From the Guidelines
A lower extremity angiogram is a medical imaging procedure that provides a definitive method for anatomic evaluation of lower extremity peripheral arterial disease using catheter arteriography with iodinated contrast, as stated in the 2023 update of the ACR Appropriateness Criteria 1. This procedure involves inserting a thin catheter into an artery, typically in the groin area, and guiding it to the arteries in the legs, where a contrast dye is injected to make the blood vessels visible on X-ray images. The resulting images help doctors identify blockages, narrowing, aneurysms, or other abnormalities in the leg arteries, which is crucial for diagnosing peripheral artery disease (PAD) and planning treatments for circulation problems. Some key points to consider when performing a lower extremity angiogram include:
- The use of digital subtraction angiography, which allows for enhanced imaging capabilities compared to conventional unsubtracted contrast angiography 1.
- The importance of selective or super selective catheter placement to enhance imaging, reduce contrast dose, and improve sensitivity and specificity of the procedure 1.
- The need for patients with baseline renal insufficiency to receive hydration before undergoing contrast angiography to minimize the risk of adverse effects 1.
- The recommendation for follow-up clinical evaluation, including a physical examination and measurement of renal function, within 2 weeks after contrast angiography to detect any delayed adverse effects 1. Overall, a lower extremity angiogram is a valuable diagnostic tool for evaluating lower extremity peripheral arterial disease, and its use should be guided by the most recent and highest quality evidence, such as the 2023 update of the ACR Appropriateness Criteria 1.
From the Research
Definition of Lower Extremity Angiogram
A lower extremity angiogram is a medical imaging procedure used to visualize the blood vessels in the lower extremities, such as the legs and feet.
Purpose of the Procedure
The purpose of a lower extremity angiogram is to diagnose and treat peripheral arterial disease (PAD) and critical limb ischemia, which can lead to limb amputation if left untreated 2, 3.
Diagnostic and Interventional Angiography
Diagnostic and interventional angiography using iodinated contrast agents provides excellent image resolution, but can be associated with contrast-induced nephropathy (CIN) 2.
- The use of carbon dioxide (CO2) as a contrast agent reduces the volume of iodine contrast required for angiography and reduces the incidence of CIN.
- Modern CO2 delivery systems with advanced digital subtraction angiography techniques and hybrid angiography have improved imaging accuracy and reduced the incidence of CIN.
Management of Peripheral Artery Disease
The management of peripheral arterial disease includes conservative therapies, pharmacological treatments, interventional and surgical revascularization of blood vessels 3, 4.
- Percutaneous transluminal angioplasty with balloons and stents has improved clinical outcomes compared to medical treatment alone.
- Medical therapies have demonstrated efficacy in reducing the risk of major adverse cardiovascular events and major adverse limb events, and improving function in patients with PAD.
Catheter-Based Interventions
Catheter-based interventions are used to treat lower extremity peripheral artery disease, with a growing evidence base for treatment and a myriad of new interventional approaches to complex disease 5.