Noninvasive Techniques to Detect Subcritical Iliac Artery Stenoses

Abstract

Severe iliac stenoses in patients with peripheral arterial occlusive disease (PAOD) can be accurately detected bymeans of angiography or duplex scanning. Unfortunately, sub-critical, or borderline, iliac artery stenoses (i.e. with diameter reduction between severe and mild) are missed in approximately 25% of the cases by both angiography and duplex scanning. Since, most of the patients with PAOD are known to have multi-level disease, involving both iliac and femoro-popliteal segments, it is important for the therapeutic management to assess whether iliac stenoses with a sub-critical diameter reduction are of haemodynamic significance and can be regarded as causal to the patient’s complaints. Intra-arterial pressure measurement (IAPM) before and after the administration of a vasodilating agent is the reference diagnostic tool for the haemodynamic assessment of lesions in the iliac arteries. Here, we focus on the noninvasive haemodynamic approach in the detection of sub-critical iliac artery stenoses and discuss the potential of hyperaemic duplex scanning and phase-contrast MRI.