Vascular imaging relies on “poor man’s surrogate”


Three dimensional and functional imaging is set to revolutionise the vascular field, Joachim Wildberger, University Hospital of Aachen, Germany, told delegates at the European Vascular Course, Maastricht, in February.

Wildberger said that vascular imaging presently relies on the “poor man’s surrogate”: “We check the patient for the length of the lesion and the diameter – usually, we place a ruler on the level of the lesion, in order to get some kind of idea,” he said.

He also described how the field acquires “pseudo-3D” images through rotational angiograms, and derives additional “functional” information from the delivery of contrast media.

A poll of the audience showed that European vascular surgeons have high expectations for functional imaging, but that, for lower limb procedures, they mostly still rely on conventional catheter angiography (48.1%), and for carotid procedures they have a preference for ultrasound (44.7%).

Half of the audience felt that computed tomography and magnetic resonance angiography modalities are presently of limited use.

Wildberger responded: “From my perspective the wrong answer is that computed tomography and magnetic resonance angiography are not robust enough to serve as a basis for individual decision making.

“Nonetheless, it’s quite true that there is still a need for a lot of post-processing, which can limit their use unless you have a dedicated technician available.”

However, he said that, as they increase their capacity for gathering functional data, these modalities could be of great value to the vascular surgeon.

Wildberger described the increasing utility of 3D images: “If you can make this kind of assessment, then you do not just rely on an estimate, but can really take a measurement on the level of the disease.”

“The trends in imaging are that we are leaving anatomy, because most of the questions regarding anatomy are already covered,” he added, “and we are going more and more into the area of biology.

“Or, we can put it another way; we are leaving the morphology and are interested in more functional data.”


Papers from the European Vascular Course are published by Edizioni Minerva Medica.