PURPOSE: To compare angiograms, considered the gold standard for diagnostic imaging of peripheral arterial disease (PAD), to the corresponding histological sections of popliteal and tibial vessels obtained after amputation to determine if angiography fails to define atheroma burden in "normal appearing" arteries in patients with PAD. METHODS: Between 2004 and 2006, 69 patients underwent amputation of a lower extremity for severe tissue loss, gangrene, or pedal sepsis precluding limb salvage. Popliteal and tibial vessels were harvested, perfusion-fixed, and analyzed histologically. Thirty-four of these patients had pre-amputation angiography during attempted salvage procedures. Angiograms with patent or minimally diseased vessel segments (n = 19) were assessed for stenoses, diameter, and calcification by 3 vascular surgeons (n = 72 evaluations). These results were compared to corresponding cross-sectional histological slides (n = 66) in a blinded manner. RESULTS: Angiograms performed prior to above-knee (n = 9) or below-knee (n = 10) amputation revealed 24 stenoses with a mean (+/-SD) diameter-reducing stenosis of 19.5%+/-15.2%. Corresponding histological cross sections revealed greater linear stenoses measured via boundaries of the internal elastic lamina (IEL stenosis, 28.9%+/-20.2%, p = 0.003 versus angiography) or via boundaries of the external elastic membrane (vessel stenosis, 43.1%+/-15.2%, p<0.0001). Stenosis calculated by area methods (IEL area) were greater and measured 39.2%+/-24.2% (p<0.0001) and 60.9%+/-15.2% (vessel area, p<0.0001). Popliteal arteries had greater discrepancy in stenosis measurement than tibial arteries (18.5%+/-14.6% versus 34.9%+/-21.0%, p = 0.0005). However, evaluations of tibial arteries for concentricity of plaque (44% versus 69%, p = 0.08) and calcification grade (1.6 versus 2.2, p = 0.002) by angiography were discordant with histological analyses. Measurement of arterial diameter by histology for popliteal arteries (6.2+/-0.9 mm) and tibial arteries (3.1+/-0.7 mm) was greater than angiographic diameter determination (p<0.001). CONCLUSION: Angiography provides information on luminal characteristics of peripheral arteries but severely underestimates the extent of atherosclerosis in patients with PAD even in "normal appearing" vessels.
PURPOSE: To compare angiograms, considered the gold standard for diagnostic imaging of peripheral arterial disease (PAD), to the corresponding histological sections of popliteal and tibial vessels obtained after amputation to determine if angiography fails to define atheroma burden in "normal appearing" arteries in patients with PAD. METHODS: Between 2004 and 2006, 69 patients underwent amputation of a lower extremity for severe tissue loss, gangrene, or pedal sepsis precluding limb salvage. Popliteal and tibial vessels were harvested, perfusion-fixed, and analyzed histologically. Thirty-four of these patients had pre-amputation angiography during attempted salvage procedures. Angiograms with patent or minimally diseased vessel segments (n = 19) were assessed for stenoses, diameter, and calcification by 3 vascular surgeons (n = 72 evaluations). These results were compared to corresponding cross-sectional histological slides (n = 66) in a blinded manner. RESULTS: Angiograms performed prior to above-knee (n = 9) or below-knee (n = 10) amputation revealed 24 stenoses with a mean (+/-SD) diameter-reducing stenosis of 19.5%+/-15.2%. Corresponding histological cross sections revealed greater linear stenoses measured via boundaries of the internal elastic lamina (IEL stenosis, 28.9%+/-20.2%, p = 0.003 versus angiography) or via boundaries of the external elastic membrane (vessel stenosis, 43.1%+/-15.2%, p<0.0001). Stenosis calculated by area methods (IEL area) were greater and measured 39.2%+/-24.2% (p<0.0001) and 60.9%+/-15.2% (vessel area, p<0.0001). Popliteal arteries had greater discrepancy in stenosis measurement than tibial arteries (18.5%+/-14.6% versus 34.9%+/-21.0%, p = 0.0005). However, evaluations of tibial arteries for concentricity of plaque (44% versus 69%, p = 0.08) and calcification grade (1.6 versus 2.2, p = 0.002) by angiography were discordant with histological analyses. Measurement of arterial diameter by histology for popliteal arteries (6.2+/-0.9 mm) and tibial arteries (3.1+/-0.7 mm) was greater than angiographic diameter determination (p<0.001). CONCLUSION: Angiography provides information on luminal characteristics of peripheral arteries but severely underestimates the extent of atherosclerosis in patients with PAD even in "normal appearing" vessels.
Authors: Nicoletta Anzalone; Francesco Scomazzoni; Renata Castellano; Laura Strada; Claudio Righi; Letterio S Politi; Miles A Kirchin; Roberto Chiesa; Giuseppe Scotti Journal: Radiology Date: 2005-06-13 Impact factor: 11.105
Authors: R A Kruger; C A Mistretta; A B Crummy; J F Sackett; M M Goodsitt; S J Riederer; T L Houk; C G Shaw; D Fleming Journal: Radiology Date: 1977-10 Impact factor: 11.105
Authors: Steven E Nissen; E Murat Tuzcu; Paul Schoenhagen; Tim Crowe; William J Sasiela; John Tsai; John Orazem; Raymond D Magorien; Charles O'Shaughnessy; Peter Ganz Journal: N Engl J Med Date: 2005-01-06 Impact factor: 91.245
Authors: Steven E Nissen; Stephen J Nicholls; Ilke Sipahi; Peter Libby; Joel S Raichlen; Christie M Ballantyne; Jean Davignon; Raimund Erbel; Jean Charles Fruchart; Jean-Claude Tardif; Paul Schoenhagen; Tim Crowe; Valerie Cain; Kathy Wolski; Marlene Goormastic; E Murat Tuzcu Journal: JAMA Date: 2006-03-13 Impact factor: 56.272
Authors: Alan T Hirsch; Ziv J Haskal; Norman R Hertzer; Curtis W Bakal; Mark A Creager; Jonathan L Halperin; Loren F Hiratzka; William R C Murphy; Jeffrey W Olin; Jules B Puschett; Kenneth A Rosenfield; David Sacks; James C Stanley; Lloyd M Taylor; Christopher J White; John White; Rodney A White; Elliott M Antman; Sidney C Smith; Cynthia D Adams; Jeffrey L Anderson; David P Faxon; Valentin Fuster; Raymond J Gibbons; Sharon A Hunt; Alice K Jacobs; Rick Nishimura; Joseph P Ornato; Richard L Page; Barbara Riegel Journal: Circulation Date: 2006-03-21 Impact factor: 29.690
Authors: Abraham R Tzafriri; Fernando Garcia-Polite; Brett Zani; James Stanley; Benny Muraj; Jennifer Knutson; Robert Kohler; Peter Markham; Alexander Nikanorov; Elazer R Edelman Journal: J Control Release Date: 2017-09-01 Impact factor: 9.776
Authors: Zachary M Arthurs; Paul D Bishop; Lindsay E Feiten; Matthew J Eagleton; Daniel G Clair; Vikram S Kashyap Journal: J Vasc Surg Date: 2010-01-15 Impact factor: 4.268
Authors: Andor W J M Glaudemans; Riemer H J A Slart; Alessandro Bozzao; Elena Bonanno; Marcello Arca; Rudi A J O Dierckx; Alberto Signore Journal: Eur J Nucl Med Mol Imaging Date: 2010-03-20 Impact factor: 9.236
Authors: Paul D Bishop; Lindsay E Feiten; Kenneth Ouriel; Sean P Nassoiy; Mircea L Pavkov; Daniel G Clair; Vikram S Kashyap Journal: Ann Vasc Surg Date: 2008-07-21 Impact factor: 1.466
Authors: René R Sevag Packard; Yuan Luo; Parinaz Abiri; Nelson Jen; Olcay Aksoy; William M Suh; Yu-Chong Tai; Tzung K Hsiai Journal: Theranostics Date: 2017-06-22 Impact factor: 11.556
Authors: Tony Das; Jihad Mustapha; Jeffrey Indes; Robert Vorhies; Robert Beasley; Nilesh Doshi; George L Adams Journal: Catheter Cardiovasc Interv Date: 2013-10-07 Impact factor: 2.692