  
2016 ◽  
Vol 45 (4) ◽  
pp. 325-330 ◽  
Author(s):  
Beatriz Gavier ◽  
Fernando Vazquez ◽  
Esteban Gandara
Keyword(s):  
Systematic Review ◽  
Peripheral Arterial Disease ◽  
Lower Extremity ◽  
Antiphospholipid Antibodies ◽  
Meta Analysis ◽  
Arterial Disease ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Disease Case ◽  
Peripheral Arterial

Abstract. Background: Despite being an important risk factor for venous thromboembolism and ischaemic stroke, the role of antiphospholipid antibodies in patients with peripheral arterial disease remains a matter of debate. The aim of this study was to evaluate the association of persistently elevated antiphospholipid antibodies and lower extremity peripheral arterial disease. Methods: We conducted a systematic review of electronic databases including MEDLINE, EUROPUBMED and EMBASE to assess the prevalence of antiphospholipid antibodies in patients with lower extremity peripheral arterial disease. Case-control studies were included if they reported the prevalence of antiphospholipid antibodies in patients with lower extremity peripheral arterial disease. Two reviewers (FV and EG) independently assessed the eligibility of all articles. The primary outcome measure was the odds ratio (OR) for the prevalence of antiphospholipid antibodies patients with lower extremity peripheral arterial disease, along with the corresponding 95 % confidence intervals (CIs). Results: Our initial electronic search identified 128 relevant abstracts, of which two studies were included. Antiphospholipid antibodies were found in 50/571 patients with lower extremity peripheral arterial disease and 13/490 of the controls, OR 3.32 (95 % CI = 1.49 to 7.4). In those with critical limb ischaemia, the prevalence of antiphospholipid antibodies was elevated compared to controls, pooled OR 4.78 (95 % CI = 2.37 to 9.65). Conclusions: Our systematic review and meta-analysis suggests that the prevalence of persistently elevated levels of antiphospholipid antibodies is increased in patients with lower extremity peripheral diseases when compared to healthy controls, especially in those with critical limb ischaemia.

Aortic and peripheral vascular disease

2010 ◽  
pp. 315-326
Author(s):  
Juan Carlos Kaski
Keyword(s):  
Peripheral Arterial Disease ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Arterial Disease ◽  
Aortic Aneurysms ◽  
Lower Limbs ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Peripheral Vascular ◽  
Peripheral Arterial

Peripheral arterial disease 316 Aortic aneurysms 320 Aortic dissection 322 Large-vessel vasculitis 324 Peripheral arterial disease (PAD)—sometimes termed peripheral vascular disease—refers to atherosclerosis, usually of the lower limbs, with obstruction to blood supply. This usually gives rise to intermittent claudication and may progress to critical limb ischaemia characterized by rest pain, ulceration, and gangrene. Symptoms may become acutely worse due to atherothrombosis or acute embolization. PAD is increasingly recognized as a marker of arterial disease in other vascular beds as atherosclerosis is usually widespread....

scholarly journals A study on prostaglandin E1 therapy in critical limb ischaemia patients to evaluate the improvement in vascularity

2017 ◽  
Vol 4 (10) ◽  
pp. 3306
Author(s):  
John S. Kurien ◽  
Sansho E. U. ◽  
Sandeep Varghese ◽  
Toney Jose
Keyword(s):  
Peripheral Arterial Disease ◽  
Ulcer Healing ◽  
Prostaglandin E1 ◽  
Arterial Disease ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Occlusive Vascular Disease ◽  
Peripheral Arterial ◽  
Angioplasty And Stenting

Background: Diffuse peripheral arterial disease or peripheral occlusive vascular disease (POVD) involving the lower limb is a debilitating illness with high incidence of morbidity and mortality. The objective of this study was to assess the improvement of ulcer healing and improvement of the level of amputation in patients with diffuse peripheral arterial disease after administration of prostaglandin E1.Methods: From June 2013 to November 2014, a total of 45 patients having critical limb ischaemia (Fontaine’s grade III and IV) not suitable for angioplasty and stenting or bypass procedures received different courses of Prostaglandin E1 (PGE1). 20 patients (44.44%) received 6 full courses of PGE1, 3 patients (6.66%) received 5 courses, 5 patients (11.11%) received 4 courses, 4 patients (8.8%) received 3 courses, 4 patients (8.8%) received 2 courses and 9 patients (20%) received one course. PGE1 was administered through intravenous infusion (Alprastodil 100mcg) over 10 hours a day for 5 days in one month (1course). They were followed up for 3 years till June 2017.The improvement in level of amputation, ulcer healing and complications were assessed.Results: 14 patients (31.1%) did not require amputation of limbs/ toes, 24 patients (53.3%) have the same amputated status while 7 patients (15.6%) required higher amputation. This study justifies the role of PGE1 therapy in improving the peripheral arterial pulsations and thereby augmenting ulcer healing and improving the level of amputation.Conclusions: After diagnosing a patient with advanced CLI where angioplasty and stenting or bypass procedures are not possible, aggressive treatment for the non-healing ulcer, amputation of gangrenous limbs or toes and starting the PGE1 therapy early not only arrest the progression of POVD but even reverses it to some extent.

Infrared thermography as option for evaluating the treatment effect of percutaneous transluminal angioplasty by patients with peripheral arterial disease

Vascular ◽  
2016 ◽  
Vol 25 (1) ◽  
pp. 42-49 ◽  
Author(s):  
Erik Staffa ◽  
Vladan Bernard ◽  
Lubos Kubicek ◽  
Robert Vlachovsky ◽  
Daniel Vlk ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Infrared Thermography ◽  
Treatment Effect ◽  
Percutaneous Transluminal Angioplasty ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Transluminal Angioplasty ◽  
Significant Difference ◽  
Peripheral Arterial ◽  
Percutaneous Transluminal

Aim of this study was to evaluate the possible use of infrared thermography as a supplementary method to the ankle-brachial index used in assessing the treatment effect of percutaneous transluminal angioplasty. The study included 21 patients, mean age was 60.22 years. Healthy control group included 20 persons, mean age was 55.60 years. Patients with symptomatic peripheral arterial disease (Fontaine stages I–III) were admitted for endovascular treatment by percutaneous transluminal angioplasty. Thermal images and ankle-brachial index values were obtained before and after treatment by percutaneous transluminal angioplasty. Median temperature change in the treated limb was 0.4℃, for non-treated limb was –0.5℃. The median value of ankle-brachial index in the treated limb increased by 0.17 from 0.81 after the procedure. The median value of ankle-brachial index in the non-treated limb decreased by 0.03 from the value of 1.01. Significant difference between treated limb and non-treated limb in change of ankle-brachial index was found with p value = .0035. The surface temperature obtained by the infrared thermography correlates with ankle-brachial index. We present data showing that the increase of ankle-brachial index is associated with increase of skin temperature in the case of limbs treated by percutaneous transluminal angioplasty. Our results also suggest potential of the use of infrared thermography for monitoring foot temperature as a means of early detection of onset of foot ischemic disorders.

Cardiovascular long-term outcome and prophylactic treatment patterns in peripheral arterial disease in a population-based cohort

2019 ◽  
Vol 5 (4) ◽  
pp. 310-320 ◽  
Author(s):  
Fredrik Sartipy ◽  
Fredrik Lundin ◽  
Eric Wahlberg ◽  
Birgitta Sigvant
Keyword(s):  
Peripheral Arterial Disease ◽  
Prophylactic Treatment ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Population Based ◽  
Treatment Patterns ◽  
Limb Ischaemia ◽  
Long Term Outcome ◽  
Increased Risk ◽  
Peripheral Arterial

Abstract Aims This study evaluates 10-year follow-up data on associated comorbidity, mortality, and pharmacological treatment patterns for men and women with different stages of peripheral arterial disease (PAD) in a population-based setting. Methods and results This was a prospective observational population-based cohort study, based on physical examinations and questionnaires at baseline supplemented with national register data between 2005 and 2015. Subjects were placed in subgroups defined by ankle–brachial index levels and reported symptoms; asymptomatic PAD (APAD), intermittent claudication (IC), severe limb ischaemia (SLI), or references (Ref). Cox proportional hazards regression models were used for analysis with adjustments for sex and baseline age and comorbidity. The cohort consisted of 5080 subjects (45% males). At baseline, APAD, IC, and SLI were prevalent in 559 (11%), 320 (6.3%), and 78 (1.5%) subjects, respectively. A significant increased risk for cardiovascular (CV) death, even when adjusted for age and baseline morbidity, were noted in all PAD stages as compared with reference group with a small difference between APAD and IC, an adjusted hazard ratio 1.80 (confidence interval 1.45–2.22) and 1.95 (1.50–2.53), respectively. Only about 60% of PAD subjects received medical prophylactic treatment as recommended in guidelines. Conclusion Peripheral arterial disease subjects had significantly increased CV morbidity and mortality risks, especially males. Asymptomatic PAD subjects confer similar risk for CV events as symptomatic patients. Our findings motivate enhanced preventive efforts of all PAD stages, including in asymptomatic disease.

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