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Duplex ultrasonography has multiple advantages for the assessment of the peripheral arterial tree. It is the least expensive modality, provides physiologic data in addition to imaging, and can easily be performed in the office as well as in the angiosuite or operating room, especially with the newer, more portable machines now available. It is completely non-invasive and does not require the use of potentially nephrotoxic contrast agents. It has been used successfully as a screening tool to decrease the necessity for contrast angiography and may also be used as the single preprocedural imaging modality prior to intervention in approximately 90% of patients The sensitivity and specificity for the detection and determination of degree of stenosis of PAD range between 70 and 90%.
Spatial resolution will continue to improve with the addition of detectors to multidetector CT scanners. Furthermore, the development of non-contrast imaging modalities such as MRA will result in significant advances in vascular imaging by obviating the need for potentially nephrotoxic or systemically toxic contrast agents. With an increasing awareness of the hazards associated with cumulative radiation exposure to both the patient and the clinician, improvements in radiation exposure are likely to be realized.
Cost limitations may drive future adoption of arterial duplex as the primary pre-, during and postintervention imaging modality. Knowledge gained about how specific lesion characteristics on preintervention imaging react to various endovascular treatment modalities will improve the future effectiveness of endovascular therapy for PAD. Advances in molecular imaging will allow interventions to be targeted to those patients with vulnerable plaque, as well as determine which patients are more likely to progress to critical limb ischemia.
Ref: Advances in Diagnostic Imaging for Peripheral Arterial Disease
Gale L Tang; Jason Chin; Melina R Kibbe
Expert Rev Cardiovasc Ther. 2010;8(10):1447-1455.