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 below-knee
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 |
