Contemporary follow-up imaging after endovascular repair of lower extremity atherosclerotic lesions
More details
Hide details
Submission date: 2018-11-01
Acceptance date: 2018-11-22
Publication date: 2018-12-09
Pol J Radiol, 2018; 83: 521-529
Atherosclerotic disease is currently one of the most important problems of modern medicine because it is a leading cause of increased morbidity, morbidity and mortality, and disability in the Western World. Atherosclerosis of the lower limbs (peripheral arterial disease – PAD) significantly affects the quality of life and in a considerable proportion of patients is a cause of disability. Radical treatment of PAD, both surgical and endovascular, aims at revascularisation of ischaemic tissues distal to obstructed arteries. Surveillance imaging is an important part of patient management after endovascular repair of PAD. Apart from availability and contraindications, challenges of imaging include calcifications, flow dynamics, and stent-related artefacts. The aim of this paper was to review the current literature on imaging methods for follow-up after endovascular repair of atherosclerotic lesions, with special attention paid to novel techniques. As a non-invasive modality, ultrasound is still the first-line examination, but computed tomography angiography remains a current state-of-the art technique for follow-up. However, since current imaging recommendations seem not to adhere to contemporary imaging possibilities, more attention should be paid to recent improvements in magnetic resonance angiography technology.
Golec K, Szewczyk MT, Stodolska A, et al. Evaluation of perioperative standard of care among patients with peripheral arterial occlusive disease. Surg Vasc Nurs 2007; 2: 69-76.
Faisal AA, Leslie T, Cooper JR. Peripheral arterial Disease: Diagnosis and management. Mayo Clin Proc 2008; 83: 944-950.
Tendera M, Aboyans V, Bartelink ML, et al. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases. Eur Heart J 2011; 32: 2851-2906.
Russell R. Atherosclerosis an inflammatory disease. N Engl J Med 1999; 340: 115-126.
Dua A, Lee CJ. Epidemiology of Peripheral Arterial Disease and Critical Limb Ischemia. Tech Vasc Interv Radiol 2016; 19: 91-95.
Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg 2007; 33: 1-70.
Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg 2007; 33: 1-75.
Setacci C, de Donato G, Terra M, et al. Treatment of critical limb ischaemia. Eur J Vasc Endovasc Surg 2011; 42: 43-59.
Cheshire NJ, Noone MA, Wolfe JH. Re-intervention after vascular surgery for critical leg ischaemia. Eur J Vasc Surg1992; 6: 545-550.
Giles K, Pomposelli FB, Spence TL, et al. Infrapopliteal angioplasty for critical limb ischemia: relation of TransAtlantic InterSociety Consensus class to outcome in 176 limbs. J Vasc Surg 2008; 48: 128-136.
Jos C. In-stent restenosis management: the best is yet to come. J Cardiovasc Surg 2017; 58: 508-517.
Dhore C, Cleutjens JP, Letqens E, et al. Differential expression of bone matrix regulatory proteins in human atherosclerotic plaques. Arterioscler Thromb Vasc Biol 2001; 21: 1998-2003.
Parhami F. Regulation of vascular calcification in atherosclerosis. Z Kardiol 2001; 90: 27-30.
Spronk HM. Matrix Gla protein accumulates at the border of regions of calcification and normal tissue in the media of the arterial vessel wall. Biochem Biophys Res Commun 2001; 289: 485-490.
Jóźwicka M, Głąbiński A. Pathogenesis of development of atheromatous plaque in carotid arteries. Aktual Neurol 2011; 11: 265-273.
Tam M, Ahnood D, Tanqueray A, et al. Endovascular treatment of a superficial femoral artery aneurysm using an Amplatzer Vascular Plug. Diagn Interv Radiol 2013; 19: 516-517.
Alfonso F. Treatment of In-stent Restenosis – Past, Present and Future. Eur Cardiol 2009; 5: 74-78.
Rastan A, Krankenberg H, Baumgartner I, et al. Stent placement versus balloon angioplasty for the treatment of obstructive lesions of the popliteal artery: A prospective, multicenter, randomized trial. Circulation 2013; 127: 2535-2541.
Kazimierczak W, Serafin Z, Kazimierczak N, et al. Contemporary imaging methods for the follow-up after endovascular abdominal aneurysm repair: a review. Videosurgery Miniinv; DOI:
Barleben A, Bandyk DF. Surveillance and follow-up after revascularization for critical limb ischemia. Semin Vasc Surg 2014; 27: 75-81.
Małek G, Elwertowski M, Nowicki A. Standards of the Polish Ultrasound Society – update. Ultrasound examination of the aorta and arteries of the lower extremities. J Ultrasonogr 2014; 14: 192-202.
Mills JL, Conte MS, Armstrong DG, et al. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg 2014; 59: 220-234.
Ignjatović N, Stojanović M, Stanojević G, et al. Relationship between subjective discomforts and evaluation of diagnostic procedures based on the stages of chronical artery insufficienty of lower extermities. Acta Med Medianae 2016; 55: 44-55.
Lemanowicz A, Serafin Z. Imaging of patients treated with bariatric surgery. Pol J Radiol 2014; 79: 12-19.
Humphries M, Pevec WC, Laird JR, et al. Early duplex scanning after infrainguinal endovascular therapy. J Vasc Surg 2011; 53: 353-358.
Bui TD, Mills JL, Ihnat DM, et al. The natural history of duplex-detected stenosis after femoropopliteal endovascular therapy suggests questionable clinical utility of routine duplex surveillance. J Vasc Surg 2012; 55: 346-352.
Serafin Z, Karolkiewicz M, Gruszka M, et al. High incidence of nephropathy in neurosurgical patients after intra-arterial administration of low-osmolar and iso-osmolar contrast media. Acta Radiol 2011; 52: 422-429.
Cao P, Eckstein HH, De Rango P, et al. Management of Critical Limb Ischaemia and Diabetic Foot. Clinical Practice Guidelines of the European Society for Vascular Surgery. Chapter II: Diagnostic Methods. Eur J Vasc Endovasc Surg 2011; 42: 13-32.
Met R, Bipat S, Legemate DA, et al. Diagnostic performance of computed tomography angiography in peripheral arterial disease: a systematic review and meta-analysis. JAMA 2009; 301: 415-424.
Anzidei M, Lucatelli P, Napoli A, et al. CT angiography and magnetic resonance angiography findings after surgical and interventional radiology treatment of peripheral arterial obstructive disease. J Cardiovasc Comput Tomogr 2015; 9: 165-182.
Nyheim T, Staxrud LE, Jorgensen JJ, et al. Radiation exposure in patients treated with endovascular aneurysm repair: what is the risk of cancer, and can we justify treating younger patients? Acta Radiol 2017; 58: 323-330.
Maaniitty T, Stenström I, Uusitalo V, et al. Incidence of persistent renal dysfunction after contrast enhanced coronary CT angiography in patients with suspected coronary artery disease. Int J Cardiovasc Imaging 2016; 32: 1567-1575.
Abada HT, Golzarian J. Multidetector CT in Abdominal Aortic Aneurysm Following Endovascular Repair: How to Consider the Value of a Delayed Phase. Eur Radiol 2005; 15: 334-341.
Böninig G, Rotzinger RA, Kahn JF, et al. Tailored CT angiography in follow-up after endovascular aneurysm repair (EVAR): combined dose reduction techniques. Acta Radiol 2018; 59: 1316-1325.
Hansen NJ, Kaza RK, Maturen KE, et al. Evaluation of low-dose CT angiography with model-based iterative reconstruction after endovascular aneurysm repair of a thoracic or abdominal aortic aneurysm. AJR Am J Roentgenol 2014; 202: 648-655.
Ota H, Takase K, Igarashi K, et. al. MDCT compared with Digital Substraction Angiography for assessment of lower extremity arterial occlusive disease: Importance of reviewing cross-sectional images. AJR Am J Roentgenol 2004; 182: 201-209.
Zhang X. Metal artifact reduction in x-ray computed tomography (CT) by constrained optimization. Med Phys 2011; 38: 701-711.
He C, Gu M, Jiang R, et al. Noninvasive assessment of the carotid and cerebrovascular atherosclerotic plaques by multidetector CT in type-2 diabetes mellitus patients with transient ischemic attack or stroke. Diabetol Metab Syndr 2013; 5: 9.
Köhler M, Burg MC, Bunck AC, et al. Dual-source CT Angiography of Peripheral Arterial Stents: In Vitro Evaluation of 22 Different Stent Types. Radiol Res Pract 2011; 103873: 1-7.
Abdulrahman A, Sun Z, Al Safran Z, et. al. Optimal Scanning Protocols for Dual-Energy CT Angiography in Peripheral Arterial Stents: An in Vitro Phantom Study. Int J Mol Sci 2015; 16: 11531-11549.
Hentsch A, Aschauer MA, Balzer JO, et. al. Gadobutrol-enhanced moving-table magnetic resonance angiography in patients with peripheral vascular disease: a prospective, multi-centre blinded comparison with digital subtraction angiography. Eur Radiol 2003; 13: 2103-2114.
Ho KJ, Leiner T, Hann MW, et al. Peripheral vascular tree stenoses: evaluation with moving-bed infusion-tracking MR angiography. Radiology 1998; 206: 683-692.
Pollak AW, Kramer CM. MRI in Lower Extremity Peripheral Arterial Disease: Recent Advancements. Curr Cardiovasc Imaging Rep 2013; 6: 55-60.
Ersoy H, Rybicki FJ. MR angiography of the lower extremities. AJR Am J Roentgenol 2008; 190:1675-1684.
Lakshminarayan R, Simpson JO, Ettles DF. Magnetic resonance angiography: Current status in the planning and follow-up of endovascular treatment in lower-limb arterial disease. Cardiovasc Intervent Radiol 2009; 32: 397-405.
Bartels LW, Smits HF, Bakker CJ et al. MR imaging of vascular stents: effects of susceptibility, flow, and radiofrequency eddy currents. J Vasc Interv Radiol 2001; 12: 365-371.
Bartels LW, Bakker CJ, Viergever MA. Improved lumen visualisation in metallic vascular implants by reducing RF artifacts. J Magn Reson Med 2002; 47: 171-180.
Quick HH, Ladd ME, Nanz D, et al. Vascular stents as RF antennas for intravascular MR guidance and imaging. J Magn Reson Med 1999; 42: 738-745.
Maintz D, Kugel H, Schellhammer F, et al. In vitro evaluation of intravascular stent artifacts in three-dimensional MR angiography. Invest Radiol 2001; 36: 218-224.
Admas GJ, Baltazar U, Karmonik C, et al. Comparison of 15 different stents in superficial femoral arteries by high resolution mri ex vivo and in vivo. J Magn Reson Imaging 2005; 22: 125-135.
Bartels LW, Smits HF, Bakker CJ, et al. MR imaging of vascular stents: effects of susceptibility, flow, and radiofrequency eddy currents. J Vasc Interv Radiol 2001; 12: 365-371.
Maintz D, Tombach B, Juergens K, et al. Revealing in-stent stenoses of the iliac arteries: comparison of multidetector CT with MR angio­graphy and digital radiographic angiography in Phantom model. AJR Am J Roentgenol 2002; 179: 1319-1322.
Gitsioudis G, Fortner P, Stuber M, et. al. Off-resonance magnetic resonance angiography improves visualization of in-stent lumen in peripheral nitinol stents compared to conventional T1-weighted acquisitions: an in vitro comparison study. Int J Cardiovasc Imaging 2016; 32: 1645-1655.
Dick F, Ricco JB, Davies AH, et. al. Chapter VI: Follow-up after revascularisation. Eur J Vasc Endovasc Surg 2011; 42: 75-90.
Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017; 135: 726-779.
Connors G, Todoran TM, Engelson BA, et al. Percutaneous revascularization of long femoral artery lesions for claudication: patency over 2.5 years and impact of systematic surveillance. Catheter Cardiovasc Interv 2011; 77: 1055-1062.
DeRubertis BG, Pierce M, Ryer EJ, et al. Reduced primary patency rate in diabetic patients after percutaneous intervention results from more frequent presentation with limb-threatening ischemia. J Vasc Surg 2008; 47: 101-108.
Owens CD, Ho KJ, Kim S, et al. Refinement of survival prediction in patients undergoing lower extremity bypass surgery: stratification by chronic kidney disease classification. J Vasc Surg 2007; 45: 944-952.
Journals System - logo
Scroll to top