Clinical significance of mirror lesions in lower extremity arterial disease

R. Stefan Kiesz, Bartłomiej Góra, Aleksandra Kolarczyk-Haczyk, Mateusz Kachel, Wojciech Trendel, Jesica Paz, Przemysław Nowakowski, Robert Proczka, Krzysztof Milewski

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1 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)300-306
Number of pages7
JournalCatheterization and Cardiovascular Interventions
Volume95
Issue number2
DOIs
StatePublished - Feb 1 2020

Keywords

  • ankle-brachial index
  • critical limb ischemia
  • duplex Doppler ultrasonography
  • fluoroscopic angiography
  • peripheral arterial disease

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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  • Cite this

    Kiesz, R. S., Góra, B., Kolarczyk-Haczyk, A., Kachel, M., Trendel, W., Paz, J., Nowakowski, P., Proczka, R., & Milewski, K. (2020). Clinical significance of mirror lesions in lower extremity arterial disease. Catheterization and Cardiovascular Interventions, 95(2), 300-306. https://doi.org/10.1002/ccd.28559