References

Advised 1st choice investigation method

Advantages of CTA

Disadvantages of CTA

Ikuo Fukuda

(2015) Japan

CTA or Doppler Ultrasound

Availability and scan timing

Accurate

Radiation exposure

Nephrotoxic

S Puppala

(2009) UK

CTA is described as a “clinical tool” for the evaluation of the arterial system. Imaging should be used in Rutherford classification I - IIa; Revascularisation if Rutherford classification more than IIb

Availability out-of-hours and scan timing

Accurate—0.6-millimetre slices and 3D reconstruction

Can be used if MRA is contraindicated

Additional information on structural anatomy

Radiation exposure

Iodinated contrast allergy

False-positive due to vessels calcification.

False-positive due to unopacified vessels with the contrast (contrast timing)

Alex Wallace

(2019) USA

Authors preference is CTA for ALI Rutherford classification I - IIa and in some cases IIb.

Non-invasive

Available

Accurate—0.6-millimetre slices and 3D reconstruction

Extravascular findings

Preoperative planning

Radiation exposure

Nephrotoxic

Contraindicated if eGFR less than 30 mL/min.

False-positive results due to vessels calcification (over staging 8%, under-staging 15%) or unopacified vessels with the contrast

Anthony N. Hage

(2018) USA

CTA for ALI Rutherford classification I - IIa and in some cases IIb.

Non-invasive

Accurate—High resolution imaging

Preoperative planning

-

Charles Gilliland

(2017) USA

The authors “favoured” choice of imaging is CTA.

Preoperative planning

-

M. Duran

(2016) Germany

Doppler for ALI Rutherford classification I - II

DSA

Available and scan timing

Helps to make definitive management

-

M. Duran

(2017) Germany

Doppler and CTA

Available and scan timing

Helps to make definitive management

-

T. Gregory

(2009) USA

Doppler or DSA for ALI Rutherford classification I - IIa, in some cases IIb

-

Radiation exposure

Use of ionizing contrast

Fail to visualise target vessels

Andrew Nickinson

(2018) UK

CTA

Non-invasive

Availability

Accurate—High resolution imaging

Nephrotoxicity

Dan-Mircea Olinic

(2019) Romania

Doppler—1st imaging choice for Rutherford classification I - IIa

DSA—“gold standard”

Non-invasive

Accurate—High resolution imaging

Contraindicated if eGFR less than 60 mL/min.

Nephrotoxicity

Balaji Natarajan (2020) USA

Doppler—1st imaging choice

DSA—“gold standard”.

Availability and scan timing

Accurate—3D resolution

Preoperative planning

Sensitivity 91% - 100%

Specificity 93% - 96%

Allergy to ionizing contrast

Contraindications, such as chronic kidney disease

Nephrotoxicity

Martin Bjorck

(2020) UK

DSA—“gold standard”

Availability

Accurate—High resolution imaging

Extravascular findings

Preoperative planning

Nephrotoxicity

Contraindicated with eGFR less than 30 mL/min

Delay in treatment

Clifford R. Weiss

(2017) USA

DSA—“gold standard”

Noni-invasive

Accurate—multidetector-row resolution

Affordability—cost-effectiveness

Can be used in patients with MRA contraindications

Reduced radiation dosages for a single CTA examination

Radiation exposure

Contraindication if eFDR less than 45 mL/min

Nephrotoxicity

Poor visualisation of heavily calcified vessels

Yaseen Oweis (2016) USA

-

Availability

Accuracy

Preoperative planning

Nephrotoxicity

False-positive due to unopacified vessels with the contrast

False-positive results die to vessels calcification

Extravascular findings can be missed