LE Angiographic Anatomy

Lower Extremity Angiographic Anatomy & Basics of Angiography:

Lower Extremity Angiographic Anatomy & Basics of Angiography AHMED A. ARAFAT

I- Anatomy:

I- Anatomy

Anatomic Hints: Abdominal Aorta:

Anatomic Hints: Abdominal Aorta

Anatomic Hints: Abdominal Aorta:

Anatomic Hints: Abdominal Aorta Branches of the abdominal aorta: Unpaired: Celiac SMA IMA Median sacral

Anatomic Hints: Abdominal Aorta:

Anatomic Hints: Abdominal Aorta Branches of the abdominal aorta: Paired: Inferior phrenic arteries Middle adrenal arteries Renal arteries Lumbar arteries

Angiographically: Abdominal Aorta:

Angiographically : Abdominal Aorta

Anatomic Hints: The Thigh:

Anatomic Hints: The Thigh

Anatomic Hints: The Thigh:

Anatomic Hints: The Thigh Arteries of the thigh: CFA Superficial epigastric artery Superficial circumflex iliac artery Superficial external pudendal artery Deep external pudendal artery Arteria profunda femoris Superficial femoral artery

Angiographically : The Thigh:

Angiographically : The Thigh

Anatomic Hints: The Popliteal Artery:

Anatomic Hints: The Popliteal Artery

Anatomic Hints: The Popliteal Artery:

Anatomic Hints: The Popliteal Artery Variations of the popliteal bifurcation: A , Regular most frequent trifurcation B , Tibioperoneal trunk with the anterior tibial artery C , Trifurcation of the three main arteries at the same level D , Anastomosis of the anterior tibial artery and tibioperoneal trunk E , Long tibioperoneal trunk .

Anatomic Hints: The Popliteal Artery:

Anatomic Hints: The Popliteal Artery

Anatomic Hints: The Popliteal Artery:

Anatomic Hints: The Popliteal Artery

Angiographically: The Popliteal Artery:

Angiographically : The Popliteal Artery

Angiographically: The Popliteal Artery:

Angiographically : The Popliteal Artery

Anatomic Hints: Angiosomes:

Anatomic Hints: Angiosomes

Anatomic Hints: Angiosomes:

Anatomic Hints: Angiosomes

Anatomic Hints: Angiosomes:

Anatomic Hints: Angiosomes

Anatomic Hints: Angiosomes:

Anatomic Hints: Angiosomes

Anatomic Hints: Angiosomes:

Anatomic Hints: Angiosomes

Anatomic Hints: Angiosomes:

Anatomic Hints: Angiosomes

Anatomic Hints: Pedal Arch Variations:

Anatomic Hints: Pedal Arch Variations A , Type Ia —deep plantar artery originated from the anterior dorsalis pedis , which gives origin to all the metatarsal arteries B , Type Ib —deep plantar artery originated from the arteria dorsalis pedis and partially from the lateral plantar artery C , Type IIa —lateral plantar artery originates the fourth space metatarsal artery

Anatomic Hints: Pedal Arch Variations:

Anatomic Hints: Pedal Arch Variations

Anatomic Hints: Pedal Arch Variations:

Anatomic Hints: Pedal Arch Variations D , Type IIb —lateral plantar artery originates the fourth and third metatarsal arteries E , Type IIc —lateral plantar artery originates the fourth, third, and second metatarsal arteries F , Type III—lateral plantar artery after originating the metatarsal arteries goes to the dorsal aspect of the foot and communicates with the arteria dorsalis pedis .

Anatomic Hints: Pedal Arch Variations:

Anatomic Hints: Pedal Arch Variations

II- Angiography:

II- Angiography

Indications:

Indications Trauma ALI IC CLI

Contraindications:

Contraindications Recent myocardial infarction or significant arrhythmia History of serious reaction to contrast material Significant hypertension—diastolic pressure greater than llOmmHg Bleeding diathesis, e.g., prothrombin time greater than twice the control, platelets less than 50,000 Impaired renal function (S. creat > 1.5 mg/dl) Inability to lie supine on angiography table, e.g., congestive heart failure Retained barium from recent examination

Access:

Access Contralateral CFA puncture 4 or 5 French diagnostic sheath Straight , curved, or pigtail for aortography Crossover Cath tip distal to IIA

Contrast Media:

Contrast Media Iodinated nonionic agents CO2 Gadolinium

Technique of injection:

Technique of injection

Common Signs:

Common Signs Non filling (Occlusion) Filling defect (Stenosis) Collateralization (Chronic ischemia) Meniscus sign (Clot silhouette) (ALI)

Interpretation:

Interpretation Length Diameter Aneurysmal dilatation Calcification Thrombosis

Complications:

Complications Hematoma A rteriovenous (AV) fistula P seudoaneurysm I ntimal tear, occasionally resulting in arterial rupture T hrombosis D istal embolization related to atheroemboli or pericatheter thrombosis .

Complications:

Complications CIN Contrast neuropathy Allergy