CT Angio in the workup of PAD

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CT Angio in the workup of PAD

• Jack Chamberlin MD, FACC
• Assistant Director of Cardiac Cath Lab
• Director of Cardiac CT
• Alexian Brothers Medical Center

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CTA in PAD

• Carotid Disease
• Once we decide the patient needs an angio, CTA is
  a reasonable alternative
• Can decide on treatment plan without catheter
  manipulation
• Not really significantmed management
• Heavily calcified/tortuous archsurgery
• Atheromatous (without Ca)/friendly archpossible
  stent candidate
• Arch Type Type I to Type III
• If common carotids are at nearly the same level
  as the peak of the arch
• easier to pass sheaths into common carotidsokay
  for stenting
• If common carotids are lower than peak of arch
• More difficult to pass sheath into common
  carotids
• Risk of carotid stenting is higher

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CTA in PAD

• Carotid Disease
• Why spend the contrast and radiation?
• Can avoid any angio if not too bad or if surgical
• Can limit angio to one vessel for stenting
• Can help plan stenting
• Vessel sizing
• See where the calcium is
• Rule out proximal common carotid disease

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CTA
Angio post stent
Angio pre
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CTA in PAD

• Abdominal Aortic Aneurysm
• CTA a requirement for stent graft workup
• CTA quality is such (and software so good) that
  angio not needed in most cases
• CTA is how we decide if stent graft an opton
• Not a stent graft candidate if
• Neck too short
• Diameter of aneurysm too large proximally
• Unable to preserve at least one internal iliac
• Iliacs too tortuous/calcified/diseased

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Aortic Ulcer-- Contained perf?
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CTA-pre
Angiopre
Angio-post stent graft
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CTA in PAD

• Lower Extremity PAD
• Can see from celiac artery to the feet with 15
  min outpatient visit without sticking the groin
• Why spend the contrast and radiation?
• Without catheter manipulation (and risk of
  emboli)
• Can discover mesenteric disease easily
• Can evaluate renal arteries from any angle
• Can find accessory renals much easier
• Can find aortic pathology safely
• Aortic ulcer/AAA
• Can plan intervention
• Iliac involvement or not
• Occluded or stenotic SFA and what kind of
  reconstitution
• Tibial runoff

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Post stents
Angio pre
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CTA pre
Angio post Silver Hawk
Angio pre
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Post Angiojet and Lytics
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Post covered stents
Runoff
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Angio Pre
Angio Post Silver Hawk
Pre CTA
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CTA in PAD

• Conclusion
• CTA is an excellent pre-intervention test
• It is less invasive than diagnostic angio
• No risk of stroke with carotid evaluation vs.
  angio
• Can help plan AAA and lower extremity
  interventions