Perfusion Assessment Key for Critical Limb Ischemia Diagnosis
MONDAY, Aug. 12, 2019 -- Strategies for perfusion assessment necessary for critical limb ischemia (CLI) diagnosis remain limited, according to an American Heart Association scientific statement published online Aug. 12 in Circulation.
To prepare the scientific statement, Sanjay Misra, M.D., from the Mayo Clinic in Rochester, Minnesota, and colleagues reviewed the strengths and limitations of current imaging techniques, including the ankle-brachial index, toe brachial index, toe systolic pressure, transcutaneous oximetry, and skin perfusion pressure as well as the use of laser Doppler and speckle imaging devices.
Accurate noninvasive limb perfusion assessment is necessary for timely diagnosis and to reduce unnecessary invasive procedures in patients with adequate blood flow or among those with venous, neuropathic, or pressure ulcers. No noninvasive hemodynamic measures of peripheral artery disease are 100 percent sensitive or specific for CLI. Complicating diagnosis, the authors highlight sex and ethnic differences in how CLI patients present. For example, women are more likely to experience emergency hospitalization and have differences in blood flow, while black and Hispanic patients with CLI are more likely to have diabetes and chronic kidney disease and are more likely to develop gangrene. White patients are more likely to have ulcers and pain in their legs while at rest.
"Because timely revascularization for CLI is a Class I indication in the American Heart Association/American College of Cardiology guidelines, accurate perfusion assessment is critically important," the authors write.
Several authors disclosed financial ties to the medical device industry.
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Posted: August 2019