Timely referrals to and assessment by vascular specialists are essential for determining optimal limb salvage treatment in high-risk patients with diabetes and chronic limb-threatening ischemia (CLTI). Accordingly, we have compiled a list of reference resources broken down into noninvasive vascular testing as well as advanced vascular imaging utilized by vascular specialists. This is by no means an exhaustive compendium. However, it is our hope that the content of the referenced publications below — ranging from literature on non-invasive screening options for detecting peripheral arterial disease (PAD) to studies on advanced imaging modalities, such as computed tomographic angiography (CTA) and magnetic resonance angiography (MRA) — provides a convenient guide to key diagnostic considerations for this patient population.
Noninvasive Vascular Testing
Comparison of ankle pressure, systolic toe pressure, and transcutaneous oxygen pressure to predict major amputation after 1 year in the COPART cohort.
Screening for peripheral artery disease using the ankle-brachial index: updated evidence report and systematic review for the US Preventive Services Task Force.
Sensitivity and specificity of the ankle-brachial index to diagnose peripheral artery disease: a structured review.
Vasc Med. 2010;15(5):361-9.
The association between elevated ankle systolic pressures and peripheral occlusive arterial disease in diabetic and nondiabetic subjects.
Duplex Ultrasound Imaging (DUS)
Prospects of contrast-enhanced ultrasonography for the diagnosis of peripheral arterial disease: a meta-analysis.
Early results of infragenicular revascularization based solely on duplex arteriography.
Computed Tomographic Angiography (CTA)
Diagnostic performance of computed tomography angiography in peripheral arterial disease: a systematic review and meta-analysis.
Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer.
Arch Intern Med. 2009;169(22):2078-86.
Lower extremity arterial disease multidetector CT angiography meta-analysis.
Magnetic Resonance Angiography (MRA)
Non-contrast enhanced MR angiography in critical limb ischemia: performance of quiescent-interval single-shot (QISS) and TSE-based subtraction techniques.
Eur Radiol. 2017;27(3):1218-26.
Meta-analysis: accuracy of contrast-enhanced magnetic resonance angiography for assessing steno-occlusions in peripheral arterial disease.
Ann Intern Med. 2010;153(5):325-34.
Peripheral vascular surgery with magnetic resonance angiography as the sole preoperative imaging modality.
J Vasc Surg. 1994;20(6):861-71.
Digital Subtraction Angiography (DSA)
Assessment of critical limb ischemia in patients with diabetes: comparison of MR angiography and digital subtraction angiography.
AJR Am J Roentgenol. 2005;185(6):1641-50.
Automated carbon dioxide angiography for the evaluation and endovascular treatment of diabetic patients with critical limb ischemia.
J Endovasc Ther. 2016;23(1):40-8.