الفهرس 
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Abstract
Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis and is defined as any pathologic process causing obstruction to blood flow in the arteries, exclusive of the coronary and cerebral vascular beds. PAD affects a large segment of the adult population. Less than 20% of patients with PAD have typical symptoms of intermittent claudication, whereas another third have atypical exertional leg symptoms.Management strategies are governed by the severity of the disease. Imaging is necessary for planning interventions in patients with lower extremity peripheral arterial disease (PAD). Non-invasive imaging modalities, including duplex ultrasonography, magnetic resonance angiography (MRA), and multi-detector computed tomography angiography (MDCTA) are available for grading lower extremity arterial disease.The aim of this work was to evaluate the role of Multi-detector Computerized Tomography Angiography (MDCT Angiography) in imaging the arterial tree of the lower limbs in peripheral vascular disease.This study included 30 patients .They were 18 male and 12 female .The age of the patients ranged from 24 to 75 years old with average age of presentation 56.3 years. Fifteen patients (50%) were hypertensive, ten were diabetics (10%), seventeen (56.67%) where smokers with seven of them (23.33 %) chronic heavy smokers.Twelve (40%) of them complained of intermittent claudication, seven (23.33%) complained of rest pain, five (16.67%) with acute lower limb pain and three of them presented with gangrene (10%).The arterial system was divided into 21 anatomical parts: each and every anatomical part of the arterial tree was assigned a grade for the disease extent .These grades were given for all arterial parts as evaluated by multi-detector row CT angiography and color Doppler ultrasonography.Multi-detector row CT angiography was used to examine a total of 624 arterial parts showing 120 lesions (one patient showed marked diffuse wall calcification of the infrapopliteal vessels which interfered with proper assessment by CTA) . Out of these lesions, 45 lesions were involving the supra-popliteal and popliteal arterial system, while 75 lesions were detected in the infra-popliteal arterial system.The arterial tree was then divided into three segments including aortoiliac, femoropopliteal, and infrapopliteal segments to assess the segmental distribution of the disease .The PAD showed multisegmental distribution: affecting 1 segment in 9 patients (30%), two segments in 11 patients (36.67%) and three segments in 10 patients (33.33%).No statistically significant difference between Doppler and CT angiography regarding all the examined lower limb arterial tree parts except for the internal iliac artery which was not examined by Doppler sonogrpahy.Color Doppler ultrasonography is also a reliable non-invasive method of investigating the lower limb arterial system. It has an advantage over conventional angiography and MDCT angiography that it provides us with data about the velocity of blood distal to the obstruction and shape of the waveform that adds more to determining the hemodynamic significance of this lesion. The limiting factor for Color Doppler sonography imaging is that this examination is totally operator dependent. It requires highly trained personnel which is not always available. It also lacks the arterial imaging capabilities of MDCT angiography that surgeons need for preoperative planning. It can only document a small arterial part in each image. This leads us to the conclusion that MDCT angiography may replace CCD in many cases.
from this study we concluded that MDCT angiography is a reliable method of investigating the lower limb arterial disease. It has demonstrated its efficacy as a promising, fast, accurate, safe and a minimally-invasive imaging modality in cases of trauma with suspected arterial injuries and in cases of peripheral vascular diseases for diagnosis, grading and for preoperative evaluation. The limiting factors that prevent the widespread usage of MDCT angiography are the limited number of multi-detector row CT machines and the limited experienced staff that can perform such a recent examination. Another limiting factor is the inability to perform MDCT in patients with renal compromise due to IV contrast injection requirement. Interpretation of the images by a radiologist with experience in vascular imaging combined with experience in multi-detector row CT imaging is mandatory.