In such patients, it has been suggested that this modality only be performed if it is part of a planned interventional procedure (eg, coil embolization of remote bleeding arteries, etc) [4]. US Duplex Doppler Lower Extremity There is no relevant literature regarding the use of US duplex Doppler in the evaluation of lower-extremity connective disease. US Intravascular Lower Extremity There is no relevant literature regarding the use of IVUS in the evaluation of lower-extremity connective disease, but the same concerns regarding arterial puncture would apply. Variant 5: Suspected or known other noninflammatory lower-extremity vascular diseases (such as fibromuscular dysplasia, segmental arterial mediolysis). Initial imaging. CTA Lower Extremity While selective arteriography is considered the gold standard in diagnosing FMD, CTA has proven helpful in the initial diagnosis and follow-up of FMD within the lower extremities [25,37]. Because of its high spatial resolution, several studies have demonstrated the superiority of CTA over MRA in visualizing vascular lesions in FMD [4,36]. Despite this, one study found CTA to have limited sensitivity in the evaluation of small vessels in patients with mild FMD [36]. CTA may be helpful in the workup of cystic adventitial disease [31]. It has also been advocated as a first-line imaging study in the diagnosis of SAM [28,29] with follow-up recommended at 1- year intervals [27]. MRA Lower Extremity The improved contrast resolution inherent to MRA renders superior characterization of the extravascular soft tissues. This is of particular importance in the workup of cystic adventitial disease, where T1-weighted and T2- weighted sequences may demonstrate connections between adventitial cysts and the adjacent joint capsule. It has been recommended as the modality of choice in preoperative planning for cystic adventitial disease [31]. MRA has also been found useful for annual follow-up in SAM [27].
Nonatherosclerotic Peripheral Arterial Disease. In such patients, it has been suggested that this modality only be performed if it is part of a planned interventional procedure (eg, coil embolization of remote bleeding arteries, etc) [4]. US Duplex Doppler Lower Extremity There is no relevant literature regarding the use of US duplex Doppler in the evaluation of lower-extremity connective disease. US Intravascular Lower Extremity There is no relevant literature regarding the use of IVUS in the evaluation of lower-extremity connective disease, but the same concerns regarding arterial puncture would apply. Variant 5: Suspected or known other noninflammatory lower-extremity vascular diseases (such as fibromuscular dysplasia, segmental arterial mediolysis). Initial imaging. CTA Lower Extremity While selective arteriography is considered the gold standard in diagnosing FMD, CTA has proven helpful in the initial diagnosis and follow-up of FMD within the lower extremities [25,37]. Because of its high spatial resolution, several studies have demonstrated the superiority of CTA over MRA in visualizing vascular lesions in FMD [4,36]. Despite this, one study found CTA to have limited sensitivity in the evaluation of small vessels in patients with mild FMD [36]. CTA may be helpful in the workup of cystic adventitial disease [31]. It has also been advocated as a first-line imaging study in the diagnosis of SAM [28,29] with follow-up recommended at 1- year intervals [27]. MRA Lower Extremity The improved contrast resolution inherent to MRA renders superior characterization of the extravascular soft tissues. This is of particular importance in the workup of cystic adventitial disease, where T1-weighted and T2- weighted sequences may demonstrate connections between adventitial cysts and the adjacent joint capsule. It has been recommended as the modality of choice in preoperative planning for cystic adventitial disease [31]. MRA has also been found useful for annual follow-up in SAM [27].