MR angiography is a noninvasive technique that can be acquired without contrast administration, however, sometimes it can overestimate stenosis severity. Maximum intensity projections (MIP) and volume rendering techniques (VRT) can also be used in the assessment of the vessels. Assessment of the stenosis, occlusion and collateral circulation can be done using multislice thin axial cuts followed by multiplanar reconstruction. CTĪnother noninvasive technique is CTA, which utilizes intravenous contrast medium injection to opacify the arterial lumen and detect any change in the caliber. B-Mode ultrasonography can evaluate the arterial wall as well as the luminal stenosis by measuring diameter and surface area reduction.Ītheromatous calcification in the arterial wall can be seen as hyperechoic foci and when large causes acoustic shadowing.ĭoppler study can estimate stenosis by measuring the difference in blood peak systolic velocity pre- and post-stenosis. Non-invasive technique and most widely used as the first step in any patient with claudication pain, particularly the ankle brachial index. May show calcified atherosclerotic plaques along the vessels. chronic total occlusion of the popliteal artery and proximal trifurcation vessels 4.chronic total occlusion of the common or superficial femoral artery (>20 cm, involving the popliteal artery).recurrent stenoses or occlusions that need treatment after two endovascular interventions.multiple stenoses or occlusions totalling >15 cm with or without heavy calcification.heavily calcified occlusion ≤5 cm in length.single or multiple lesions in the absence of continuous tibial vessels to improve inflow for a distal bypass.single stenosis or occlusion ≤15 cm not involving the infrageniculate popliteal artery.multiple lesions (stenoses or occlusions), each ≤5 cm.TASC II classification of femoral and popliteal lesions stage IIb: intermittent claudication after less than 200 meters of walking.stage IIa: intermittent claudication after more than 200 meters of pain free walking.stage 6: severe ischemic ulcers or frank gangrene.stage 5: ischemic ulceration not exceeding ulcer of the digits of the foot.stage 2: moderate claudication - the distance that delineates mild, moderate and severe claudication is not specified in the Rutherford classification but is mentioned in the Fontaine classification as 200 meters.The risk factors for PAD are basically the same as for coronary artery disease: PathologyĪtherosclerosis is the leading cause of occlusive arterial disease of the extremities in patients over 40 years of age with the highest incidence in the sixth and seventh decades of life. The age-adjusted prevalence of peripheral arterial disease is ~12% 3.
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