Semin intervent Radiol 2018; 35(05): 384-392
DOI: 10.1055/s-0038-1676328
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Noninvasive Arterial Testing: What and When to Use

Derek Mittleider
1   Vascular and Interventional Radiology, Maine Medical Center, Portland, Maine
› Author Affiliations
Further Information

Publication History

Publication Date:
05 February 2019 (online)

Abstract

Peripheral arterial disease (PAD) represents a growing public health issue that continues to be underdiagnosed. In its most severe form, critical limb ischemia, it contributes to expanding morbidity with minor and major limb amputations. PAD is strongly associated with increased mortality, as it is known to be concomitant with coronary and cerebrovascular disease. Diagnosis of PAD relies on noninvasive arterial testing, a class of tests that can provide physiologic or morphologic information. Physiologic tests such as ankle-brachial index, toe-brachial index, pulse volume recordings, and arterial duplex evaluation are the mainstay of gateway evaluation and surveillance. Morphologic exams such as computer tomographic angiography and magnetic resonance angiography are appropriate for preprocedural anatomic evaluation in patients with established vascular disease. This review focuses on physiologic exams.

 
  • References

  • 1 Nehler MR, Duval S, Diao L. , et al. Epidemiology of peripheral arterial disease and critical limb ischemia in an insured national population. J Vasc Surg 2014; 60 (03) 686-95.e2
  • 2 Fowkes FG, Rudan D, Rudan I. , et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet 2013; 382 (9901): 1329-1340
  • 3 Cooke JP, Chen Z. A compendium on peripheral arterial disease. Circ Res 2015; 116 (09) 1505-1508
  • 4 McCann TE, Scoutt LM, Gunabushanam G. A practical approach to interpreting lower extremity noninvasive physiologic studies. Radiol Clin North Am 2014; 52 (06) 1343-1357
  • 5 Del Conde I, Benenati JF. Noninvasive testing in peripheral arterial disease. Interv Cardiol Clin 2014; 3 (04) 469-478
  • 6 Gerhard-Herman MD, Gornik HL, Barrett C. , et al. 2016 AHA/ACC Guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017; 135 (12) e686-e725
  • 7 Cao P, Eckstein HH, De Rango P. , et al. Chapter II: Diagnostic methods. Eur J Vasc Endovasc Surg 2011; 42 (Suppl. 02) S13-S32
  • 8 Álvaro-Afonso FJ, García-Morales E, Molines-Barroso RJ, García-Álvarez Y, Sanz-Corbalán I, Lázaro-Martínez JL. Interobserver reliability of the ankle-brachial index, toe-brachial index and distal pulse palpation in patients with diabetes. Diab Vasc Dis Res 2018; 15 (04) 344-347
  • 9 Aerden D, Massaad D, von Kemp K. , et al. The ankle--brachial index and the diabetic foot: a troublesome marriage. Ann Vasc Surg 2011; 25 (06) 770-777
  • 10 Randhawa MS, Reed GW, Grafmiller K, Gornik HL, Shishehbor MH. Prevalence of tibial artery and pedal arch patency by angiography in patients with critical limb ischemia and noncompressible ankle brachial index. Circ Cardiovasc Interv 2017; 10 (05) e004605
  • 11 Osmundson PJ, Chesebro JH, O'Fallon WM. , et al. A prospective study of peripheral arterial occlusive disease in diabetes. II. Vascular laboratory assessment. Mayo Clin Proc 1981; 56 (04) 223-232
  • 12 Stein R, Hriljac I, Halperin JL, Gustavson SM, Teodorescu V, Olin JW. Limitation of the resting ankle-brachial index in symptomatic patients with peripheral arterial disease. Vasc Med 2006; 11 (01) 29-33
  • 13 Barshes NR, Flores E, Belkin M, Kougias P, Armstrong DG, Mills Sr JL. The accuracy and cost-effectiveness of strategies used to identify peripheral artery disease among patients with diabetic foot ulcers. J Vasc Surg 2016; 64 (06) 1682-1690.e3
  • 14 Sibley III RC, Reis SP, MacFarlane JJ, Reddick MA, Kalva SP, Sutphin PD. Noninvasive physiologic vascular studies: a guide to diagnosing peripheral arterial disease. Radiographics 2017; 37 (01) 346-357
  • 15 Stone PA, Glomski A, Thompson SN, Adams E. Toe pressures are superior to duplex parameters in predicting wound healing following toe and foot amputations. Ann Vasc Surg 2018; 46: 147-154
  • 16 Hashimoto T, Ichihashi S, Iwakoshi S, Kichikawa K. Combination of pulse volume recording (PVR) parameters and ankle-brachial index (ABI) improves diagnostic accuracy for peripheral arterial disease compared with ABI alone. Hypertens Res 2016; 39 (06) 430-434
  • 17 Lewis JE, Williams P, Davies JH. Non-invasive assessment of peripheral arterial disease: Automated ankle brachial index measurement and pulse volume analysis compared to duplex scan. SAGE Open Med 2016; 4: 2050312116659088
  • 18 Lewis JE, Owens DR. The pulse volume recorder as a measure of peripheral vascular status in people with diabetes mellitus. Diabetes Technol Ther 2010; 12 (01) 75-80
  • 19 Rutherford RB, Lowenstein DH, Klein MF. Combining segmental systolic pressures and plethysmography to diagnose arterial occlusive disease of the legs. Am J Surg 1979; 138 (02) 211-218
  • 20 Faccenda F, Usui Y, Spencer MP. Doppler measurement of the pressure drop caused by arterial stenosis: an experimental study: a case report. Angiology 1985; 36 (12) 899-905
  • 21 Begelman SM, Jaff MR. Noninvasive diagnostic strategies for peripheral arterial disease. Cleve Clin J Med 2006; 73 (Suppl. 04) S22-S29
  • 22 Jaffer U, Singh P, Pandey VA, Aslam M, Standfield NJ. Validation of a novel duplex ultrasound objective structured assessment of technical skills (DUOSATS) for arterial stenosis detection. Heart Lung Vessel 2014; 6 (02) 92-104
  • 23 Patel MR, Conte MS, Cutlip DE. , et al. Evaluation and treatment of patients with lower extremity peripheral artery disease: consensus definitions from Peripheral Academic Research Consortium (PARC). J Am Coll Cardiol 2015; 65 (09) 931-941
  • 24 Ohana M, Georg Y, Lejay A. , et al. Current optimal morphological evaluation of peripheral arterial diseases. J Cardiovasc Surg (Torino) 2015; 56 (02) 287-297
  • 25 Met R, Bipat S, Legemate DA, Reekers JA, Koelemay MJ. Diagnostic performance of computed tomography angiography in peripheral arterial disease: a systematic review and meta-analysis. JAMA 2009; 301 (04) 415-424
  • 26 Weisbord SD, Gallagher M, Jneid H. , et al; PRESERVE Trial Group. Outcomes of angiography with sodium bicarbonate and acetylcysteine. N Engl J Med 2018; 378 (07) 603-614
  • 27 Meyersohn NM, Walker TG, Oliveira GR. Advances in axial imaging of peripheral vascular disease. Curr Cardiol Rep 2015; 17 (10) 87-93
  • 28 Schicchi N, Tagliati C, Agliata G, Esposto Pirani P, Spadari R, Giovagnoni A. MRI evaluation of peripheral vascular anomalies using time-resolved imaging of contrast kinetics (TRICKS) sequence. Radiol Med (Torino) 2018; 123 (08) 563-571
  • 29 Healy DA, Boyle EM, Clarke Moloney M. , et al. Contrast-enhanced magnetic resonance angiography in diabetic patients with infra-genicular peripheral arterial disease: systematic review. Int J Surg 2013; 11 (03) 228-232
  • 30 Nazarian S, Hansford R, Rahsepar AA. , et al. Safety of magnetic resonance imaging in patients with cardiac devices. N Engl J Med 2017; 377 (26) 2555-2564
  • 31 ACR Manual on Contrast Media. Version 2018; 10 (03) 81-89 . Available at: https://www.acr.org/-/media/ACR/files/clinical-resources/contrast_media.pdf . Accessed December 5, 2018
  • 32 Qato K, Conway AM, Mondry L, Giangola G, Carroccio A. Management of isolated femoropopliteal in-stent restenosis. J Vasc Surg 2018; 68 (03) 807-810