Vascular Imaging of the Foot: The First Step toward Endovascular Recanalization
RadioGraphics 2011; 31:1623-1636
Marco Manzi, MD , Giacomo Cester, MD , Luis M. Palena, MD , Josef Alek, RT ,Alessandro Candeo, RT , Roberto Ferraresi, MD
In the past 5 years, with the introduction of new techniques and dedi¬cated materials, endovascular recanalization of distal tibial and pedal vessels has become a valid alternative to inframalleolar bypass for limb salvage in patients with severe arterial occlusive disease, particularly diabetics. Revascularization of the foot is now often performed by using percutaneous transluminal angioplasty; over a 4-year period, the authors performed more than 2500 antegrade interventional procedures in pa¬tients with critical limb ischemia, diabetes, and infrainguinal arterial disease. Intraprocedural angiography of the foot is crucial for successful planning and guidance of percutaneous transluminal angioplasty in tibi¬al and pedal arteries, and its effective use requires both anatomic knowl¬edge and technical skill. To select the best revascularization strategy and obtain optimal clinical results, interventional radiologists, cardiologists, and vascular surgeons performing below-the-knee endovascular proce¬dures also must be familiar with the functional aspects of circulation in the foot.