Page 7 - Carotid and peripheral vascular interventions textbook

CHAPTER 12 • FEMOROPOPLITEAL ARTERIAL DISEASE

A B

Figure 12-4. Comparison between computed tomography angiography (CTA) and magnetic resonance angiography (MRA). A: CTA of
bilateral superf cial femoral arteries showing calcif cation clearly. B: MRA of aortoiliac and infrainguinal vessels showing a long occlusion of
right iliac, common femoral, and superif cal femoral artery (white arrows) with reconstitution of blood f ow distal to the occlusion (yellow arrow).
Unlike CTA, MRA is lacking visualization of vascular calcif cation.

• Persistent lifestyle-limiting claudication with of claudication. For asymptomatic patients with PAD
insuff cient response to guideline-directed medical and in patients without signif cant translesional pressure
therapy (GDMT), including structured exercise gradient, endovascular procedures should not be 335
therapy (Class IIa, LOE A). conducted in PAD patients just to prevent or to prophylaxis
• CLI (e.g., non-healing ulcer or gangrene), progression to CLI (Class III, LOE B-R).
revascularization should be conducted whenever
practical to minimize the loss of tissue (Class I, PATIENT SELECTION

LOE B-NR)
• Staged approach for endovascular procedures Preoperative assessment includes angiography
is reasonable for ischemic rest pain patients to def ne location and severity of vascular occlusion
(Class IIa, LOE A) together with guiding the choice of the appropriate
Endovascular procedures are practical as a revascularization strategy. Decision making for treating
revascularization choice for patients who have with surgery or endovascular intervention relies on the
hemodynamically signif cant femoropopliteal disease degree of disabling symptoms, the presence of comorbid
and lifestyle-limiting claudication. The persistent illness, and the anticipated short-and long-term
life-style limiting claudication includes impeded activities outcomes. In general, patients with mild non-disabling
of recreational and/or vocational and/or daily living because claudication should be placed on conservative treatment