Extravascular incidental findings in run-off CT angiography in patients with acute limb ischaemia: incidence and clinical relevance

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia

“…In one study, relevant findings needing further investigation or treatment were seen in up to 74% of investigations. 49 Four (2.8%) patients in the latter series had previously unknown malignancy. 49 CTA is considered more useful than DSA because it can combine evaluation of the possible primary cause of ALI with high resolution evaluation of the outflow tract and provide a roadmap to guide treatment.…”

“…49 Four (2.8%) patients in the latter series had previously unknown malignancy. 49 CTA is considered more useful than DSA because it can combine evaluation of the possible primary cause of ALI with high resolution evaluation of the outflow tract and provide a roadmap to guide treatment. In patients with chronic PAD, CTA has a sensitivity of 96% (95% CI 93% e 98%) and a specificity of 95% (95% CI 92% e 97%) for the detection of stenoses > 50% or occlusions from the aorta to the popliteal arteries.…”

Incidental extravascular findings in CT angiograms in patients post endovascular abdominal aortic aneurysm repair: clinical relevance and frequency

“…This study included a large sample of patients (418) and scans (2203) compared to previous studies, ranging from 82 to 290 patients (Preuss et al 2015;Tornqvist et al 2016;Naidu et al 2010;Indes et al 2008;Waqas et al 2014;Gufler et al 2014). The incidence of EVIFs in Class I was higher than most previous studies (range 6.5% -23.7%), but lower than 37 and 42% in Tornqvist et al and Indes et al's studies respectively (Katz et al 1999;McDougal et al 2006;Preuss et al 2015;Tornqvist et al 2016;Naidu et al 2010;Indes et al 2008;Waqas et al 2014;Gufler et al 2014). In our study, classification of EVIFs was similar to Preuss et al's study, which explains the comparable 27% of EVIF incidence (Preuss et al 2015).…”

“…EVIFs were classified according to a previous study and the White Paper of the American College of Radiology (ACR) Incidental Findings Committee 2010 based on clinical relevance, into (I) immediate, (II) potential and (III) no clinical relevance (Preuss et al 2015;Berland et al 2010). Immediate clinical relevance (Class I) was defined as any finding that required urgent intervention, treatment or follow-up and included any highly suspicious malignant findings and infective sources that may lead to severe morbidity or mortality.…”

“…Extravascular structures are readily depicted on CTA and previous studies demonstrated the prevalence of clinically significant incidental findings to be in the range of 5.6 and 12% (Katz et al 1999;McDougal et al 2006). Interestingly, higher rates of detection were shown in more recent studies which focussed on lower limb run off CTA with figures as high as 27% in patients presenting with acute limb ischaemia (Preuss et al 2015). Therefore, our objectives were to primarily evaluate the frequency and clinical relevance of extravascular incidental findings (EVIF) in the post EVAR patient sub-set who undergo CTA and secondarily to assess reporting accuracy by retrospectively scrutinising prior images for evidence of early disease in cases where malignant findings had been demonstrated.…”