Peripheral arterial occlusive disease: prospective comparison of MR angiography and color duplex US with conventional angiography

Article Abstract:

Peripheral arterial occlusive disease is characterized by stenosis (narrowing) and occlusion (blockage) of the arteries in the limbs. The areas of stenosis need to be visualized for diagnosis and treatment. Presently, the most commonly used technique is angiography, which involves taking X-rays of the arteries after they have been injected with a contrast material to obtain more well-defined images. This technique is invasive and it exposes the patient to ionizing radiation. Two noninvasive techniques for imaging these vessels have recently been developed. Color duplex ultrasound (US) produces color images using high-frequency sound waves that map blood flow in the vessels. Magnetic resonance (MR) angiography produces images by using the magnetic properties that are unique to a substance. These two techniques were compared with conventional angiography to assess their abilities to detect, diagnose, and help treat peripheral arterial occlusive disease. All three procedures were performed on 12 male patients with symptoms of the disease. Color duplex US was highly sensitive in detecting significant disease (reduction in arterial diameter greater than 49 percent) in the arteries except for those in the iliac region. It correctly classified extent of disease, as found by conventional angiography, in 114 of 123 cases (93 percent). MR angiography was only able to detect disease with a sensitivity of 43 to 59 percent, depending on the location of the artery. MR angiography results agreed with conventional angiography results in severity of disease in 71 percent of cases. These findings are encouraging, but further research and improvements in technique are needed before these noninvasive techniques could be used in place of conventional angiography. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Magnetic resonance imaging

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Rapid progression of peripheral vascular disease after diagnostic angiography

Article Abstract:

Peripheral vascular disease is characterized by a slowly progressive narrowing of the blood vessels in the limbs. Angiography is an imaging technique used to diagnose disease in blood vessels. It involves inserting a catheter into the vessel to deliver contrast agents into the blood stream. Although a low rate of blood clot formation at the site where the catheter is inserted has been reported, it has also been reported that some cases of the disease have progressed rapidly following angiography, but at a distance from the insertion area. This study examined whether angiography might cause this rapid progression, and the possible mechanisms by which this would occur. The records of 175 cases of percutaneous transluminal angioplasty (PTA), a technique used to treat peripheral vascular disease, were examined. Specifically, seven cases in which angiography was performed and the initial diagnosis indicated that no treatment was required, but PTA was soon needed, were selected and examined more closely. Six cases involved occlusions (blockages) in the vessels that were not seen in the initial angiography, but appeared less than 90 days afterwards. The other case occurred within one hour of angiography. The results indicate that angiography may accelerate peripheral vascular disease. The exact mechanism is not known, but contrast materials may play a role. Further research is needed to establish the role angiography might play in this progression. It is suggested that heparin be administered during angiography in patients with severe vessel narrowing, and that PTA might be considered in cases of less severe disease than those in which it is typically used. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Development and progression

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Evaluation of the peripheral arteries with duplex US after angioplasty

Article Abstract:

Percutaneous transluminal angioplasty (PTA) is a procedure for treating narrowing or blockage in blood vessels. It involves inserting a balloon-tip catheter into the constricted vessel and inflating it to open the vessel. It is important to have both an accurate evaluation of the vessel prior to and after the procedure, as this can reveal the extent of the problem in the vessel, residual narrowing in the vessels after the PTA, and success of the PTA. The evaluation of PTA performed in peripheral arteries (that is, those outside the trunk) is normally accomplished by measuring blood flow or pressure beyond the site of the constriction. Duplex ultrasound (US) is an imaging technique that uses high-frequency sound waves. The use of duplex US to image peripheral (outside the trunk) arteries both before and after PTA was evaluated as an alternative method for determining the relative success of the procedure. Twenty-one patients with narrowed or blocked peripheral arteries were examined with duplex US prior to and immediately after PTA, and 25 US image pairs were obtained. PTA was considered successful in 24 of the 25 paired images as determined using traditional measures. Images from the duplex US showed significant residual narrowing in 8 of 24 patients, although clinical results did not indicate such narrowing in six of those same eight patients. The results indicate that duplex US of peripheral arteries is not useful in evaluating the success of PTA when the imaging is performed immediately after PTA is performed. It may be useful for long-term evaluation of the effectiveness of PTA, but further research is needed to evaluate this role. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Physiological aspects, Transluminal angioplasty, Balloon angioplasty, Arteries

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