Vascular Imaging of the Foot

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Registered Radiologist Assistant: 2.50
Procedures: 2.50
Neurological, Vascular, and Lymphatic Sections: 2.50

Vascular-Interventional Radiography: 2.50
Procedures: 2.50
Vascular Diagnostic Procedures: 2.50

Vascular Sonography: 1.00
Procedures: 1.00
Extracranial Cerebral Vasculature and Other Sonographic Procedures: 1.00

Outline

1. Introduction
2. Patient Preparation and Interventional Procedure
3. Imaging Technique
4. Pedal Arterial Anatomy and Angiosomes
   1. Anterior Circulation and Angiosomes
   2. Posterior Circulation and Angiosomes
   3. Peroneal Artery Angiosomes
   4. Pedal-Plantar Anastomosis
   5. Anatomic Variants of the Pedal Arteries
5. Conclusions

Objectives

Upon completion of this course, students will:

1. learn an alternative to inframalleolar bypass for limb salvage
2. be familiar with the terms recanalization and revascularization
3. recognize the specialty physicians who perform below-the-knee endovascular procedures
4. know the most common cause of critical limb ischemia
5. identify the most important risk factor for critical limb ischemia
6. learn techniques that have improved results of percutaneous transluminal angioplasty
7. recognize the condition described as calf pain only while walking
8. learn an alternative to an antegrade approach during angiography
9. understand source arteries and what they are called
10. know the number of angiosomes in the foot
11. identify relative contraindications to angiography
12. understand proper patient preparation for a digital subtraction angiogram (DSA)
13. recognize the technique recommended for complex infrapopliteal revascualrization
14. understand radiation safety measures
15. know how to minimize motion artifacts during an angiographic procedure
16. know the key objective when performing a revascularization procedure in the foot
17. realize key characteristics of a DSA unit
18. recognize risks to watch for following an angiography procedure
19. learn the projection that best depicts the common plantar artery bifurcation
20. know the technique to best record collateral or retrograde circulation
21. be able to describe post-processing techniques used with DSA
22. know the projection to best visualize the pedal-plantar loop
23. understand the post-processing technique that allows selection of background anatomy
24. be able to describe the basic vascular anatomy of the foot and it branches
25. identify the circulatory pathways of the foot
26. know the vessel supplying blood to the dorsal part of the foot
27. recognize the arteries of the posterior circulation of the foot
28. know another name for the distal posterior tibial artery
29. identify the bony landmark where the peroneeal artery bifurcates
30. be able to explain the type of cross over technique when performing complex infrapopliteal revascularization procedures
31. know the vessels of the pedal-planter loop
32. understand anatomical variants pertaining to blood supply feeding the first toe
33. identify a vessel with a more constant course than the dorsalis pedis artery
34. learn the percentage of patients with a complete pedal-plantar loop anastomosis
35. understand advances in imaging and catheter technology that have made vascular recanalization of the foot a feasible interventional option