Guidelines for the assessment of the aorta and iliac arteries

After clinical assessment of the patient, the first diag- nostic procedure is duplex scanning (DS) and color-coded duplex scanning (CDS). They are extremely reliable in aneu- rysm and obstructive disease. In a review of 14 comparative studies of DS and angiography reported in literature, Koe- lemay et al indicate a sensitivity for the aorto-iliac district that ranges from 80% to 86%, with specificity of 95-97% for the stenosis above 50%, and a sensitivity of 94%, with specificity of 99%, for occlusion. The CDS allows for the highlighting of the profile of the aortic and iliac wall and of the diameter as well as providing information on the ori- gin of the main branches. In aneurysms, it allows an assess- ment of the diameter at the renal level (above and below), of the maximum diameter of the aorta and, whether there is a horizontal collar below the renal area. It also high- lights any thickening of the walls (aortitis – inflammatory aneurysm) and the presence of a endoluminal thrombus or signs of dryness. Supplementary radiological imaging completes the US study in determining the area and nature of the lesion and in assessing the wall pathology, in view of a reconstructive surgical or endovascular approach. The planning of surgi- cal treatment based on AngioMR6 with contrast means as completion of an CDS differs significantly from that based on US investigation alone. A study carried out by 3 surgeons who proceeded to plan treatment to the aorta-iliac- femoral area highlighted a correct choice in 49-63% with DS alone, and in 70-77% with AngioMR alone, which is thus proved to be more efficient than US, but does not suf- fice for correct therapeutic planning. The supplementary and complementary angiography is no longer used in diagnostics. In patients with mul- ti-district arterial disease, destined for surgery and for whom non-invasive diagnostics is not considered to be sufficient, angiography may be performed during actual surgery.