{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T12:43:21Z","timestamp":1772369001608,"version":"3.50.1"},"reference-count":34,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T00:00:00Z","timestamp":1694131200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Digital subtraction angiography (DSA) still represents the gold standard for anatomical arterial mapping and revascularization decision-making in patients with chronic limb-threatening ischemia (CLTI), although DUS (Doppler Ultrasound) remains a primary non-invasive examination tool. The Global Vascular Guidelines established the importance of preoperative arterial mapping to guarantee an adequate in-line flow to the foot. The aim of this study was to evaluate the accuracy of DUS in guiding therapeutic vascular treatments on the basis of Global Vascular Guidelines without the need of a second-level examination. Methods: Between January 2022 and June 2022, all consecutive patients with CLTI to be revascularized underwent clinical examination and DUS without further diagnostic examinations. Primary outcomes assessed were technical success, and 30-day mortality. Secondary outcomes were 1-year amputation free survival, and time between evaluation and revascularization. Results: Sixty-eight patients with a mean age of 73.6 \u00b1 8.5 years underwent lower limb revascularization. Technical success was 100%, and the 30-day mortality rate was 2.9%. Mean time between evaluation and revascularization was 29 \u00b1 17 days. One-year amputation free survival was 97.1%. Conclusions: DUS without further diagnostic examinations can accurately assess the status of the vascular tree and foot runoff, providing enough information about target vessels to guide revascularization strategies.<\/jats:p>","DOI":"10.3390\/diagnostics13182879","type":"journal-article","created":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T07:57:17Z","timestamp":1694159837000},"page":"2879","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Peripheral Interventional Strategy Assessment (PISA) for Diabetic Foot Ulcer Revascularization: Preliminary Outcomes of a Multidisciplinary Pilot Study"],"prefix":"10.3390","volume":"13","author":[{"given":"Raffaella","family":"Berchiolli","sequence":"first","affiliation":[{"name":"Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1363-489X","authenticated-orcid":false,"given":"Giulia","family":"Bertagna","sequence":"additional","affiliation":[{"name":"Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniele","family":"Adami","sequence":"additional","affiliation":[{"name":"Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Piaggesi","sequence":"additional","affiliation":[{"name":"Diabetic Foot Section, Department of Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabetta","family":"Iacopi","sequence":"additional","affiliation":[{"name":"Diabetic Foot Section, Department of Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Giangreco","sequence":"additional","affiliation":[{"name":"Diabetic Foot Section, Department of Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1587-2763","authenticated-orcid":false,"given":"Lorenzo","family":"Torri","sequence":"additional","affiliation":[{"name":"Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8779-9120","authenticated-orcid":false,"given":"Nicola","family":"Troisi","sequence":"additional","affiliation":[{"name":"Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s13047-020-00383-2","article-title":"Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer","volume":"13","author":"Armstrong","year":"2020","journal-title":"J. Foot Ankle Res."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Berchiolli, R., Bertagna, G., Adami, D., Canovaro, F., Torri, L., and Troisi, N. (2023). Chronic Limb-Threatening Ischemia and the Need for Revascularization. J. Clin. Med., 12.","DOI":"10.3390\/jcm12072682"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"187","DOI":"10.2147\/VHRM.S209241","article-title":"The burden of critical limb ischemia: A review of recent literature","volume":"15","author":"Duff","year":"2019","journal-title":"Vasc. Health Risk Manag."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3S","DOI":"10.1016\/j.jvs.2019.02.016","article-title":"Global vascular guidelines on the management of chronic limb-threatening ischemia","volume":"69","author":"Conte","year":"2019","journal-title":"J. Vasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.jvs.2013.08.003","article-title":"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)","volume":"59","author":"Mills","year":"2014","journal-title":"J. Vasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1007\/s00772-018-0368-x","article-title":"Noninvasive measurements of tissue perfusion in critical limb ischemia","volume":"23","author":"Rother","year":"2018","journal-title":"Gefasschirurgie"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1111\/dme.13634","article-title":"Clinical examination and non-invasive screening tests in the diagnosis of peripheral artery disease in people with diabetes-related foot ulceration","volume":"35","author":"Vriens","year":"2018","journal-title":"Diabet. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1053\/j.tvir.2009.10.003","article-title":"Imaging evaluation of lower extremity infrainguinal disease: Role of the noninvasive vascular laboratory, computed tomography angiography, and magnetic resonance angiography","volume":"13","author":"Chan","year":"2010","journal-title":"Tech. Vasc. Interv. Radiol."},{"key":"ref_9","first-page":"814","article-title":"Is 64-Row Multi-Detector Computed Tomography Angiography Equal to Digital Subtraction Angiography in Treatment Planning in Critical Limb Ischemia?","volume":"31","author":"Gojak","year":"2019","journal-title":"Psychiatr. Danub."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"iii-184","DOI":"10.3310\/hta11200","article-title":"A systematic review of duplex ultrasound, magnetic resonance angiography and computed tomography angiography for the diagnosis and assessment of symptomatic, lower limb peripheral arterial disease","volume":"11","author":"Collins","year":"2007","journal-title":"Health Technol. Assess."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/j.ejvs.2010.06.002","article-title":"Duplex ultrasound scanning of peripheral arterial disease of the lower limb","volume":"40","author":"Eiberg","year":"2010","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1177\/1534734620948351","article-title":"Ultrasound in the Modern Management of the Diabetic Foot Syndrome: A Multipurpose Versatile Toolkit","volume":"19","author":"Pieruzzi","year":"2020","journal-title":"Int. J. Low. Extrem. Wounds"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1053\/j.semvascsurg.2023.04.012","article-title":"Emergent management of diabetic foot problems in the modern era: Improving outcomes","volume":"36","author":"Troisi","year":"2023","journal-title":"Semin. Vasc. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/0741-5214(92)90249-8","article-title":"Accuracy of lower extremity arterial duplex mapping","volume":"15","author":"Moneta","year":"1992","journal-title":"J. Vasc. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S0741-5214(97)70288-X","article-title":"Value of color duplex sonography for evaluation of tibioperoneal arteries in patients with femoropopliteal obstruction: A prospective comparison with anterograde intraarterial digital subtraction angiography","volume":"25","author":"Larch","year":"1997","journal-title":"J. Vasc. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/S0741-5214(99)70352-6","article-title":"Can duplex scan arterial mapping replace contrast arteriography as the test of choice before infrainguinal revascularization?","volume":"29","author":"Wain","year":"1999","journal-title":"J. Vasc. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Chen, P., Vilorio, N.C., Dhatariya, K., Jeffcoate, W., Lobmann, R., McIntosh, C., Piaggesi, A., Steinberg, J., Vas, P., and Viswanathan, V. Guidelines on interventions to enhance healing of foot ulcers in people with diabetes (IWGDF 2023 update). Diabetes Metab. Res. Rev., 2023. in press.","DOI":"10.1002\/dmrr.3644"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/s12928-020-00660-8","article-title":"Contrast-induced acute kidney injury","volume":"35","author":"Chandiramani","year":"2020","journal-title":"Cardiovasc. Interv. Ther."},{"key":"ref_19","first-page":"553","article-title":"Contrast media-induced nephropathy in patients undergoing angiography prior to or during vascular surgery: A systematic review","volume":"66","author":"Zaraca","year":"2011","journal-title":"Minerva Chir."},{"key":"ref_20","first-page":"618","article-title":"Contrast-induced encephalopathy","volume":"122","author":"Babalova","year":"2021","journal-title":"Bratisl. Lek. Listy."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1148\/radiology.137.2.7433658","article-title":"Adverse reactions to contrast media: A report from the Committee on Safety of Contrast Media of the International Society of Radiology","volume":"137","author":"Shehadi","year":"1980","journal-title":"Radiology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1053\/j.semvascsurg.2007.02.005","article-title":"Preprocedural imaging: New options to reduce need for contrast angiography","volume":"20","author":"Hingorani","year":"2007","journal-title":"Semin. Vasc. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1053\/ejvs.2002.1730","article-title":"Pedal artery imaging--a comparison of selective digital subtraction angiography, contrast enhanced magnetic resonance angiography and duplex ultrasound","volume":"24","author":"Hofmann","year":"2002","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1641","DOI":"10.2214\/AJR.04.1111","article-title":"Assessment of critical limb ischemia in patients with diabetes: Comparison of MR angiography and digital subtraction angiography","volume":"185","author":"Lapeyre","year":"2005","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1016\/0741-5214(89)90133-X","article-title":"Comparison of contrast arteriography to arterial mapping with color-flow duplex imaging in the lower extremities","volume":"10","author":"Cossman","year":"1989","journal-title":"J. Vasc. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"147","DOI":"10.2310\/6670.2008.00014","article-title":"Limitations of and lessons learned from clinical experience of 1020 duplex arteriography","volume":"16","author":"Hingorani","year":"2008","journal-title":"Vascular"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1007\/s10016-004-0082-x","article-title":"Duplex arteriography prior to femoral-popliteal reconstruction in claudicants: A proposal for a new shortened protocol","volume":"18","author":"Ascher","year":"2004","journal-title":"Ann. Vasc. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"337","DOI":"10.2459\/01.JCM.0000268124.51543.b2","article-title":"Analysis of agreement between Duplex ultrasound scanning and arteriography in patients with lower limb artery disease","volume":"8","author":"Favaretto","year":"2007","journal-title":"J. Cardiovasc. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/S1078-5884(98)80071-3","article-title":"A comparison between colour duplex ultrasonography and arteriography for imaging infrapopliteal arterial lesions","volume":"15","author":"Sensier","year":"1998","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1053\/ejvs.2001.1561","article-title":"Duplex scanning as the sole preoperative imaging method for infrainguinal arterial surgery","volume":"23","author":"Ljungman","year":"2002","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1007\/s40477-020-00534-y","article-title":"Duplex ultrasound versus CT angiography for the treatment planning of lower-limb arterial disease","volume":"24","author":"Martinelli","year":"2021","journal-title":"J. Ultrasound."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"20480040211070481","DOI":"10.1177\/20480040211070481","article-title":"Duplex ultrasound derived maximal systolic acceleration can be a reliable and rapid alternative to ankle brachial pressure indices for the diabetic population with lower extremity arterial disease; a prospective, observational cohort study","volume":"11","author":"Williamson","year":"2022","journal-title":"JRSM Cardiovasc. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.jvs.2017.05.132","article-title":"Patient selection and perioperative outcomes of bypass and endovascular intervention as first revascularization strategy for infrainguinal arterial disease","volume":"67","author":"Bodewes","year":"2018","journal-title":"J. Vasc. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1093\/bjs\/znac109","article-title":"Delays to revascularization for patients with chronic limb-threatening ischaemia","volume":"109","author":"Li","year":"2022","journal-title":"Br. J. Surg."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/18\/2879\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:47:11Z","timestamp":1760129231000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/18\/2879"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,8]]},"references-count":34,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["diagnostics13182879"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13182879","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,8]]}}}