scholarly journals The Efficacy of Cone-Beam CT-Based Perfusion Mapping in Evaluation of Tissue Perfusion in Peripheral Arterial Disease

2021 ◽  
Vol 10 (5) ◽  
pp. 947
Author(s):  
Ran Kim ◽  
Sun Young Choi ◽  
Yeo Ju Kim
Keyword(s):  
Logistic Regression ◽  
Peripheral Arterial Disease ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Tissue Perfusion ◽  
Arterial Disease ◽  
Observer Agreement ◽  
Cone Beam ◽  
Multiple Logistic Regression ◽  
Peripheral Arterial

This study investigated the use of cone-beam computed tomography (CBCT)-based perfusion mapping during percutaneous transluminal angioplasty (PTA) to predict clinical outcome in the peripheral arterial disease (PAD). From January 2016 to March 2020, 43 patients (28 male, 15 female; mean age, 69) with 51 limbs, who underwent PTA with CBCT-based foot perfusion mapping for PAD were included. Parenchymal blood volume (PBV) of foot was measured. Clinical response was investigated based on medical records. Predictive value for clinical success was evaluated using multiple logistic regression with C-statistics. Two reviewers visually assessed the improvement on angiography and CBCT-based foot perfusion mapping; inter-observer agreement of clinical success between the two were measured. Technical and clinical success rate of PTA was 90.8% and 68.6%, respectively. In multiple logistic regression, the maximum value of PBV (PBVmax) on perfusion mapping after PTA was significant (p = 0.03) for evaluating clinical success with the highest C-statistic (0.84). Using a cutoff of 235.7 mL/L for PBVmax after PTA, area under curve for prediction of clinical success was 0.664, and sensitivity and specificity were 71.4% and 68.8%, respectively. Consistency in prediction of clinical success between the two reviewers was almost perfect for CBCT-based foot perfusion mapping.

scholarly journals Hybrid atherectomy for lower extremity peripheral arterial disease

Vascular ◽  
2018 ◽  
Vol 27 (1) ◽  
pp. 60-70 ◽  
Author(s):  
Saygin Turkyilmaz ◽  
Ali Aycan Kavala
Keyword(s):  
Peripheral Arterial Disease ◽  
Lower Extremity ◽  
Clinical Success ◽  
Demographic Data ◽  
Clinical Success Rate ◽  
Arterial Disease ◽  
Technical Success ◽  
Directional Atherectomy ◽  
Procedural Success ◽  
Peripheral Arterial

Objective To evaluate the effectiveness of directional atherectomy with a Phoenix atherectomy system in lower extremity peripheral arterial disease (LE-PAD). Materials and methods A retrospective review of subjects who had undergone atherectomy for severe and occluded LE-PAD. Demographic data, procedural properties, and follow-up information were recorded. The technical, procedural and clinical successes were reported. Results In total, 120 subjects were evaluated. The superficial femoral artery (SFA) group consisted of 64 subjects (53.3%), and the popliteal group consisted of 56 (46.7%) subjects. Groups did not differ in terms of age, gender, comorbid diseases and tobacco use. In both groups, four subjects (6.3% of SFA and 7.1% of the popliteal group) experienced extravasation was encountered in from the vessel during the procedure. During atherectomy, two (3.3%) of the subjects in the SFA group and one (1.9%) subject in the popliteal group experienced vessel dissection. Acute technical success in this study was 96.7% for SFA and 98.1% for the popliteal group. Overall technical success was 97.7%. In the first 72 h, three (5%) of the subjects in the SFA group and four (7.7%) of the subjects in the popliteal group experienced major adverse events. Acute procedural success in this study was 91.7% for SFA and 90.4% for the popliteal group. Overall procedural success was 91.1%. Success was defined as an improvement of at least one grade in the Rutherford classification; two (3.3%) subjects did not demonstrate improvements in the SFA group, and the clinical success rate was 96.7%. All subjects in the popliteal group demonstrated an improvement of at least one grade in the Rutherford classification, and clinical success was 100%. When the groups combined all subjects, the clinical success in this study was 98.2%. Conclusion Directional atherectomy with a Phoenix atherectomy system demonstrated comparable results with the literature.

CO2-based C-arm computed tomography (CACT) of the pelvic arteries: feasibility and diagnostic performance in comparison to CO2-angiography in patients with peripheral arterial disease

2020 ◽  
pp. 028418512096995
Author(s):  
Lena S Becker ◽  
Cornelia LA Dewald ◽  
Sabine K Maschke ◽  
Thomas Werncke ◽  
Bernhard C Meyer ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Peripheral Arterial Disease ◽  
Excellent Agreement ◽  
Diagnostic Performance ◽  
Arterial Disease ◽  
Observer Agreement ◽  
Consensus Values ◽  
Peripheral Arterial ◽  
Work Up ◽  
Consensus Reading

Background Patients with substantially impaired kidney function and peripheral arterial disease (PAD) underwent comparative CO2-based depiction of the pelvic arteries (PAs). Purpose To evaluate the feasibility and diagnostic performance of CO2-based C-arm computed tomography (CACT) and compare its depiction of PAs with CO2-digital subtraction angiography (DSA). Material and Methods Fifteen patients (10 men, mean age 70 ± 11 years) with PAD received CO2-DSA and CO2-CACT of the PAs, depicted from the aorta to femoral arteries. These were divided into nine segments (135 in total) and graded by two independent readers for image quality (IQ; 1 = sufficient, 2 = minimal impairments, 3 = insufficient, 4 = outside field of view) and subsequent stenosis grading (SG; grade 1: normal to grade 4: occlusion), under exclusion of all segments with insufficient IQ. Inter-observer and inter-modality agreement calculation and subsequent consensus reading were performed and correlated to a standard of reference (StOR), representing a modality consensus. Results Of 135 segments, 117 showed sufficient IQ, excluding 18 segments (10 CACT, 8 DSA). Inter-observer agreement for IQ and consecutive SG demonstrated good to excellent agreement: IQDSA: κ = 0.83, IQCACT: κ = 0.76; StenosisDSA: κ = 0.71, StenosisCACT: κ = 0.84. Inter-modality agreement for SG lay at κ = 0.76 and κ = 0.65, respectively. More stenoses could be detected by CACT, and analysis of pooled consensus values of SG in CACTcons versus StOR showed an excellent agreement (κ = 0.96) that proved considerably higher than the moderate agreement between consensus values in DSAcons versus StOR (κ = 0.43). Conclusion CO2-CACT proved feasible, and has the potential to optimize angiographic work-up of PAD in patients with contraindications for other contrast media.

scholarly journals Different Lower Extremity Arterial Calcification Patterns in Patients with Chronic Limb-Threatening Ischemia Compared with Asymptomatic Controls

2021 ◽  
Vol 11 (6) ◽  
pp. 493
Author(s):  
Louise C. D. Konijn ◽  
Richard A. P. Takx ◽  
Willem P. Th. M. Mali ◽  
Hugo T. C. Veger ◽  
Hendrik van Overhagen
Keyword(s):  
Logistic Regression ◽  
Vessel Wall ◽  
Lower Extremities ◽  
Arterial Disease ◽  
Arterial Calcification ◽  
Multiple Logistic Regression ◽  
Therapeutic Consequences ◽  
Peripheral Arterial ◽  
Crural Arteries ◽  
Severe Type

Objectives: The most severe type of peripheral arterial disease (PAD) is critical limb-threatening ischemia (CLI). In CLI, calcification of the vessel wall plays an important role in symptoms, amputation rate, and mortality. However, calcified arteries are also found in asymptomatic persons (non-PAD patients). We investigated whether the calcification pattern in CLI patients and non- PAD patients are different and could possibly explain the symptoms in CLI patients. Materials and Methods: 130 CLI and 204 non-PAD patients underwent a CT of the lower extremities. This resulted in 118 CLI patients (mean age 72 ± 12, 70.3% male) that were age-matched with 118 non-PAD patients (mean age 71 ± 11, 51.7% male). The characteristics severity, annularity, thickness, and continuity were assessed in the femoral and crural arteries and analyzed by binary multiple logistic regression. Results: Nearly all CLI patients have calcifications and these are equally frequent in the femoropopliteal (98.3%) and crural arteries (97.5%), while the non-PAD patients had in just 67% any calcifications with more calcifications in the femoropopliteal (70.3%) than in the crural arteries (55.9%, p < 0.005). The crural arteries of CLI patients had significantly more complete annular calcifications (OR 2.92, p = 0.001), while in non-PAD patients dot-like calcifications dominated. In CLI patients, the femoropopliteal arteries had more severe, irregular/patchy, and thick calcifications (OR 2.40, 3.27, 1.81, p ≤ 0.05, respectively) while in non-PAD patients, thin continuous calcifications prevailed. Conclusions: Compared with non-PAD patients, arteries of the lower extremities of CLI patients are more frequently and extensively calcified. Annular calcifications were found in the crural arteries of CLI patients while dot-like calcifications were mostly present in non-PAD patients. These different patterns of calcifications in CLI point at different etiology and can have prognostic and eventually therapeutic consequences.

Abstract 15999: Machine Learning to Identify Patients at High Risk for Peripheral Arterial Disease From Electronic Health Record Data

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mark Sonderman ◽  
Eric Farber-Eger ◽  
Aaron W Aday ◽  
Matthew S Freiberg ◽  
Joshua A Beckman ◽  
...  
Keyword(s):  
Machine Learning ◽  
Logistic Regression ◽  
High Risk ◽  
Peripheral Arterial Disease ◽  
Electronic Health Record ◽  
Arterial Disease ◽  
Health Record ◽  
Electronic Health Record Data ◽  
Electronic Health ◽  
Peripheral Arterial

Introduction: Peripheral arterial disease (PAD) is a common and underdiagnosed disease associated with significant morbidity and increased risk of major adverse cardiovascular events. Targeted screening of individuals at high risk for PAD could facilitate early diagnosis and allow for prompt initiation of interventions aimed at reducing cardiovascular and limb events. However, no widely accepted PAD risk stratification tools exist. Hypothesis: We hypothesized that machine learning algorithms can identify patients at high risk for PAD, defined by ankle-brachial index (ABI) <0.9, from electronic health record (EHR) data. Methods: Using data from the Vanderbilt University Medical Center EHR, ABIs were extracted for 8,093 patients not previously diagnosed with PAD at the time of initial testing. A total of 76 patient characteristics, including demographics, vital signs, lab values, diagnoses, and medications were analyzed using both a random forest and least absolute shrinkage and selection operator (LASSO) regression to identify features most predictive of ABI <0.9. The most significant features were used to build a logistic regression based predictor that was validated in a separate group of individuals with ABI data. Results: The machine learning models identified several features independently correlated with PAD (age, BMI, SBP, DBP, pulse pressure, anti-hypertensive medication, diabetes medication, smoking, and statin use). The test statistic produced by the logistic regression model was correlated with PAD status in our validation set. At a chosen threshold, the specificity was 0.92 and the positive predictive value was 0.73 in this high-risk population. Conclusions: Machine learning can be applied to build unbiased models that identify individuals at risk for PAD using easily accessible information from the EHR. This model can be implemented either through a high-risk flag within the medical record or an online calculator available to clinicians.

scholarly journals Prospective Evaluation of Tissue Perfusion in Patients with Peripheral Arterial Disease Using Laser-Assisted Fluorescent Angiography

2013 ◽  
Vol 58 (2) ◽  
pp. 566
Author(s):  
Venita Chandra ◽  
Mohamed Zayed ◽  
Elizabeth Hitchner ◽  
Vinit N. Varu ◽  
Oliver Aalami ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Tissue Perfusion ◽  
Arterial Disease ◽  
Prospective Evaluation ◽  
Peripheral Arterial
Sign in / Sign up

Export Citation Format

Share Document