A practical approach to interpreting lower extremity noninvasive physiologic studies

The Role of Imaging in Peripheral Interventions

Patient evaluation is critical to identify and quantitate patient's disease. Aside from the patient's history and physical examination, imaging can help confirm and determine the extent of disease. Imaging can aid in treatment planning once the decision to proceed to intervention has been made. This chapter will discuss the role of imaging before and after peripheral arterial interventions and how it may improve intervention outcomes. It will discuss the value of the arterial noninvasive examinations (ankle-brachial index, toe-brachial index, pulse volume recordings, and arterial duplex ultrasound), computed tomographic angiograms, magnetic resonance angiogram, and intravascular ultrasound.

ACR Appropriateness Criteria® Lower Extremity Arterial Revascularization-Post-Therapy Imaging

Peripheral arterial disease (PAD) affects millions across the world and in the United States between 9% to 23% of all patients older than 55 years. The refinement of surgical techniques and evolution of endovascular approaches have improved the success rates of revascularization in patients afflicted by lower extremity PAD. However, restenosis or occlusion of previously treated vessels remains a pervasive issue in the postoperative setting. A variety of different imaging options are available to evaluate patients and are reviewed within the context of asymptomatic and symptomatic patients with PAD who have previously undergone endovascular or surgical revascularization. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Noninvasive Arterial Testing: What and When to Use

Peripheral arterial disease (PAD) represents a growing public health issue that continues to be underdiagnosed. In its most severe form, critical limb ischemia, it contributes to expanding morbidity with minor and major limb amputations. PAD is strongly associated with increased mortality, as it is known to be concomitant with coronary and cerebrovascular disease. Diagnosis of PAD relies on noninvasive arterial testing, a class of tests that can provide physiologic or morphologic information. Physiologic tests such as ankle-brachial index, toe-brachial index, pulse volume recordings, and arterial duplex evaluation are the mainstay of gateway evaluation and surveillance. Morphologic exams such as computer tomographic angiography and magnetic resonance angiography are appropriate for preprocedural anatomic evaluation in patients with established vascular disease. This review focuses on physiologic exams.

Lower Extremity Arterial Duplex, Toe-Brachial Index, and Computed Tomography Angiography Examinations in Peripheral Arterial Disease: A Case Presentation

Peripheral arterial disease (PAD) commonly results from progressive narrowing of arteries in the extremities because of atherosclerosis. More than 8 million people in the United States have PAD. The majority of individuals with PAD are seniors with one or more cardiovascular disease risk factors. Because patients with PAD may be asymptomatic, the true incidence of PAD may be underreported. Accurate and timely diagnosis of PAD is very important for optimal treatment.