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[Indications for arteriography for chronic obliterative arteriopathy of the lower extremities]
Insights
Aorto-arteriography is preferred for younger patients with exercise symptoms and absent femoral pulses, while femoral arteriography suits elderly patients with rest pain. Treatment levels depend on clinical and angiographic factors.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Interventional Radiology
Background:
- Chronic occlusive arterial disease (COAD) of the lower limbs significantly impacts patient mobility and quality of life.
- Accurate diagnostic imaging is crucial for guiding effective treatment strategies in COAD.
- Aorto-arteriography and femoral arteriography are key imaging modalities for evaluating lower limb arterial disease.
Purpose of the Study:
- To review the indications for aorto-arteriography and femoral arteriography in patients with chronic occlusive arterial disease of the lower limbs.
- To correlate imaging choices with clinical parameters, patient demographics, and treatment outcomes.
- To inform the development of an algorithm for selecting appropriate arteriography techniques.
Main Methods:
- Retrospective review of 161 patients with chronic occlusive arterial disease of the lower limbs.
- Analysis of 94 aorto-arteriographies and 67 femoral arteriographies.
- Correlation of imaging procedures with clinical data including age, risk factors, symptoms, femoral pulse status, and revascularization treatment.
Main Results:
- Aorto-arteriography was more common in younger patients without risk factors, presenting with exercise symptoms and reduced/absent femoral pulses.
- Femoral arteriography was more frequent in elderly patients with comorbidities, rest symptoms, and present femoral pulses.
- Revascularization levels were associated with clinical and angiographic parameters, with aorto-femoral revascularization favored in younger patients with absent pulses undergoing aorto-arteriography.
Conclusions:
- Clinical presentation and patient factors significantly influence the choice between aorto-arteriography and femoral arteriography for lower limb COAD.
- The data supports the development of a clinical algorithm to guide the selection of arteriography based on patient characteristics and therapeutic potential.
- Optimizing imaging modality selection can lead to more targeted and effective revascularization strategies.
Abstract:
The indications of aorto-arteriography and femoral arteriography in the investigation of chronic occlusive arterial disease of the lower limbs, were reviewed in 161 patients with respect to clinical parameters, age, associated risk factors, symptoms, the presence of a femoral pulse and with respect to treatment:revascularisation or not, and level of revascularisation. Ninety-four aorto-arteriographies and 67 femoral arteriographies were performed. Aortography was carried out more commonly in young patients (p less than 0,001) without associated risk factors, with exercise symptomatology (p less than 0,0001) and with reduced or absent femoral pulses (p less than 0,0001). Conversely, femoral arteriography was performed more frequently in elderly patients with associated diseases, in the presence of symptoms at rest and when the femoral pulses were present. The absence of revascularisation was not related to age, symptoms or type of arteriography performed. The level of revascularisation on the other hand, was related to clinical and angiographic parameters. An aorto-femoral revascularisation was performed more commonly in young patients (p less than 0,01) with decreased or absent femoral pulses (p less than 0,001) in whom aorto-arteriography had been performed (p less than 0,00001). The level of revascularisation was not related to clinical symptoms. An algorithm can be elaborated from this data on the respective indications of aorto-arteriography in the investigation of chronic occlusive arterial disease of the lower limbs based on clinical parameters and the therapeutic possibilities.