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ABSTRACT: Background: To analyze differences in morphological changes in the vascular tree among patients presenting with intermittent claudication (IC) and critical limb ischemia (CLI). In addition, suitability for endovascular treatment was evaluated. Patients and methods: Our study included 690 lower extremities with IC or CLI in 500 consecutive patients who were assessed by magnetic resonance angiography (MRA) according to the TASC II classification and in terms of the below the knee run-off status. Multivariable logistic regressions models adjusted for cardiovascular risk factors were used to evaluate differences in arteriosclerotic lesion patterns and eligibility for endovascular treatment. Results: Multivariable analysis showed that compared with IC extremities, CLI extremities have significantly more severe arteriosclerotic lesions at the aortoiliac (p < 0.001), femoropopliteal (p < 0.001), and crural levels (p < 0.001), with a greater risk of multilevel disease (odds ratio [OR], 1.71; 95 % confidence interval [CI] 1.10 - 2.66; p = 0.018). More than 80 % of extremities with IC and more than 50 % of extremities with CLI appeared to be eligible for endovascular treatment in an isolated evaluation of the aortoiliac and femoropopliteal axis. For combined evaluation of the aortoiliac and femoropopliteal axis, the proportion of endovascular suitability (TASC A+B lesions) decreased to 65 % (IC) and 41 % (CLI). For TASC A+B+C lesions, the proportions were 79 % (IC) and 41 % (CLI). Conclusions: Lower extremities with IC and CLI significantly differ in terms of arteriosclerotic lesion morphology and patterns of lesion localization. The majority of IC and CLI extremities appear to be eligible for endovascular treatment. Because of further improvement in endovascular equipment, even more patients will be eligible for treatment.
VASA.: Zeitschrift für Gefässkrankheiten. Journal for vascular diseases 11/2012; 41(6):432-9. · 1.31 Impact Factor
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ABSTRACT: Chronic limb ischemia (CLI) is a clinical diagnosis, but should be approved by technical tests like the ankle-brachial index (ABI). Although the ABI is well established, less is known about the influence of collateralization on clinical stage.
Magnetic resonance angiographies (MRA) of 129 lower extremities were searched for morphological changes and for the number of collateral vessels according to Sorlie. Ankle pressures were recorded as higher (APmax) and lower (APmin) systolic blood pressures of the two ankle arteries with consecutive calculation of ABImax and ABImin.
In comparisons of ROC curves, APmax (AUC=0.749) did significantly better as a prognostic marker than APmin (AUC=0.642) (p=0.005) and ABImax (AUC=0.744) did significantly better than ABImin (AUC=0.650) (p=0.019). APmax showed a positive likelihood ratio (+LR) of 5.79 and a negative likelihood ratio (-LR) of 0.47 (cutoff ≤55 mmHg). For the number of collateral vessels a +LR 2.27 and a -LR of 0.09 and in patients with an APmax ≤55 mmHg a +LR of 5.50 and a -LR of 0.00 were calculated (cutoff ≤1 collateral vessel).
Whereas APmax is more eligible for verification of CLI, collateral count is better in exclusion of CLI. Both seem to be independent factors for validating the clinical diagnosis of CLI.
Advances in Medical Sciences 09/2011; 56(2):249-54.
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ABSTRACT: Popliteal artery aneurysm is defined as an enlargement of the popliteal artery of more than 50 % of the original diameter. In more than 95 % of the cases, arteriosclerosis is the cause. The prevalence of asymptomatic and symptomatic popliteal artery aneurysms is less than 0.5 % of the population but rises in the age group of the 65-80-year-olds up to 1 %. About one-third of all diagnosed popliteal artery aneurysms are asymptomatic incidental findings, whereas the other two-thirds are noticed due to their symptoms (acute or chronic ischaemia, local compression syndrome, rupture). The indication for invasive treatment is considered for asymptomatic popliteal artery aneurysms at a diameter of more than 2 cm. Symptomatic popliteal artery aneurysms are always an indication for treatment, but acute and chronic ischaemia is associated with a high morbidity. Since the middle of the last century surgical techniques have been used in the therapy for popliteal artery aneurysms and represent the gold standard in treatment strategies. Nevertheless, a growing number of reports about endovascular interventions for popliteal artery aneurysms are being published. In this review the state of knowledge about indications, applicability and results of invasive therapies for the treatment of popliteal artery aneurysms are presented.
Zentralblatt für Chirurgie 08/2010; 135(4):363-8. · 1.02 Impact Factor
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ABSTRACT: Less than 0.1% of the population experiences a popliteal aneurysm (PA), and the consequences of not treating PA include a significant risk of embolization, thrombosis, and limb loss. Surgical treatment for this vascular disease has produced excellent clinical results, but there remain an increasing number of published reports that continue to question the efficacy of endovascular therapies.
All consecutive patients operated on for PA at our hospital in the years 2000-2007 were reviewed retrospectively for clinicopathological data and applicability for endovascular treatment.
Forty-six patients were surgically treated for 56 PAs (42 vein, 11 alloplastic material, and one composite graft). Overall survival rates after 2 and 5 years were 77% and 54%, respectively. Reintervention-free survival rates at 2 and 5 years were 71% and 43%, respectively. Graft patency for veins was significantly higher, with a hazard ratio of 0.025 (95% confidence interval 0.002-0.304, p=0.004). Twenty-two of the 37 patients (59.5%) with a sufficient angiograph appeared to be eligible for endovascular treatment.
Despite the positive results of surgical repair shown in our study and in the existing literature, endovascular treatment has a high technical eligibility with good reported outcomes and represents an alternative for open surgery.
Annals of Vascular Surgery 04/2010; 24(3):342-8. · 1.03 Impact Factor
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ABSTRACT: The Trans-Atlantic Inter-Society Document on Management of Peripheral Arterial Disease (TASC) gives treatment recommendations depending on the classification of aorto-iliacal or femoro-popliteal vascular pathologies. Therefore, the best treatment could only be offered if the right TASC classification was obtained. The purpose of this study was to assess the interobserver agreement of the evaluation of the TASC II classification for peripheral arterial occlusive disease (PAOD) in magnetic resonance angiography (MRA).
Three hundred arterial segments of 149 patients with a magnetic MRA for PAOD were evaluated according to the TASC II classification. A resident and a consultant for radiology and vascular surgery both performed independent grading. A comparative assessment of the consensus agreement was quantified by the marginal probabilities calculated by generalised estimation equation models, as well as by using the weighted kappa coefficient (kappa), classified according to Altman.
In relation to the consensus, the overall agreement was good to excellent for the consultants of radiology and vascular surgery. The consultants obtained a statistically significant higher agreement than did the residents (Odds ratio (OR): 2.86, 95% confidence interval (CI): 2.21-3.69, p<0.001). A significantly higher consensus agreement probability was observed for the surgeons compared with the radiologists (OR: 1.43, 95% CI: 1.11-1.84, p=0.006) and for the femoro-popliteal regions compared with the aorto-iliacal regions (OR: 1.64, 95% CI: 1.12-2.14, p=0.012).
Although good results can be achieved in the assessment of vascular lesions according to the TASC II document, a simplification of this classification could increase its practicability in a daily clinical routine.
European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 02/2010; 39(5):586-90. · 2.92 Impact Factor
