Eastern J Med. 2022; 27(1): 16-21 | DOI: 10.5505/ejm.2022.91328

Superficial femoral artery mirror lesions; risk factors, diagnosis, and clinical presentation

Emrah Erdogan¹, Ender Ozgun Cakmak², Elmin Ýmanov², Ayhan Tosun², Ali Furkan Tekatlý², Çetin Geçmen², Seyhmus Külahcioglu², Regayip Zehir², Mesut Sismanoglu³, Cengiz Koksal^4
1Department of Cardiology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
²Department of Cardiology, University of Medical Sciences, Kartal Koþuyolu High Specialty Training and Research Hospital, Istanbul, Turkey
³Department of Cardiovascular Surgery, University of Medical Sciences, Kartal Koþuyolu High Specialty Training and Research Hospital, Istanbul, Turkey
⁴Department of Cardiovascular Surgery, Bezmialem Vakýf University, Faculty of Medicine, Istanbul, Turkey

INTRODUCTION: Two-sided atherosclerotic involvement of peripheral arteries is common in clinical practice however the data about it in the literature is limited.This study aimed to investigate the frequency, clinical characteristics, and predictors of bilateral symmetric total superficial femoral artery (SFA) occlusions (mirror lesions).
METHODS: Between January 2015 and April 2020, 167 patients with symptomatic total SFA occlusions were retrospectively analyzed. Unilateral and bilateral SFA occlusions were determined, and the risk factors and clinical presentation were investigated between the two groups.
RESULTS: Among 167 patients, 95 (57%) had bilateral SFA lesions, and 30 (18%) presented with critical limb ischemia (CLI). In the bilateral SFA occlusion group, male sex was dominant (p=0.002), and peripheral artery disease (PAD) history was higher (p=0.030). Additional iliac lesions (p = 0.003) and below-knee lesions (p <0.001) were more common in the bilateral SFA occlusion group. The sensitivity of Doppler ultrasonography in detecting SFA occlusions was 83.9%. In multivariate logistic regression analysis, younger age (OR; 0.95 CI; 0.91-0.99 p = 0.030) and history of PAD (OR; 2.08 CI; 1.02- 4, 24 p = 0.040) were identified as independent markers for predicting mirror SFA occlusions
DISCUSSION AND CONCLUSION: Our study demonstrates that the mirror lesion pattern is common in patients with symptomatic SFA total occlusion. Thus, the non-index leg evaluation should be recommended. The younger the age, and PAD history were the predictors of mirror total SFA occlusions.

Keywords: Superficial femoral artery, peripheral artery disease, duplex Doppler ultrasonography

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