Digital Subtraction Angiography or Computed Tomography Angiography in the Preoperative Evaluation of Lower Limb Peripheral Artery Disease - A Comparative Analysis.

INTRODUCTION: For several years, digital subtraction angiography (DSA) was considered the gold standard method for the evaluation of PAD patients. This is an invasive technique and allows a good evaluation of collaterals and the vessel lumen, even in cases with associated calcification. Nevertheless, recent technical development of computed tomography angiography (CTA) has improved its specificity and sensibility, besides the fact that CTA is a fast and non-invasive procedure.

OBJECTIVE: To characterize a cohort of lower limb PAD patients and clarify if there are differences among the patients preoperatively evaluated by DSA or CTA.

METHODS: This retrospective study focused on PAD patients with a Rutherford classification ≥ 3 and submitted to intervention (endovascular revascularization or open surgery). The CTA group included all patients submitted to this method as their preoperative exam, between March 2009 and April 2017. In the same period of time, patients submitted to DSA as their preoperative exam, were randomly selected. The exclusion criteria were: realization of the exam for a different diagnosis than PAD, amputation not preceded by revascularization, absence of intervention during a period of 1 year after the realization of the exam. The groups were compared upon the type of surgery (open vs endovascular), number of revascularization sectors, reintervention, amputation, mortality and length of hospital stay.

RESULTS: 34 CTA patients and 71 DSA patients were included. The groups were demographically and clinically homogeneous. In what regards to arterial lesions, the DSA group showed more often lesions of the distal sector with TASC C or D classification (25% in DSA group and 0% in CTA group; p=0,001), as well as scarcity of runoff vessels (0 or 1 in 72% of DSA patients group and 26% in CTA group; p=0.001). There were no differences about the endovascular and open surgery ratio (1.8 to CTA and 1.4 to DSA; p=0.305), reintervention rates (21% CTA and 16% DSA; p=0.517), major amputation (9% CTA and 11% DSA; p=1), minor amputation (9% CTA and 16% DSA; p=0.541), mortality (18% CTA and 23% DSA; p=0,602), or length of hospital stay (median and (interquartile range) of 14 (27) for CTA and 14 (17) for DSA; p=0.933).

CONCLUSION: CTA seems to be a method for morphological and therapeutic planning of PAD that is non-inferior to DSA.