Kazuhiro Nishigami1, Yukari Imada2, Touitsu Hirayama3, Koichi Nakao4. 1. Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami, Kumamoto, 861-4193, Japan. kazuhiro-nishigami@saiseikaikumamoto.jp. 2. Cardiovascular Echo Laboratory, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan. 3. Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan. 4. Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami, Kumamoto, 861-4193, Japan.
Abstract
BACKGROUND: Arterial thromboembolism (ATE) leading to acute arterial occlusion can involve life-threatening complications, including limb loss and death, without prompt thrombectomy. Several ATEs are hard to differentiate from acute aggravation of atherosclerotic peripheral artery disease (PAD). We determined four characteristics of vascular echos suggesting ATE for the differentiation from PAD and validated their use. METHODS AND RESULTS: Twenty patients (11 men and 9 women; mean age, 74 years) with ATE confirmed by therapeutic findings and 19 patients with PAD including occlusive lesions (14 men and 5 women; mean age, 78 years) were enrolled. Four hallmarks of vascular echo suggesting ATE were defined as the manifestation of the intima-media complex next to the adventitia (M1), mild to moderate echolucency of the intravascular structure (M2), mobility of the intravascular structure (M3), and the pulsatile movement of the arterial wall (M4) in occlusive arterial lesions. In the ATE group, 6 patients had three positive items, and 14 patients had four positive items. In the PAD group, ten patients had no positive items, and nine patients had one positive item. Using a cutoff score of more than 3 for ATE, the sensitivity was 100%, the specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 100%. CONCLUSIONS: The presented characteristics of vascular echo suggesting ATE could be useful for making the differential diagnosis against PAD.
BACKGROUND: Arterial thromboembolism (ATE) leading to acute arterial occlusion can involve life-threatening complications, including limb loss and death, without prompt thrombectomy. Several ATEs are hard to differentiate from acute aggravation of atherosclerotic peripheral artery disease (PAD). We determined four characteristics of vascular echos suggesting ATE for the differentiation from PAD and validated their use. METHODS AND RESULTS: Twenty patients (11 men and 9 women; mean age, 74 years) with ATE confirmed by therapeutic findings and 19 patients with PAD including occlusive lesions (14 men and 5 women; mean age, 78 years) were enrolled. Four hallmarks of vascular echo suggesting ATE were defined as the manifestation of the intima-media complex next to the adventitia (M1), mild to moderate echolucency of the intravascular structure (M2), mobility of the intravascular structure (M3), and the pulsatile movement of the arterial wall (M4) in occlusive arterial lesions. In the ATE group, 6 patients had three positive items, and 14 patients had four positive items. In the PAD group, ten patients had no positive items, and nine patients had one positive item. Using a cutoff score of more than 3 for ATE, the sensitivity was 100%, the specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 100%. CONCLUSIONS: The presented characteristics of vascular echo suggesting ATE could be useful for making the differential diagnosis against PAD.
Authors: R L Tawes; E J Harris; W H Brown; P M Shoor; J J Zimmerman; G R Sydorak; J P Beare; R G Scribner; T J Fogarty Journal: J Vasc Surg Date: 1987-06 Impact factor: 4.268