Role of Multi-Detector Computed Tomography Angiography in the Evaluation of Lower Limb Ischemia

Abstract

Objective: To evaluate the value of MDCT Angiography in imaging the arterial tree of the lower limbs in peripheral vascular disease. Background: Peripheral arterial disease (PAD) is defined as any pathologic process causing obstruction to blood flow in the arteries, exclusive of the coronary and cerebral vascular beds. Conventional angiography is associated with 1-2% rate of complications and requires highly skilled physician to perform it. Non-invasive imaging modalities include duplex ultrasonography, magnetic resonance angiography (MRA), and multi-detector computed tomography angiography (MDCTA). Methods: This study includes 30 patients of variable ages, complaining from peripheral arterial disease manifestations referred to the radiology department of Menoufia University hospital. All patients underwent multi-detector row CT angiography of the lower limbs arteries. The findings were then analyzed and retrospectively compared with the surgical outcome in cases of operative intervention or Color Doppler correlation. Results: 120 lesions were detected in which 12 lesions (10%) were noted at the aortoiliac vessels, 33 lesions (27.5%) were noted at the femoropopliteal vessels in and 75 lesions (62.5%) were noted at the infrapopliteal vessels. No statistically significant difference between Doppler and CT angiography regarding all the anatomic segments of the arterial tree. Conclusion: Multi-detector CT angiography has demonstrated its efficacy as a promising new, fast, accurate, safe and a minimallyinvasive imaging modality in cases of trauma with suspected arterial injuries and in cases of peripheral vascular diseases for diagnosis, grading and for preoperative evaluation. It can also replace color Doppler ultrasonography in many cases.

Multidetector Ct Angiography v/S Colour Doppler Ultrasonography in the Diagnosis of Peripheral Arterial Diseases of Lower Extremities

“…5,6 Noninvasive imaging modalities. 7 are Doppler ultrasonography, magnetic resonance angiography, MDCT angiography, and conventional arteriography. The gold standard of investigation in peripheral arterial disease is conventional arteriography, but it does not estimate the haemodynamic significance of obstructive lesions.…”

CT Angiography in Patients with Peripheral Arterial Disease

“…Of the 40 patients in this study, 30 (75%) patients were male and 10 (25%) were female (male to female ratio of 3:1). Similarly Kumar et al, 16 and Algazaar et al, 17 noted male predominance with male to female ratio of 6:1 and 1.5:1 respectively. However, Selvin 7 and Meijer et al, 18 found no gender differences in the prevalence of PAD.…”

“…19 Algazaar et al, similarly found smoking to be the most common risk factor (56.67%) followed by hypertension (50%) and diabetes (10%). 17 Cessation of smoking is associated with lower rates of amputation and longer survival in patients with PAD. 20 Hence cessation of smoking need to be encouraged to reduce the morbidity and mortality associated with PAD.…”

“…15 Similarly Algazaar et al, found intermittent claudication (stage II) to be the most common presentation (40%) and gangrene (stage IV) to be the least common (10 %). 17 The reason for the delayed presentation compared to western countries may be due to poor socio-economic background of the patients and non-availability of CTA in primary health centers. Most of the lesion in our study involved the femoro-popliteal segment (27.5%), followed by crural segment (22.5 %) and aorto-iliac segment (15%).…”

Comparative study between duplex ultrasound and 160-multidetectors CT angiography in assessment of chronic lower limb ischemia

“…Systemic atherosclerosis is a condition which progresses with age and decreases quality of life and life expectancy. Lower extremity peripheral arterial disease (PAD) is a common manifestation of systemic atherosclerosis in the elderly [1,2]. Peripheral arterial disease (PAD) is the most common condition affecting the arteries of the lower extremity.…”