Vascular Ulcers

Preliminary Diagnosis: Vascular Ulcers

I. What imaging technique is first-line for this diagnosis?

• Ultrasound of the vessel of concern.

II. Describe the advantages and disadvantages of this technique for diagnosing vascular ulcers.

Advantages

• Highly portable imaging modality.

• Does not expose patients to ionizing radiation.

• Highly adept in detailing the velocity and directionality of the flow of blood within vessels.

Disadvantages

• Limited in sensitivity and specificity in evaluating the endothelium of the vessel of concern.

• Less useful in guiding endovascular therapy in patients, compared to catheter angiography.

• Highly operator dependent.

• Limited in evaluating the surrounding soft tissues and osseous structures.

III. What are the contraindications for the first-line imaging technique?

No specific contraindications to ultrasound exist.

IV. What alternative imaging techniques are available?

• CTA imaging

• MRA imaging

• Catheter angiography all utilizing IV contrast medium

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing vascular ulcers.

CTA imaging

Advantages

• Highly sensitive and specific in evaluating the vasculature and detailing any endothelial abnormality.

• Offers exquisite visualization of the surrounding soft tissues, osseous structures, and vasculature.

• Highly specific in characterizing any secondary complications.

Disadvantages

• Exposes the patients to ionizing radiation.

• Less adept in guiding therapeutic intervention.

MRA imaging

Advantages

• Does not expose patients to ionizing radiation.

• Offers exquisite detail of the surrounding soft tissues.

• Moderate in sensitivity and specificity in detecting the vasculature structures and is less sensitive and specific in detailing any endothelial abnormalities.

Disadvantages

• Expensive.

• Time consuming.

• Subject to motion and susceptibility weighted artifact, degrading image quality.

Catheter angiography all utilizing IV contrast medium

Advantages

• Gold standard in detecting, characterizing, and diagnosing vascular ulcers and any vascular endothelial abnormalities.

• Offers both diagnostic capabilities and therapeutic access in diagnosing and treating vascular ulcers and any secondary complications.

Disadvantages

• Exposes patients to ionizing radiation.

• Exposes patients to increased morbidity and mortality secondary to the invasiveness of the procedure.

• Contraindicated in patients who are in an hypocoaguable state.

VI. What are the contraindications for the alternative imaging techniques?

CTA imaging

• May be contraindicated in pregnant patients and those in renal failure who are not on an adequate dialysis regimen.

• May be contraindicated in patients with contrast allergy.

MRA imaging

• May be contraindicated in patients with non-MR compatible hardware.

Catheter angiography all utilizing IV contrast medium

• Catheter angiography may be contraindicated in patients in a hypocoaguable state.