• diagnostic efficacy
• image quality
• lower extremity CT angiography
• split-bolus injection scheme

• Humans
• Middle Aged
• Aged
• Computed Tomography Angiography/methods
• Constriction, Pathologic
• Angiography, Digital Subtraction/methods
• Arteries/diagnostic imaging
• Lower Extremity/diagnostic imaging
• Lower Extremity/blood supply
• Contrast Media

• Science Development Foundation of the First Affiliated Hospital of Xi'an Jiaotong University
• 2020GXLH-Y-026 Key R & D Plan Project of Shaanxi Province-Joint University
• Science Development Foundation of the First Affiliated Hospital of Xi’an Jiaotong University
• Key R & D Plan Project of Shaanxi Province—Joint University

• AUC
• Acute limb ischemia
• Appropriateness Criteria
• CTA
• MRA
• angiography
• appropriate use criteria
• critical limb ischemia
• peripheral artery disease

• Humans
• Arterial Occlusive Diseases
• Ischemia
• Leg/diagnostic imaging
• Lower Extremity
• Pain
• Societies, Medical
• United States

• deep vein thrombosis
• gadolinium-containing contrast agent
• magnetic resonance angiography
• magnetic resonance imaging
• magnetic resonance venography
• pulmonary artery embolism

• Arterial blood flow velocity
• Atherosclerosis
• Diabetes mellitus
• Magnetic resonance imaging
• Peripheral artery disease
• Superficial femoral artery

• Femoral Artery/diagnostic imaging
• Humans
• Lower Extremity/pathology
• Magnetic Resonance Imaging
• Peripheral Arterial Disease/diagnostic imaging
• Thigh/pathology

• K25 HL121149 NHLBI NIH HHS
• R01 HL137763 NHLBI NIH HHS

• Diabetes mellitus
• acute limb ischemia
• computed tomography angiography
• diagnostic accuracy

• Angiogenesis
• delivery
• imaging
• peripheral artery disease (PAD)
• regenerative medicine
• stem cells

• Diabetic foot ulcers
• HbA1c
• Mortality
• Wound healing

• Diagnostic quality
• Dynamic CT scan protocol
• Peripheral arterial disease
• Run-off CT angiography

• Adult
• Aged
• Aged, 80 and over
• Female
• Humans
• Male
• Middle Aged
• Arterial Occlusive Diseases/diagnostic imaging
• Arteries
• Computed Tomography Angiography/instrumentation
• Computed Tomography Angiography/methods
• Constriction, Pathologic/diagnostic imaging
• Contrast Media/administration & dosage
• Leg/blood supply
• Observer Variation
• Peripheral Arterial Disease/diagnostic imaging
• Prospective Studies
• Reproducibility of Results
• Subtraction Technique
• Tomography Scanners, X-Ray Computed
• Tomography, X-Ray Computed/methods

• Ankle-brachial index
• Diagnosis
• Exercise test
• Peripheral artery disease

• CEUS
• Glomerulonephritis
• Kidney
• Nephropathy
• Ultrasonography

• CTA (CT angiogram)
• DSA (digital subtraction angiogram)
• PAOD (peripheral arterial occlusive disease)

• Aged
• Aged, 80 and over
• Angiography, Digital Subtraction
• Arterial Occlusive Diseases/diagnostic imaging
• Constriction, Pathologic
• Female
• Femoral Artery/diagnostic imaging
• Humans
• Male
• Middle Aged
• Popliteal Artery/diagnostic imaging
• Predictive Value of Tests
• ROC Curve
• Registries
• Research Design
• Retrospective Studies
• Sensitivity and Specificity
• Severity of Illness Index
• Ultrasonography, Doppler, Duplex

The burden of diabetic foot disease (DFD) is expected to increase in the future. The incidence of DFD is still rising due to the high prevalence of DFD predisposing factors. DFD is multifactorial in nature; however most of the diabetic foot amputations are preceded by foot ulceration. Diabetic peripheral neuropathy (DPN) is a major risk factor for foot ulceration. DPN leads to loss of protective sensation resulting in continuous unconscious traumas. Patient education and detection of high risk foot are essential for the prevention of foot ulceration and amputation. Proper assessment of the diabetic foot ulceration and appropriate management ensure better prognosis. Management is based on revascularization procedures, wound debridement, treatment of infection and ulcer offloading. Management and type of dressing applied are tailored according to the type of wound and the foot condition. The scope of this review paper is to describe the diabetic foot syndrome starting from the evaluation of the foot at risk for ulceration, up to the new treatment modalities.

• Diabetes
• Diabetic foot
• Diabetic ulcer
• Diabetic complications
• Diabetic neuropathy
• Diabetic macroanggiopathy

Although patients with peripheral artery disease (PAD) are known to have an increased risk of adverse prognosis, simple techniques to further risk‐stratify PAD patients would be clinically useful. A plausible but unexplored factor to predict such risk would be greater disease burden, manifested as multiple lower extremity lesions. The aim of this study was to examine the association between having multiple versus isolated lower extremity PAD lesions and long‐term prognosis.

A prospective cohort of 756 newly diagnosed PAD patients underwent duplex ultrasound testing to determine the number of lower extremity lesions. Cox regression models examined the independent association of lesion number (≥3 and 2 versus 1) and adverse prognosis (defined as a composite end point comprising first occurrence of either lower extremity amputation, admission for heart failure, nonfatal stroke, myocardial infarction, or unstable angina or mortality), adjusting for demographic and clinical risk factors. Analyses were replicated using an advanced Cox‐based model for multiple events. A total of 173 patients (23%) had ≥3 lesions, 197 (26%) had 2 lesions, and 386 (51%) had 1 lesion. After a median follow‐up of 3.2 years, patients with ≥3 lesions had an increased risk of experiencing a first adverse event (adjusted hazard ratio 1.60, 95% CI 1.08–2.38, P=0.020) and an increased risk of having multiple events (adjusted hazard ratio 1.53, 95% CI 1.08–2.18, P=0.018). Patients with 2 lesions had a prognosis similar to those with 1 lesion.

Among PAD patients, a greater number of lesions is associated with an increased risk of an adverse prognosis over 3 years of follow‐up. Assessing the number of lower extremity lesions might serve as a simple risk‐stratification tool at initial PAD diagnosis.

• claudication
• peripheral artery disease
• prognosis
• statistics
• survival

Peripheral arterial disease (PAD) represents systematic atherosclerosis of great vessels. PAD affects approximately 10-20 % of patients older than 60 years and is associated with high mortality and morbidity rate debilitating individuals’ life.

To compare the results of Gadolinium enhanced MR-Angiography and surgery in patients suspected to have peripheral arterial disease.

In this prospective cohort study, 30 consecutive patients matching the inclusion criteria were enrolled and MR-Angiography was performed prior to surgery for each one.

22 patients were male (73.3%) and the mean age was 60.3 ± 10.6 years in our study group. The most common artery for cut off and run off was superior femoral artery in both assessments. Proximal section of each artery was the most common anatomical section for cut off and run off. There was a same report of cut off artery by MR-Angiography and surgery (kappa coefficient of agreement was 0.96, P value < 0.001) and positive predictive value was 0.97 (95% CI: 0.83-0.99).

According to our findings MR-angiography is an appropriate alternative imaging modality for patients suspected to have peripheral arterial disease and it facilitates the early diagnosis proposed by the clinical findings. Also beneficial characteristics of this method such as low exposure to ionizing radiation, repeatability, and low risk of contrast agent-induced nephropathy make it a modality of choice in patients with renal impairment.

• Angiography
• Peripheral Vascular Disease
• Surgery

• cell therapy
• clinical trials
• imaging techniques
• peripheral artery disease
• regenerative medicine
• stem cells

The purpose of this study was to compare the success rate of successful arterial peak flow (APF) and ankle-brachial index (ABI) measurements in patients with suspected or known peripheral arterial disease (PAD).

183 patients with varying degrees of PAD were included. All subjects underwent ABI measurements and MR imaging of the popliteal artery to determine APF. Proportions of patients with successful APF and ABI measurements were compared and the discriminative capability was evaluated.

APF was successfully measured in 91% of the patients, whereas the ABI could be determined in 71% of the patients (p<0.01). Success rates of APF and ABI were significantly higher in patients with intermittent claudication (95% and 80%, respectively) than in patients with critical ischemia (87% and 62%, respectively).

Compared to the assessment of PAD severity with ABI, the success rate of MRI-based APF measurements in patients with a clinical indication for MRA is 20% higher, with similar discriminatory capacity for disease severity. Therefore, APF is an especially convenient and valuable measure to assess severity in PAD patients scheduled to undergo MR angiography to obtain additional functional information concerning the vascular status.

• Aged
• Aged, 80 and over
• Ankle Brachial Index
• Arteries/pathology
• Arteries/physiopathology
• Female
• Humans
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Peripheral Arterial Disease/diagnosis
• Peripheral Arterial Disease/pathology
• Peripheral Arterial Disease/physiopathology

Treatment of peripheral arterial diseases may be distinguished into conservative and interventional management; the latter is divided into surgical and endovascular procedures. Management of peripheral artery stenosis and occlusion with vascular stents is associated with the risk of late complications such as restenosis, stent fracture or dislocation.

A 62-year-old woman with generalized atherosclerosis, particularly extensive in lower limb arteries, was admitted to the Department of Angiology 11 months after having an endovascular procedure performed due to critical ischemia of left lower limb. Because of stent occlusion, a decision to perform angiographic examination of lower limb arteries was made. Examination revealed occlusion of the superficial femoral artery along its entire length, including previously implanted stents. Distal stent was fractured with slight dislocation of the proximal segment. A decision was made to perform mechanical thrombectomy using a Rotarex system followed by a stent-in-stent placement procedure. Follow-up angiography and ultrasound scan performed 24 hours after the procedure revealed a patent vessel with satisfactory blood flow.

Nowadays, imaging diagnostics of peripheral artery stenosis involves non-invasive examinations such as ultrasound, minimally invasive examinations such as angio-MRI and MDCT, or invasive examinations such as DSA and IVUS. DSA examinations are used to confirm significant stenosis or occlusion of a vessel, particularly when qualifying a patient for endovascular treatment. Due to their anatomic location, the superficial femoral artery and the popliteal artery are subject to various forces e.g. those exerted by the working muscles. Mechanical thrombectomy and atherectomy are efficient methods of arterial recanalization used in the treatment of acute, subacute or even chronic occlusions or stenosis of peripheral vessels.

Frequency of angioplasty and vascular stent implantation procedures is increased in patients with peripheral arterial disease, thus increasing the incidence of reported early and late complications such as acute stent thrombosis, restenosis and stent fractures. The Rotarex transcutaneous mechanical thrombectomy system is an efficient method of treating occlusions in arterial stents. It is also safe when performed by experienced operators.

• femoral artery occlusion
• mechanical thrombectomy
• stent fracture

• Alloys
• Angiography/methods
• Chromium Alloys
• Cobalt
• Femoral Artery/diagnostic imaging
• Humans
• In Vitro Techniques
• Phantoms, Imaging
• Radiographic Image Interpretation, Computer-Assisted
• Stents
• Tomography, X-Ray Computed/methods

The aim of the current study was to describe a method that assesses the hyperemic microvascular blood plasma volume of the calf musculature. The reversibly albumin binding contrast agent gadofosveset was used in dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) to assess the microvascular status in patients with peripheral arterial disease (PAD) and healthy controls. In addition, the reproducibility of this method in healthy controls was determined.

Ten PAD patients with intermittent claudication and 10 healthy control subjects were included. Patients underwent contrast-enhanced MR angiography of the peripheral arteries, followed by one DCE MRI examination of the musculature of the calf. Healthy control subjects were examined twice on different days to determine normative values and the interreader and interscan reproducibility of the technique. The MRI protocol comprised dynamic imaging of contrast agent wash-in under reactive hyperemia conditions of the calf musculature. Using pharmacokinetic modeling the hyperemic fractional microvascular blood plasma volume (V_p, unit: %) of the anterior tibial, gastrocnemius and soleus muscles was calculated.

V_p was significantly lower for all muscle groups in PAD patients (4.3±1.6%, 5.0±3.3% and 6.1±3.6% for anterior tibial, gastrocnemius and soleus muscles, respectively) compared to healthy control subjects (9.1±2.0%, 8.9±1.9% and 9.3±2.1%). Differences in V_p between muscle groups were not significant. The coefficient of variation of V_p varied from 10–14% and 11–16% at interscan and interreader level, respectively.

Using DCE MRI after contrast-enhanced MR angiography with gadofosveset enables reproducible assessment of hyperemic fractional microvascular blood plasma volume of the calf musculature. V_p was lower in PAD patients than in healthy controls, which reflects a promising functional (hemodynamic) biomarker for the microvascular impairment of macrovascular lesions.

• Adult
• Aged
• Case-Control Studies
• Female
• Humans
• Hyperemia/diagnosis
• Hyperemia/etiology
• Magnetic Resonance Imaging
• Male
• Microvessels
• Middle Aged
• Peripheral Arterial Disease/complications
• Peripheral Arterial Disease/diagnosis
• Plasma Volume
• Reproducibility of Results
• Young Adult

The aim of this work was to develop a MRI method to determine arterial flow reserve in patients with intermittent claudication and to investigate whether this method can discriminate between patients and healthy control subjects.

Ten consecutive patients with intermittent claudication and 10 healthy control subjects were included. All subjects underwent vector cardiography triggered quantitative 2D cine MR phase-contrast imaging to obtain flow waveforms of the popliteal artery at rest and during reactive hyperemia. Resting flow, maximum hyperemic flow and absolute flow reserve were determined and compared between the two groups by two independent MRI readers. Also, interreader reproducibility of flow measures was reported.

Resting flow was lower in patients compared to controls (4.9±1.6 and 11.1±3.2 mL/s in patients and controls, respectively (p<0.01)). Maximum hyperemic flow was 7.3±2.9 and 16.4±3.2 mL/s (p<0.01) and the absolute flow reserve was 2.4±1.6 and 5.3±1.3 mL/s (p<0.01), respectively in patients and controls. The interreader coefficient of variation was below 10% for all measures in both patients and controls.

Quantitative 2D MR cine phase-contrast imaging is a promising method to determine flow reserve measures in patients with peripheral arterial disease and can be helpful to discriminate patients with intermittent claudication from healthy controls.

• Aged
• Angiography
• Arteries/physiopathology
• Case-Control Studies
• Female
• Femoral Artery
• Humans
• Intermittent Claudication/diagnosis
• Intermittent Claudication/physiopathology
• Leg/blood supply
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Peripheral Arterial Disease/diagnosis
• Regional Blood Flow
• Reproducibility of Results

• accf/aha expert consensus document
• cardiovascular magnetic resonance
• cardiovascular disease
• magnetic resonance imaging
• safety

• Cardiac-Gated Imaging Techniques
• Cardiovascular Diseases/diagnosis
• Humans
• Magnetic Resonance Angiography
• Magnetic Resonance Imaging/methods
• Magnetic Resonance Imaging/standards
• Magnetic Resonance Imaging, Cine
• Magnetic Resonance Imaging, Interventional

• ZIA CL090019-01 Intramural NIH HHS
• ZIA EB000072-01 Intramural NIH HHS

• accf/aha expert consensus document
• cardiovascular magnetic resonance
• cardiovascular disease
• magnetic resonance imaging
• safety

• Advisory Committees/standards
• Advisory Committees/trends
• Cardiology/standards
• Cardiology/trends
• Cardiovascular Diseases/diagnosis
• Cardiovascular Diseases/therapy
• Foundations/standards
• Humans
• Magnetic Resonance Imaging/standards
• Magnetic Resonance Imaging/trends
• Societies, Medical/standards
• Societies, Medical/trends
• United States

• ZIA CL090019-01 Intramural NIH HHS
• ZIA EB000072-01 Intramural NIH HHS