Diagnostic Performance of Computed Tomography Angiography in Peripheral Arterial Disease

Met, Rosemarie; Bipat, Shandra; Legemate, Dink A.; Reekers, Jim A.; Koelemay, M.J.W.

doi:10.1001/jama.301.4.415

Cited by 339 publications

(224 citation statements)

References 39 publications

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“…While one systemic review and another meta-analysis indicate a lower sensitivity for detecting lower limb arterial thrombosis of [50 % by ultrasound (median sensitivity 90 %, specificity 99 %), duplex sonography was found to have a similarly high specificity as CTA (median sensitivity 97 %, specificity 99.6 %) and MRA (median sensitivity 94 %, specificity 99.2 %) [14,15].…”

Section: Discussionmentioning

confidence: 98%

Diagnosis of abdominal mural aortic thrombus following discovery of common femoral artery and vein thrombosis by point-of-care ultrasound

et al. 2015

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Acute limb ischemia (ALI) is a limb-threatening and life-threatening disease process. Mural aortic thrombosis (MAT) is a rare cause of ALI. While there is limited evidence on the use of bedside ultrasound for the detection of ALI or MAT, duplex ultrasound remains the standard in the diagnosis and ultimate medical decision-making in patients with acute and chronic limb ischemia. Point-of-care ultrasound may be used in the evaluation of patients with signs and symptoms of this disease entity. This is a case of a 79-year-old female with a complicated medical history, who presented with a pulseless right leg and abdominal tenderness. The patient quickly decompensated requiring intubation for airway protection. A post-intubation arterial blood gas (ABG) was unsuccessfully attempted in the right femoral artery, prompting an ultrasound-guided ABG. On B-mode ultrasound evaluation, echogenic material was visualized in the right common femoral artery without evidence of Doppler flow signal. Additionally, a partially obstructing echogenic material was also noted at the femorosaphenous vein junction with only partial compressibility by compression sonography. A computed tomography angiography of the aorta was performed indicating extensive infrarenal aortic thrombosis. The patient expired despite the relatively prompt diagnosis, highlighting the importance of early identification of acute arterial occlusion.Keywords Mural aortic thrombus Á Acute limb ischemia Á Point-of-care ultrasound Á Bedside ultrasound Á Arterial thrombus Á Deep vein thrombosis Riassunto L'ischemia acuta degli arti inferiori (ALI) è una malattia che mette in pericolo gli arti e la vita stessa del paziente. La trombosi parietale dell'aorta (MAT) è una causa rara di ALI. Mentre vi è una limitata evidenza sull'uso dell'ecografia al letto del paziente per la rilevazione di ALI o MAT, il Doppler rimane lo standard nella diagnosi e nel processo decisionale medico finale, in pazienti con ischemia acuta e cronica degli arti. L'ecografia può essere utilizzata nella valutazione dei pazienti con segni e sintomi di questa malattia. Presentiamo il caso di una donna di 79 anni, con una complicata storia clinica che si è presentata senza polso nella gamba destra e tensione addominale. La paziente si scompensava rapidamente, richiedendo l'intubazione per la protezione delle vie respiratorie. Dopo l'intubazione è stato tentato un arterial blood gas test (ABG) nell'arteria femorale destra, senza successo spingendo verso un ABG con guida ecografica. La valutazione ecografica in B-mode ha evidenziato materiale ecogeno nell'arteria femorale comune destra senza evidenza di segnali Doppler. Inoltre materiale ecogeno ostruente è stato osservato a livello della giunzione femoro-safena con solo parziale compressibilità con la compressione ecografica. E' stata effettuata un'angio tomografia computerizzata dell'aorta che ha evidenziato un'ampia trombosi dell'aorta sotto-renale. Il paziente moriva, nonostante la diagnosi in tempi relativamente brevi, mettendo in evidenza l...

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Section: Discussionmentioning

confidence: 98%

Diagnosis of abdominal mural aortic thrombus following discovery of common femoral artery and vein thrombosis by point-of-care ultrasound

et al. 2015

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“…(32) MSCT is increasingly being used for the more demanding role of screening vascular access routes for TAVI. (33,34) The advantage is that an overview of all potential vascular access routes, including transfemoral, -subclavian or -apical may be obtained, (35) (Figure 4).…”

Section: Vascular Accessmentioning

confidence: 99%

Multislice computer tomography (MSCT) for the optimisation of transcatheter aortic valve implantation (TAVI)

Schultz

Jaegere

2017

SAHJ

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Multislice computer tomography (MSCT) for the optimisation of transcatheter aortic valve implantation (TAVI) and 3-D TEE can evaluate all anatomical aspects of the aortic root. (6)(7)(8) MSCT is particularly attractive for the evaluation of anatomy because it provides the user with a 3-D virtual representation that can be viewed from any angle or cut-plane after acquisition. What follows is a review of the role of MSCT pre-and post-TAVI. DIAGNOSIS OF SEVERE AORTIC STENOSISThe diagnosis of severe aortic stenosis is typically based on demonstrated that the LVOT is oval shaped, a fact which cannot be appreciated on 2-D echocardiography. (10,12,13,) In 3 separate studies the assumption of circularity of the LVOT was abandoned when using the continuity equation and instead the LVOT area measured on MSCT was used to replace the LVOT diameter from TTE for the calculation of AVA. (14,15,16)

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“…Recent studies using direct perforator injection combined with static and dynamic computed tomographic angiography have shown that each perforator holds a unique vascular territory that was, consequently, termed the perforasome. 46 This perforasome has a highly complex and variable vascular territory and, like the angiosomes, perforasomes are linked by direct and indirect vessels. Direct linking vessels are defined as large vessels communicating directly from one perforator to the next that are able to take over adjacent perforasomes through an interperforator flow mechanism.…”

Section: Evolution Of the Perforator Flapmentioning

confidence: 99%

“…30,31,[44][45][46] It does not necessitate arterial puncture or day-care admittance and, as a result of increased scan speed and improved spatial resolution, the recently introduced multislice technology may even offer improved quality for angiographic imaging. 30,31,[44][45][46][47] Three-dimensional reconstruction protocols of CT-scans permit the arteries and veins to be viewed from any perspective and allow vascular diameters to be accurately measured. These advantages can be contrasted with limited disadvantages such as the need for larger amounts of contrast medium, the need to optimize the timing of the contrast bolus and the scan, and a fair amount of radiation for the scanning protocol.…”

Section: Pre-operative Assessment Of the Internal Mammary Vascular Symentioning

confidence: 99%

30 Internal Mammary Artery Perforator Flap

Hanasono¹,

Robb²,

Skoracki³

et al. 2016

Reconstructive Plastic Surgery of the Head and Neck: Current Techniques and Flap Atlas

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Diagnostic Performance of Computed Tomography Angiography in Peripheral Arterial Disease

Cited by 339 publications

References 39 publications

Diagnosis of abdominal mural aortic thrombus following discovery of common femoral artery and vein thrombosis by point-of-care ultrasound

Diagnosis of abdominal mural aortic thrombus following discovery of common femoral artery and vein thrombosis by point-of-care ultrasound

Multislice computer tomography (MSCT) for the optimisation of transcatheter aortic valve implantation (TAVI)

30 Internal Mammary Artery Perforator Flap

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