title: Three-dimensional rotational angiography of the foot in critical limb ischemia: a new dimension in revascularization strategy.
abstract: OBJECTIVE
  To evaluate the additional value of three-dimensional rotational angiography (3DRA) of the foot compared with digital subtraction angiography (DSA) in patients with critical limb ischemia (CLI).
  
  
  METHODS
  For 3DRA, the C-arm was placed in the propeller position with the foot in an isocentric position. The patient's unaffected foot was positioned in a footrest outside the field of view. For correct timing of 3DRA, the delay from contrast injection in the popliteal artery at the level of knee joint to complete pedal arterial enhancement was assessed using DSA. With this delay, 3DRA was started after injection of 15 ml contrast. Imaging of the 3DRA could directly be reconstructed and visualized.
  
  
  METHODS
  Patients undergoing 3DRA of the foot were prospectively registered. DSA and 3DRA images were scored separately for arterial patency and presence of collaterals. Treatment strategies were proposed based on DSA with and without the availability of 3DRA.
  
  
  RESULTS
  Eleven patients underwent 3DRA of the foot. One 3DRA was not included because the acquisition was focused on the heel instead of the entire foot. Diagnostic quality of 3DRA was good in all ten patients. 3DRA compared with DSA showed additional patent arteries in six patients, patent plantar arch in three patients, and collaterals between the pedal arteries in five patients. Additional information from 3DRA resulted in a change of treatment strategy in six patients.
  
  
  CONCLUSIONS
  3DRA of the foot contains valuable additional real-time information to better guide peripheral vascular interventions in patients with CLI and nonhealing tissue lesions.
authors.affiliation: Department of Radiology, Academic Medical Center, Room G1-229, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. s.jens@amc.uva.nl
authors.forename: Sjoerd
authors.initials: S
authors.lastname: Jens
authors.forename: Pierleone
authors.initials: P
authors.lastname: Lucatelli
authors.forename: Mark J W
authors.initials: MJ
authors.lastname: Koelemay
authors.forename: Henk A
authors.initials: HA
authors.lastname: Marquering
authors.forename: Jim A
authors.initials: JA
authors.lastname: Reekers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000379:methods*; D003097:Collateral Circulation; D003287:Contrast Media; D005260:Female; D005528:Foot / Q000098:blood supply* / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional; D007511:Ischemia / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D011150:Popliteal Artery; D011446:Prospective Studies; D015641:Radiography, Interventional; D012307:Risk Factors; D014283:Triiodobenzoic Acids
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; C044834:iodixanol