الفهرس 
Anatomy of Aortoiliac and Lower Extremity ArteriesOnly 14 pages are availabe for public view
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Abstract
There is an increasing prevalence of peripheral arterial disease, which affects approximately 12% of adults.
Conventional digital subtraction angiography (DSA) is still considered the reference standard in the assessment of aortoiliac and lower extremity arteries, with the advantage being that performance of therapeutic interventions is possible during the examination. Its main drawbacks, however, are invasiveness, high cost, patient discomfort, and a complication rate of approximately 1%.
Duplex ultrasonography (US), magnetic resonance (MR) angiography, and CT angiography have been shown to be valuable noninvasive alternatives to conventional DSA in the evaluation of aortoiliac and lower extremity arteries.
Duplex US does not depict complete inflow (including the iliac arteries) or outflow (including the pedal arteries) for routine purposes because acquisition of a complete duplex angiogram is extremely time-consuming and investigator-dependent. There is a risk of missing lesions in patients with multiple stenosis, with unsatisfactory results in the evaluation of lesions located in the calves or in the detection of lesions distal to high grade stenosis, and obese patients or patients with excessive bowel gas or calcified arteries are difficult to examine. In addition, duplex US does not provide a road map equivalent to that obtained with conventional DSA, or MR or CT angiography.
MRA is increasingly being used in patients with PAD especially those with chronic renal insufficiency. MRA is not widely available and requires expensive equipment investments, skilled personnel, and more time for imaging and is contraindicated in patients with claustrophobia, pacemaker and metal implants.
With the introduction of multi-detector row CT (MDCT) technology in 1998 and the continuous development of this technology from 4-detector, 8-detector and 16-detector to 64-detector-row CT scanners within the following years, a complete coverage of the lower extremity inflow and runoff arteries was possible with one acquisition using a single-contrast bolus, the main advantage of this novel technology are the fast scan times ,high spatial resolution ,increased anatomic coverage and capability to regenerate high quality multiplaner and 3D renderings from raw data that can be reprocessed easily and quickly.
CT angiography is increasingly used to evaluate patients with arterial diseases; it is therefore important for all vascular specialists to become familiar with the strengths and limitations of this new technique.
Multi-detector row CT angiography is feasible, accurate, and reliable in the assessment of aortoiliac and lower extremity arteries.
MDCTA reduces diagnostic costs and provides adequate information for decision making. It can accurately detect degree and length of arterial stenosis. Assessment of post-traumatic vascular lesions e.g. occlusion, aneurysms or arterial dissection, is superior by MDCT.
MDCTA is an accurate technique for preoperative and post-interventional evaluation of the patency of stents and grafts. MDCT shows incomparable ability in detecting extra-arterial causes of occlusion, or other remote non-arterial pathologies.
It is favorable and less invasive procedure in pediatric age group. MDCTA shows an overall sensitivity of 91 %, specificity 95 %, and accuracy 96.7 %.