Clinical significance of mirror lesions in lower extremity arterial disease

Abstract

Objective: The aim of this study was to investigate the clinical relevance of bilateral peripheral arterial disease (PAD) patterns.Background: No prior study has evaluated the clinical significance of symmetrical lesion patterns, particularly the coexistence of same-level significant plaques in both lower extremities ("mirror lesions"). Methods:We conducted a single-facility, primary data analysis involving 225 patients with symptomatic PAD.Results: Eighty-two percent of the patients had bilateral lesions: 14.2% had femoropopliteal, 38.7% had infrapopliteal, and 27.1% had both femoropopliteal and infrapopliteal lesions. The lesions were found in the exact same arteries bilaterally in 24.9% of the patients, while 26.7% had a local mirror pattern limited to the femoropopliteal (13.7%) or infrapopliteal (12.9%) arteries.Having a lesion in an artery was a risk factor for occlusive disease of the corresponding artery on the other side. Patients presenting with critical limb ischemia (CLI) had a history of resting pain (17%), ulceration/gangrene (13%), or prior amputation (26%) of the contralateral limb. Patients with significant bilateral disease had unilateral falsenegative ABI results in 11.6% of the cases. The arterial Doppler study results were unilaterally false-negative in 19.6% and bilaterally false-negative in 2.8% of the patients.Conclusions: Patients with known peripheral arterial disease need to have both limbs fully evaluated and monitored, even in cases with negative screening results. Mirror angiographic imaging is common and often accompanied by symptoms of claudication. Unilateral ischemia is a strong risk factor for contralateral disease. Patients with CLI are at high risk for occlusive lesions of the nonindex limb. K E Y W O R D Sankle-brachial index, critical limb ischemia, duplex Doppler ultrasonography, fluoroscopic angiography, peripheral arterial disease

Prior probability of significant obstructive arterial disease in the contralateral lower extremity

“…Kiesz et al provide a single center analysis of the prevalence of significant arterial “mirror” lesions in the contralateral lower extremity of patients with severe unilateral claudication or critical limb ischemia . In lower extremity arterial disease patients with unilateral symptoms and/or ulcers, several clinical situations arise where ballpark knowledge of the probability of contralateral significant disease is potentially useful.…”

Explore the Value of Dual Source Computer Tomography Automatic Tube Current Regulation in Reducing the Radiation Dose of CTA in Lower Extremity Vessels

“…Arterial disease of the lower limbs is a kind of vascular disease that seriously harms human health, and it involves a wide range of asperts. In the later stage, it is mainly manifested as severe stenosis or occlusion of blood vessels, aneurysm formation, etc., which easily leads to ischemia or necrosis of the distal limbs, and often requires surgery or intervention therapy ( 1 , 2 ). At present, the examination of lower limb arterial obstructive disease mainly diagnoses the cause, location, scope and degree of the disease when the disease occurs in the main artery or larger branch.…”