Peripheral Arterial Obstructive Disease: Patient Management and Therapy Decision according to Trans Atlantic Inter-Society Consensus Guidelines—A Prospective 64-CT Angiography Study Using DSA as Reference

VI31-09

Peripheral Arterial Obstructive Disease: Patient Management and Therapy Decision according to Trans Atlantic Inter-Society Consensus Guidelines—A Prospective 64-CT Angiography Study Using DSA as Reference

Scientific Papers

Presented on December 1, 2009
Presented as part of VI31: Interventional Radiology Series: Peripheral Vascular Disease Imaging and Interventions

Alessandro Napoli MD, Presenter: Nothing to Disclose

Michele Anzidei MD, Abstract Co-Author: Nothing to Disclose

Chiara Zini MD, Abstract Co-Author: Nothing to Disclose

Fulvio Zaccagna MD, Abstract Co-Author: Nothing to Disclose

Gulia Brachetti, Abstract Co-Author: Nothing to Disclose

Carlo Catalano MD, Abstract Co-Author: Nothing to Disclose

to compare provisional therapeutic approach after 64-CTA with that initiated after DSA.

212 consecutive patients with intermittent claudicatio scheduled for DSA, underwent peripheral CTA. CTA was performed, before the DSA, using a 64x0.6mm detector configuration (Siemens) and 110 ml of contrast medium (Iomeron 400;Bracco) @ 4 ml/sec. For stenosis analysis, the arterial bed was divided into 35 segments. According to TASC guidelines, lesions were classified into four categories, depending on the degree, number, and length of stenosis. Based on the findings of the CTA and the patient’s surgical risk, comorbid conditions, fully informed preference and the local operator’s long-term success rates, a provisional indication was made as to whether treatment should most likely be conservative, endovascular, surgical or combined.

Summary of results is shown in table. After undergoing DSA, 87 patients (44.84%) were referred for conservative treatment and 51 (26.28%) underwent endovascular procedures. Thirty-eight patients (19.59%) underwent surgery, while in 18 cases (9.28%) a combined treatment was preferred. Therapy recommendation based on CTA findings alone was super imposable to DSA in all cases but two, both of type D lesions, and Wilcoxon’s Rank test showed no significant difference between the two modality (p=0.069).

CTA reliably yielded therapy decision-making and patient management as compared to DSA.

whether CTA can reliably take over DSA on therapy recommendation and its translational clinical impact in routine practice is still lacking

Napoli, A, Anzidei, M, Zini, C, Zaccagna, F, Brachetti, G, Catalano, C, Peripheral Arterial Obstructive Disease: Patient Management and Therapy Decision according to Trans Atlantic Inter-Society Consensus Guidelines—A Prospective 64-CT Angiography Study Using DSA as Reference. Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8010517.html