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Vascular and Interventional Radiology

E3227. Peripheral Arterial Disease (PAD): Imaging review and Interventional management.

Daruwalla V,  Gunduru M,  Raval K,  Critchfield J,  Harvill M. Wayne State University/DMC, Detroit, Michigan

Address correspondence to V. Daruwalla (vistasp.daruwalla@gmail.com)

Background Information: Peripheral artery disease (PAD) refers to the clinical presentation of atherosclerosis in the lower extremity, usually distal to the iliac arteries. PAD is a major issue among the older population, specifically those above 55 years. The first clinical presentation of PAD is usually intermittent claudication. In few patients, the disease progresses to critical limb ischemia along with rest pain and leading to tissue necrosis. In elderly patients it has demonstrated significant morbidity. Diagnostic imaging is usually performed when PAD progresses to lifestyle-limiting changes and a revascularization procedure is considered. Decision making prior to surgery or percutaneous intervention depends on accurate characterization of the level, multiplicity, and severity of stenoses. The purpose of this exhibit is to review the pathophysiology, incidence, clinical presentation, imaging findings on multiple modalities, and interventional management of PAD.

Educational Goals/Teaching Points: This exhibit reviews incidence, epidemiology, and pathophysiology of PAD; understanding the clinical presentation and classification of various types of PAD; and anatomy of various lower extremity arteries and diagnostic evaluation like segmental blood pressures and Ankle-Brachial Index. The role of various imaging modalities such as color Doppler, CT/MR angiography, interventional angiography, and related imaging findings are reviewed with indication, contraindication, and complication of percutaneous transluminal angioplasty and arterial stenting; and outcomes and patency rates for various types of stents. Viewers of this exhibit will benefit from having a comprehensive understanding of the incidence, pathophysiology, and imaging modalities available for diagnosis, complications, and the role of various management options available for PAD.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: We describe the imaging findings of peripheral arterial disease along with diagnostic and interventional techniques on multiple imaging modalities.

Conclusion: PAD is increasing in prevalence in the aging population. Understanding patient screening and noninvasive testing like blood pressure indexes and color Doppler is vital in deciding further line of management. Interventional procedures and diagnostic imaging assist in lowering morbidity and hospital stay through minimally invasive procedures. Therefore, a thorough knowledge of PAD from occurrence to management is crucial in daily practice.