Vascular Assessment

American Limb Preservation Society

Introduction

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
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Comparison of ankle pressure, systolic toe pressure, and transcutaneous oxygen pressure to predict major amputation after 1 year in the COPART cohort.

Salaun P, Desormais I, Lapebie FX, et al.Angiology. 2019;70(3):229-236.
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Screening for peripheral artery disease using the ankle-brachial index: updated evidence report and systematic review for the US Preventive Services Task Force.

Guirguis-Blake JM, Evans CV, Redmond N, Lin JS.JAMA. 2018;320(2):184-196.
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Sensitivity and specificity of the ankle-brachial index to diagnose peripheral artery disease: a structured review.

Dachun X, Jue L, Liling Z, et al.Vasc Med. 2010;15(5):361-9.
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The association between elevated ankle systolic pressures and peripheral occlusive arterial disease in diabetic and nondiabetic subjects.

Aboyans V, Ho E, Denenberg JO, Ho LA, Natarajan L, Criqui MH.J Vasc Surg. 2008;48(5):1197-1203.
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ROC analysis of noninvasive tests for peripheral arterial disease.

Lijmer JG, Hunink MG, van den Dungen JJ, Loonstra J, Smit AJ.Ultrasound Med Biol. 1996;22(4):391-8.
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Duplex Ultrasound Imaging (DUS)
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Prospects of contrast-enhanced ultrasonography for the diagnosis of peripheral arterial disease: a meta-analysis.

Hou XX, Chu GH, Yu Y.J Ultrasound Med. 2018;37(5):1081-90.
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Early results of infragenicular revascularization based solely on duplex arteriography.

Proia RR, Walsh DB, Nelson RR, et al.J Vasc Surg. 2001;33(6):1165-70.
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Duplex ultrasound scanning defines operative strategies for patients with limb-threatening ischemia.

Ligush J Jr, Reavis SW, Preisser JS, Hansen KJ.J Vasc Surg. 1998;28(3):482-90; discussion: 490-1.
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Angiography

Computed Tomographic Angiography (CTA)

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Diagnostic performance of computed tomography angiography in peripheral arterial disease: a systematic review and meta-analysis.

Met R, Bipat S, Legemate DA, Reekers JA, Koelemay MJ.JAMA. 2009;301(4):415-24.
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Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer.

Smith-Bindman R, Lipson J, Marcus R, et al.Arch Intern Med. 2009;169(22):2078-86.
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Lower extremity arterial disease multidetector CT angiography meta-analysis.

Heijenbrok-Kal MH, Kock MC, Hunink MG.Radiology. 2007;245(2):433-9.
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Magnetic Resonance Angiography (MRA)

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Non-contrast enhanced MR angiography in critical limb ischemia: performance of quiescent-interval single-shot (QISS) and TSE-based subtraction techniques.

Altaha MA, Jaskolka JD, Tan K, et al.Eur Radiol. 2017;27(3):1218-26.
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Meta-analysis: accuracy of contrast-enhanced magnetic resonance angiography for assessing steno-occlusions in peripheral arterial disease.

Menke J, Larsen J.Ann Intern Med. 2010;153(5):325-34.
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Peripheral vascular surgery with magnetic resonance angiography as the sole preoperative imaging modality.

Carpenter JP, Baum RA, Holland GA, Barker CF.J Vasc Surg. 1994;20(6):861-71.
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Digital Subtraction Angiography (DSA)

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Assessment of critical limb ischemia in patients with diabetes: comparison of MR angiography and digital subtraction angiography.

Lapeyre M, Kobeiter H, Desgranges P, Rahmouni A, Becquemin JP, Luciani A.AJR Am J Roentgenol. 2005;185(6):1641-50.
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CO2 Angiography

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Automated carbon dioxide angiography for the evaluation and endovascular treatment of diabetic patients with critical limb ischemia.

Palena LM, Diaz-Sandoval LJ, Candeo A, Brigato C, Sultato E, Manzi M.J Endovasc Ther. 2016;23(1):40-8.
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Perfusion Angiography

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Perfusion angiography of the foot in patients with critical limb ischemia: description of the technique.

Jens S, Marquering HA, Koelemay MJ, Reekers JA.Cardiovasc Intervent Radiol. 2015;38(1):201-5.
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