AHA Publishes Statement on Perfusion Assessment in Patients With CLI
August 12, 2019—The American Heart Association (AHA) announced the publication of "Perfusion Assessment in Critical Limb Ischemia: Principles for Understanding and the Development of Evidence and Evaluation of Devices: A Scientific Statement From the American Heart Association" by Sanjay Misra, MD, et al, which is available online in the AHA journal Circulation. The statement addresses noninvasive techniques and devices for assessing blood flow and other diagnostic considerations for patients with critical limb ischemia (CLI).
According to the AHA, the statement provides perspective on the strengths and limitations of current imaging techniques, including the ankle-brachial index, toe-brachial index, toe systolic pressure, transcutaneous oximetry, and skin perfusion pressure. Additionally, it examines tools such as laser Doppler, speckle imaging devices, and others, as well as identifying opportunities for technology improvement and reducing disparities in detection and treatment.
The statement advised on differences in sex and ethnicity in terms of how CLI is diagnosed, coexisting conditions, and disparities in treatment:
- Women are more likely to experience emergency hospitalization, have differences in blood flow, and higher disability and death rates.
- Black and Hispanic patients with CLI are more likely to have diabetes and chronic kidney disease and are more likely to develop gangrene.
- White patients are more likely to have ulcers and pain in their legs while at rest.
- Black patients are 78% more likely to undergo lower extremity amputation for CLI compared to their white peers, even after adjustment for socioeconomic status, access to facilities with revascularization services, and other factors.
As noted in the AHA announcement, strategies to assess blood flow remain limited despite the high prevalence of CLI. New technologies offer potential opportunities to improve the precision and quality of CLI management, with the goal of earlier detection and treatment to reduce amputations and disability as well as improving the quality of life for patients, advised the AHA.