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Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
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Atherosclerosis is a progressive disorder that leads to the thickening and narrowing of arterial walls due to plaque buildup. This condition can cause various symptoms depending on the arteries affected:Coronary Artery Disease (CAD): This condition affects the coronary arteries and may lead to chest pain (angina), shortness of breath (dyspnea), heart attacks, and other heart disease symptoms.Cerebrovascular Disease: This affects blood flow to the brain, causing transient ischemic attacks (TIAs)...
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Obstacles in Screening Below-the-Knee Arterial Lesions in CLTI Patients Using Doppler Ultrasound.

Tomofumi Tsukizawa1, Mitsuyoshi Takahara2, Yuko Yazu3

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Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|October 30, 2025
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Duplex ultrasound (DUS) has limited accuracy for below-the-knee (BTK) arteries in chronic limb-threatening ischemia (CLTI) patients. Angiography is recommended for high-risk groups to ensure accurate diagnosis and treatment planning.

Keywords:
chronic limb‐threatening ischemiaduplex ultrasonographyendovascular therapyinfrapopliteal artery

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Area of Science:

  • Vascular Surgery
  • Diagnostic Imaging
  • Medical Technology

Background:

  • Duplex ultrasound (DUS) is widely used for lower extremity arterial disease evaluation.
  • Its accuracy for below-the-knee (BTK) arteries in chronic limb-threatening ischemia (CLTI) patients is not well-established.

Purpose of the Study:

  • To assess the diagnostic accuracy of DUS for BTK arterial lesions in CLTI patients.
  • To compare DUS findings with angiography in femoropopliteal and BTK arteries.

Main Methods:

  • Retrospective analysis of 233 CLTI patients (Rutherford grades 4-6) from 2018-2022.
  • Comparison of DUS findings with angiography for femoropopliteal arteries (FPA) and BTK arteries.
  • Identification of clinical factors influencing DUS-angiography concordance.

Main Results:

  • Femoropopliteal artery concordance was 82.0%.
  • BTK artery concordance was significantly lower: anterior tibial (52.9%), posterior tibial (58.6%), and peroneal (59.9%).
  • Reduced concordance was linked to older age, lean BMI, dialysis-dependent renal failure, and FPA stenosis.

Conclusions:

  • DUS has limited reliability for screening BTK lesions in CLTI patients, especially the elderly and dialysis-dependent.
  • Angiography is crucial for confirming DUS findings in high-risk patients to prevent underestimation of disease.
  • Identifying predictors of reduced DUS accuracy aids in individualized diagnostic pathways for CLTI.