Peripheral vascular disease



Peripheral vascular disease



GASTROINTESTINAL VASCULAR DISORDERS


MESENTERIC HAEMORRHAGE







DSA

This can detect active bleeding at a rate of 0.5ml/min image it is performed if an endoscopy is negative or if it is not possible to control the site of haemorrhage








MESENTERIC OCCLUSIVE VASCULAR DISEASE











CAROTID ARTERY STENOSIS


CAROTID ARTERY STENOSIS


DEFINITION




• A reduction in the luminal diameter of the internal or common carotid artery – this is determined by the ratio of the luminal diameter at the point of the maximal stenosis to the luminal diameter in an adjacent normal internal carotid arterial segment


• The carotid bifurcation is the commonest extracranial vessel location for atheroma deposition: >90% of carotid artery stenoses are found at the bifurcation of the common carotid artery or within the proximal internal carotid artery


• An internal carotid arterial stenosis > 50% is an important cause of an ischaemic stroke or a transient ischaemic attack (TIA)


• Patients with a symptomatic carotid stenosis are at higher risk of developing further ischaemic cerebral events than with an asymptomatic stenosis – the risk of developing a cerebral infarction after an ischaemic neurological event is highest within the first 6 months



RADIOLOGICAL FEATURES




Doppler US

This is the first-line investigation and allows reliable identification of the key stenosis levels of a 50% and 70% diameter reduction



• The external carotid artery can be distinguished from the internal carotid artery by the following:



• A 50% diameter reduction is equivalent to a 75% cross-sectional area reduction


• Flow through a stenosis is first accelerated, and only decreases when the lumen is severely narrowed


• Distal to a stenosis, the waveform broadens with a loss in amplitude and eventually pulsatility image it may be difficult to distinguish a critical stenosis (with very slow distal flow) from a total occlusion




DSA

This is not routinely used (it has been replaced by non-invasive methods such as duplex US and MRA/CTA) image it is occasionally used as a problem-solving tool if the non-invasive methods are discordant




PEARLS



Endovascular treatment of a carotid arterial stenosis




US evaluation of an internal carotid arterial stenosis






















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Feb 27, 2016 | Posted by in GENERAL RADIOLOGY | Comments Off on Peripheral vascular disease

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Lesion severity PSV (cm/s) EDV (cm/s) Ratio of the internal carotid PSV to the middle/distal common carotid PSV
≥ 50% 150 60 2.5
≥ 60% 175 70 2.75
≥ 70%