LAUSR

• The probability of significant contralateral lower extremity mirror lesions ranges from 11 to 57%, with the superficial femoral artery and tibial arteries having the highest likelihood. • Assessing the prior probability of contralateral disease based on ipsilateral angiography may help inform proceeding with or forgoing angiography in the asymptomatic contralateral extremity, particularly in patients with diabetes and chronic kidney disease as well as inconclusive noninvasive tests. • These single center observations in 225 patients with significant peripheral arterial disease, if confirmed, suggest a larger multicenter investigation may yield a useful prediction instrument for contralateral disease based on unilateral imaging. Kiesz et al provide a single center analysis of the prevalence of significant arterial “mirror” lesions in the contralateral lower extremity of patients with severe unilateral claudication or critical limb ischemia. In lower extremity arterial disease patients with unilateral symptoms and/or ulcers, several clinical situations arise where ballpark knowledge of the probability of contralateral significant disease is potentially useful. First, the frequently encountered combination of diabetes and chronic kidney disease limits the attractiveness of computed tomographic angiography or bilateral selective angiography if high-quality CO2 angiography is unavailable. 2