Peripheral arterial disease (PAD) is a common cause of morbidity and mortality in developed countries. Traditionally, imaging for risk stratification and therapeutic planning involved catheter angiography. In recent years, cross-sectional imaging by CTA and MRA has proven a robust technique for non-invasive PAD assessment.Given ubiquity of CT scanning technology, CTA is widely available. High resolution datasets can be acquired rapidly, which facilitates assessment of clinically labile or trauma patients.To be optimally effective, CTA techniques require particular attention to contrast medium and scan protocol. With appropriate protocol design, data acquisition requires limited operator dependence. The acquired 3D dataset is rich with information, but requires careful scrutiny by the interpreting physician. Volumetric review of these datasets produces the most accurate results. Extensive small vessel calcification remains a potential barrier to full assessment of pedal vessels by CTA.Recent published data validates the clinical effectiveness of CTA for diagnosis of PAD and for the direction of treatment planning. Ongoing research aims to exploit the newest generation of CT scanners to acquire additional information, including dual energy data, time-resolved information, and radiation dose savings.
 

The prevalence of symptomatic peripheral artery disease (PAD) ranges around 3% in patients aged 40 and 6% at an age of 60 years. Additionally, the prevalence of asymptomatic PAD lies between 3% and 10% in the general population increasing to 15% to 20% in persons older than 70 years of age. However, these data still might underestimate the total prevalence of PAD since screening studies showed that between 10% and 50% of all patients with intermittent claudication (IC) never consult a doctor about their symptoms.These data prove the need for an accurate and reliable method for assessment of the peripheral vasculature. Digital subtraction angiography (DSA) still serves as the reference standard for all vascular imaging techniques. However, because of the absence of ionizing radiation, the use of non-nephrotoxic contrast agents or even non contrast-enhanced sequences and the large toolbox of available techniques for high-resolution static and dynamic imaging Magnetic Resonance Angiography (MRA) constitute an excellent non-invasive alternative. Different acquisition schemes and contrast agent application protocols as well as different types of data sampling for static, dynamic, contrast- and non contrast-enhanced imaging enable to tailor each exam to a specific question and patient respectively.