CTA revolutionizes treatment of peripheral vascular disease

We continue to be both amazed and intrigued by the hype showered on cardiac CT angiography and the corresponding lack of hype given to peripheral vascular CTA. No doubt, 64-slice cardiac or coronary CTA is potentially a revolutionizing technology, but PV-CTA has already revolutionized the comprehensive diagnosis and treatment of peripheral vascular disease. This cardiac CTA infatuation should come as no surprise, as most new technologies are initially tailored toward percutaneous coronary interventions and then adapted to treat PVD. We have experienced this process over the last two decades; endovascular technologies have only recently been designed specifically for PVD. PV-CTA is just as important a tool for treating PVD as any novel device or pharmaceutical technology. As the honeymoon with cardiac CTA wears thin due to multiple practice and clinical issues, including reimbursement, credentialing, and turf wars, PV-CTA continues to shape the comprehensive treatment of PVD with far fewer challenges. PV-CTA may even be the savior for many practices and centers that want to maintain cardiac CTA or pursue a new comprehensive cardiovascular CTA program. An estimated 18 to 20 million patients have peripheral arterial disease in the U.S. Twenty million diabetic patients and a similar number of patients with peripheral venous disease easily make the clinical population significantly greater for PV-CTA than cardiac CTA. An estimated three to four million symptomatic PVD patients are misdiagnosed or go untreated, and twice that number are asymptomatic and, therefore, untreated as well. This latter asymptomatic group would include patients with > 4.5-cm abdominal aortic aneurysm, significant internal carotid artery disease, renal artery stenosis, and celiac artery/superior mesentery artery (CA-SMA) disease. PV-CTA is the ideal noninvasive tool to identify this large asymptomatic patient population for which less invasive endovascular therapies are now available. A paradigm shift to earlier diagnosis and treatment facilitated by PV-CTA has improved our patients' outcomes and dramatically changed our practice. PV-CTA has the potential to improve overall outcomes in millions of PVD patients yearly.