More common with newer CT technologies is imaging too early either for one leg with slow flow from outflow disease or for both legs secondary to the very fast scanning protocols. Delayed images of the calves can be obtained to catch the bolus in these patients. The presence of diffusely diseased arteries can present challenges during angiography, because stenosis severity can be difficult to determine in the absence of normal arterial segments for comparison. In addition, serial lesions, luminal irregularity, and the degree of collateral development may produce effects on the blood flow that are difficult to quantify angiographically. The main drawbacks of arteriography in patients with claudication are its invasive nature and the known complications from catheterization [2,10]. These difficulties can be avoided by using examinations such as duplex ultrasound (US), MR angiography (MRA), or CTA to accurately triage patients with confirmed PAD for percutaneous or surgical treatments. For the latter, preoperative arteriography may not be needed. Finally, arteriography has inconsistent correlation between the hemodynamic or functional effects and the morphology of the arterial lesions [12]. Several studies have reported this problem, but in some of them the problem may be accentuated by less-than-optimal angiographic technique (eg, single-projection, nonselective injections). CTA Abdomen and Pelvis with Bilateral Lower Extremity Runoff With IV Contrast CTA is commonly used for imaging peripheral vascular disease. Multidetector CT scanners, including helical and multistation axial acquisitions, enable rapid scanning of the entire arterial system [13]. When compared with catheter arteriography, CTA offers volumetric as opposed to planar images. The volumetric acquisition enables extensive image postprocessing, including multiplanar reformatted and maximum-intensity projection images to create an arterial road map [13].
Lower Extremity Arterial Claudication Imaging Assessment for Revascularization. More common with newer CT technologies is imaging too early either for one leg with slow flow from outflow disease or for both legs secondary to the very fast scanning protocols. Delayed images of the calves can be obtained to catch the bolus in these patients. The presence of diffusely diseased arteries can present challenges during angiography, because stenosis severity can be difficult to determine in the absence of normal arterial segments for comparison. In addition, serial lesions, luminal irregularity, and the degree of collateral development may produce effects on the blood flow that are difficult to quantify angiographically. The main drawbacks of arteriography in patients with claudication are its invasive nature and the known complications from catheterization [2,10]. These difficulties can be avoided by using examinations such as duplex ultrasound (US), MR angiography (MRA), or CTA to accurately triage patients with confirmed PAD for percutaneous or surgical treatments. For the latter, preoperative arteriography may not be needed. Finally, arteriography has inconsistent correlation between the hemodynamic or functional effects and the morphology of the arterial lesions [12]. Several studies have reported this problem, but in some of them the problem may be accentuated by less-than-optimal angiographic technique (eg, single-projection, nonselective injections). CTA Abdomen and Pelvis with Bilateral Lower Extremity Runoff With IV Contrast CTA is commonly used for imaging peripheral vascular disease. Multidetector CT scanners, including helical and multistation axial acquisitions, enable rapid scanning of the entire arterial system [13]. When compared with catheter arteriography, CTA offers volumetric as opposed to planar images. The volumetric acquisition enables extensive image postprocessing, including multiplanar reformatted and maximum-intensity projection images to create an arterial road map [13].