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Preinterventional imaging strategies for patients with peripheral arterial disease

Is duplex ultrasound examination adequate for clinical decision-making? English version

Strategien für die präinterventionelle Bildgebung bei peripherer arterieller Verschlusskrankheit

Reicht die Duplex-Sonographie zur klinischen Entscheidungsfindung aus?

  • Vascular sonography
  • Published:
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Abstract

Background

In peripheral arterial disease (PAD) it is necessary to obtain precise anatomical and functional information of the patient prior to an intervention. Traditionally digital subtraction angiography (DSA) is the gold standard but recently contrast-enhanced magnetic resonance angiography (CE-MRA), color-coded duplex ultrasound (DUS) and contrast-enhanced high speed multi-row computed tomography angiography (CT-A) are now additionally available.

Objective

The aim of this article is to give a review of the currently available techniques for obtaining detailed patient information prior to an intervention and to compare these techniques with respect to diagnostic performance and clinical usefulness.

Material and methods

A literature search was carried out in PubMed with respect to English language articles involving studies on the effectiveness of preinterventional imaging methods for the identification and characterization of PAD. The imaging techniques were evaluated with respect to the usefulness under various clinically relevant situations for decision-making and planning of interventions.

Results and conclusion

Selection of the appropriate imaging modality for PAD has become more sophisticated and needs to be made on an individual basis depending on the particular requirements and situation of the patient. Each of the methods described here have advantages and disadvantages, which must be weighed up against the patient situation. Of all the methods, DUS would appear to be more universally applicable if available. Duplex ultrasound only rarely needs support from other imaging methods for clinical decision-making. 

Zusammenfassung

Hintergrund

Bei Patienten mit peripherer arterieller Verschlusskrankheit („peripheral arterial disease“, PAD) ist es erforderlich, genaue anatomische und funktionelle Befunde vor einer Intervention zu gewinnen. Der Goldstandard ist traditionell die digitale Subtraktionsangiographie (DSA), inzwischen stehen jedoch auch die kontrastverstärkte Magnetresonanztomographie (CE-MRA), die farbkodierte Duplexsonographie (DUS) und die kontrastverstärkte, Hochgeschwindigkeits-Mehrzeilen-Detektor CT-Angiographie (CT-A) zur Verfügung.

Ziele

Ziel des Review-Beitrags ist eine Übersicht über die derzeit verfügbaren Techniken zur Gewinnung möglichst detaillierter Information vor einer operativen Intervention. Ferner werden die Techniken im Hinblick auf diagnostische Performance und klinischen Nutzen miteinander verglichen.

Materialen und Methoden

Eine PubMed-Recherche wurde durchgeführt, gesucht wurde dabei nach englischsprachigen Artikeln über Studien zur Effektivität periinterventioneller bildgebender Verfahren für die Identifikation und Charakterisierung einer peripheren Verschlusskrankheit. Die bildgebenden Verfahren wurden evaluiert im Hinblick auf ihren Nutzen für Entscheidungen und für die Planung von Operationen in verschiedenen klinisch relevanten Situationen.

Ergebnisse und Schlüssfolgerungen

Die Entscheidung für eine geeignete bildgebende Modalität bei PAD ist komplizierter geworden, und sie muss auf individueller Basis getroffen werden, je nach der Situation des Patienten und seiner spezifischen Bedürfnisse. Jede der beschriebenen Verfahren hat Vor- und Nachteile, vor dem Hintergrund der Patientensituation sind sie gegeneinander abzuwägen sind. Falls sie zur Verfügung steht, scheint am ehesten die DUS („color-coded duplex ultrasound“) universell einsetzbar. Duplex ultrasound benötigt nur selten Unterstützung durch weitere Methoden, wenn es um die präinterventionelle klinische Entscheidungsfindung geht.

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Authors and Affiliations

  1. HELIOS Kliniken Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany

    P. Klein-Weigel M.D.

  2. Vascular Center at St. Luke’s Medical Center, Milwaukee, USA

    J. Fish

  3. Klinik für Gefäßchirurgie, Medizinische Universität Innsbruck, Innsbruck, Austria

    G. Fraedrich

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  1. P. Klein-Weigel M.D.
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Correspondence to P. Klein-Weigel M.D..

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P. Klein-Weigel, J. Fish and G. Fraedrich declare that there are no conflicts of interest.

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Klein-Weigel, P., Fish, J. & Fraedrich, G. Preinterventional imaging strategies for patients with peripheral arterial disease. Gefässchirurgie 21 (Suppl 1), 24–29 (2016). https://doi.org/10.1007/s00772-015-0007-8

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