2 minute read
Pedal flow hemodynamics in patients with chronic limb – threatening ischemia
WHY THE STUDY WAS PERFORMED:
Whilst it is standard practice to image the three-vessel run-off at the ankle, sonographers tend to stop scanning at the ankle. There is also have a poor understanding of pedal arterial anatomy and how it collateralises when disease is present. With the advances in ultrasound technology, it is now possible to comprehensively evaluate the haemodynamic flow in the pedal arterial system. This is important as it gives an understanding of the perfusion in this region, which will help with the prediction of wound healing in the foot and can aid in interventional planning.
HOW THE STUDY WAS PERFORMED:
The paper begins by going over the arterial anatomy at the foot on both the dorsal and the plantar aspect and how these vessels branch to perfuse the toes. This is demonstrated in diagram 1 below.
It also covers important collateral pathways from the peroneal artery at the ankle;
• Posterior Communicating Artery (PCA) and the Lateral Calcaneal Branch (LCB) both communicate from the Peroneal Artery to the Posterior Tibial Artery
• The Anterior Communicating Artery (ACA) communicates from the Peroneal Artery to the
Anterior Tibial Artery (ATA)
The paper goes on to describe a 12 month retrospective review that was performed on thirty patients with peripheral vascular disease. This was to evaluate the changes in haemodynamic flow in the foot with ultrasound when different areas of occlusion were present.
REVIEWED BY Daniel Rae ASA SIG Vascular
REFERENCE J. Sommerset, D. Teso, R. Karmy-Jones, Y. Vea and B. Feliciano. Journal of Vascular Ultrasound
READ THE FULL ARTICLE HERE
WHAT THE STUDY FOUND:
When retrograde flow is identified in the arcuate artery, one should be suspicious of more proximal obstruction in the anterior circulation (ATA)
When retrograde flow is identified in the lateral and/or deep plantar, one should be suspicious of proximal obstruction in the posterior circulation (PTA)
This has been well demonstrated in diagram 2.
RELEVANCE TO CLINICAL PRACTICE:
Improved sonographer understanding of the arterial system in the foot and how the haemodynamics change with disease will aid vascular surgeons in the management and interventional planning for patients with chronic limb-threatening ischemia. As ultrasound techniques for evaluating disease in the foot develop further, understanding these haemodynamics will become essential. n
