Colour Doppler Ultrasound Versus CT Angiography or MR Angiography in Diagnosis of Lower Limb Ischaemia
Authors: Abd El-Hamid Aya Talaat Ibrahim , Nooman Darweesh Abd Elmonem , ElWageih Mohamed Morsy , Hamesa Manal Fathy 
Published: January 2022

Background: Limb Ischemia is an obstruction of the arteries which reduces blood flow to the extremities (hands, feet and legs) and has progressed to the point of severe pain and even skin ulcers, sores, or gangrene. The pain caused by ischaemia can -wake up an individual at night. This pain is often in the leg and can be relieved temporarily by hanging the leg over the bed or getting up to walk. The complications of diabetic vasculopathy commonly include two categories: microvascular and macro-vascular complications. Macro vascular disease is the most common reason of mortality and morbidity in diabetes and is responsible for high incidence of vascular diseases such as stroke, myocardial infarction, and peripheral vascular diseases (PAD). Epidemiological evidence has confirmed an association between diabetes and increased prevalence of PAD. The duration and severity of diabetes correlate with incidence and extent of PAD. Diabetes changes the nature of PAD.

Aim of the Work: The aim of this present study is to evaluate the role of colour Doppler Ultrasound (US) in the diagnosis of lower limb ischaemia.

Patients and Methods: In this study, 40 diabetic patients with ischemic limb underwent arterial reconstruction or intervention bypass surgery at Department of Diagnostic Radiology, Tanta University Hospitals. The age of our selected patients ranged from 40-80 years showing that about 2/3 patients in this study were above the age of 60 years and this was found in 24 patients (60%) this is due to high incidence of ischemia and prevalence of atherosclerosis in old age.

Results: There are variable risk factors were present. DM was present in 100% of patients followed by hypertension was found in 30 patients (75%) coronary heart disease was found in 9 patients (22.5%) and at least cigarettes smoking was found in 12 patients (30%). Regarding the clinical presentation, intermittent claudication pain was the most frequent symptoms and was present in 26 patients (65%), followed by persistent pain and delayed healing foot ulcer was present in 9 patients (22.5%), followed by rest pain was present in 4 patients (10%) at least amputated leg was present in one patient (2.5%). Colour Doppler US has some limitation eg. In ability to see particular vessels wall due to wall calcification, gases and vessels tortuously. Colour Doppler US sometimes failed to differentiate between tight stenosis and total occlusion. CTA still had an important role especially in the infra-popliteal region and peri-vascular masses.

Conclusion: Our study suggested that computed tomography angiography can be used to assess the entirety of lower extremity arterial inflow and runoff, with volumetric data that demonstrate robust arterial enhancement and minimal venous opacification. Nevertheless, computed tomography angiography cannot be considered a viable clinical alternative to colour Doppler US until its diagnostic accuracy and effectiveness are determined.