Peripheral Artery Disease and Aortic Disease

Criqui, Michael H.; Aboyans, Victor; Allison, Matthew A.; Denenberg, Julie O.; Forbang, Nketi I.; McDermott, Mary McGrae; Wassel, Christina L.; Wong, Nathan D.

doi:10.1016/j.gheart.2016.08.005

Cited by 8 publications

(3 citation statements)

References 92 publications

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“…Calcification of the thoracic aorta is a risk factor for PAD 28) . PAD is an independent predictor of cardiovascular disease, reflecting systemic atherosclerosis 29) . The prevalence of PAD was sharply age-related, with patients in their 70s being > 10% more likely to have PAD compared to patients in their 60s 30) , whereas aortic atherosclerosis began in youth 31) .…”

Section: Discussionmentioning

confidence: 99%

Aortic Plaque Distribution, and Association between Aortic Plaque and Atherosclerotic Risk Factors: An Aortic Angioscopy Study

Kojima

Kimura

Hayasaka

et al. 2019

JAT

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Aim: Knowledge of subclinical plaque morphology and plaque distribution in the aorta in vivo remains unclear. This study aimed to increase the body of knowledge in this area.Methods: We enrolled 37 consecutive patients with stable angina pectoris patients who underwent non-obstructive angioscopy for both the coronary artery and aorta immediately after percutaneous coronary intervention. We evaluated the presence of aortic plaques and the distribution of plaque instability. Patients were allocated into two groups according to the number of vulnerable plaques in whole aorta (a low [0–11] and high [≥ 12] group). We evaluated the relationships between the two groups in terms of cardiovascular risk factors.Results: Aortic plaques were identified using non-obstructive angioscopy in all patients, and the greatest number of plaques was found at the infrarenal abdominal aorta (IAA) (the aortic arch, the descending thoracic aorta, the suprarenal abdominal aorta, the IAA, and common iliac artery; 65%, 76%, 65%, 95%, and 49%, respectively; p < 0.001). The maximum yellow grade, and the number of intense yellow plaques, ruptured plaques, and thrombi were highest at the IAA (p < 0.001). The prevalence of diabetes mellitus and peripheral arterial disease was higher in the high vulnerable plaque group (83.3% vs. 40.0%, p = 0.010, 50.0% vs. 8.0%, p = 0.005, respectively).Conclusions: Aortic atherosclerosis was the most severe at the IAA, and aortic plaque vulnerability and distribution were associated with the prevalence of diabetes mellitus and peripheral artery disease in patients with stable angina pectoris. Non-obstructive angioscopy may identify patients at high risk of future aortic events.

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Section: Discussionmentioning

confidence: 99%

Aortic Plaque Distribution, and Association between Aortic Plaque and Atherosclerotic Risk Factors: An Aortic Angioscopy Study

Kojima

Kimura

Hayasaka

et al. 2019

JAT

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“…Although Stanford type A dissections require emergency surgeries [14, 15], Stanford type B dissections may be managed with medication [6, 16]. However, impaired blood flow to the organs and limbs necessitates surgical intervention [17]; our patient showed progression of neurological symptoms and decreased ABI, indicative of low perfusion to the lower limbs and cardiovascular abnormality [18], and decreased renal artery RI, suggesting a further decrease in renal perfusion [19]. Generally speaking, for patients with life-threatening complications of acute type B aortic dissections emergency treatment options include open surgical aortic graft replacement; thoracic aortic stent-grafting; interventional or surgical abdominal fenestration; and catheter reperfusion or extra-anatomic surgical bypass, or both [6].…”

Section: Discussionmentioning

confidence: 99%

Complete post-operative resolution of “temporary” end-stage kidney disease secondary to aortic dissection without static renal artery obstruction: a case study

et al. 2019

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Background Acute kidney injury (AKI), which may progress to end-stage kidney disease (ESKD), is a potential complication of aortic dissection. Notably, in all reported ESKD cases secondary to aortic dissection, imaging evidence of static obstruction of the renal arteries always shows either renal artery stenosis or extension of the dissection into the renal arteries. Case presentation We present the case of a 58-year-old man with hypertension who was diagnosed with a Stanford type B aortic dissection and treated with medications alone because there were no obvious findings indicative of dissection involving the renal arteries. He had AKI, which unexpectedly progressed to ESKD, without any radiological evidence of direct involvement of the renal arteries. Thus, we failed to attribute the ESKD to the dissection and hesitated to perform any surgical intervention. Nevertheless, the patient’s hormonal levels, fractional excretion values, ankle brachial indices, and Doppler resistive indices seemed to indirectly suggest kidney malperfusion and implied renal artery hypo-perfusion. However, abdominal computed tomography imaging only revealed progressive thrombotic obstruction of the false lumen and compression of the true lumen in the descending thoracic aorta, despite the absence of anatomical blockage of renal artery perfusion. Later, signs of peripheral malperfusion, such as intermittent claudication, necessitated surgical intervention; a graft replacement of the aorta was performed. Post-operatively, the patient completely recovered after 3 months of haemodialysis, and the markers that had pre-operatively suggested decreased renal bloodstream normalised with recovery of kidney function. Conclusions To the best of our knowledge, this is the first report of severe AKI, secondary to aortic dissection, without direct renal artery obstruction, which progressed to “temporary” ESKD and was resolved following surgery. This case suggests that only coarctation above the renal artery branches following an aortic dissection can progress AKI to ESKD, despite the absence of radiological evidence confirming an obvious anatomical blockage. Further, indirect markers suggestive of decreased renal blood flow, such as ankle brachial indices, renal artery resistive indices, urinary excretion fractions, and hormonal changes, are useful for evaluating concomitant AKI and may indicate the need for surgical intervention after a Stanford type B aortic dissection.

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“…Both modalities were found to have equally high specificity in this regard (CT: 97.7%-98.4%; US: 99.2%-99.6%) [78]. Several large prospective studies have used CT chest and abdomen without IV contrast to quantify calcified atherosclerotic disease in the aorta [79][80][81][82][83][84]. However, the clinical utility of this approach as initial imaging is limited because the lack of IV contrast leads to an underestimation of noncalcified atherosclerotic plaque and does not provide an assessment of the aortic lumen [85].…”

Section: Variant 3: Degenerative or Atherosclerotic Aortic Disease Initial Imagingmentioning

confidence: 99%

ACR Appropriateness Criteria® Nontraumatic Aortic Disease

Imaging¹,

Gunn²,

Kalva

et al. 2021

Journal of the American College of Radiology

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Nontraumatic aortic disease can be caused by a wide variety of disorders including congenital, inflammatory, infectious, metabolic, neoplastic, and degenerative processes. Imaging examinations such as radiography, ultrasound, echocardiography, catheter-based angiography, CT, MRI, and nuclear medicine examinations are essential for diagnosis, treatment planning, and assessment of therapeutic response. Depending upon the clinical scenario, each of these modalities has strengths and weaknesses. Whenever possible, the selection of a diagnostic imaging examination should be based upon the best available evidence.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current

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Peripheral Artery Disease and Aortic Disease

Cited by 8 publications

References 92 publications

Aortic Plaque Distribution, and Association between Aortic Plaque and Atherosclerotic Risk Factors: An Aortic Angioscopy Study

Aortic Plaque Distribution, and Association between Aortic Plaque and Atherosclerotic Risk Factors: An Aortic Angioscopy Study

Complete post-operative resolution of “temporary” end-stage kidney disease secondary to aortic dissection without static renal artery obstruction: a case study

ACR Appropriateness Criteria® Nontraumatic Aortic Disease

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