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Jan Apelqvist

Physician

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Influence of diabetes on diagnostic performance of computed tomography angiography of the calf arteries in acute limb ischemia

Author

  • Talha Butt
  • Leena Lehti
  • Jan Apelqvist
  • Anders Gottsäter
  • Stefan Acosta

Summary, in English

Background: Patients with diabetes mellitus (DM) have a more extensive distal arterial occlusive disease compared to non-diabetic patients. Diagnostic imaging is a necessity to identify the location and extent of the arterial occlusion in acute limb ischemia (ALI). Computed tomography angiography (CTA) is the most commonly used modality and the diagnostic performance with CTA of calf arteries may be questioned. Purpose: To evaluate diagnostic performance of CTA of calf arteries in ALI and to compare patients with and without DM. Material and Methods: All thrombolytic treatments performed during 2001–2008 in patients with ALI were included. Initial digital subtraction angiography (DSA) and CTA of all patients were classified according to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) below-the-knee arteries and compared to CTA. Two raters assessed the CTA images independently. Inter-rater reliability was expressed as intraclass correlation (ICC) with 95% confidence intervals (CI). Results: Patients with (n = 23) and without (n = 85) DM had lower (P = 0.006) glomerular filtration rate. ICC between CTA and DSA was 0.33 (95% CI –0.22 to 0.56) and 0.71 (95% CI 0.38–0.68) in patients with and without DM, respectively. Sensitivity with CTA for TASC D lesions in patients with and without DM was 0.14 (95% CI –0.12 to 0.40) and 0.64 (95% CI 0.48–0.80), respectively. Conclusion: The sensitivity of CTA for assessment of infra-popliteal TASC D lesions in patients with ALI was not acceptable in patients with DM in contrast to those without DM. Another imaging option at present times should be considered for patients with DM.

Department/s

  • Vascular Diseases - Clinical Research
  • Genomics, Diabetes and Endocrinology
  • EXODIAB: Excellence of Diabetes Research in Sweden
  • Internal Medicine - Epidemiology
  • EpiHealth: Epidemiology for Health

Publishing year

2021-04-15

Language

English

Publication/Series

Acta Radiologica

Document type

Journal article

Publisher

SAGE Publications

Topic

  • Endocrinology and Diabetes

Keywords

  • acute limb ischemia
  • computed tomography angiography
  • Diabetes mellitus
  • diagnostic accuracy

Status

Epub

Research group

  • Vascular Diseases - Clinical Research
  • Genomics, Diabetes and Endocrinology
  • Internal Medicine - Epidemiology

ISBN/ISSN/Other

  • ISSN: 0284-1851