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Value of MDCT Angiography in Developing Treatment Strategies for Critical Limb Ischemia

¹ Department of Radiology, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria.
² Present address: Department of Radiology, Stanford University Medical Center, Stanford, CA.

OBJECTIVE. The purpose of this study was to assess the value of MDCT angiography in the development of strategies for the treatment of patients with critical limb ischemia.

MATERIALS AND METHODS. During a 12-month period, 150 patients were referred to our department for CT angiography of the peripheral arteries. All patients (n = 28) with clinical stage IV peripheral arterial occlusive disease were included in this retrospective study. The treatment reports, discharge summaries, and follow-up examinations were reviewed to ascertain the number of patients correctly treated on the basis of the CT angiographic findings.

RESULTS. After CT angiography, endovascular treatment was indicated for eight patients, surgical revascularization for four patients, and a combined endovascular and surgical approach for two patients. That the correct treatment decision had been made in all 14 cases was confirmed on the basis of successful endovascular or surgical revascularization. In eight patients, medical treatment was indicated, and one patient underwent amputation at the level of the thigh. Five patients were referred for complementary digital subtraction angiography, but no additional findings were made. During follow-up, three of the original 28 patients were in grave general condition and died within 7 weeks after CT angiography. Thirteen patients needed no additional treatment during the follow-up period through January 2008. After a median treatment-free interval of 381 days, 12 patients underwent additional revascularization because of clinical progression of disease.

CONCLUSION. MDCT angiographic findings lead to accurate recommendations for the management of critical limb ischemia. Thus CT angiography seems to be an important technique for the management of stage IV peripheral arterial occlusive disease in patients without absolute contraindications to CT angiography.

Keywords: chronic critical limb ischemia • CT angiography • treatment decisions • vascular imaging

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