Imaging
Peripheral Artery Disease
- Preliminary Diagnosis: Peripheral artery disease
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I. What imaging technique is first-line for this diagnosis?
- II. Describe the advantages and disadvantages of this technique for diagnosis of Peripheral artery disease.
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III. What are the contraindications for the first-line imaging technique?
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IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of peripheral artery disease.
- VI. What are the contraindications for the alternative imaging techniques?
Preliminary Diagnosis: Peripheral artery disease
I. What imaging technique is first-line for this diagnosis?
Ankle-brachial index (ABI) with segmental pressures and waveforms
II. Describe the advantages and disadvantages of this technique for diagnosis of Peripheral artery disease.
Advantages
Simple to perform, well-tolerated, and cost-effective screening examination
Segmental pressures help localize the level of disease
Dampened waveforms help indicate the level of significant stenosis
Disadvantages
Screening examination that does not provide anatomic detail for treatment planning
May be limited in patients with heavily calcified vessels (often in diabetic patients)
Abnormalities may not be present at rest (in these cases a treadmill test may be utilized to elicit symptoms)
III. What are the contraindications for the first-line imaging technique?
No significant contraindications exist
IV. What alternative imaging techniques are available?
Doppler US
CT angiography
MR angiography
Angiography
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of peripheral artery disease.
Doppler US
Advantages
The level of a low-resistive waveform can help localize the disease
The lesion can often be directly visualized
Peak systolic velocity can help determine if a lesion is hemodynamically significant
Inexpensive and simple examination to perform
Disadvantages
May not provide adequate anatomic detail for treatment planning
May not be adequate to evaluate proximal inflow disease (especially in the presence of dense calcifications)
Dependent on operator expertise
CT angiography
Advantages
Accurately defines the level of disease and may help characterize the nature of plaque
Can detect stenosis and occlusions as well as adjacent nonvascular pathology
Detailed images are useful for treatment planning
Disadvantages
Requires intravenous contrast, which may result in contrast-induced nephropathy
Poor evaluation in the presence of extensive calcified plaque
Bolus timing must be appropriate to avoid artifact
Exposure to ionizing radiation
MR angiography
Advantages
Can detect stenosis and occlusions as well as adjacent nonvascular pathology
Accurately defines the level of disease
Avoids radiation exposure
Disadvantages
Poor bolus timing may result in venous contamination artifact
May overestimate the degree of stenosis
Expensive
Time consuming
Requires significant patient cooperation to minimize motion artifact
Angiography
Advantages
Traditional gold-standard exam
Pressure measurements can help determine if a lesion is hemodynamically significant
Treatment may be performed at the same time as diagnosis
Disadvantages
Invasive procedure with potential for access site and catheter-based complications
Not as accurate as CT or MRI in defining the degree of luminal cross-sectional narrowing
Requires intravenous contrast, which may result in contrast-induced nephropathy
VI. What are the contraindications for the alternative imaging techniques?
Doppler US
No significant contraindications exist
CT angiography
Renal failure owing to the risk of contrast-induced nephropathy
Pregnancy
Contrast allergy may be a relative contraindication
MR angiography
Non–MR-compatible hardware
Renal failure due to the risk of nephrogenic systemic fibrosis
First trimester pregnancy may be a relative contraindication
Angiography
Renal failure due to the risk of contrast-induced nephropathy
Pregnancy
Contrast allergy may be a relative contraindication
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