Angiography underestimates peripheral atherosclerosis: lumenography revisited

Area of Science:

• Vascular Surgery
• Diagnostic Imaging
• Pathology

Background:

• Peripheral arterial disease (PAD) significantly impacts lower limb health.
• Angiography is the gold standard for diagnosing PAD, assessing luminal characteristics.
• Accurate assessment of atherosclerosis burden is crucial for effective PAD management.

Purpose of the Study:

• To compare angiographic findings with histological data of popliteal and tibial vessels.
• To determine if angiography underestimates atheroma burden in PAD patients, particularly in seemingly normal arteries.

Main Methods:

• Analysis of 69 lower extremity amputations for severe PAD complications (2004-2006).
• Histological examination of harvested popliteal and tibial vessels.
• Comparison of pre-amputation angiograms (n=34) with corresponding histological sections (n=66) in a blinded manner.

Main Results:

• Angiography underestimated stenosis severity compared to histology (e.g., vessel stenosis 43.1% vs. 19.5%).
• Histological analysis revealed significantly larger arterial diameters than angiograms.
• Discrepancies were more pronounced in popliteal arteries and for plaque concentricity and calcification in tibial arteries.

Conclusions:

• Angiography provides limited information on luminal characteristics in PAD.
• Diagnostic imaging via angiography severely underestimates the true extent of atherosclerosis in PAD patients.
• Histological assessment is critical for a comprehensive understanding of PAD severity, even in non-obvious arterial segments.