Impact of duplex arteriography in the evaluation of acute lower limb ischemia from thrombosed popliteal aneurysms

Comparisons of outcomes of open surgery versus endovascular intervention for thrombotic popliteal artery aneurysm with acute lower limb ischemia: a systematic review

Background

Thrombotic popliteal artery aneurysm (PAA) with acute lower limb ischemia (ALI) is a serious disease leading to amputation. The choice of emergency procedures is not clearly defined, and the difference in therapeutic efficiency between open surgery and endovascular intervention is still unclear.

Method

We conducted a comprehensive search through PubMed, Wiley Online Library and ScienceDirect. According to the predefined inclusion and exclusion criteria, eligible articles were screened out, and all relevant data were extracted for further analysis. Our study was designed and developed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guideline. We critically assessed all included articles by Joanna Briggs Institute (JBI) Critical Appraisal Checklists and the Methodological Index for Non-Randomized Studies (MINORS).

Result

A total of 29 articles (1338 patients/1387 limbs) were included in the study. After a 1-year follow-up, the primary patency rate of the open surgery group was significantly lower than that of the endovascular intervention group (72.65 vs. 81.46%, P = 0.004), but without significant difference in the secondary patency rate (86.19 vs. 86.86%, P = 0.825). The limb salvage rate of the open surgery group was also significantly lower (83.07 vs. 98.25%, P < 0.001). After the 2-year follow-up, the primary patency rate of the open surgery group was still significantly lower (48.57 vs. 59.90%, P = 0.021).

Conclusion

The outcome of endovascular intervention was better than that of open surgery especially in the 1-year limb salvage rate and primary patency rate at the 1-year and 2-year follow-ups.

Acute limb ischemia: role of preoperative and postoperative duplex in differentiating acute embolic from thrombotic ischemia

BACKGROUND

Acute limb ischemia (ALI) represents an emergency in which delayed intervention results in significant morbidity, and potentially, death.

PURPOSE

To assess the role of duplex in differentiating embolic from thrombotic ALI.

METHODS AND MATERIALS

We prospectively recruited 57 patients; with 62 non-traumatic ALI. We measured the diameter at the occluded site (dO) and the corresponding contralateral healthy side (dC). The absolute (∆) and percent change (∆%) between the two diameters were calculated as: (dO-dC) and [(∆/dC)×100] respectively. According to the reference standard (contrast angiography or surgery), limbs were classified into embolic (E-group:37 limbs) and thrombotic (T-group:25 limbs) groups. Postoperative duplex was done in 34 patients after embolectomy and the absolute (∆P) and percent change (∆P%) between the postoperative (dP) and preoperative (dO) diameters at the occlusion were calculated as: (dP-dO) and [(∆P/dO)×100] respectively.

RESULTS

The baseline clinical characteristics were similar between both groups. However, in the E-group, (∆%) was 21.96±17.53% vs. -11.03±16.16% in the T-group, (p<0.001). A cutoff value of >1.41% for (∆%) had 100% sensitivity and 76% specificity for the diagnosis of embolic vs. thrombotic occlusion with AUC 0.95 (95% CI: 0.901-0.999, p<0.00l). Postoperatively (∆P%) was -11.8±8.2% with a significant negative correlation found between (∆) and (∆P); Spearman's coefficient (rho)=-0.912, P<0.001.

CONCLUSIONS

A cut off value of 1.41% as percent dilatation or diminution in the diameter of occluded artery is the most important duplex sign for predicting embolic or thrombotic ALI respectively. Postoperative reduction in the diameter of occluded artery after embolectomy confirms this sign.

Lower-limb vascular imaging with acoustic radiation force elastography: demonstration of in vivo feasibility

Acoustic radiation force impulse (ARFI) imaging characterizes the mechanical properties of tissue by measuring displacement resulting from applied ultrasonic radiation force. In this paper, we describe the current status of ARFI imaging for lower-limb vascular applications and present results from both tissue-mimicking phantoms and in vivo experiments. Initial experiments were performed on vascular phantoms constructed with polyvinyl alcohol for basic evaluation of the modality. Multilayer vessels and vessels with compliant occlusions of varying plaque load were evaluated with ARFI imaging techniques. Phantom layers and plaque are well resolved in the ARFI images, with higher contrast than B-mode, demonstrating the ability of ARFI imaging to identify regions of different mechanical properties. Healthy human subjects and those with diagnosed lower-limb peripheral arterial disease were imaged. Proximal and distal vascular walls are well visualized in ARFI images, with higher mean contrast than corresponding B-mode images. ARFI images reveal information not observed by conventional ultrasound and lend confidence to the feasibility of using ARFI imaging during lower-limb vascular workup.

Magnetic resonance imaging of popliteal artery pathologies

This paper illustrates examples of popliteal artery pathologies imaged with contrast enhanced magnetic resonance angiography (CE-MRA) and magnetic resonance imaging (MRI) at a single tertiary referral centre. Popliteal artery pathologies were identified in 1710 patients referred over a 6-year period with symptoms suggesting lower limb arterial occlusive disease. Common pathologies such as atherosclerotic occlusive disease, thromboemboli and aneurysm disease are discussed as well as unusual pathologies such as cystic adventitial disease, mycotic aneurysm and arterial entrapment. The combination of CE-MRA and the excellent soft tissue resolution of MRI allow detailed evaluation of arterial and peri-arterial pathologies, and facilitate appropriate management decisions.