MDCTA can be used to investigate the spectrum of diseases comprising peripheral vascular occlusive disease. This would include patients presenting with either critical limb ischaemia or claudication. The aim is to characterize steno-occlusive disease of inflow, femoral and run-off vessels so as to triage patients into treatment groups.
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| (a) Thrombus seen within the stent-graft following endovascular aneurysm repair. (b) This extended to cause thrombotic occlusion of one iliac limb, subsequently recovered by thrombolysis and secondary stenting. |
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| (a) Maximum intensity projection image showing bilateral common iliac stenosis in a patient with bilateral claudication. (b) Digital subtraction angiography image during iliac stenting demonstrates similar disease. |
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| Add cPost-graft sepsis. Multidetector CT angiography demonstrates occluded graft and developing perigraft collection.aption |
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| Aneurysm of the common femoral artery. Multidetector CT angiography demonstrates the relationship to the branches, helping treatment planning. |
This is without doubt the most demanding study on the MDCT scanner and post-processing software. A recent comparative study between MDCTA and catheter angiography revealed that arterial segments distal to occlusions were not seen on catheter angiography but were demonstrated on MDCTA [
Rubin GD, Schmidt AJ, Logan LJ, Sofilos MC. Multi-detector row CT angiography of lower extremity arterial inflow and runoff: initial experience. Radiology 2001;221:146–58].
MRA evaluation of the peripheral arterial tree is an alternative imaging strategy. The most commonly used technique, namely 3D contrast-enhanced MRA, has the following limitations: (a) artefacts/non-visualization of the lumen in the presence of some surgical clips and stents; (b) pseudo-occlusion of tortuous arteries is sometimes a problem if they are not carefully included in the imaging plane; and (c) no bony landmarks are available for surgeons to plan incisions.
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