Clinical outcomes after digital subtraction angiography versus computed tomography angiography in the preoperative evaluation of lower limb peripheral artery disease.

Abstract

Introduction: Digital subtraction angiography (DSA) was considered the gold standard method for peripheral artery disease (PAD) evaluation. Notwithstanding, recent developments of computed tomography angiography (CTA) have improved the specificity and sensibility of this method. The main objective of this study is to characterize a cohort of patients with lower limb PAD and clarify if there are differences upon groups using different preoperative imaging methods (DSA or CTA).

Methods: This retrospective study focused on patients with PAD that underwent surgical intervention (endovascular revascularization or open surgery). CTA group included all patients submitted to this method as their pre-operative exam, between March 2009 and April 2017. DSA group included patients submitted to DSA as their pre-operative exam within the same period. The groups were compared regarding intervention details, ankle-brachial index (ABI) variation, reintervention, major amputation and mortality rates, and hospital length of stay.

Results: One hundred and two patients were included (33 CTA and 69 DSA). DSA group presented more below the knee lesions with TASC C or D classification (p=0.002), as well as runoff vessels scarcity (p=0.001). There were no differences in the endovascular/open surgery ratio (p=0.308), ABI alteration with intervention (p=0.860), reintervention rates (p=0.236), major amputation (p=0.999), mortality (p=0.574), or hospital length of stay (p=0.933).

Conclusion: CTA seems to achieve equivalent performance to DSA for morphological and therapeutic planning of PAD. Nevertheless, extrapolation to patients with TASC C or D distal lesions cannot be performed.