The role of MSCT angiography in early detection of lower limb arterial lesions in patients with antiphospholipid syndrome

Abstract

Antiphospholipid syndrome (APS) is an autoimmune disease which is characterized by arterial and venous thromboses, fetal loss, and the presence of antiphospholipid antibodies in the serum. It is characterized by accelerated atherosclerosis. Increased tendency towards thrombosis leads to the occurrence of various vascular events. The objective of our study was to determine if there are subclinical changes on lower limb arteries in APS patients and what the best diagnostic choice for their establishment is. In this study, we analyzed 50 patients with primary antiphospholipid syndrome (PAPS) and 50 patients, who have secondary antiphospholipid syndrome (SAPS). The results were compared to 50 controls. The groups were comparable with respect to age, gender, and traditional risk factors except for the lipid status, since controls had significantly higher levels of cholesterol and triglycerides. Study was conducted on 64-multi-slice computed tomography (64-MSCT), where we analyzed quantitative and morphological characteristics of blood vessel-detected lesions. Patients from the control group had statistically very significant elevated cholesterol and triglyceride levels in regard to the patients with SAPS and PAPS (p < 0.001 and p < 0.05). Analyzing percentage of diameter stenosis, we have established that lesions from group with 0-30% diameter stenosis (DS) in patients with PAPS (n = 47) and SAPS (n = 39) are more common than that in control group (n = 3, p < 0.001). The incidence of lesions higher than 70% DS in control group (n = 74) was statistically significant than that in patients with SAPS (n = 74, p < 0.05), while very statistically significant than that in patients with PAPS (n = 48, p < 0.001). Analyzing the qualitative characteristics of plaques, we have established significant higher frequency of soft tissue (n = 32) and mixed lesions (n = 36) in patients with PAPS than the calcified one (n = 7, p < 0.001). Our study showed that the subclinical manifestation of changes on lower extremity arteries is more common in patients with APS. Because of its safety and accuracy, the method of choice is 64-MSCT angiography in monitoring disease progression.

Quantitative and Qualitative Characteristics of Atherosclerotic Plaques on Carotid Arteries in Patients with Antiphospholipid Syndrome: The Role of MDCT Angiography

“…By comparing our results with previous findings, we have shown that MDCTA is a superior method compared to DUS, which cannot be used to visualise smaller blood vessels and cannot provide the precise quantitative and qualitative characteristics of the atheromatous plaque under examination [23][24][25][26]. Invasive angiography was, despite its possible complications during and after the procedure, until recently, the gold standard.…”

Hallux Partial Necrosis Associated with Antiphospholipid Syndrome: The Importance of Early Accurate Diagnosis

“…In the absence of histopathology, it may be difficult to distinguish APL-related thrombosis of another concomitant atherosclerotic occlusions from vasculitis of peripheral vessels, and clinicians must be guided purely by clinical presentation [19].The available evidence shows that subclinical changes in the lower extremities arteries in patients with APS are more common than in healthy subjects, and 64-slice CT-angiography with contrast is the method of choice for monitoring disease progression [20]. In the present case, the CT angiography did not show stenosis, atheroma plaques, or signs of thrombosis in the arterial system of the affected foot; however, a drastic decrease in the caliber of the posterior tibial artery of the right extremity was observed without filling in the plantar arteries, although without clinical manifestation.…”

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“…Saponjski et al [14] used 64-multi-sliced computed tomography to analyse lower limb vascular lesions and found a high prevalence of vascular lesions in patients with APS. They argue that this technique may be more accurate than ultrasound, but the downside is the use of radiation.…”