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Mirror Distribution of Lesions in the Lower Extremities in Patients with Critical Limb Ischemia


Aleksandra Kolarczyk-Haczyk, MD, Wojciech Trendel, MD, Aleksandra Blachut, MD, Maciej Pruski, Jr, MD, American Heart of Poland, Silesia, Poland; Radoslaw Stefan Kiesz, MD, San Antonio Endovascular and Heart Institute, San Antonio, Texas

Abstract Number

Introduction: Prevalence of critical limb ischemia (CLI) is still increasing. Symptoms for CLI are resting pain with or without small ulcers to gangrene. Doppler ultrasound is the first diagnostic tool used in these patients; however, it is often performed in the symptomatic leg only. In angiography, which is the gold standard of lower-extremity vessel visualization, mirror occurrence of lesions in the arteries can be observed. 

Objectives: The aim of the study was to estimate the distribution of lesions in patients with CLI. 

Methods: This is an outpatient, single-center, retrospective study of 87 consecutive patients with CLI who underwent diagnostic lower-extremity angiography between January 2014 and December 2016. Distribution and mirror occurrence of lesions in the lower-extremity arteries were estimated. 

Results: In the registry, 52% patients were men, and mean age was 74 ± 12 years. Hypertension was present in 95%, hyperlipidemia in 90%, and diabetes in 64%. Sixty-two percent of patients had history of coronary artery disease (25% post myocardial infarction), 56% had prior peripheral arterial disease (PAD), and 18% had history of stroke. Patients were treated with aspirin, thienopyridine-class antiplatelet agents, and statins in 71%, 61%, and 69%, respectively. Fifty-four percent of patients had a history of PAD-related lower-extremity interventions (endovascular intervention, bypass surgery, or amputation in 44%, 20%, and 15%, respectively). Most of the patients (52%) were in Rutherford 4 class. Ulceration occurred in 45%. The mean probability rate of mirror lesion distribution for each vessel was 46%. The vessels with the highest percentage of mirror distribution were superficial femoral artery, anterior tibial artery, and posterior tibial artery (60%, 57%, and 55%, respectively). 

Conclusions: There is a trend for mirror distribution of lesions in CLI patients. Patients should be screened with bilateral Doppler examination, even if only one extremity is symptomatic.

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