Page 7 - Carotid and peripheral vascular interventions textbook
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                  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
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