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Related Concept Videos

Imaging Studies VII: Vascular Imaging01:19

Imaging Studies VII: Vascular Imaging

DefinitionRenal angiography, also known as renal arteriography, is an imaging technique used to obtain a comprehensive view of blood flow and the vascular structure of blood vessels in the kidneys and surrounding areas.PurposeRenal angiography detects blood vessel abnormalities in the kidneys, such as aneurysms, stenosis, thrombosis, vascular tumors, and renal artery stenosis. It evaluates kidney function and guides interventional treatments like angioplasty or stent placement.Pre-Procedure...

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A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis
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Interobserver and Intraobserver Variability in Crural Angiography.

Chrissy van Wely1,2, Rens J Oosterveld1,2, Niek Zonnebeld1

  • 1Department of Vascular Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands.

Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists
|January 24, 2025
PubMed
Summary
This summary is machine-generated.

Digital subtraction angiography (DSA) shows moderate agreement for vessel diameter and treatment decisions, but poor agreement for balloon sizing in crural arterial disease assessment. Objective imaging is needed for accurate below-the-knee percutaneous transluminal angioplasty guidance.

Keywords:
atherosclerosisballoon angioplastybelow-the-kneechronic limb ischemiacritical limb ischemiadigital subtraction angiographyinfrapopliteal arterieslower limbpercutaneous transluminal angioplastyperipheral artery disease

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Area of Science:

  • Vascular Surgery
  • Medical Imaging
  • Interventional Cardiology

Background:

  • Digital subtraction angiography (DSA) is the gold standard for assessing crural arterial disease and guiding below-the-knee percutaneous transluminal angioplasty (PTA).
  • DSA relies on operator estimation for critical measurements like vessel diameter and stenosis degree, leading to potential variability.
  • Interobserver and intraobserver variability in DSA interpretation can impact treatment decisions and outcomes.

Purpose of the Study:

  • To quantify the interobserver and intraobserver variability in the assessment of crural angiography using digital subtraction angiography (DSA).
  • To evaluate the consistency of measurements for vessel diameter, degree of stenosis, and treatment decisions among vascular specialists.
  • To identify specific areas of disagreement in DSA interpretation relevant to below-the-knee PTA.

Main Methods:

  • Fifteen crural angiographies were independently reviewed by seven vascular specialists (residents and surgeons) on three separate occasions.
  • Assessors estimated vessel diameter, degree of stenosis, determined treatment decisions, and selected balloon/stent sizes.
  • Interobserver and intraobserver agreement were calculated using intraclass correlation coefficients (ICCs) and Hubert's kappa.

Main Results:

  • Moderate interobserver agreement was found for estimated vessel diameter (.62) and degree of stenosis (.72), but poor agreement for balloon diameter (.21).
  • Intraobserver agreement ranged from moderate to good for vessel diameter (.62-.80) and good for stenosis degree (.76-.87).
  • Agreement on treatment decisions showed moderate to excellent intraobserver variability (.76-.87) and moderate interobserver variability (.53), with poor to moderate agreement on balloon diameter (.07-.57).

Conclusions:

  • Significant interobserver and intraobserver variability exists in DSA assessments of crural arterial disease, particularly concerning balloon sizing.
  • While intraobserver agreement for vessel diameter and stenosis is moderate to good, interobserver agreement is only moderate.
  • The findings highlight the need for more objective imaging modalities to improve the accuracy and consistency of guiding below-the-knee PTA.