Aim To evaluate run-off computed tomography angiography (CTA) of abdominal
aorta and lower extremities for detecting musculoskeletal pathologies and
clinically relevant extravascular incidental findings in patients with
intermittent claudication (IC) and suspected peripheral arterial disease
(PAD). Does run-off CTA allow image-based therapeutic decision making by
discriminating the causes of intermittent claudication in patients with
suspected peripheral arterial disease PAD? Material and Methods Retrospective
re-evaluation of CTAs performed in patients with acute or chronic intermittent
claudication (i.e., Fontaine stages I to IIB) between January 2005 and October
2013. Allocation to one of three categories of underlying causes of IC
symptoms: vascular, musculoskeletal (MSK) or both. Clinically relevant
extravascular incidental findings were evaluated. Medical records were
reviewed to verify specific therapies as well as main and incidental findings.
Results While focused on vascular imaging, CTA image quality was sufficient
for evaluation of the MSK system in all cases. The underlying cause of IC was
diagnosed in run-off CTA as vascular, MSK and a combination in n = 138 (65%),
n = 10 (4%), and n = 66 (31%) cases, respectively. Specific vascular or MSK
therapy was recorded in n = 123 and n = 9 cases. In n = 82, no follow-up was
possible. Clinically relevant extravascular incidental findings were detected
in n = 65 patients (30%) with neoplasia, ascites and pleural effusion being
the most common findings. Discussion Run-off CTA allows identification of
vascular, MSK, and combined causes of IC in patients with suspected PAD and
can guide specific therapy. CTA also allowed confident detection of crEVIF
although detection did not necessarily trigger workup or treatment
