Frank Pomposelli, MD Journal of Vascular Surgery

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Presentation transcript:

Arterial imaging in patients with lower extremity ischemia and diabetes mellitus Frank Pomposelli, MD Journal of Vascular Surgery Volume 52, Issue 3, Pages 81S-91S (September 2010) DOI: 10.1016/j.jvs.2010.06.013 Copyright © 2010 Terms and Conditions

Fig 1 A hybrid, endovascular operating suite. Note the anesthesia equipment and ceiling mounted C-arm that can be moved away from the table during surgery. The fluoroscopy table can be tilted like a typical operating room table and has attachments for the connection of self-retaining retractors. Journal of Vascular Surgery 2010 52, 81S-91SDOI: (10.1016/j.jvs.2010.06.013) Copyright © 2010 Terms and Conditions

Fig 2 Ultrasound scan-guided femoral arterial access is performed by one operator. In this example, the right hand controls the ultrasound probe (a) to image the common femoral artery just proximal to the femoral bifurcation (b). The left hand punctures the artery with the access needle, which can be seen as it enters the common femoral artery (c). Journal of Vascular Surgery 2010 52, 81S-91SDOI: (10.1016/j.jvs.2010.06.013) Copyright © 2010 Terms and Conditions

Fig 3 Foot arteriogram of a woman with toe gangrene: (a) In a contrast injection performed from the external iliac artery with a superficial femoral artery occlusion, the foot arteries are not visualized suggesting a poor situation for either bypass surgery or an intervention. After angioplasty and stenting of the superficial femoral artery, the catheter was repositioned in the proximal popliteal artery. The dorsalis pedis artery and arch vessels are now clearly seen in lateral (b) and anterior/posterior views (c). Journal of Vascular Surgery 2010 52, 81S-91SDOI: (10.1016/j.jvs.2010.06.013) Copyright © 2010 Terms and Conditions

Fig 4 Axial images of a computed tomography (CT) angiogram of the distal lower extremity through the proximal portion of the anterior tibial artery (within the boxes). In the image on the left, setting the window level with too much brightness makes it impossible to differentiate calcium from contrast giving the appearance that the anterior tibial artery is occluded. In the image on the right, after decreasing the brightness, the anterior tibial artery can be seen to be patent with contrast visible within the lumen adjacent to a calcified plaque. Journal of Vascular Surgery 2010 52, 81S-91SDOI: (10.1016/j.jvs.2010.06.013) Copyright © 2010 Terms and Conditions

Fig 5 Maximum intensity projections (MIPs) of an anterior tibial artery displays calcium and stents brightly and can obscure luminal detail making it impossible to determine if the artery is patent (a). With the use of curved planar reformatting, the image of the anterior tibial artery can be reconstructed repeatedly as it is rotated along the center line of the artery allowing visualization of many different points of view (b). The same arterial segment reconstructed from a different perspective demonstrates that the artery is patent. Journal of Vascular Surgery 2010 52, 81S-91SDOI: (10.1016/j.jvs.2010.06.013) Copyright © 2010 Terms and Conditions