Imaging for peripheral artery disease

Summary

The goal of imaging in peripheral artery disease (PAD) is to acquire angiographic images that allow for accurate treatment planning for atherosclerotic disease of the lower limbs. In patients with intermittent claudication, a full diagnostic study will demonstrate the arteries bilaterally from the distal aorta to the ankles in both legs. In critical limb ischaemia patients, one is interested in the affected side only and imaging should be done unilaterally from the distal aorta up to and including the level of the pedal arteries.

Digital subtraction angiography (DSA) is the time-honoured reference stand- ard for angiography. However, as an invasive procedure, DSA is costly and carries a small risk of complications.

Magnetic resonance (MR) angiography is a readily available and accurate non-invasive imaging technique. New time-resolved sequences have improved the accuracy for imaging the arteries in critical limb ischaemia. MR imaging of metallic vascular stents is not possible. As a major advantage, vessel calcifications do not limit MR angiography.

Contrast-enhanced computed tomography (CT) angiography is another widely available technique. Images tend to be sharper than those of MR angiography. Imaging of in-stent restenosis is possible. This technique is limited in calcified vessels and carries the risks associated with iodinated...