Arteriography has been criticized for its imperfect evaluation of outflow vessels, specifically for limited visualization of pedal vasculature and patent distal vessels beyond significant obstructive lesions [22]. Preprocedural examinations including duplex US, MRA, or CTA may provide useful information given these considerations and to inform preprocedural/presurgical planning [8]. CTA Abdomen and Pelvis with Bilateral Lower Extremity Runoff With IV Contrast CTA is useful in the diagnosis of ALI and peripheral arterial disease [12-18]. CTA in multiple meta-analyses has demonstrated sensitivity and specificity for detecting hemodynamically significant arterial stenosis of up to 96% and 96%, respectively, relative to DSA [15,18,23,24]. This cross-sectional imaging technique has several advantages over catheter arteriography via the manipulation of acquired imaging data, which includes thin axial, multiplanar, 3-D volume rendering, and maximum intensity projection reconstructions [25]. Additionally, poststenotic or postocclusive vascular anatomy and collateralization may be better demonstrated using CTA than by catheter arteriography. Compared to MRA, CTA demonstrates superior spatial resolution and shorter scan time, contributing to lower likelihood of motion degradation. CTA generally also is less susceptible to severe image degradation due to metal artifact. A major disadvantage of CTA is its limited ability to depict the lumen in heavily calcified arteries. Artifact induced by calcium can lead to an overestimation of stenosis [26]. Dual-energy CTA can be employed to reduce beam- hardening artifact from calcium or vascular stents [27,28]. CTA of the abdomen and pelvis can be obtained in addition to the lower extremity when aortoiliac disease is a concern or if the aorta and iliac arteries have not already been imaged and to assess for vascular suitability before endovascular intervention.
Sudden Onset of Cold Painful Leg. Arteriography has been criticized for its imperfect evaluation of outflow vessels, specifically for limited visualization of pedal vasculature and patent distal vessels beyond significant obstructive lesions [22]. Preprocedural examinations including duplex US, MRA, or CTA may provide useful information given these considerations and to inform preprocedural/presurgical planning [8]. CTA Abdomen and Pelvis with Bilateral Lower Extremity Runoff With IV Contrast CTA is useful in the diagnosis of ALI and peripheral arterial disease [12-18]. CTA in multiple meta-analyses has demonstrated sensitivity and specificity for detecting hemodynamically significant arterial stenosis of up to 96% and 96%, respectively, relative to DSA [15,18,23,24]. This cross-sectional imaging technique has several advantages over catheter arteriography via the manipulation of acquired imaging data, which includes thin axial, multiplanar, 3-D volume rendering, and maximum intensity projection reconstructions [25]. Additionally, poststenotic or postocclusive vascular anatomy and collateralization may be better demonstrated using CTA than by catheter arteriography. Compared to MRA, CTA demonstrates superior spatial resolution and shorter scan time, contributing to lower likelihood of motion degradation. CTA generally also is less susceptible to severe image degradation due to metal artifact. A major disadvantage of CTA is its limited ability to depict the lumen in heavily calcified arteries. Artifact induced by calcium can lead to an overestimation of stenosis [26]. Dual-energy CTA can be employed to reduce beam- hardening artifact from calcium or vascular stents [27,28]. CTA of the abdomen and pelvis can be obtained in addition to the lower extremity when aortoiliac disease is a concern or if the aorta and iliac arteries have not already been imaged and to assess for vascular suitability before endovascular intervention.