Prevalence of Tibial Artery and Pedal Arch Patency by Angiography in Patients With Critical Limb Ischemia and Noncompressible Ankle Brachial Index

Randhawa, Mandeep Singh; Reed, Grant W.; Grafmiller, Kevin; Gornik, Heather L.; Shishehbor, Mehdi H.

doi:10.1161/circinterventions.116.004605

Cited by 28 publications

(17 citation statements)

References 31 publications

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“…The detection of a triphasic pedal Doppler arterial waveform with a handheld Doppler appears to provide stronger evidence for the absence of PAD. The same applies for measurement of a TBI, which makes the presence of PAD unlikely if it is ≥0.75 and provides additional information compared with the ABI, particularly in patients with severe PAD below the ankle . Unfortunately, toe pressures may also be falsely elevated by the same factors that affect ABI (including digital artery calcification).…”

Section: Diagnosismentioning

confidence: 99%

“…The same applies for measurement of a TBI, which makes the presence of PAD unlikely if it is ≥0.75 20 and provides additional information compared with the ABI, particularly in patients with severe PAD below the ankle. 34 Unfortunately, toe pressures may also be falsely elevated by the same factors that affect ABI (including digital artery calcification). There is insufficient evidence to support the use of a single bedside diagnostic test for PAD that may be used for all patients with diabetes and foot ulceration.…”

Section: Rationalementioning

confidence: 99%

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Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update)

Hinchliffe

Forsythe

Apelqvist

et al. 2020

Diabetes Metabolism Res

257

262

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The International Working Group on the Diabetic Foot (IWGDF) has published evidence‐based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the diagnosis, prognosis, and management of peripheral artery disease (PAD) in patients with foot ulcers and diabetes and updates the previous IWGDF Guideline. Up to 50% of patients with diabetes and foot ulceration have concurrent PAD, which confers a significantly elevated risk of adverse limb events and cardiovascular disease. We know that the diagnosis, prognosis, and treatment of these patients are markedly different to patients with diabetes who do not have PAD and yet there are few good quality studies addressing this important subset of patients. We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to devise clinical questions and critically important outcomes in the patient‐intervention‐comparison‐outcome (PICO) format, to conduct a systematic review of the medical‐scientific literature, and to write recommendations and their rationale. The recommendations are based on the quality of evidence found in the systematic review, expert opinion where evidence was not available, and a weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to the intervention. We here present the updated 2019 guidelines on diagnosis, prognosis, and management of PAD in patients with a foot ulcer and diabetes, and we suggest some key future topics of particular research interest.

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Section: Diagnosismentioning

confidence: 99%

Section: Rationalementioning

confidence: 99%

Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update)

Hinchliffe

Forsythe

Apelqvist

et al. 2020

Diabetes Metabolism Res

257

262

View full text Add to dashboard Cite

show abstract

“…While pulse wave recording (PVR) analysis can be a mean of assessing limb perfusion; however, this was not widely available. Importantly, a recent study by Randhawa et al showed mild association between PVR and tibial patency . Because of this, many other technologies are available or being developed to assess perfusion including skin perfusion pressure, TcPO 2 , indocyanine green fluorescence angiography, and continuous subcutaneous oxygen sensors .…”

Section: Discussionmentioning

confidence: 99%

Analysis of IN.PACT DEEP trial on the association between changes in perfusion from pre‐ to postrevascularization and clinical outcomes in critical limb ischemia

Hammad

Zeller

Baumgartner

et al. 2017

Cathet Cardio Intervent

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“…A recent analysis showed that >70% of the tibial vessels that were considered to be noncompressible were actually occluded or severely stenotic by angiography. 17 The current noninvasive modalities for limb perfusion assessment measure different aspects of perfusion, and each modality has unique limitations. For example, TcPo 2 measures oxygen tension, but SPP measures the capillary opening pressure.…”

Section: Pathophysiological Challenges Of the Abimentioning

confidence: 99%

Perfusion Assessment in Critical Limb Ischemia: Principles for Understanding and the Development of Evidence and Evaluation of Devices: A Scientific Statement From the American Heart Association

Misra¹,

Shishehbor²,

Takahashi³

et al. 2019

Circulation

Self Cite

101

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There are >12 million patients with peripheral artery disease in the United States. The most severe form of peripheral artery disease is critical limb ischemia (CLI). The diagnosis and management of CLI is often challenging. Ethnic differences in comorbidities and presentation of CLI exist. Compared with white patients, black and Hispanic patients have higher prevalence rates of diabetes mellitus and chronic renal disease and are more likely to present with gangrene, whereas white patients are more likely to present with ulcers and rest pain. A thorough evaluation of limb perfusion is important in the diagnosis of CLI because it can not only enable timely diagnosis but also reduce unnecessary invasive procedures in patients with adequate blood flow or among those with other causes for ulcers, including venous, neuropathic, or pressure changes. This scientific statement discusses the current tests and technologies for noninvasive assessment of limb perfusion, including the ankle-brachial index, toe-brachial index, and other perfusion technologies. In addition, limitations of the current technologies along with opportunities for improvement, research, and reducing disparities in health care for patients with CLI are discussed.

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Prevalence of Tibial Artery and Pedal Arch Patency by Angiography in Patients With Critical Limb Ischemia and Noncompressible Ankle Brachial Index

Cited by 28 publications

References 31 publications

Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update)

Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update)

Analysis of IN.PACT DEEP trial on the association between changes in perfusion from pre‐ to postrevascularization and clinical outcomes in critical limb ischemia

Perfusion Assessment in Critical Limb Ischemia: Principles for Understanding and the Development of Evidence and Evaluation of Devices: A Scientific Statement From the American Heart Association

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