Objective To establish associations between leg strength and mortality in men and women with lower extremity peripheral arterial disease (PAD). Design Observational, prospective study. Setting Chicago area medical centers. Subjects Participants were 410 men and women with PAD age 55 and older followed for a mean of 60.0 months. Interventions Isometric knee extension, knee flexion, hip extension, and hip flexion were measured at baseline. Primary outcomes were all-cause and cardiovascular disease mortality. Cox proportional hazards models were used to assess relations between leg strength and all-cause and cardiovascular disease mortality among men and women, adjusting for age, race, comorbidities, smoking, body mass index, and the ankle brachial index. Results Among the 246 male participants, poorer baseline strength for knee flexion (P trend = .029), knee extension (P trend =.010), and hip extension (P trend = .013) were each associated independently with higher all-cause mortality. Poorer strength for knee flexion (P trend = .042) and hip extension (P trend = .029) were associated with higher cardiovascular mortality. Compared to those in the fourth (best) baseline knee flexion quartile, Hazard Ratios for all-cause and cardiovascular disease mortality among men in the 1st (poorest) knee flexion quartile were 2.23 (95% Confidence Interval (CI) = 1.02–4.87, P=.045) and 4.20 (95% CI = 1.12–15.79, P=.043), respectively. No significant associations of leg strength and all-cause mortality were identified among women. Conclusions Poorer leg strength is associated with increased mortality in men, but not women, with PAD. Future study is needed to determine whether interventions that increase leg strength improve survival in men with PAD.

Current standard practice for radioembolization treatment planning makes use of nuclear medicine imaging (NMI) of 99m Tc-macroaggregated albumin ( 99m Tc-MAA) arterial distributions for the assessment of lung shunting and extrahepatic uptake. Our aim was to retrospectively compare NMI with mapping angiography in the detection and localization of extrahepatic 99m Tc-MAA and to evaluate the typical and atypical findings of NMI in association with catheter placement. Methods: One hundred seventy-four patients underwent diagnostic angiography in preparation for radioembolization. 99m Tc-MAA was administered to the liver via a microcatheter positioned in the desired hepatic artery. Planar scintigraphy imaging followed by SPECT/CT imaging was obtained within 2 h. All images were reviewed for hepatic and extrahepatic 99m Tc-MAA deposition and compared with the mapping angiogram. Results: Intrahepatic lobe shunting was present on NMI in only 2.9% of the cases but was present in 62.5% of the patients with portal vein thrombosis. Extrahepatic distributions included lungs (100%), the gallbladder (49%) if present, and locations involving hepaticoenteric arterial anatomy recognized on angiograms (16%). Free pertechnetate was identified on 38% of the nuclear medicine images. Three percent of nuclear medicine images showed alternative findings such as a thyroid nodule or metallic artifact. Conclusion: Patients being considered for radioembolization should undergo both angiography and scintigraphy for the assessment of hepaticoenteric arterial anatomy, hepatopulmonary shunting, and appropriate dosimetry considerations. Knowledge of the expected distribution of 99m Tc-MAA with normal variants and potential nontarget delivery to adjacent structures is critical in improving clinical outcomes. Cur rently, nuclear medicine imaging (NMI) of 99m Tc-labeled macroaggregated albumin ( 99m Tc-MAA) is performed routinely before radioembolization for the assessment of lung shunting and extrahepatic uptake. NMI is widely recognized to be important for minimizing the risk of potentially debilitating adverse events such as radiation-induced pneumonitis or radiation gastritis/duodenitis after radioembolization using 90 Y-microspheres for inoperable hepatic tumors (1,2). The seminal work in a canine liver model demonstrating the safety and feasibility of using 90 Y-microsphere therapy for hepatic malignancies was reported in the late 1980s. Human studies of 90 Y-microsphere therapy in liver applications followed from the late 1980s through the 1990s. These investigations established the safety of 90 Y for intrahepatic applications and the optimal dosimetry for tumor radiation kill, while minimizing exposure to normal liver tissue (3-8).Given the similarities in sizes of 90 Y-microspheres (20-40 mm) and 99m Tc-MAA (20-50 mm), the pattern of 99m Tc-MAA deposition as determined from a high-resolution SPECT/CT acquisition serves as a surrogate to demonstrate how 90 Y-microspheres will localize during treatment. Radioembolization has evolved for the ...

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