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62 - Lower limb CT angiogram

from Section 11 - Surgical radiology

Published online by Cambridge University Press:  05 July 2015

Hardi Madani
Affiliation:
Royal Free Hospital, London Deanery, London, UK
John Curtis
Affiliation:
University Hospital Aintree, Liverpool, UK
Helen Marmery
Affiliation:
Royal Free Hampstead NHS Trust, London, UK
Petrut Gogalniceanu
Affiliation:
Specialist Registrar, General and Vascular Surgery, London Deanery
James Pegrum
Affiliation:
Orthopaedic Registrar, Oxford Deanery
William Lynn
Affiliation:
Specialist Registrar, General Surgery, North East Thames
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Summary

Introduction

‘This is a CT angiogram, in axial/coronal/sagittal view of lower limb arteries’

Summary

  1. A Arterial anatomy

  2. B Blockage

  3. C Contrast extravasation

  4. D Dissection

  5. E Extra-arterial – bone and soft tissue

  6. F Flow improvements: stents, bypasses

Checklist

Arterial anatomy

• Aorta:

• divisions : single and bilateral

• Iliac:

• internal

• external

• Femoral:

• common

• profunda

• superficial

• popliteal

• Run-offs:

• anterior tibial (AT)

• posterior tibial (PT)

• peroneal

Blockage

• Filling defect: stenosis or occlusion

• Collaterals

• Calcification

Contrast extravasation

• Intramural

• Extramural

Dissection

Extra-arterial

• Bone:

• fractures, osteomyelitis secondary to amputation or vascular ulcers

• Soft tissue:

• ulcers, cellulitis, collections

Flow improvements

• Bypasses: vein vs. prosthetic; patent vs. blocked

• Stents

Look for associated pathology

• Bony fracture and soft tissue haematomas, foreign body, gas (trauma or infection)

• Metallic mesh: arterial stents

• High concentration arterial calcification: arteriosclerosis

Tips

It is essential to know normal vascular limb anatomy.

Compare one limb to the other to identify pathology.

Type
Chapter
Information
Physical Examination for Surgeons
An Aid to the MRCS OSCE
, pp. 471 - 472
Publisher: Cambridge University Press
Print publication year: 2015

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