Early results of infragenicular revascularization based solely on duplex arteriography

Proia, Richard R; Walsh, Daniel B.; Nelson, Peter R.; Connors, John P.; Powell, Richard J.; Zwolak, Robert M.; Fillinger, Mark F.; Cronenwett, Jack L.

doi:10.1067/mva.2001.115376

Cited by 46 publications

(22 citation statements)

References 21 publications

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“…18-7). [34][35][36][37] Duplex ultrasonography is also used in the postoperative surveillance of arterial bypass grafts. 32 In another meta-analysis of 14 studies, the sensitivity and specificity of duplex ultrasound with and without color-guided Doppler analysis to detect 50% or greater stenosis or occlusion was 93% and 95%, respectively.…”

Section: Duplex Ultrasonographymentioning

confidence: 99%

Peripheral Artery Disease

Beckman¹,

Creager²

2013

Vascular Medicine: A Companion to Braunwald's Heart Disease

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Section: Duplex Ultrasonographymentioning

confidence: 99%

Peripheral Artery Disease

Beckman¹,

Creager²

2013

Vascular Medicine: A Companion to Braunwald's Heart Disease

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“…Some centers have reported excellent results with preoperative duplex ultrasonography either as a stand-alone imaging modality 52,53 or as an adjunct to contrast arteriography, in which duplex imaging can identify areas of significant stenosis limiting the contrast arteriogram to a specific area requiring treatment. In our practice, we prefer DSA in these patients using strategies to limit contrast exposure including the use of nonionic iso-osmolar contrast diluted to 50% strength, using CO 2 for proximal arteries or avoiding aortoiliac imaging altogether.…”

mentioning

confidence: 98%

Arterial imaging in patients with lower extremity ischemia and diabetes mellitus

Pomposelli

2010

Journal of Vascular Surgery

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Precise, comprehensive imaging of the arterial circulation is the cornerstone of successful revascularization of the ischemic extremity in patients with diabetes mellitus. Arterial imaging is challenging in these patients because the disease is often multisegmental with a predilection for the distal tibial and peroneal arteries. Occlusive lesions and the arterial wall itself are often calcified and patients presenting with ischemic complications frequently have underlying renal insufficiency. Intra-arterial digital subtraction angiography (DSA), contrast enhanced magnetic resonance angiography (MRA), and more recently, computerized tomographic angiography (CTA) have been used as imaging modalities in lower extremity ischemia. Each has specific advantages and shortcomings in this patient population, which will be summarized and contrasted in this review. DSA is an invasive technique most often performed from a femoral arterial puncture and requires the injection of arterial contrast, which can occasionally cause allergic reactions. In patients with pre-existing renal insufficiency, contrast infusion can result in worsening renal failure; although usually self-limited, it may occasionally require hemodialysis, especially in patients with diabetes. However, DSA provides the highest degree of spatial resolution and image quality. It is also the only modality in which the diagnosis and treatment of arterial disease can be performed simultaneously. MRA is noninvasive, and when enhanced with gadolinium contrast injection provides arterial images of comparable quality to DSA and in some circumstances may uncover distal arterial targets not visualized on DSA. However, spatial resolution is inferior to DSA and erroneous interpretations due to acquisition artifacts are common. Specialized equipment and imaging techniques are necessary to minimize their occurrence in the distal lower extremity. In addition, due to the risk of inducing nephrogenic systemic fibrosis, gadolinium-enhanced MRA cannot be used in patients with renal insufficiency. CTA is noninvasive and rapidly performed, with better spatial resolution than MRA, but requires the largest volume of contrast infusion, exposes patients to high-doses of radiation, and is subject to interpretive error due to reconstruction artifacts especially in heavily calcified arteries, limiting its usefulness in many patients with diabetes. For patients in whom the planned intervention is a surgical bypass, DSA and MRA will provide high quality images of the lower extremity arterial anatomy. For patients in whom a catheter-based intervention is the likely treatment, a diagnostic DSA immediately followed by a catheter-based treatment in the same procedure is the preferred approach. In patients with pre-existing renal dysfunction, in which gadolinium-enhanced MRA is contraindicated, DSA or CTA can be performed. However, patients should have an infusion of intravenous normal saline solution or sodium bicarbonate before the procedure to reduce the incidence of contrast-induced nephropathy.

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“…When the findings are documented as a cartoonography, illustrating their severity, endovascular treatment can be planned on the basis of an ultrasound examination only (Fig. 2) (28,29). In the femoropopliteal area, accuracies of 84%-87% have been found when PTA has been performed on the basis of ultrasound (27,28).…”

Section: Duplex Ultrasound (Dus)mentioning

confidence: 99%