Chapter II: Diagnostic methods

Cao, P; Eckstein, H H; De Rango, P; Setacci, C; Ricco, J-B; de Donato, G; Becker, F; Robert-Ebadi, H; Diehm, N; Schmidli, J; Teraa, M; Moll, F L; Dick, F; Davies, A H; Lepäntalo, M; Apelqvist, J (2011). Chapter II: Diagnostic methods. European journal of vascular and endovascular surgery EJVES, 42 Suppl 2, S13-32. London: Elsevier 10.1016/S1078-5884(11)60010-5

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Non-invasive vascular studies can provide crucial information on the presence, location, and severity of critical limb ischaemia (CLI), as well as the initial assessment or treatment planning. Ankle-brachial index with Doppler ultrasound, despite limitations in diabetic and end-stage renal failure patients, is the first-line evaluation of CLI. In this group of patients, toe-brachial index measurement may better establish the diagnosis. Other non-invasive measurements, such as segmental limb pressure, continuous-wave Doppler analysis and pulse volume recording, are of limited accuracy. Transcutaneous oxygen pressure (TcPO(2)) measurement may be of value when rest pain and ulcerations of the foot are present. Duplex ultrasound is the most important non-invasive tool in CLI patients combining haemodynamic evaluation with imaging modality. Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are the next imaging studies in the algorithm for CLI. Both CTA and MRA have been proven effective in aiding the decision-making of clinicians and accurate planning of intervention. The data acquired with CTA and MRA can be manipulated in a multiplanar and 3D fashion and can offer exquisite detail. CTA results are generally equivalent to MRA, and both compare favourably with contrast angiography. The individual use of different imaging modalities depends on local availability, experience, and costs. Contrast angiography represents the gold standard, provides detailed information about arterial anatomy, and is recommended when revascularisation is needed.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Angiology 04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Heart Surgery
UniBE Contributor:	Diehm, Nicolas Alexander, Schmidli, Jürg, Dick, Florian
ISSN:	1078-5884
Publisher:	Elsevier
Language:	English
Submitter:	Factscience Import
Date Deposited:	04 Oct 2013 14:20
Last Modified:	27 Feb 2024 14:29
Publisher DOI:	10.1016/S1078-5884(11)60010-5
PubMed ID:	22172470
Web of Science ID:	000298517700003
URI:	https://boris.unibe.ch/id/eprint/6626 (FactScience: 211624)