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Role of lower extremity run-off CT angiography in the evaluation of acute vascular disease

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Abstract

In the acute care setting, radiologists are frequently asked to assist in the evaluation of patients presenting with signs and symptoms of lower extremity peripheral vascular disease. Non-traumatic peripheral vascular emergencies are most commonly the result of thrombosis, either in a native vessel or within a bypass graft or stent. Arterial emboli, peripheral aneurysm with embolus or thrombosis, and direct arterial trauma are additional, less common causes. Traumatic peripheral vascular emergencies include vessel occlusion, transection, pseudoaneurysms, active extravasation, and arteriovenous fistulas. The high morbidity and mortality associated with acute limb ischemia makes rapid diagnosis and early initiation of therapy critical in the management of such patients. Computed tomographic angiography (CTA) offers the vascular specialist a rapid, widely available, and accurate means to diagnose and grade the extent of vascular disease in the acute care setting. In this pictorial essay, the key elements of lower extremity run-off CTA are reviewed, including relevant anatomy, imaging approach, and spectrum of imaging findings.

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References

  1. Norgren L, et al. (2007) Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg 45 (Suppl S):S5–67

  2. Walker TG (2009) Acute limb ischemia. Tech Vasc Interv Radiol 12(2):117–129

    Article  PubMed  Google Scholar 

  3. Cook TS (2016) Computed Tomography Angiography of the Lower Extremities. Radiol Clin North Am 54(1):115–130

    Article  PubMed  Google Scholar 

  4. Keeling AN, et al. (2011) Technical considerations for lower limb multidetector computed tomographic angiography. Vasc Med 16(2):131–143

    Article  PubMed  Google Scholar 

  5. Gakhal MS, Sartip KA (2009) CT angiography signs of lower extremity vascular trauma. AJR Am J Roentgenol 193(1):W49–W57

    Article  PubMed  Google Scholar 

  6. Naidu SG, et al. (2010) Incidence of highly important extravascular findings detected on CT angiography of the abdominal aorta and the lower extremities. AJR Am J Roentgenol 194(6):1630–1634

    Article  PubMed  Google Scholar 

  7. Lopera JE, et al. (2008) Multidetector CT angiography of infrainguinal arterial bypass. Radiographics 28(2):529–548 (discussion 549)

  8. Foley WD, Stonely T (2010) CT angiography of the lower extremities. Radiol Clin North Am 48(2):367–396, ix

  9. Dawson I, Sie RB, van Bockel JH (1997) Atherosclerotic popliteal aneurysm. Br J Surg 84(3):293–299

    Article  CAS  PubMed  Google Scholar 

  10. Pennywell DJ, Tan TW, Zhang WW (2014) Optimal management of infrainguinal arterial occlusive disease. Vasc Health Risk Manag 10:599–608

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Meier GH (2008) Current literature for evidence-based infrainguinal endovascular treatment. Semin Vasc Surg 21(4):210–216

    Article  PubMed  Google Scholar 

  12. Bradbury AW, et al. (2010) Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: An intention-to-treat analysis of amputation-free and overall survival in patients randomized to a bypass surgery-first or a balloon angioplasty-first revascularization strategy. J Vasc Surg 51(5 Suppl):5S–17S

    Article  PubMed  Google Scholar 

  13. Iezzi R, et al. (2007) Multi-slice CT (MSCT) angiography for assessment of traumatic lesions of lower limbs peripheral arteries. Emerg Radiol 14(6):389–394

    Article  PubMed  Google Scholar 

  14. Rieger M, et al. (2006) Traumatic arterial injuries of the extremities: initial evaluation with MDCT angiography. AJR Am J Roentgenol 186(3):656–664

    Article  PubMed  Google Scholar 

  15. Inaba K, et al. (2006) Multi-slice CT angiography for arterial evaluation in the injured lower extremity. J Trauma 60(3):502–506 (discussion 506–7)

  16. Pieroni S, et al. (2009) Use of 64-row multidetector CT angiography in blunt and penetrating trauma of the upper and lower extremities. Radiographics 29(3):863–876

    Article  PubMed  Google Scholar 

  17. Kalra N, et al. (2008) MDCT arteriographic spectrum in acute blunt peripheral trauma—a pictorial review. Emerg Radiol 15(2):91–97

    Article  PubMed  Google Scholar 

  18. Hamilton JD, et al. (2008) Multidetector CT evaluation of active extravasation in blunt abdominal and pelvic trauma patients. Radiographics 28(6):1603–1616

    Article  PubMed  Google Scholar 

  19. Bozlar U, et al. (2013) CT angiography of the upper extremity arterial system: part 1-anatomy, technique, and use in trauma patients. AJR Am J Roentgenol 201(4):745–752

    Article  PubMed  Google Scholar 

  20. Chen JK, Johnson PT, Fishman EK (2007) Diagnosis of clinically unsuspected posttraumatic arteriovenous fistulas of the pelvis using CT angiography. AJR Am J Roentgenol 188(3):W269–W273

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, 510 S. Kingshighway Blvd., Box 8131, St. Louis, MO, 63110, USA

    Yaseen Oweis, Zachary Viets & Anup S. Shetty

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  1. Yaseen Oweis
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  2. Zachary Viets
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  3. Anup S. Shetty
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Correspondence to Yaseen Oweis.

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Oweis, Y., Viets, Z. & Shetty, A.S. Role of lower extremity run-off CT angiography in the evaluation of acute vascular disease. Abdom Radiol 42, 1028–1045 (2017). https://doi.org/10.1007/s00261-016-0907-4

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