Computed tomography angiography in the management of lower limb peripheral arterial disease at Moi Teaching and Referral Hospital, Kenya

Abstract

Background: Peripheral arterial disease (PAD) is a slow and progressive disease of the lower extremities characterised by stenosis or occlusion of the arteries and a major cause of morbidity globally. In the past decade, Computer Tomography Angiography (CTA) has become a standard non-invasive imaging modality for the depiction of vascular anatomy and pathology. Objective: To describe CTA as a diagnostic tool and treatment planning in peripheral artery disease of the lower limbs. Methods: This was a descriptive cross-sectional study conducted among 66 patients with peripheral artery disease of the lower limbs at the Radiology and Imaging department of Moi Teaching and Referral Hospital (MTRH) between September 2021 and August 2022. Imaging findings from CTA were documented, detailing anatomical artery involved and extent in the same questionnaire. Fisher’s exact test was used to test the association between diagnosis and CTA findings, as well as the relationship between CTA findings and treatment plan calculated. Likelihood ratios between predictor and outcome variables were computed at 95% confidence interval. Results: On CTA, 56.1% had occlusions. The posterior tibial artery had highest occlusions at 39.4% with a statistically significant association between CTA findings and claudication of walking less than 200 meters noted. Additionally, CTA findings directly influenced the surgical intervention offered. Conclusions: Majority of those enrolled were elderly males with claudication of walking less than 200 meters. The most common CTA finding was posterior tibial occlusion. CTA findings were significantly associated with surgical management plan. Recommendations: This study stimulates further inquiry and scholarship, creating the need for a larger study to elucidate additional risk factors.