Professional Practice Guide -FCSV-EN

17 for the Management of Peripheral Artery Disease A computer then generates three-dimensional reconstructions of the vessels, allowing precise evaluation of the arterial walls and lumen. This technique is very effective, particularly for assessing the aorta and iliac arteries; however, it is costly, exposes the patient to ionizing radiation, and is contraindicated in patients with renal insufficiency. In the case of magnetic resonance imaging (MRI), the patient also lies in a tunnel and, in some cases, receives an intravenous injection of contrast agent (gadolinium). Using a magnet that generates an electromagnetic field, MRI produces highly detailed cross-sectional images of blood vessels while avoiding exposure to X-ray radiation. MRI is the examination of choice for evaluating soft-tissue pathologies that may be associated with PAD (e.g., arterial entrapment). However, this examination is expensive, less accessible, and contraindicated in patients with cardiac defibrillators or metallic foreign bodies. 3.5 TEST OF LAST RESORT Arteriography involves visualization of the body’s arteries using X-ray imaging (fluoroscopy) combined with direct injection of iodine contrast into the arteries. The physician performing the procedure generally uses a femoral approach and, after puncturing the femoral artery and inserting a catheter, advances it to the vessel of interest, where contrast is injected and visualized under fluoroscopy. Long considered the reference standard for diagnosing PAD, this technique is now rarely used for diagnostic purposes due to its invasive nature and the improved performance of CTA and MRI. In specific situations, the specialist may still use it if the diagnostic evaluation is considered inconclusive. 3.6 WHEN SHOULD A SPECIALIST BE CONSULTED? Consultation with a specialist should be considered when symptoms worsen despite optimal medical treatment. Patients classified as Leriche and Fontaine clinical stage III or IV, or those with disabling claudication (stage IIb; Table 4), should also be referred, as should patients with iliac lesions or arterial aneurysms. Urgent consultation is required in cases of acute vascular complications, thrombosis, or embolism. Ӌ Patients classified as Leriche and Fontaine clinical stage III or IV, or those with disabling claudication should be referred to a specialist.