From the Guidelines
The workup for suspected right iliac artery stenosis should begin with a thorough clinical assessment, including a detailed history and physical examination, followed by non-invasive testing such as ankle-brachial index (ABI) measurement and duplex ultrasonography, as recommended by the American College of Radiology 1. The clinical assessment should focus on symptoms like claudication, diminished femoral pulses, and bruits over the iliac arteries. Initial non-invasive testing includes:
- Ankle-brachial index (ABI) measurement, with a value below 0.9 suggesting peripheral artery disease
- Duplex ultrasonography, which provides information on blood flow velocities and the degree of stenosis For more detailed anatomical assessment,
- CT angiography (CTA) or MR angiography (MRA) is recommended, with CTA offering excellent spatial resolution and MRA being advantageous for patients with renal impairment due to reduced contrast requirements 1 In cases where intervention might be necessary,
- Digital subtraction angiography (DSA) provides the most detailed imaging and allows for simultaneous therapeutic intervention Laboratory tests should include:
- Lipid profile
- Blood glucose
- Renal function
- Inflammatory markers to assess cardiovascular risk factors and guide management This comprehensive approach enables accurate diagnosis of right iliac artery stenosis and helps determine the most appropriate treatment strategy, whether medical management or revascularization, with antiplatelet adjunctive therapy and bilateral percutaneous transluminal angioplasty being usually appropriate treatments 1.
From the Research
Workup for Suspected Right Iliac Artery Stenosis
The workup for suspected right iliac artery stenosis involves several diagnostic steps to confirm the presence and severity of the stenosis. The following are some of the key components of the workup:
- Color Doppler Sonography: This non-invasive test uses sound waves to create images of the blood vessels and can help identify areas of stenosis or occlusion 2.
- Ankle-Brachial Index (ABI): This test compares the blood pressure in the ankles to the blood pressure in the arms and can help diagnose peripheral artery disease, which can be caused by iliac artery stenosis 2, 3.
- Computed Tomography (CT) Angiogram: This imaging test uses X-rays and contrast dye to create detailed images of the blood vessels and can help identify areas of stenosis or occlusion 2.
- Digital Subtraction Angiography (DSA): This imaging test uses X-rays and contrast dye to create detailed images of the blood vessels and can help identify areas of stenosis or occlusion 3.
- Duplex Scanning: This non-invasive test uses sound waves to create images of the blood vessels and can help identify areas of stenosis or occlusion 3.
Diagnostic Criteria
The diagnostic criteria for right iliac artery stenosis include:
- Stenosis of 50% or greater: This is typically considered significant and may require treatment 4.
- Occlusion: This is a complete blockage of the artery and may require urgent treatment 4.
- Symptomatic relief: Patients with iliac artery stenosis may experience symptoms such as claudication, which can be relieved with treatment 2, 5.
Treatment Options
The treatment options for right iliac artery stenosis include:
- Endovascular stenting: This minimally invasive procedure involves placing a stent in the affected artery to keep it open 2, 6.
- Angioplasty: This minimally invasive procedure involves using a balloon to widen the affected artery 6, 5.
- Surgery: This may be necessary in some cases, such as when the stenosis is severe or when other treatments have failed 6.