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Diagnostics
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Screening and Diagnosis of Peripheral Arterial Disease
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Screening and Diagnosis of Peripheral Arterial Disease

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (31 May 2023) | Viewed by 5366

Special Issue Editor

Prof. Dr. Lars Norgren

E-Mail Website
Guest Editor
Department of Surgery, Örebro University, Örebro, Sweden
Interests: peripheral arterial disease (PAD); metabolism; prevention; revascularization; cell/gene therapy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Peripheral arterial disease (PAD) is a serious manifestation of atherosclerosis that is increasing worldwide—most extensively in low- and middle-income countries. It is causing increasing mortality and severe cardiovascular and limb complications, and thus there is an urgent need to find patients at risk as early as possible. Most importantly, around 50% of subjects are asymptomatic, frequently depending on low exercise activity. Preventive measures are required, both regarding lifestyle and to some extent the use of pharmaceuticals. Obviously the critical issue is to find the subjects. Unfortunately there is sometimes a lack of understanding of these problems even in the medical community, and besides information provided to the general public, general practitioners and other physicians should also be updated.

General screening has been effective regarding detection of abdominal aortic aneurysms, while general screening of PAD in the population is still not practiced. Major reasons are that methods such as ankle-brachial index (ABI) measurement require rather extensive resources to be adequate. On the other hand, screening by primary care physicians is very reasonable and should be of great value to reduce cardiovascular mortality and complications. Besides ABI measurement, ultrasonographic examination of the femoral artery has been suggested.

Regarding diagnostic procedures in patients suffering from PAD, methods depend on symptoms and intended treatment. Basically, ABI measurement is sufficient in intermittent claudication when revascularization is not suggested, while all from Doppler-duplex examination to various angiographic methods (digital, CT, MRI) may be used to guide an intervention in critical limb ischemia or more severe intermittent claudication. It may be added that methods to study perfusion (e.g., NIRS, near-infrared spectroscopy) might be of interest in the future, specifically to study outcome of interventions.  

Prof. Dr. Lars Norgren
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • PAD
  • prevention
  • screening
  • diagnostics

Published Papers (3 papers)

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Research

12 pages, 1518 KiB  
Article
Coronary Artery Disease in Patients Hospitalized for Peripheral Artery Disease: A Nationwide Analysis of 1.8 Million Patients
by Magnus Helmer, Christian Scheurig-Muenkler, Verena Brandt, Christian Tesche, Stefanie Bette, Florian Schwarz, Thomas Kroencke and Josua A. Decker
Diagnostics 2023, 13(6), 1163; https://doi.org/10.3390/diagnostics13061163 - 18 Mar 2023
Viewed by 1673
Abstract
Purpose: Coronary artery disease (CAD) and peripheral artery disease (PAD) are highly prevalent in society. This nationwide analysis aimed to evaluate the trends of in-hospital treatment of patients admitted due to PAD with and without concomitant CAD, to determine the prevalence and risk [...] Read more.
Purpose: Coronary artery disease (CAD) and peripheral artery disease (PAD) are highly prevalent in society. This nationwide analysis aimed to evaluate the trends of in-hospital treatment of patients admitted due to PAD with and without concomitant CAD, to determine the prevalence and risk factors of concomitant CAD in patients with PAD. Methods: Using data from the German Federal Statistical Office, we included all admissions for PAD (with and without concomitant CAD) in Germany between 2009 and 2018. Baseline patient characteristics, outcomes and comorbidities were analyzed. Elixhauser comorbidity groups and the linear van Walraven comorbidity score (vWs) were calculated to assess the comorbidity burden. Results: Of all 1,793,517 patients hospitalized for PAD, a total of 21.8% (390,259) had concomitant CAD, increasing from 18.6% in 2009 to 24.4% in 2018. Patients with accompanying CAD showed higher in-hospital mortality (3.7 vs. 2.6%), more major amputations (9.0 vs. 7.7%) and more comorbidities (Elixhauser score: 4.2 vs. 3.2 and vWs: 9.1 vs. 6.1), resulting in higher costs (median: EUR 4541 vs. EUR 4268 per case). More advanced stages of PAD were associated with multi-vessel CAD (10% of all patients with PAD Fontaine IV showed 3-vessel CAD) and the prevalence of multi-vessel CAD increased predominantly in patients with advanced PAD. Conclusion: One in four patients hospitalized for PAD had concomitant CAD, showing an increase over time with an additional medical and economic burden for hospitals compared with patients without CAD. Full article
(This article belongs to the Special Issue Screening and Diagnosis of Peripheral Arterial Disease)
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9 pages, 892 KiB  
Article
A Modified Run-Off Resistance Score from Cross-Sectional Imaging Discriminates Chronic Critical Limb Ischemia from Intermittent Claudication in Peripheral Arterial Disease
by Jan Paul Frese, Larissa Schawe, Jan Carstens, Karlis Milbergs, Fiona Speichinger, Alexandra Gratl, Andreas Greiner and Ben Raude
Diagnostics 2022, 12(12), 3155; https://doi.org/10.3390/diagnostics12123155 - 14 Dec 2022
Viewed by 1307
Abstract
Atherosclerotic peripheral arterial disease (PAD) leads to intermittent claudication (IC) and may progress into chronic limb-threatening ischemia (CLTI). Scoring systems to determine the atherosclerotic burden of a diseased extremity have been developed. This study aimed to evaluate a modification of the run-off resistance [...] Read more.
Atherosclerotic peripheral arterial disease (PAD) leads to intermittent claudication (IC) and may progress into chronic limb-threatening ischemia (CLTI). Scoring systems to determine the atherosclerotic burden of a diseased extremity have been developed. This study aimed to evaluate a modification of the run-off resistance (mROR) score for its usability in cross-sectional imaging. The mROR was determined from preoperative imaging of patients undergoing revascularization for PAD. A total of 20 patients with IC and 20 patients with CLTI were consecutively included. A subgroup analysis for diabetic patients was conducted. The mROR was evaluated for its correlation with disease severity and clinical covariates. Patients with CLTI were older; cardiovascular risk factors, diabetes, and ASA 4 were more frequent. The mROR scores were higher in CLTI than in IC. In diabetic patients, no difference was detected between CLTI and IC. In CLTI, non-diabetic patients had a higher mROR. The mROR score is positively correlated with the severity of PAD and can discriminate CLTI from IC. In diabetic patients with CLTI, the mROR is lower than in non-diabetic patients. The mROR score can be determined from cross-sectional imaging angiographies. It may be useful for clinicians helping with vascular case planning, as well as for scientific purposes. Full article
(This article belongs to the Special Issue Screening and Diagnosis of Peripheral Arterial Disease)
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12 pages, 1810 KiB  
Article
Utility of Superb Microvascular Imaging in the Assessment of Foot Perfusion in Patients with Critical Limb Ischemia
by Yuta Suto, Wakana Sato, Takayuki Yamanaka, Mayu Unuma, Yuki Kobayashi, Mako Aokawa and Hiroyuki Watanabe
Diagnostics 2022, 12(11), 2577; https://doi.org/10.3390/diagnostics12112577 - 24 Oct 2022
Viewed by 1776
Abstract
(1) Background: Although the ankle–brachial index (ABI) and skin perfusion pressure (SPP) are commonly used to evaluate the peripheral circulation in critical limb ischemia (CLI), they often cannot be performed on sore areas. We investigated the utility of superb microvascular imaging (SMI) for [...] Read more.
(1) Background: Although the ankle–brachial index (ABI) and skin perfusion pressure (SPP) are commonly used to evaluate the peripheral circulation in critical limb ischemia (CLI), they often cannot be performed on sore areas. We investigated the utility of superb microvascular imaging (SMI) for assessing foot perfusion in CLI patients. (2) Methods: We measured the SMI-based vascular index (SMI-VI) at six sites in the foot before and after endovascular treatment (EVT) in 50 patients with CLI who underwent EVT of the superficial femoral artery and compared the results with SPP values and the ABI. (3) Results: SMI visualized foot perfusion in all subjects in accordance with the angiosome, including the toe areas, while the ABI was unmeasurable in three patients on hemodialysis and SPP failed in four patients. SMI-VI values were significantly lower in the CLI group than in controls, and the plantar SMI-VI had the highest diagnostic performance for CLI (sensitivity 88.6%, specificity 95.6%). After EVT, the increase in the SMI-VI was positively correlated with the increase in SPP but not that in the ABI, implying that the SMI-VI reflects foot microcirculation. (4) Conclusions: SMI enables the visualization and quantification of foot microcirculation based on the angiosome. SMI has high utility as a tool for assessing foot perfusion in CLI. Full article
(This article belongs to the Special Issue Screening and Diagnosis of Peripheral Arterial Disease)
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