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Abstract
CT angiography emerges as a powerful minimally invasive alternative to conventional angiography for identifying aorto-iliac and femoro-politeal aneurysms, stenoses, occlusions, and dissections. It has been particularly successful in imaging patients with aorto-iliac and femoro-popliteal aneurysms. The minimally invasive nature of the method, short examination time, and capability of three dimensional depiction of arteries, all make it an attractive alternative. Color Doppler ultrasound determines not only the presence but also the location and most importantly the homodynamic significance of vascular disease. It is a simple, cheap, and completely non-invasive method, it could replace arteriography in some patients, especially if revealed normal findings. In other patients it will determine the affected segments to be subjected to arteriography leading to improving its results, saving time, contrast media and decreasing complications. This work aimed to evaluate the role of CT angiography and color Doppler imaging as two non invasive techniques in the assessment of different femoral artery diseases. The pathological vascular lesions in the femoral artery segments were classified into: normal, irregular, hemodynamically non-significant (less than 50% DR), hemodynamically significant lesions (50-99% DR) and total occlusion (100% DR).
Twelve patients with limb threatening ischemia or intermittent claudications were referred from the vascular surgical departments of Zagazig University Hospital and outpatients clinics. Their ages ranged from 40-80 years with a mean age of 60 years. Patients population consisted of 9 males (75%) and 3 females (25%). Ten cases were studied with angiography, color Doppler ultrasound and CT angiography, the other two cases were studied by CT angiography and color Doppler US.
With ten femoral stenotic and occluded segments; MIP had overall sensitivity of 97% and specificity of 91%. With color Doppler sensitivity of 94% and specificity 89%.
In our study that was conducted on twelve cases of lower limb with different vascular pathological lesions as irregularity, non significant stenosis, significant stenosis and occlusion vascular lesions. They were examined by conventenal angiography, Doppler scanning and CT angiography. There is ten examined cases of 100 arterial segments where the femoral artery divided into three main arterial segments, common femoral artery, profunda femoral artery and superficial femoral artery that was subdivided into three vascular arterial segment, proximal, middle and distal segment.
In this study, we had 2 cases, one of them was failed to be examined by conventional angiography because there was no detected femoral pulsation at both sides, when examined by C.T.A revealed bilateral common-iliac, external iliac and bilateral proximal CFA occlusion, also with C.D.S no Doppler signals were detected.
So CTA was mere suitable in such cases with absent or weak femoral pulsation as it does not depend upon puncture site. The other case was referred for CTA, it revealed soft tissue mass causing displacement of adjacent distal femoral artery, CTA is more consent in such cases as it well demonstrate the soft tissue, bone and vascular component as well.
The results of our study were comparable to the results of others, in detecting and grading the femoral artery stenoses and occlusions, considering catheter arteriography as the ”gold standard” of references.Conventional angiography, though still generally regarded as the definitive examination for vascular diagnosis, has some limitations. It is invasive, expensive, and poorly suited for screening or long-term follow up testing. In addition, it provides a biplanar view for anatomic rather than physiologic information.