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- Title
Lower-extremity pressure, staging, and grading thresholds to identify chronic limb-threatening ischemia.
- Authors
Choi, Justin Chin-Bong; Miranda, Jorge; Greenleaf, Erin; Conte, Michael S; Gerhard-Herman, Marie D; Mills Sr, Joseph L; Barshes, Neal R
- Abstract
Introduction: The Society for Vascular Surgery Threatened Limb Classification System ('WIfI') is used to predict risk of limb loss and identify peripheral artery disease in patients with foot ulcers or gangrene. We estimated the diagnostic sensitivity of multiple clinical and noninvasive arterial parameters to identify chronic limb-threatening ischemia (CLTI). Methods: We performed a single-center review of 100 consecutive patients who underwent angiography for foot gangrene or ulcers. WIfI stages and grades were determined for each patient. Toe, ankle, and brachial pressure measurements were performed by registered vascular technologists. CLTI severity was characterized using Global Limb Anatomic Staging System (GLASS stages) and angiosomes. Medial artery calcification in the foot was quantified on foot radiographs. Results: GLASS NA (not applicable), I, II, and III angiographic findings were seen in 21, 21, 23, and 35 patients, respectively. A toe–brachial index < 0.7 and minimum ipsilateral ankle–brachial index < 0.9 performed well in identifying GLASS II and III angiographic findings, with sensitivity rates 97.8% and 91.5%, respectively. The diagnostic accuracy rates of noninvasive measures peaked at 74.7% and 89.3% for identifying GLASS II/III and GLASS I+ angiographic findings, respectively. The presence of medial artery calcification significantly diminished the sensitivity of most noninvasive parameters. Conclusions: The use of alternative noninvasive arterial testing parameters improves sensitivity for detecting PAD. Abnormal noninvasive results should suggest the need for diagnostic angiography to further characterize arterial anatomy of the affected limb. Testing strategies with better accuracy are needed.
- Subjects
ARTERIAL calcification; PERIPHERAL vascular diseases; FOOT ulcers; ANKLE brachial index; ANGIOGRAPHY
- Publication
Vascular Medicine, 2023, Vol 28, Issue 1, p45
- ISSN
1358-863X
- Publication type
Article
- DOI
10.1177/1358863X221147945