Prospects of Contrast‐Enhanced Ultrasonography for the Diagnosis of Peripheral Arterial Disease: A Meta‐analysis

Hou, Xiaoxia; Chu, Guanghua; Yu, Yuan

doi:10.1002/jum.14451

Cited by 16 publications

(12 citation statements)

References 47 publications

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“…Some vascular specialists advocate the use of ultrasound contrast agents to improve visualization; however, clinical studies to date are limited. 260 Although multiple studies have shown DUS to be inferior to other imaging techniques, such as DSA, it offers many advantages as a first-line imaging modality, including its noninvasive nature, low cost, no iodinated contrast media, no ionizing radiation, and no fixed installation (mobility). 25,261,262 The main disadvantages of DUS are that it is time-consuming and highly operator dependent, and it does not produce a continuous lesion map.…”

Section: Imaging Of Vascular Anatomymentioning

confidence: 99%

Global vascular guidelines on the management of chronic limb-threatening ischemia

Conte

Bradbury

Kolh³

et al. 2019

Journal of Vascular Surgery

1,189

865

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Chronic limb-threatening ischemia (CLTI) is associated with mortality, amputation, and impaired quality of life. These Global Vascular Guidelines (GVG) are focused on definition, evaluation, and management of CLTI with the goals of improving evidence-based care and highlighting critical research needs. The term CLTI is preferred over critical limb ischemia, as the latter implies threshold values of impaired perfusion rather than a continuum. CLTI is a clinical syndrome defined by the presence of peripheral artery disease (PAD) in combination with rest pain, gangrene, or a lower limb ulceration >2 weeks duration. Venous, traumatic, embolic, and nonatherosclerotic etiologies are excluded. All patients with suspected CLTI should be referred urgently to a vascular specialist. Accurately staging the severity of limb threat is fundamental, and the Society for Vascular Surgery Threatened Limb Classification system, based on grading of Wounds, Ischemia, and foot Infection (WIfI) is endorsed. Objective hemodynamic testing, including toe pressures as the preferred measure, is required to assess CLTI. Evidence-based revascularization (EBR) hinges on three independent axes: Patient risk, Limb severity, and ANatomic complexity (PLAN). Average-risk and high-risk patients are defined by estimated procedural and 2-year all-cause mortality. The GVG proposes a new Global Anatomic Staging System (GLASS), which involves defining a preferred target artery path (TAP) and then estimating limb-based patency (LBP), resulting in three stages of complexity for intervention. The optimal revascularization strategy is also influenced by the availability of autogenous vein for open bypass surgery. Recommendations for EBR are based on best available data, pending level 1 evidence from ongoing trials. Vein bypass may be preferred for average-risk patients with advanced limb threat and high complexity disease, while those with less complex anatomy, intermediate severity limb threat, or high patient risk may be favored for endovascular intervention. All patients with CLTI should be afforded best medical therapy including the use of antithrombotic, lipid-lowering, antihypertensive, and glycemic control agents, as well as counseling on smoking cessation, diet, exercise, and preventive foot care. Following EBR, long-term limb surveillance is advised. The effectiveness of nonrevascularization therapies (eg, spinal stimulation, pneumatic compression, prostanoids, and hyperbaric oxygen) has not been established. Regenerative medicine approaches (eg, cell, gene therapies) for CLTI should be restricted to rigorously conducted randomizsed clinical trials. The GVG promotes standardization of study designs and end points for clinical trials in CLTI. The importance of multidisciplinary teams and centers of excellence for amputation prevention is stressed as a key health system initiative.

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Section: Imaging Of Vascular Anatomymentioning

confidence: 99%

Global vascular guidelines on the management of chronic limb-threatening ischemia

Conte

Bradbury

Kolh³

et al. 2019

Journal of Vascular Surgery

1,189

865

View full text Add to dashboard Cite

show abstract

“…40,41 Ultrasound contrast agents (CEUS) to evaluate PAD was aimed to assess physiopathology and muscular reserve in normal or with clinical suspicion of peripheral arterial insufficiency patients, or to improve diagnostic accuracy of vascular arterial mapping. 42,43 In contrast to extracranial carotid arteries, there is a lack of reference guidelines on how to perform DUS of the lower limb arterial tree in diabetic patients with or without foot lesions. Also, there is no clear idea on what the benefits of using DUS before revascularization would be.…”

Section: Us In the Diagnosis Management And Followup Of Peripheral mentioning

confidence: 99%

“…Ultrasound contrast agents (CEUS) to evaluate PAD was aimed to assess physiopathology and muscular reserve in normal or with clinical suspicion of peripheral arterial insufficiency patients, or to improve diagnostic accuracy of vascular arterial mapping. 42,43…”

Section: Ultrasound In the Ischemic Diabetic Footmentioning

confidence: 99%

Ultrasound in the Modern Management of the Diabetic Foot Syndrome: A Multipurpose Versatile Toolkit

Pieruzzi

Napoli

Goretti

et al. 2020

The International Journal of Lower Extremity Wounds

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Ultrasound (US) is a noninvasive and versatile technology that in recent years found acceptance in almost all the medical specialties, with diagnostic and interventional applications. In the diabetic foot syndrome (DFS), US found specific indications mainly in the screening, quantification, and follow-up of the vascular component of the pathology, but also in the study of the deformities and structural modifications induced by neuropathy and in the diagnosis and surgical management of infections, especially those that induce anatomical changes, like abscesses and fasciitis. This review will summarize all these application of US, giving special attention to the vascular aspects, and on the predominant role that US gained in recent times to guide the indication to revascularization, on the new standardized approach to the study of the arterial tree of the limb and the foot, the so-called duplex ultrasound arterial mapping, which significantly increased the utilization of US to plan the revascularizations in this complex pathology. Outside the vascular fields, the diagnosis of neuropathy and infection and the intraoperative use of US in the surgical management of abscesses and fasciitis will be discussed, leaving the last part to the new and interesting applications of US in the management of DFU, a field that is still in evolution, offering new possibilities to the health care professionals involved in the management of these chronic wounds. The variety of applications both in diagnostic and operative fields makes US a rather versatile technology—a toolkit—that should have a special place among those at reach of the specialists of DFS care.

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“…Неинвазивность, отсутствие нефротоксичности, возможность многократного повторения исследования, меньшая стоимость в сравнении с инвазивными методами диагностики увеличивают ценность этого исследования [10]. Возможно применение ультразвукового сканирования с контрастным усилением, но исследований по оценке эффективности этой методики пока недостаточно [11].…”

Section: особенности диагностики атеросклеротического поражения у пациентов с синдромом диабетической стопыunclassified

Current Aspects of Diagnosis and Treatment of Atherosclerosis of the Lower Extremities Arteries in Patients With Diabetic Foot Syndrome

Толстокоров¹,

Kulikova²,

Larin³

2021

Novosti Khirurgii

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Atherosclerosis of lower-extremity arterial disease is a common pathology in diabetes mellitus, contributing to the development of ischemic and neuroischemic forms of diabetic foot syndrome. Early diagnosis of vascular lesions helps to reduce the number of cardiovascular complications, performed amputations and improves the quality of life in these patients.The review presents the current arsenal of modern comprehensive examinations of patients with diabetic foot syndrome, including clinical and functional screening, non-invasive and invasive methods of radiological diagnosis, as well as specific assessment scales and new classifications that allow detailing and systematizing trophic foot changes with the ability to predict the course of the pathological processoccurring at sites. The using of open revascularization methods helps to achieve the healing of diabetic ulcers in a large percentage of cases, but the point is the problems associated with the localization of the lesion, the choice of conduit for bypass surgery and technical aspects significantly limit the possibilities of this treatment method. Recent technological advances in the development of endovascular surgery have expanded the indications for successful revascularization. The article highlights the results of shunting and endovascular methods in the treatment of atherosclerotic process in infrainguinal area in patients with diabetic foot syndrome.

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Prospects of Contrast‐Enhanced Ultrasonography for the Diagnosis of Peripheral Arterial Disease: A Meta‐analysis

Abstract: Contrast-enhanced ultrasonography is a valuable tool for the diagnosis of PAD based on its ability to differentiate the time to peak intensity between patients with PAD and healthy individuals, but little data are yet available to assess its diagnostic ability in clinical practice.

Cited by 16 publications

References 47 publications

Global vascular guidelines on the management of chronic limb-threatening ischemia

Global vascular guidelines on the management of chronic limb-threatening ischemia

Ultrasound in the Modern Management of the Diabetic Foot Syndrome: A Multipurpose Versatile Toolkit

Current Aspects of Diagnosis and Treatment of Atherosclerosis of the Lower Extremities Arteries in Patients With Diabetic Foot Syndrome

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