Comparison of Computed Tomography Angiography to Contrast Arteriography for Patients Undergoing Evaluation for Lower Extremity Revascularization

Abstract

In an effort to explore alternatives to contrast arteriography, we compared computed tomography angiography to contrast arteriography for defining anatomic features of patients undergoing lower extremity revascularization. From November 2003 to March 2004, 36 inpatients with chronic lower extremity ischemia underwent contrast arteriography and computed tomography angiography before undergoing lower extremity revascularization procedures. A Siemens 16 slice multiplanar computed tomography device with bolus tracking was used for these exams. The reports of these tests and images were compared prospectively, and the differences in the aorto-iliac segment, femoral-popliteal, and infrapopliteal segments were noted. The vessels were classified as mild disease (<50%), moderate disease (50%-70%), severe (71%-99%), and occluded. The studies and treatment plans based on these data were compared. The mean age was 76 ± 12 years (SD). Indications for the procedures included gangrene (45%), ischemic ulcer (32%), rest pain (19%), and severe claudication (3%); 69% were diabetics. Accuracy of computed tomography angiography in the aorto-iliac, femoral-popliteal, and infrapopliteal segments was 100%, 81%, and 59%, respectively. Thirteen of 18 (72%) of these disagreements resulted in a different procedure than that suggested by computed tomography angiography. A review of the data obtained in this series indicated that computed tomography angiography appears to be unable to obtain adequate information in this highly selected population at our institution.

Keywords

imaging lower extremities duplex arterial mapping C-T angio lower extremities

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References

Catalano C. , Fraioli F. , Laghi A. , et al. Infrarenal aortic and lower-extremity arterial disease: diagnostic performance of multi-detector row CT angiography . Radiology . 2004;231(2): 555-563 .

Martin ML , Tay KH , Flak B. , et al. Multidetector CT angiography of the aortoiliac system and lower extremities: a prospective comparison with digital subtraction angiography . AJR Am J Roentgenol. 2003;180(4): 1085-1091 .

Rubin GD , Schmidt AJ , Logan LJ , Sofilos MC Multidetector row CT angiography of lower extremity arterial inflow and runoff: initial experience . Radiology. 2001; 221(1): 146-158 .

Ascher E. , Hingorani A. , Markevich N. , et al. Role of duplex arteriography as the sole preoperative imaging modality prior to lower extremity revascularization surgery in diabetic and renal patients . Ann Vasc Surg. 2004;18(4): 433-439 .

Mazzariol F. , Ascher E. , Hingorani A. , Gunduz Y. , Yorkovich W. , Salles-Cunha S. Lower-extremity revascularisation without preoperative contrast arteriography in 185 cases: lessons learned with duplex ultrasound arterial mapping . Eur J Vasc Endovasc Surg. 2000;19(5): 509-515 .

Mazzariol F. , Ascher E. , Salles-Cunha SX , Gade P. , Hingorani A. Values and limitations of duplex ultrasonography as the sole imaging method of preoperative evaluation for popliteal and infrapopliteal bypasses . Ann Vasc Surg. 1999;13(1): 1-10 .

Ascher E. , Mazzariol F. , Hingorani A. , Salles-Cunha S. , Gade P. The use of duplex ultrasound arterial mapping as an alternative to conventional arteriography for primary and secondary infrapopliteal bypasses . Am J Surg. 1999;178(2): 162-165 .

Hingorani A. , Ascher E. Dyeless vascular surgery . Cardiovasc Surg. 2003;11(1): 12-18 .

Ascher E. , Hingorani A. , Markevich N. , Costa T. , Kallakuri S. , KhanimoyY. Lower extremity revascularization without preoperative contrast arteriography: experience with duplex ultrasound arterial mapping in 485 cases . Ann Vasc Surg. 2002;16(1): 108-114 .

10.

Ascher E. , Markevich N. , Schutzer RW , et al. Duplex arteriography prior to femoral-popliteal reconstruction in claudicants: a proposal for a new shortened protocol . Ann Vasc Surg. 2004;18(5): 544-551 .

11.

Soule B. , Hingorani A. , Ascher E. , et al. Comparison of magnetic resonance angiography (MRA) and duplex ultrasound arterial mapping (DUAM) prior to infrainguinal arterial reconstruction . Eur J Vasc Endovasc Surg. 2003;25(2): 139-146 .

12.

Hingorani A. , Ascher E. , Markevich N. , et al. Magnetic resonance angiography versus duplex arteriography in patients undergoing lower extremity revascularization: which is the best replacement for contrast arteriography? J Vasc Surg. 2004;39(4): 717-722 .

13.

Hingorani A. , Ascher E. , Markevich N. , et al. A comparison of magnetic resonance angiography, contrast arteriography, and duplex arteriography for patients undergoing lower extremity revascularization . Ann Vasc Surg. 2004;18(3): 294-301 .

14.

Mesurolle B. , Qanadli SD , El Hajjma M. , Goeau-Brissonniere OA , Mignon F. , Lacombe P. Occlusive arterial disease of abdominal aorta and lower extremities: comparison of helical CT angiography with transcatheter angiography . Clin Imaging. 2004;28(4): 252-260 .

15.

Portugaller HR , Schoellnast H. , Hausegger KA , Tiesenhausen K. , Amann W. , Berghold A.

Multislice spiral CT angiography in peripheral arterial occlusive disease: a valuable tool in detecting significant arterial lumen narrowing?

Eur Radiol. 2004;14(9): 1681-1687 .

16.

Heuschmid M. , Krieger A. , Beierlein W. , et al. Assessment of peripheral arterial occlusive disease: comparison of multislice-CT angiography (MS-CTA) and intraarterial digital subtraction angiography (IA-DSA) . Eur J Med Res. 2003;8(9): 389-396 .

17.

Ishikawa M. , Morimoto N. , Sasajima T. , Kubo Y. Three-dimensional computed tomographic angiography in lower extremity revascularization . Surg Today. 1999;29(3): 243-247 .

18.

Rieker O. , Duber C. , Schmiedt W. , von Zitzewitz H. , Schweden F. , Thelen M. Prospective comparison of CT angiography of the legs with intraarterial digital subtraction angiography . AJR Am J Roentgenol. 1996;166(2): 269-276 .