Accuracy of lower extremity arterial duplex mapping

Moneta, Gregory L.; Yeager, Richard A.; Antonovic, Ruza; Hall, Lee D.; Caster, John D.; Cummings, Cary A.; Porter, John M.

doi:10.1016/0741-5214(92)90249-8

Cited by 214 publications

(94 citation statements)

References 10 publications

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“…60 Duplex ultrasonography is an accurate method for determining the degree of stenosis or length of occlusion of the arteries supplying the lower extremity. [61][62][63] Furthermore, duplex ultrasonography may be useful in the follow-up of patients who have undergone endovascular (percutaneous transluminal angioplasty/stent) or surgical revascularization. Some clinicians routinely place their patients into an ultrasound surveillance program after angioplasty or stent implantation, and most surgeons do so after lower-extremity bypass surgery.…”

Section: Diagnostic Evaluation Exercise Treadmill Testing and Abimentioning

confidence: 99%

Peripheral Artery Disease: Current Insight Into the Disease and Its Diagnosis and Management

Olin

Sealove

2010

Mayo Clinic Proceedings

275

183

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Section: Diagnostic Evaluation Exercise Treadmill Testing and Abimentioning

confidence: 99%

Peripheral Artery Disease: Current Insight Into the Disease and Its Diagnosis and Management

Olin

Sealove

2010

Mayo Clinic Proceedings

275

183

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“…However, the accuracy of waveform analysis alone in assessing the severity of lower-limb arterial disease is uncertain (12,13).…”

mentioning

confidence: 99%

An Evaluation of the Efficacy of Methods Used in Screening for Lower-Limb Arterial Disease in Diabetes

2005

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OBJECTIVE -Foot-related disease is the most common cause for hospital admission among the diabetic population. Lower-limb peripheral arterial occlusive disease (PAOD) is a major risk factor in diabetic foot disease. Screening for PAOD commonly includes foot pulses and the ankle-brachial pressure index (ABPI) and/or the toe-brachial pressure index (TBI), but concerns persist regarding their accuracy. We evaluated the efficacy of several commonly used screening methods in different subject populations.RESEARCH DESIGN AND METHODS -We studied 130 limbs in 68 individuals with no critical ischemia over 8 months. Limbs were grouped on the basis of the presence or absence of diabetes, clinically detectable peripheral neuropathy, and PAOD identified on color duplex imaging. Comparative analyses of foot pulses, the ABPI, the TBI, and distal Doppler waveform analysis were performed.RESULTS -Foot pulses, the TBI, and qualitative waveform analyses were highly sensitive screening methods in individuals with and without diabetes. However, detectable peripheral neuropathy was associated with a reduced sensitivity and poor specificity of foot pulses, a reduction in sensitivity of the ABPI (71 to 38%), and a reduction in specificity of the TBI (81 to 61%) and qualitative waveform analysis (96 to 66%). Quantitative analysis failed to detect disease with severely damped and low-intensity signals.CONCLUSIONS -Screening tools that are effective in screening for lower-limb PAOD in the nondiabetic population are less efficacious in diabetes, particularly in the presence of detectable peripheral neuropathy. Qualitative waveform analysis and the TBI were demonstrated to be more effective screening methods than the ABPI and foot pulses particularly in high-risk limbs with detectable peripheral neuropathy. Diabetes Care 28:2206 -2210, 2005F oot-related disease is the most common cause for hospital admission among the diabetic population and is recognized as the most common cause of nontraumatic lower-limb amputation in the western world. People with diabetes are Ͼ20 times more likely to undergo an amputation than the rest of the population (1). The main risk factors for the development of diabetic foot disease are peripheral neuropathy and peripheral arterial occlusive disease (PAOD). The detection of significant arterial disease is vital to the prevention and treatment of foot disease. The unreliable nature of the symptoms and signs of lower-limb arterial insufficiency in diabetes means that noninvasive tests are essential to achieve effective screening (2,3). The European Working Group on Critical Leg Ischaemia recommends an additional, noninvasive vascular assessment for patients with diabetes and foot ulceration (4).Screening techniques commonly used in assessing lower-limb perfusion are the palpation of foot pulses and calculation of the ankle-brachial pressure index (ABPI) and/or the toe-brachial pressure index (TBI). There is continued debate regarding the influence of peripheral neuropathy and arterial calcification on the reliabil...

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“…Endothelial dysfunction and atherosclerosis of blood vessels that supply the penis are associated with the same cardiovascular risk factors (smoking, diabetes mellitus, hypertension and hyperlipidemia) which affect coronary arteries. 11,15,16 It has been reported that transforming growth factor-b1 and its type II receptor are significantly more noticeable in the cavernous tissue of patients with vasculogenic ED than they are in control subjects or psychogenic ED and that their prominence correlates with the degree of fibrosis of the cavernous tissue as shown by the abundance of collagen fibers following the percutaneous cavernous biopsy. 17 Patients with cardiovascular disease run more risks of developing ED.…”

Section: Discussionmentioning

confidence: 99%

“…Subclinical atherosclerosis was defined by the presence of established cardiovascular risk factors (age, hypertension, diabetes, hyperlipidemia and cigarette smoking) and ultrasound lesions of the structure of vascular (carotid and lower limb arteries) walls, such as: (a) hemodynamically nonsignificant stenosis (o50% external carotid and/or lower limb artery diameter reduction); 14,15 (b) marked (0.5-4 mm) intima-media thickness of the carotid artery, measured by means of B-mode ultrasonography; 16 (c) homogeneous or heterogeneous atheroma plaques (43 mm).…”

Section: Laboratory Testing and Echo-duplex Examinationmentioning

confidence: 99%

Incidence of extragenital vascular disease in patients with erectile dysfunction of arterial origin

et al. 2005

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This research was carried out to evaluate the prevalence of carotid and/or lower limb artery abnormalities in patients with arterial erectile dysfunction (ED). To this end, patients with ED (Andrology Unit) or suspected peripheral atherosclerosis (Angiology Unit) underwent an independent and parallel echo-Duplex examination. The Andrology Unit examined 167 patients with ED of different etiologies: 52 of them had penile artery insufficiency and consequently their carotids and lower limb arteries had to be evaluated by means of echo-Doppler. In all, 36 out of the 46 patients with nonarterial organic ED and 22 out of the 69 patients with nonorganic ED underwent the same evaluation and served as controls. The Angiology Unit enrolled 457 ED patients who initially underwent echo-Doppler for suspected carotid and/or arterial leg atherosclerosis and subsequently dynamic echo-Doppler. Isolated penile artery insufficiency was found in 23.1 and 25% of the patients evaluated in the Angiology and Andrology Units, respectively. The remaining patients were shown to have ED associated with an atheroma or marked intima-media thickness of the carotid vessels and/or of leg arteries. The frequency of penile arterial insufficiency and of carotid and/or lower limb artery abnormalities was significantly higher (Po0.01) compared to that found in patients with ED of nonarterial organic or psychogenic origin. Both Units found that the frequency of penile artery insufficiency and carotid or lower limb artery abnormalities was significantly higher than that of penile artery insufficiency alone or plus both carotid and lower limb artery abnormalities. This study showed that penile artery insufficiency is associated with carotid and/or lower limb artery ultrasound abnormalities in about 75% of the cases. Therefore, arterial ED may be regarded as a sign of a more generalized atherosclerosis.

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Accuracy of lower extremity arterial duplex mapping

Cited by 214 publications

References 10 publications

Peripheral Artery Disease: Current Insight Into the Disease and Its Diagnosis and Management

Peripheral Artery Disease: Current Insight Into the Disease and Its Diagnosis and Management

An Evaluation of the Efficacy of Methods Used in Screening for Lower-Limb Arterial Disease in Diabetes

Incidence of extragenital vascular disease in patients with erectile dysfunction of arterial origin

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