Reliability and Accuracy of Simple Visual Estimation in Assessment of Peripheral Arterial Stenosis

Rajebi, Mohammad Reza; Benenati, Matthew J.; Schernthaner, Melanie; Walker, Gail; Gandhi, Ripal; Peña, Constantino; Katzen, Barry T.

doi:10.1016/j.jvir.2015.02.018

Cited by 17 publications

(14 citation statements)

References 28 publications

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“…The ability to determine adequate perfusion through small vessels of distal tissue is especially affected. 15 More noninvasive physiologic tests, such as Doppler ultrasound or ABI, allow an objective examination of arterial flow, and they can be performed serially postoperatively to monitor disease progression. However, these methods cannot be performed intraoperatively to guide the revascularization plan.…”

Section: Discussionmentioning

confidence: 99%

Characterizing tissue perfusion after lower extremity intervention using two-dimensional color-coded digital subtraction angiography

Kim

Shevitz

Morrow

et al. 2017

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

Characterizing tissue perfusion after lower extremity intervention using two-dimensional color-coded digital subtraction angiography

Kim

Shevitz

Morrow

et al. 2017

Journal of Vascular Surgery

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“…Because of its superior spatial resolution, digital subtraction angiography is still considered the gold standard for stenosis severity assessment and treatment planning in PAD . Visual inspection of these images by the interventionalist is the fastest and easiest way to determine the degree of the stenosis but tends to underestimate stenoses with a lumen diameter reduction of 50% or less and to overestimate stenoses with >50% diameter reduction . In addition, visual assessment neglects hemodynamic factors, such as the local pressure gradient and flow, whereas these factors are the major determinants for sufficient blood supply to the peripheral tissue.…”

mentioning

confidence: 99%

In Vivo Validation of Patient‐Specific Pressure Gradient Calculations for Iliac Artery Stenosis Severity Assessment

Heinen

Heuvel

Huberts

et al. 2017

JAHA

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BackgroundCurrently, the decision to treat iliac artery stenoses is mainly based on visual inspection of digital subtraction angiographies. Intra‐arterial pressure measurements can provide clinicians with accurate hemodynamic information. However, pressure measurements are rarely performed because of their invasiveness and the time required. Therefore, the aim of the study was to test the feasibility of a computational model that can predict translesional pressure gradients across iliac artery stenoses on the basis of imaging data only.Methods and ResultsPatients (N=21) with symptomatic peripheral arterial disease and a peak systolic velocity ratio between 2.5 and 5.0 were included in the study. Patients underwent per‐procedural 3‐dimensional rotational angiography and hyperemic intra‐arterial translesional pressure measurements. Vascular anatomical features were reconstructed from the 3‐dimensional rotational angiography data into an axisymmetrical 2‐dimensional computational mesh, and flow was estimated on the basis of the stenosis geometry. Computational fluid dynamics were performed to predict the pressure gradient and were compared with the measured pressure gradients. A good agreement by overlapping error bars of the predicted and measured pressure gradients was found in 21 of 25 lesions. Stratification of the stenosis on the basis of the predicted pressure gradient into hemodynamic not significant (<10 mm Hg) and hemodynamic significant (≥10 mm Hg) resulted in sensitivity, specificity, and overall predictive values of 95%, 60%, and 88%, respectively.ConclusionsThe feasibility of the patient‐specific computational model to predict the hyperemic translesional pressure gradient over iliac artery stenosis was successfully tested. Presented results suggest that, with further optimization and corroboration, the model can become a valuable aid to the diagnosis of equivocal iliac artery stenosis.Clinical Trial Registration URL: http://www.trialregister.nl. Unique identifier: NTR5085.

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“…However, DUS sensitivity in detecting true PAD confirmed by invasive intra‐arterial DSA varied from proximal to distal arterial segments and with severity of stenosis measured as percent reduction below normal arterial diameter levels, yielding significantly different diagnostic levels of PAD severity compared with invasive DSA . Also DUS produced more false‐positive PAD diagnoses compared with simple visual evaluation of those with non‐significant arterial stenosis . To avoid false‐negative PAD diagnoses due to high DUS ankle or toe systolic pressures caused by thickened or stiff arterial walls, simultaneous low Doppler blood flow velocity results identified more patients with angiographically confirmed PAD as compared to DUS alone .…”

Section: Resultsmentioning

confidence: 99%

“…There was a noticeable trend for the more invasive PAD screening or diagnostic tools to be used only on patients with CLI or more severe levels of PAD, so their relevance remains untested as screening tools for PAD in the general population. Finally, some diagnostic tests generate higher false‐positive PAD identification for individuals with non‐significant arterial lesions . Caution should be exercised in interpreting results of those tests.…”

Section: Discussionmentioning

confidence: 99%

Peripheral arterial disease screening and diagnostic practice: A scoping review

Donohue

Adler

Bolton

2019

International Wound Journal

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Early reliable, valid screening, diagnosis, and treatment improve peripheral arterial disease outcomes, yet screening and diagnostic practices vary across settings and specialties. A scoping literature review described reliability and validity of peripheral ischaemia diagnosis or screening tools. Clinical studies in the PUBMED database January 1, 1970, to August 13, 2018, were reviewed summarising ranges of reliability and validity of peripheral ischaemia diagnostic and screening tools for patients with non-neuropathic lower leg ischaemia. Peripheral ischaemia screening and diagnostic practices varied in parameters measured such as timing, frequency, setting, ordering clinicians, degree of invasiveness, costs, definitions, and cutoff points informing clinical and referral decisions. Traditional ankle/brachial systolic blood pressure index <0.9 was a reliable, valid lower leg ischaemia screening test to trigger specialist referral for detailed diagnosis. For patients with advanced peripheral ischaemia or calcified arteries, toe-brachial index, claudication, or invasive angiographic imaging techniques that can have complications were reliable, valid screening, and diagnostic tools to inform management decisions. Ankle/brachial index testing is sufficiently reliable and valid for use during routine examinations to improve timing and consistency of peripheral ischaemia screening, triggering prompt specialist referral for more reliable, accurate Doppler, or other diagnosis to inform treatment decisions.

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Reliability and Accuracy of Simple Visual Estimation in Assessment of Peripheral Arterial Stenosis

Cited by 17 publications

References 28 publications

Characterizing tissue perfusion after lower extremity intervention using two-dimensional color-coded digital subtraction angiography

Characterizing tissue perfusion after lower extremity intervention using two-dimensional color-coded digital subtraction angiography

In Vivo Validation of Patient‐Specific Pressure Gradient Calculations for Iliac Artery Stenosis Severity Assessment

Peripheral arterial disease screening and diagnostic practice: A scoping review

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