Clinical Assessment of Peripheral Arterial Disease in the Office: What Do the Guidelines Say?

Abstract

Lower extremity peripheral arterial disease (PAD) is the manifestation of atherosclerotic disease within the lower extremities. The presentation of PAD is diverse ranging from asymptomatic disease to claudication or to debilitating rest pain, nonhealing ulcers, and gangrene. PAD is associated with significant morbidity, mortality, and healthcare costs. Proper diagnosis and management of PAD is important so as to maintain quality of life and reduce the risk of cardiovascular disease and adverse limb events such as amputation. This document provides a comprehensive outpatient approach to the clinical assessment of PAD that includes risk factors, diagnosis, treatment, and follow-up options.

Keywords

peripheral artery disease - guidelines - outpatient - critical limb ischemia - claudication - interventional radiology

• References

• 1 Fowkes FGR, Rudan D, Rudan I. , et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet 2013; 382 (9901): 1329-1340
• 2 Mozaffarian D, Benjamin EJ, Go AS. , et al; Writing Group Members; American Heart Association Statistics Committee; Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2016 Update: a report from the American Heart Association. Circulation 2016; 133 (04) e38-e360
• 3 Subherwal S, Patel MR, Kober L. , et al. Peripheral artery disease is a coronary heart disease risk equivalent among both men and women: results from a nationwide study. Eur J Prev Cardiol 2015; 22 (03) 317-325
• 4 Caro J, Migliaccio-Walle K, Ishak KJ, Proskorovsky I. The morbidity and mortality following a diagnosis of peripheral arterial disease: long-term follow-up of a large database. BMC Cardiovasc Disord 2005; 5 (01) 14
• 5 Fowkes FG. Epidemiology of atherosclerotic arterial disease in the lower limbs. Eur J Vasc Surg 1988; 2 (05) 283-291
• 6 Fowkes FGR, Aboyans V, Fowkes FJI, McDermott MM, Sampson UKA, Criqui MH. Peripheral artery disease: epidemiology and global perspectives. Nat Rev Cardiol 2017; 14 (03) 156-170
• 7 Gerhard-Herman MD, Gornik HL, Barrett C. , et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017; 69 (11) e71-e126
• 8 Berger J, Davies M, Clement D. , et al. Overview of lower extremity peripheral artery disease. In: Post T. , ed. UpToDate. Waltham, MA: UpToDate; 2018
• 9 Neschis D, Golden M, Eidt J. , et al. Clinical features and diagnosis of lower extremity peripheral artery disease. In: Post T. , ed. UpToDate. Waltham, MA: UpToDate; 2018
• 10 Bailey MA, Griffin KJ, Scott DJ. Clinical assessment of patients with peripheral arterial disease. Semin Intervent Radiol 2014; 31 (04) 292-299
• 11 Schainfeld RM. Management of peripheral arterial disease and intermittent claudication. J Am Board Fam Pract 2001; 14 (06) 443-450
• 12 Edinburgh Claudication Questionnaire. Occas Pap R Coll Gen Pract 2002; 82: 44
• 13 McDermott MM. Lower extremity manifestations of peripheral artery disease: the pathophysiologic and functional implications of leg ischemia. Circ Res 2015; 116 (09) 1540-1550
• 14 McDermott MM, Greenland P, Liu K. , et al. Leg symptoms in peripheral arterial disease: associated clinical characteristics and functional impairment. JAMA 2001; 286 (13) 1599-1606
• 15 McDermott MM, Liu K, Greenland P. , et al. Functional decline in peripheral arterial disease: associations with the ankle brachial index and leg symptoms. JAMA 2004; 292 (04) 453-461
• 16 McDermott MM, Ferrucci L, Liu K. , et al. Leg symptom categories and rates of mobility decline in peripheral arterial disease. J Am Geriatr Soc 2010; 58 (07) 1256-1262
• 17 Collins TC, Petersen NJ, Suarez-Almazor M. Peripheral arterial disease symptom subtype and walking impairment. Vasc Med 2005; 10 (03) 177-183
• 18 Criqui MH, Denenberg JO, Bird CE, Fronek A, Klauber MR, Langer RD. The correlation between symptoms and non-invasive test results in patients referred for peripheral arterial disease testing. Vasc Med 1996; 1 (01) 65-71
• 19 Gardner AW, Montgomery PS, Afaq A. Exercise performance in patients with peripheral arterial disease who have different types of exertional leg pain. J Vasc Surg 2007; 46 (01) 79-86
• 20 Wang JC, Criqui MH, Denenberg JO. , et al. Exertional leg pain in patients with and without peripheral arterial disease. Circulation 2005; 112 (22) 3501-3508
• 21 Norgren L, Hiatt WR, Dormandy JA. , et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg 2007; 45: S5-S67
• 22 Mills J, Eidt J, Kathryn C. Classification of acute and chronic lower extremity ischemia. In: Post T. , ed. UpToDate. Waltham, MA: UpToDate; 2018
• 23 Bradbury A, Callum K. ABC of arterial and venous disease: Acute limb ischemia. BMJ 2000; 320 (7237): 764-767
• 24 Gerhard-Herman MD, Gornik HL, Barrett C. , et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017; 135 (12) e686-e725
• 25 Hardman RL, Jazaeri O, Yi J, Smith M, Gupta R. Overview of classification systems in peripheral artery disease. Semin Intervent Radiol 2014; 31 (04) 378-388
• 26 Mills Sr JL, Conte MS, Armstrong DG. , et al; Society for Vascular Surgery Lower Extremity Guidelines Committee. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg 2014; 59 (01) 220-34.e1, 2
• 27 Zhan LX, Branco BC, Armstrong DG, Mills Sr JL. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System based on Wound, Ischemia, and foot Infection (WIfI) correlates with risk of major amputation and time to wound healing. J Vasc Surg 2015; 61 (04) 939-944
• 28 Al-Qaisi M, Nott DM, King DH, Kaddoura S. Ankle brachial pressure index (ABPI): an update for practitioners. Vasc Health Risk Manag 2009; 5: 833-841
• 29 McPhail IR, Spittell PC, Weston SA, Bailey KR. Intermittent claudication: an objective office-based assessment. J Am Coll Cardiol 2001; 37 (05) 1381-1385
• 30 Mitchell E, Eidt J, Mills J. , et al. Noninvasive diagnosis of arterial disease. In: Post T. , ed. UpToDate. Waltham, MA: UpToDate; 2018
• 31 Carter SA, Tate RB. Value of toe pulse waves in addition to systolic pressures in the assessment of the severity of peripheral arterial disease and critical limb ischemia. J Vasc Surg 1996; 24 (02) 258-265
• 32 Vitti MJ, Robinson DV, Hauer-Jensen M. , et al. Wound healing in forefoot amputations: the predictive value of toe pressure. Ann Vasc Surg 1994; 8 (01) 99-106
• 33 Apelqvist J, Castenfors J, Larsson J, Stenström A, Agardh CD. Prognostic value of systolic ankle and toe blood pressure levels in outcome of diabetic foot ulcer. Diabetes Care 1989; 12 (06) 373-378
• 34 Fife CE, Smart DR, Sheffield PJ, Hopf HW, Hawkins G, Clarke D. Transcutaneous oximetry in clinical practice: consensus statements from an expert panel based on evidence. Undersea Hyperb Med 2009; 36 (01) 43-53
• 35 Arsenault KA, McDonald J, Devereaux PJ, Thorlund K, Tittley JG, Whitlock RP. The use of transcutaneous oximetry to predict complications of chronic wound healing: a systematic review and meta-analysis. Wound Repair Regen 2011; 19 (06) 657-663
• 36 Castronuovo Jr JJ, Adera HM, Smiell JM, Price RM. Skin perfusion pressure measurement is valuable in the diagnosis of critical limb ischemia. J Vasc Surg 1997; 26 (04) 629-637
• 37 Andreucci M, Solomon R, Tasanarong A. Side effects of radiographic contrast media: pathogenesis, risk factors, and prevention. BioMed Res Int 2014; 2014: 741018
• 38 Stacul F, van der Molen AJ, Reimer P. , et al; Contrast Media Safety Committee of European Society of Urogenital Radiology (ESUR). Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines. Eur Radiol 2011; 21 (12) 2527-2541
• 39 Zhang B, Liang L, Chen W, Liang C, Zhang S. An updated study to determine association between gadolinium-based contrast agents and nephrogenic systemic fibrosis. PLoS One 2015; 10 (06) e0129720
• 40 Nicolaï SP, Hendriks EJ, Prins MH, Teijink JA. ; EXITPAD Study Group. Optimizing supervised exercise therapy for patients with intermittent claudication. J Vasc Surg 2010; 52 (05) 1226-1233
• 41 Heart Outcomes Prevention Evaluation Study Investigators; Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000; 342 (03) 145-153
• 42 ONTARGET Investigators; Yusuf S, Teo KK, Pogue J. , et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008; 358 (15) 1547-1559
• 43 Aboyans V, Ricco JB, Bartelink MEL. , et al; ESC Scientific Document Group. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries. Eur Heart J 2018; 39 (09) 763-816
• 44 Mancia G, Fagard R, Narkiewicz K. , et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013; 34 (28) 2159-2219
• 45 Whelton P, Carey R, Aronow R. , et al. Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. J Am Coll Cardiol 2017; 2017: 24430
• 46 Aung PP, Maxwell HG, Jepson RG, Price JF, Leng GC. Lipid-lowering for peripheral arterial disease of the lower limb. Cochrane Database Syst Rev 2007; (04) CD000123
• 47 Antoniou GA, Fisher RK, Georgiadis GS, Antoniou SA, Torella F. Statin therapy in lower limb peripheral arterial disease: systematic review and meta-analysis. Vascul Pharmacol 2014; 63 (02) 79-87
• 48 Heart Protection Study Collaborative Group. Randomized trial of the effects of cholesterol-lowering with simvastatin on peripheral vascular and other major vascular outcomes in 20,536 people with peripheral arterial disease and other high-risk conditions. J Vasc Surg 2007; 45 (04) 645-654 , discussion 653–654
• 49 Stone NJ, Robinson JG, Lichtenstein AH. , et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129 (25) (Suppl. 02) S1-S45
• 50 Singh S, Armstrong EJ, Sherif W. , et al. Association of elevated fasting glucose with lower patency and increased major adverse limb events among patients with diabetes undergoing infrapopliteal balloon angioplasty. Vasc Med 2014; 19 (04) 307-314
• 51 Takahara M, Kaneto H, Iida O. , et al. The influence of glycemic control on the prognosis of Japanese patients undergoing percutaneous transluminal angioplasty for critical limb ischemia. Diabetes Care 2010; 33 (12) 2538-2542
• 52 Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324 (7329): 71-86
• 53 Berger JS, Krantz MJ, Kittelson JM, Hiatt WR. Aspirin for the prevention of cardiovascular events in patients with peripheral artery disease: a meta-analysis of randomized trials. JAMA 2009; 301 (18) 1909-1919
• 54 CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996; 348 (9038): 1329-1339
• 55 Tepe G, Bantleon R, Brechtel K. , et al. Management of peripheral arterial interventions with mono or dual antiplatelet therapy--the MIRROR study: a randomised and double-blinded clinical trial. Eur Radiol 2012; 22 (09) 1998-2006
• 56 Strobl FF, Brechtel K, Schmehl J. , et al. Twelve-month results of a randomized trial comparing mono with dual antiplatelet therapy in endovascularly treated patients with peripheral artery disease. J Endovasc Ther 2013; 20 (05) 699-706
• 57 Belch JJ, Dormandy J. , et al; CASPAR Writing Committee. Results of the randomized, placebo-controlled clopidogrel and acetylsalicylic acid in bypass surgery for peripheral arterial disease (CASPAR) trial. J Vasc Surg 2010; 52 (04) 825-833
• 58 Bedenis R, Stewart M, Cleanthis M, Robless P, Mikhailidis DP, Stansby G. Cilostazol for intermittent claudication. Cochrane Database Syst Rev 2014; 10 (10) CD003748
• 59 Murphy TP, Cutlip DE, Regensteiner JG. , et al; CLEVER Study Investigators. Supervised exercise versus primary stenting for claudication resulting from aortoiliac peripheral artery disease: six-month outcomes from the claudication: exercise versus endoluminal revascularization (CLEVER) study. Circulation 2012; 125 (01) 130-139
• 60 Fakhry F, Rouwet EV, den Hoed PT, Hunink MG, Spronk S. Long-term clinical effectiveness of supervised exercise therapy versus endovascular revascularization for intermittent claudication from a randomized clinical trial. Br J Surg 2013; 100 (09) 1164-1171
• 61 Murphy TP, Cutlip DE, Regensteiner JG. , et al. Supervised exercise, stent revascularization, or medical therapy for claudication due to aortoiliac peripheral artery disease: the CLEVER study. J Am Coll Cardiol 2015; 65 (10) 999-1009
• 62 Shishehbor MH, White CJ, Gray BH. , et al. Critical limb ischemia: an expert statement. J Am Coll Cardiol 2016; 68 (18) 2002-2015
• 63 Clark N, Sheehan P, Edmonds M. , et al; American Diabetes Association. Peripheral arterial disease in people with diabetes. Diabetes Care 2003; 26 (12) 3333-3341
• 64 Hirsch AT, Haskal ZJ, Hertzer NR. , et al; American Association for Vascular Surgery; Society for Vascular Surgery; Society for Cardiovascular Angiography and Interventions; Society for Vascular Medicine and Biology; Society of Interventional Radiology; ACC/AHA Task Force on Practice Guidelines Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease; American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; Vascular Disease Foundation. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation 2006; 113 (11) e463-e654
• 65 Leng GC, Lee AJ, Fowkes FG. , et al. Incidence, natural history and cardiovascular events in symptomatic and asymptomatic peripheral arterial disease in the general population. Int J Epidemiol 1996; 25 (06) 1172-1181
• 66 Dormandy J, Mahir M, Ascady G. , et al. Fate of the patient with chronic leg ischaemia. A review article. J Cardiovasc Surg (Torino) 1989; 30 (01) 50-57
• 67 Jelnes R, Gaardsting O, Hougaard Jensen K, Baekgaard N, Tønnesen KH, Schroeder T. Fate in intermittent claudication: outcome and risk factors. Br Med J (Clin Res Ed) 1986; 293 (6555): 1137-1140
• 68 Bloor K. Natural history of arteriosclerosis of the lower extremities: Hunterian lecture delivered at the Royal College of Surgeons of England on 22nd April 1960. Ann R Coll Surg Engl 1961; 28 (01) 36-52
• 69 Zaetta J, Baum R, Cutlip D. , et al. Percutaneous interventional procedures in the patient with lower extremity claudication. In: Post T. , ed. UpToDate. Waltham, MA: UpToDate; 2018
• 70 Creager MA, Belkin M, Bluth EI. , et al. 2012 ACCF/AHA/ACR/SCAI/SIR/STS/SVM/SVN/SVS Key data elements and definitions for peripheral atherosclerotic vascular disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Data Standards (Writing Committee to develop Clinical Data Standards for peripheral atherosclerotic vascular disease). J Am Coll Cardiol 2012; 59 (03) 294-357
• 71 Rutherford RB, Baker JD, Ernst C. , et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg 1997; 26 (03) 517-538
• 72 Blaisdell FW. The pathophysiology of skeletal muscle ischemia and the reperfusion syndrome: a review. Cardiovasc Surg 2002; 10 (06) 620-630
• 73 Comerota AJ, Weaver FA, Hosking JD. , et al. Results of a prospective, randomized trial of surgery versus thrombolysis for occluded lower extremity bypass grafts. Am J Surg 1996; 172 (02) 105-112
• 74 Ouriel K, Veith FJ, Sasahara AA. ; Thrombolysis or Peripheral Arterial Surgery (TOPAS) Investigators. A comparison of recombinant urokinase with vascular surgery as initial treatment for acute arterial occlusion of the legs. N Engl J Med 1998; 338 (16) 1105-1111
• 75 Results of a prospective randomized trial evaluating surgery versus thrombolysis for ischemia of the lower extremity. The STILE trial. Ann Surg 1994; 220 (03) 251-266 , discussion 266–268
• 76 Ouriel K, Shortell CK, DeWeese JA. , et al. A comparison of thrombolytic therapy with operative revascularization in the initial treatment of acute peripheral arterial ischemia. J Vasc Surg 1994; 19 (06) 1021-1030
• 77 Gupta R, Hennebry TA. Percutaneous isolated pharmaco-mechanical thrombolysis-thrombectomy system for the management of acute arterial limb ischemia: 30-day results from a single-center experience. Catheter Cardiovasc Interv 2012; 80 (04) 636-643
• 78 Silva JA, Ramee SR, Collins TJ. , et al. Rheolytic thrombectomy in the treatment of acute limb-threatening ischemia: immediate results and six-month follow-up of the multicenter AngioJet registry. Possis Peripheral AngioJet Study AngioJet Investigators. Cathet Cardiovasc Diagn 1998; 45 (04) 386-393
• 79 Taha AG, Byrne RM, Avgerinos ED, Marone LK, Makaroun MS, Chaer RA. Comparative effectiveness of endovascular versus surgical revascularization for acute lower extremity ischemia. J Vasc Surg 2015; 61 (01) 147-154
• 80 Leung DA, Blitz LR, Nelson T. , et al. Rheolytic pharmacomechanical thrombectomy for the management of acute limb ischemia: results from the PEARL registry. J Endovasc Ther 2015; 22 (04) 546-557
• 81 Nelson JA. Compartment pressure measurements have poor specificity for compartment syndrome in the traumatized limb. J Emerg Med 2013; 44 (05) 1039-1044
• 82 Stracciolini A, Hammerberg M, Moreira M, Bachur R, Grayzie J. Acute compartment syndrome of the extremities. In: Post T. , ed. UpToDate. Waltham, MA: UpToDate; 2018
• 83 Bekwelem W, Connolly SJ, Halperin JL. , et al. Extracranial systemic embolic events in patients with nonvalvular atrial fibrillation: incidence, risk factors, and outcomes. Circulation 2015; 132 (09) 796-803
• 84 Abu Dabrh AM, Steffen MW, Undavalli C. , et al. The natural history of untreated severe or critical limb ischemia. J Vasc Surg 2015; 62 (06) 1642-51.e3
• 85 AbuRahma AF, Robinson PA, Holt SM. Prospective controlled study of polytetrafluoroethylene versus saphenous vein in claudicant patients with bilateral above knee femoropopliteal bypasses. Surgery 1999; 126 (04) 594-601 , discussion 601–602
• 86 Green RM, Abbott WM, Matsumoto T. , et al. Prosthetic above-knee femoropopliteal bypass grafting: five-year results of a randomized trial. J Vasc Surg 2000; 31 (03) 417-425
• 87 Klinkert P, Schepers A, Burger DH, van Bockel JH, Breslau PJ. Vein versus polytetrafluoroethylene in above-knee femoropopliteal bypass grafting: five-year results of a randomized controlled trial. J Vasc Surg 2003; 37 (01) 149-155
• 88 Johnson WC, Lee KK. A comparative evaluation of polytetrafluoroethylene, umbilical vein, and saphenous vein bypass grafts for femoral-popliteal above-knee revascularization: a prospective randomized Department of Veterans Affairs cooperative study. J Vasc Surg 2000; 32 (02) 268-277
• 89 Nolan BW, De Martino RR, Stone DH. , et al; Vascular Study Group of New England. Prior failed ipsilateral percutaneous endovascular intervention in patients with critical limb ischemia predicts poor outcome after lower extremity bypass. J Vasc Surg 2011; 54 (03) 730-735 , discussion 735–736
• 90 Santo VJ, Dargon P, Azarbal AF. , et al. Lower extremity autologous vein bypass for critical limb ischemia is not adversely affected by prior endovascular procedure. J Vasc Surg 2014; 60 (01) 129-135
• 91 Uhl C, Hock C, Betz T, Töpel I, Steinbauer M. Pedal bypass surgery after crural endovascular intervention. J Vasc Surg 2014; 59 (06) 1583-1587
• 92 Gray BH, Laird JR, Ansel GM, Shuck JW. Complex endovascular treatment for critical limb ischemia in poor surgical candidates: a pilot study. J Endovasc Ther 2002; 9 (05) 599-604
• 93 Ryer EJ, Trocciola SM, DeRubertis B. , et al. Analysis of outcomes following failed endovascular treatment of chronic limb ischemia. Ann Vasc Surg 2006; 20 (04) 440-446
• 94 Nishibe T, Maruno K, Iwahori A. , et al. The role of common femoral artery endarterectomy in the endovascular era. Ann Vasc Surg 2015; 29 (08) 1501-1507
• 95 Okadome J, Matsumoto T, Aoyagi Y. , et al. Long-term results of a hybrid revascularization procedure for peripheral arterial disease. Fukuoka Igaku Zasshi 2015; 106 (09) 254-261
• 96 Starodubtsev V, Karpenko A, Ignatenko P. Hybrid and open surgery of Trans-Atlantic Inter-Society II type C and D iliac occlusive disease and concomitant lesion of common femoral artery. Int Angiol 2016; 35 (05) 484-491
• 97 Adam DJ, Beard JD, Cleveland T. , et al; BASIL Trial Participants. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet 2005; 366 (9501): 1925-1934
• 98 Bradbury AW, Adam DJ, Bell J. , et al. Multicentre randomised controlled trial of the clinical and cost-effectiveness of a bypass-surgery-first versus a balloon-angioplasty-first revascularisation strategy for severe limb ischaemia due to infrainguinal disease. The Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial. Health Technol Assess 2010; 14 (14) 1-210 , iii–iv
• 99 Fogle MA, Whittemore AD, Couch NP, Mannick JA. A comparison of in situ and reversed saphenous vein grafts for infrainguinal reconstruction. J Vasc Surg 1987; 5 (01) 46-52
• 100 Leather RP, Karmody AM. In-situ saphenous vein arterial bypass for the treatment of limb ischemia. Adv Surg 1986; 19: 175-219
• 101 Taylor Jr LM, Edwards JM, Porter JM. Present status of reversed vein bypass grafting: five-year results of a modern series. J Vasc Surg 1990; 11 (02) 193-205 , discussion 205–206
• 102 Alexandrescu V, Söderström M, Venermo M. Angiosome theory: fact or fiction?. Scand J Surg 2012; 101 (02) 125-131
• 103 Bosanquet DC, Glasbey JC, Williams IM, Twine CP. Systematic review and meta-analysis of direct versus indirect angiosomal revascularisation of infrapopliteal arteries. Eur J Vasc Endovasc Surg 2014; 48 (01) 88-97
• 104 Biancari F, Juvonen T. Angiosome-targeted lower limb revascularization for ischemic foot wounds: systematic review and meta-analysis. Eur J Vasc Endovasc Surg 2014; 47 (05) 517-522
• 105 Baker JD, Dix DE. Variability of Doppler ankle pressures with arterial occlusive disease: an evaluation of ankle index and brachial-ankle pressure gradient. Surgery 1981; 89 (01) 134-137
• 106 Back MR, Novotney M, Roth SM. , et al. Utility of duplex surveillance following iliac artery angioplasty and primary stenting. J Endovasc Ther 2001; 8 (06) 629-637
• 107 Baril DT, Marone LK. Duplex evaluation following femoropopliteal angioplasty and stenting: criteria and utility of surveillance. Vasc Endovascular Surg 2012; 46 (05) 353-357
• 108 Troutman DA, Madden NJ, Dougherty MJ, Calligaro KD. Duplex ultrasound diagnosis of failing stent grafts placed for occlusive disease. J Vasc Surg 2014; 60 (06) 1580-1584
• 109 Lundell A, Lindblad B, Bergqvist D, Hansen F. Femoropopliteal-crural graft patency is improved by an intensive surveillance program: a prospective randomized study. J Vasc Surg 1995; 21 (01) 26-33 , discussion 33–34
• 110 Brumberg RS, Back MR, Armstrong PA. , et al. The relative importance of graft surveillance and warfarin therapy in infrainguinal prosthetic bypass failure. J Vasc Surg 2007; 46 (06) 1160-1166
• 111 Calligaro KD, Doerr K, McAffee-Bennett S, Krug R, Raviola CA, Dougherty MJ. Should duplex ultrasonography be performed for surveillance of femoropopliteal and femorotibial arterial prosthetic bypasses?. Ann Vasc Surg 2001; 15 (05) 520-524
• 112 Stone PA, Armstrong PA, Bandyk DF. , et al. Duplex ultrasound criteria for femorofemoral bypass revision. J Vasc Surg 2006; 44 (03) 496-502