MULTISLICE CT ANGIOGRAPHY: A VALUABLE FIRST-LINE PREOPERATIVE IMAGING IN HIGH-RISK PATIENTS WITH LOWER LIMB ISCHEMIA?
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Purpose: To assess the clinical relevance of multislice CT angiography (MSCTA) as the first-line angiographic examination for planning lower limb revascularization in patients at high risk of complications after contrast arteriography (CA). Patients and methods: Thirty-six consecutive patients at high risk of post-CA complications because of chronic renal insufficiency, diabetes mellitus, advanced age, or the need for brachial artery catheterization or graft puncture had MSCTA as first-line angiography before a surgical or endovascular procedure for lower limb ischemia. According to initial ischemic symptoms, limbs were classified as stage II, III or IV. Technical success was evaluated based on the first month and medium-term patency rates, according to the revascularization procedure. Clinical success was evaluated based on the medium-term limb viability, according to the initial ischemic symptoms. Results: After MSCTA, 54 procedures were performed, including 38 surgical reconstructions and 16 endovascular procedures. Complementary CA was only required in 4 of the 8 patients for whom a belowknee bypass was planned. Cumulative patency rates during the month after the initial procedure were 90%, 100%, and 80% for suprainguinal, infrainguinal above-knee, and infrainguinal below-knee bypasses, respectively, and 92% for iliofemoral angioplasties. At 24 months, cumulative patency rates were 90%, 91, 55%, and 74%, respectively. After 24 months of follow-up, limb salvage, mortality and amputation rates were respectively, 86.5%, 4.5% and 4.5% for stage II and 82%, 7%, and 7% for stages III and IV. Conclusion: MSCTA is an appropriate imaging modality for planning a revascularization procedure for lower limbs because it is able to show the arterial lesion, the arterial wall and the runoff arteries and to choose the most appropriate arterial access. It is a safe alternative to contrast arteriography. Therefore, MSCTA may be recommended as a first-line preoperative imaging for patients at high risk of post-contrast arteriography complications because of chronic renal insufficiency, diabetes mellitus, advanced age, or the need for brachial artery catheterization or graft puncture. Abbreviations: CA = Contrast Arteriography, MSCT = Multislice CT, CTA = CT angiography, MSCTA = Multislice CT angiography, MI? = Maximum Intensity Projection, VR = Volume Rendered, SSD = Surface Shaded Display, CDUS = Color duplex Ultrasonography, Gd-MRA= Gadolinium-enhanced MR angiography. SFA= superficial femoral artery, CFA= common femoral artery.