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Effect of MDCT Angiographic Findings on the Management of Intermittent Claudication

¹ Department 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.

View larger version (53K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —75-year-old woman referred for peripheral CT angiography of left leg because of decrease in walking distance to less than 50 m. Multipath curved planar reformation from CT angiogram (16-MDCT scanner, 16 x 0.75 mm slice collimation, 85 mL of iomeprol) shows high-grade (90%) stenosis (arrow) in left popliteal artery. Because of high degree of stenosis of popliteal artery and clinical symptoms, percutaneous transluminal angioplasty was indicated. Multiple insignificant stenoses in superficial femoral artery and moderate stenosis of fibular artery are evident.

View larger version (50K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —75-year-old woman referred for peripheral CT angiography of left leg because of decrease in walking distance to less than 50 m. Multipath curved planar reformation from CT angiogram (16-MDCT scanner, 16 x 0.75 mm slice collimation, 85 mL of iomeprol) shows high-grade (90%) stenosis (arrow) in left popliteal artery. Because of high degree of stenosis of popliteal artery and clinical symptoms, percutaneous transluminal angioplasty was indicated. Multiple insignificant stenoses in superficial femoral artery and moderate stenosis of fibular artery are evident.

View larger version (59K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —75-year-old woman referred for peripheral CT angiography of left leg because of decrease in walking distance to less than 50 m. Digital subtraction angiogram obtained during endovascular revascularization confirms CT angiographic finding of stenosis (arrow).

View larger version (61K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —75-year-old woman referred for peripheral CT angiography of left leg because of decrease in walking distance to less than 50 m. Control angiogram after balloon dilation shows good morphologic result (arrow) and improved runoff.

View larger version (48K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1E —75-year-old woman referred for peripheral CT angiography of left leg because of decrease in walking distance to less than 50 m. Multipath curved planar reformation CT angiograms from control examination performed 10 months after treatment because of pain at rest in sole of left foot show no differences from A and B except for the absent stenosis in the previously treated left popliteal artery. Multiple insignificant stenoses are present in superficial femoral artery, and moderate stenosis is present in fibular artery. At site of percutaneous transluminal angioplasty (arrow) in left popliteal artery, no restenosis is present.

View larger version (52K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1F —75-year-old woman referred for peripheral CT angiography of left leg because of decrease in walking distance to less than 50 m. Multipath curved planar reformation CT angiograms from control examination performed 10 months after treatment because of pain at rest in sole of left foot show no differences from A and B except for the absent stenosis in the previously treated left popliteal artery. Multiple insignificant stenoses are present in superficial femoral artery, and moderate stenosis is present in fibular artery. At site of percutaneous transluminal angioplasty (arrow) in left popliteal artery, no restenosis is present.

View larger version (45K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —76-year-old man referred for CT angiography for treatment decision and planning because of intermittent claudication and known popliteal aneurysm of right leg. Multipath curved planar reformation (16-MDCT scanner, 16 x 0.75 mm slice collimation, 98 mL of iomeprol) shows ectatic right superficial femoral artery, known aneurysm in right popliteal artery, and multiple stenoses in posterior tibial artery of right leg as well as long arterial occlusion of left superficial femoral artery. Placement of femoropopliteal bypass graft for exclusion of aneurysm in right leg was planned and later performed.

View larger version (49K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —76-year-old man referred for CT angiography for treatment decision and planning because of intermittent claudication and known popliteal aneurysm of right leg. Multipath curved planar reformation control examination of bypass graft 12 months after A shows patency of graft and successful exclusion of aneurysm.

View larger version (35K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —65-year-old man referred for CT angiography for treatment planning because of intermittent claudication (stage IIb peripheral arterial occlusive disease). CT angiograms (16-MDCT scanner, 16 x 0.75 mm slice collimation, 100 mL of iomeprol) in different rotations show long occlusion (arrowhead, A and C) of right superficial femoral artery and femoropopliteal bypass graft in left leg. Right common femoral artery was rated not significantly diseased, although relevant stenosis (arrow) was detected retrospectively (C and D).

View larger version (79K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —65-year-old man referred for CT angiography for treatment planning because of intermittent claudication (stage IIb peripheral arterial occlusive disease). CT angiograms (16-MDCT scanner, 16 x 0.75 mm slice collimation, 100 mL of iomeprol) in different rotations show long occlusion (arrowhead, A and C) of right superficial femoral artery and femoropopliteal bypass graft in left leg. Right common femoral artery was rated not significantly diseased, although relevant stenosis (arrow) was detected retrospectively (C and D).

View larger version (45K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —65-year-old man referred for CT angiography for treatment planning because of intermittent claudication (stage IIb peripheral arterial occlusive disease). CT angiograms (16-MDCT scanner, 16 x 0.75 mm slice collimation, 100 mL of iomeprol) in different rotations show long occlusion (arrowhead, A and C) of right superficial femoral artery and femoropopliteal bypass graft in left leg. Right common femoral artery was rated not significantly diseased, although relevant stenosis (arrow) was detected retrospectively (C and D).

View larger version (72K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —65-year-old man referred for CT angiography for treatment planning because of intermittent claudication (stage IIb peripheral arterial occlusive disease). CT angiograms (16-MDCT scanner, 16 x 0.75 mm slice collimation, 100 mL of iomeprol) in different rotations show long occlusion (arrowhead, A and C) of right superficial femoral artery and femoropopliteal bypass graft in left leg. Right common femoral artery was rated not significantly diseased, although relevant stenosis (arrow) was detected retrospectively (C and D).

View larger version (92K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3E —65-year-old man referred for CT angiography for treatment planning because of intermittent claudication (stage IIb peripheral arterial occlusive disease). Digital subtraction angiogram shows high degree of stenosis (arrow) in right common femoral artery. Placement of femoropopliteal bypass therefore was combined with patch angioplasty of right common femoral artery.

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