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Clinical significance of mirror lesions in lower extremity arterial disease
Author(s) -
Kiesz R. Stefan,
Góra Bartłomiej,
KolarczykHaczyk Aleksandra,
Kachel Mateusz,
Trendel Wojciech,
Paz Jesica,
Nowakowski Przemysław,
Proczka Robert,
Milewski Krzysztof
Publication year - 2020
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28559
Subject(s) - medicine , claudication , critical limb ischemia , gangrene , lesion , intermittent claudication , arterial disease , amputation , radiology , clinical significance , risk factor , peripheral , vascular disease , popliteal artery , ischemia , surgery
Objective The aim of this study was to investigate the clinical relevance of bilateral peripheral arterial disease (PAD) patterns. Background No prior study has evaluated the clinical significance of symmetrical lesion patterns, particularly the coexistence of same‐level significant plaques in both lower extremities (“mirror lesions”). Methods We conducted a single‐facility, primary data analysis involving 225 patients with symptomatic PAD. Results Eighty‐two percent of the patients had bilateral lesions: 14.2% had femoropopliteal, 38.7% had infrapopliteal, and 27.1% had both femoropopliteal and infrapopliteal lesions. The lesions were found in the exact same arteries bilaterally in 24.9% of the patients, while 26.7% had a local mirror pattern limited to the femoropopliteal (13.7%) or infrapopliteal (12.9%) arteries. Having a lesion in an artery was a risk factor for occlusive disease of the corresponding artery on the other side. Patients presenting with critical limb ischemia (CLI) had a history of resting pain (17%), ulceration/gangrene (13%), or prior amputation (26%) of the contralateral limb. Patients with significant bilateral disease had unilateral false‐negative ABI results in 11.6% of the cases. The arterial Doppler study results were unilaterally false‐negative in 19.6% and bilaterally false‐negative in 2.8% of the patients. Conclusions Patients with known peripheral arterial disease need to have both limbs fully evaluated and monitored, even in cases with negative screening results. Mirror angiographic imaging is common and often accompanied by symptoms of claudication. Unilateral ischemia is a strong risk factor for contralateral disease. Patients with CLI are at high risk for occlusive lesions of the nonindex limb.