Page 46 - Virtual Vascular Vol 15

CT Angiogram

This is the CT lower limb angiogram or-
dered for a 71-old man who had a pro-
longed stay in ICU and developed small
gangrenous patches of his toes bilaterally.

CT Angiogram can show very nice anatomy

of the lower limbs (in this case, also a 6cm
AAA). Aside from multiple calcifications in
the low aorta and the SFA, and an attenu-
ated dorsalis pedis artery, the CTA is largely
normal.

This does not mean that CTA should be
used as a first line investigation for sus-
pected lower limb ischemia. Unfortunate-
ly this is commonly done. In this case the
CTA was ordered even without palpation
of pulses. He had excellent posterior tibial

pulses and reasonable anterior tibials as
well. The CTA is probably unnecessary.

Can you identify the three infrapopliteal
arteries?

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