Case of the month - April
Colour Duplex Ultrasound combined with 3D Tomographic Ultrasound as a potential sole imaging modality prior to lower limb arterial reconstruction
Dr Cleona Gray PhD Chief Vascular Physiologist, Mater Misericordiae University Hospital, Dublin 7
Mr Edward Mulkern PhD FRCSEd, Consultant Vascular Surgeon, Mater Misericordiae University Hospital, Dublin 7
The limitations and complications associated with conventional angiography (CA) and MR Angiography (MRA) prior to lower limb revascularization have led to an increased need for a suitable alternative imaging modality. Colour Duplex Ultrasound (CDU) with 3D Tomographic Ultrasound may be an appropriate alternative modality. In patients with limb ischemia a well-performed CDU offers several advantages over traditionally used imaging modalities. CDU is noninvasive and does not require the use of nephrotoxic agents. It is readily available with color flow and waveform analysis providing a better estimation of the hemodynamic significance of disease unlike MR angiography which risks overestimation of disease. It allows visualization of the entire artery and not only of the lumen of the vessel, enabling plaque characterization. Unlike conventional Angiography Color flow and power Doppler techniques have the ability to identify patent native arteries subjected to chronic disease with low flow states. CDU with 3D Tomographic Ultrasound performed by a skilled Vascular Physiologist may represent an alternative to conventional angiography for patients with lower limb ischemia.