Interventions for PAD and What the Clinician Wants to Know

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Interventions for PAD and What the Clinician
Wants to Know

• D.NAIK

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Imaging Options

• Duplex scanning
• CT Angiography
• MR Angiography
• Arteriography

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Options for Intervention

• Angioplasty
• Stenting
• Endarterectomy
• Bypass
• Hybrid procedures

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PAD Management

• Arteriography regarded as gold standard
• Duplex provides primary information
• Duplex can provide definitive information
• Can allow angiography to be used selectively

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Required information

• The proximal normal segment is delineated
• The distal normal outflow segment is delineated
• The extent of disease and degree of stenosis is
  described
• The nature of the disease is outlined
• Any other significant findings eg
  aneurysms,psuedoaneurysms

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Options

• Conservative treatment
• Investigate further
• Endovascular intervention
• Reconstructive surgery

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Useful Information

• Assessment of inflow
• Degree of disease eg stenosis vs occlusion,degree
  and length of stenosis
• Assessment of run off

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Additional information

• Anatomical details eg femoral bifurcation,tibial
  trifurcation
• Sites of stenoses or occlusions relative to known
  landmarks
• Vessel diameters
• Type and extent of disease process eg concentric
  vs eccentric plaque
• Length of stenoses or occlusions

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Preoperative Vein Mapping

• Diameter
• Competence
• Significant tributaries or varices
• Abnormal segments
• Marking of course

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Graft surveillance

• Identify proximal and distal anastomoses
• Scan length of graft
• Stenoses often seen at valve sites
• Look for dilatations or aneurysms
• Examine inflow and outflow arteries

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Limitations of Duplex Scanning

• Body habitus
• Severe calcification
• Unco-operative patient
• Low flow states
• Multiple level disease
• Dressings/wounds
• Oedema/infection