Lower Limb Arterial Insufficiency Research Articles

Calcification of Joints and Arteries (CALJA) Is a Rare Cause of Arthritis and Lower Limb Ischemia: Case Report and Literature Review

Calcification of Joints and Arteries (CALJA) is a rare disease that leads to chronic arthritis and lower limb claudication due to hydroxyapatite crystal deposition. The disease is caused by mutations in the 5-nucleotidase (NT5E) gene, which is responsible for pyrophosphate metabolism. Only 23 cases have been described so far. In this case report, we describe a new case of CALJA and provide a literature review. A 65-year-old woman was referred to the Rheumatology Unit with the diagnosis of seronegative oligo-arthritis. She complained of lower limb claudication, which was becoming progressively worse. Doppler ultrasound revealed bilateral obliteration of the popliteal and femoral arteries, and X-rays of the knees, hands, and feet showed extensive periarticular calcific deposits. The results of the NT5E gene analysis were positive for an inactivating variant, leading to the diagnosis of CALJA. The clinical features of CALJA are caused by hydroxyapatite crystal deposition at the periarticular and vascular levels due to abnormalities of pyrophosphate metabolism. Currently, no specific treatment is available, although a trial on the use of etidronate is ongoing. Patients with CALJA are often treated with immunosuppressant agents in the suspect of inflammatory rheumatologic diseases. Our case is the first in which clinical symptoms and a steady increase of inflammatory markers improved only after colchicine therapy initiation. It is crucial for the rheumatologist to recognize the features CALJA and keep it in mind in the differential diagnosis of patients with lower limb arterial insufficiency and arthritis or early osteoarthritis with joint calcification.

Comparative study between Doppler ultrasound and computed tomography angiography in diabetic lower limb arterial insufficiency

Objective This work aimed to highlight the role of color Doppler ultrasound in the assessment of lower limb arterial insufficiency in patients with diabetes as well as the characteristics of lower limb arterial disease in diabetic patients. Background Diabetic lower limb arterial insufficiency is a major health problem affecting the individuals and community health. Doppler ultrasound is a widespread relatively cheap examination with no health hazards of radiation. Hence, we considered studying the role of Doppler ultrasound in determining the characteristics of lower limb arterial diabetic insufficiency and its level of accuracy. Patients and methods One hundred diabetic patients with clinically suspected lower limb arterial insufficiency were examined using Doppler ultrasound and computed tomography angiography (CTA), and the characteristics of diabetic lower limb arterial disease and accuracy of Doppler results in relation to CTA were determined. Results Diabetic lower limb arterial disease was characterized by being bilateral and multisegmental in the majority of cases with more affection of the distal (below knee) arteries. There was no significant difference between Doppler and CTA results at the above knee arteries as regards detection of significant arterial stenosis (luminal narrowing ≥ 50% of artery diameter); P values were as follows: common iliac artery segment, 0.695; external iliac artery, 0.776; common femoral artery, 0.563; and superficial femoral artery, 0.599. Further, a low significant difference at below knee arteries was found; P values were as follows: popliteal artery segment, 0.033; anterior tibial artery, 0.025; posterior tibial artery, 0.019; and peroneal artery, 0.031. The overall sensitivity of Doppler in evaluating lower limb arteries was 90.46%, the specificity was 92.05%, and the accuracy was 91.81% when CTA was taken as a standard. Conclusion Duplex ultrasound provides high-resolution, precise anatomical and physiological information of the peripheral arteries. It should be first-line investigation for lower limb arterial assessment and also be combined with other arterial imaging modalities to obtain better diagnostic accuracy.

A Survey of the Presence of Lower Limb Arterial Insufficiency in Diabetic Patients Attending the Surgery Department of Golestan Hospital for Reasons other than Vascular Diseases

A Survey of the Presence of Lower Limb Arterial Insufficiency in Diabetic Patients Attending the Surgery Department of Golestan Hospital for Reasons other than Vascular Diseases

Combined Assessment of Arterial and Venous Anatomy in Lower Limb Ischaemia Using a Single Contrast-Enhanced Magnetic Resonance Scan

Contrast-Enhanced Magnetic Resonance Angiography (CE-MRA) is a non-invasive investigative modality for patients with lower limb arterial insufficiency. When infra-inguinal arterial reconstruction is indicated autologous great saphenous vein is the conduit of choice and adequacy of the vein is often assessed by an additional Duplex ultrasound. We evaluated whether single, high-resolution steady state MR imaging with blood pool contrast agent could generate a sufficiently informative assessment of both venous and arterial anatomy to plan surgery potentially avoiding the need for an additional venous duplex. There was good correlation between CE-MRA, venous duplex and subsequent operative findings. Combined Assessment of Arterial and Venous Anatomy in Lower Limb Ischaemia Using a Single Contrast-Enhanced Magnetic Resonance ScanEJVES ExtraVol. 24Issue 2PreviewContrast-Enhanced Magnetic Resonance Angiography (CE-MRA) is a non-invasive investigative modality for patients with lower limb arterial insufficiency. When infra-inguinal arterial reconstruction is indicated autologous great saphenous vein is the conduit of choice and adequacy of the vein is often assessed by an additional Duplex ultrasound. We evaluated whether single, high-resolution steady state MR imaging with blood pool contrast agent could generate a sufficiently informative assessment of both venous and arterial anatomy to plan surgery potentially avoiding the need for an additional venous duplex. Full-Text PDF Open Access

Combined Assessment of Arterial and Venous Anatomy in Lower Limb Ischaemia Using a Single Contrast-Enhanced Magnetic Resonance Scan

Contrast-Enhanced Magnetic Resonance Angiography (CE-MRA) is a non-invasive investigative modality for patients with lower limb arterial insufficiency. When infra-inguinal arterial reconstruction is indicated autologous great saphenous vein is the conduit of choice and adequacy of the vein is often assessed by an additional Duplex ultrasound.We evaluated whether single, high-resolution steady state MR imaging with blood pool contrast agent could generate a sufficiently informative assessment of both venous and arterial anatomy to plan surgery potentially avoiding the need for an additional venous duplex.There was good correlation between CE-MRA, venous duplex and subsequent operative findings.

Aspirin for cardiovascular disease prevention

Aspirin provides benefit in nearly all groups of patients with clinical manifestations of coronary heart disease. This includes patients with evolving acute myocardial infarction or after recovery from myocardial infarction, with unstable or stable angina, and those who undergo coronary artery bypass grafting or coronary angioplasty. Aspirin provides benefit in patients with peripheral arterial disease. This includes patients with acute or previous history of ischaemic stroke or transient ischaemic attack, those with lower limb arterial insufficiency, and those who undergo grafting or angioplasty of peripheral arterial vessels. People without symptoms but at increased risk of a coronary heart disease event (> 1% annual risk) may reduce this risk by taking low-dose aspirin. However, the decision to take aspirin requires detailed consideration of individual cardiovascular risk and the potential benefit versus harm of treatment, particularly bleeding. Aspirin should only be used to prevent a cardiovascular event in association with an overall program of lifestyle measures including healthy eating, cessation of smoking, control of blood pressure and regular physical activity. ASPIRIN FOR PREVENTION: Prevention benefits of aspirin in heart disease can be achieved with doses as low as 75-150 mg daily. Unwanted effects of aspirin include stomach upsets, activation of peptic ulcers, an increased tendency to bruising, allergic reactions and increased risk of major gastrointestinal and other bleeding, including intracranial haemorrhage. In general, the risk of bleeding increases with increasing dose of aspirin and when it is used in combination with non-steroidal anti-inflammatory drugs or oral anticoagulants.

Selection of Patients with Lower Limb Arterial Occlusive Disease for Endovascular Treatment of the Iliac Arteries with Duplex Scanning

The aim of this study was to evaluate the role of duplex scanning in selection of patients with lower limb arterial occlusive disease for endovascular treatment of the iliac arteries. From January 1995 through May 2000, 183 patients having chronic lower limb arterial insufficiency who underwent duplex scanning of the lower extremity arteries with available aortoiliac scans within 3 months before conventional aortoiliac diagnostic angiography and/or endovascular intervention of the iliac arteries were studied retrospectively. The findings obtained from duplex scanning and angiography were analyzed in a blinded manner by 2 investigators. Limbs having category 1, 2, and 3 lesions according to duplex scan findings were interpreted as being suitable for endovascular intervention. The comparison between duplex scan findings and angiography was analyzed by the third investigator. During 93 percutaneous transluminal angioplasty (PTA) procedures, 133 arterial segments, common or external iliac, were dilated with stent placement in 70. Bilateral interventions were performed in 25 cases, and of 68 unilateral interventions, 57 were at only 1 arterial segment. The accuracy, sensitivity, specificity, and negative and positive predictive values of duplex scanning to appropriately categorize the iliac artery lesions into suitable or unsuitable for endovascular intervention were 90%, 95%, 83%, 90%, and 92%, respectively when the inconclusive duplex scans were excluded (11%). In 6 patients with lesions suitable for PTA according to duplex scanning and angiography, PTA was not performed owing to clinical reasons. The accuracy of duplex scanning in predicting the performance of endovascular intervention was 88%. It is concluded that iliac artery endovascular procedures in limbs with chronic occlusive disease can be reliably planned according to duplex scan findings.