Peripheral arterial disease (summary)

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This is a basic article for medical students and other non-radiologists

Peripheral arterial disease (sometimes less accurately referred to as peripheral vascular disease) is a relatively common progressive disease of arterial degeneration that can result in a variety of symptoms.

Reference article

This is a summary article; read more in our article on peripheral arterial disease.

Summary

  • epidemiology
    • prevalence: 12-14%
    • more common in older populations
      • 20% of the over 70s in Western populations
    • risk factors: smoking, hypertension, diabetes
  • presentation
    • patients may be asymptomatic
    • intermittent claudication
      • leg pain and weakness brought on by exercise, relieved by rest
    • critical limb ischemia with rest pain and ulceration
  • pathophysiology
    • atherosclerotic change results in luminal narrowing of arteries
      • usually leg arteries
    • luminal narrowing results in distal ischemia
  • investigation
    • doppler US
      • initial investigation
      • assess flow and atherosclerotic plaque
    • angiography (CT, MR, DSA)
      • direct imaging of the vessels and runoff
  • treatment
    • modification of lifestyle (risk factor control)
    • medical therapy (antihypertensives)
    • revascularization
      • angioplasty
      • vascular bypass

Role of imaging

  • identify and grade peripheral arterial occlusion
  • aid decision making about treatment (endovascular/surgical)
  • follow up

Radiographic features

Radiology is helpful in the diagnosis of peripheral arterial disease and also helpful to assess the amount of vessel narrowing.

Ultrasound

Ultrasound examination of leg vessels has the benefit of being able to use Doppler to assess flow.

Angiography

Angiography can be performed with a number of modalities:

  • CT angiogram
    • quick and accessible
    • high contrast resolution
    • vessel wall can be assessed
    • uses radiation
  • MR angiogram
    • less accessible
    • possible problems with claustrophobia
    • MRI contraindications
  • angiogram (DSA)
    • the gold standard for vessel analysis
    • interventional technique (complications)
    • only analyzes the vessel - wall not imaged
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