Map every stenosis and occlusion from the aorta to the feet by segment, with length and degree, reconstitution and the best tibial vessel to the foot — the map the vascular team uses to choose angioplasty or bypass (GLASS/TASC).
Orient first
- Chronic limb-threatening ischaemia needs a target vessel to the foot; claudication often does not need intervention.
- Calcified vessels bloom on CT — read on a wide window and use curved reformats.
- Contrast-enhanced MRA avoids calcium blooming and radiation.
Acquire the study
- CT angiography aorta to toes; wide window for calcified segments; curved planar reformats per vessel.
The manoeuvre
- Segment by segment (aortoiliac, femoropopliteal, infrapopliteal, pedal): stenosis in % and occlusion length in cm.
- Curved reformats with a wide window through calcified segments.
- Reconstitution level and the dominant run-off vessel to the foot.
- Common femoral artery quality (access and endarterectomy).
- Popliteal aneurysm, entrapment.
What confirms it
- A segmental map concordant with symptoms and ABI.
What licenses you to exclude it
- Patent vessels without significant stenosis to the foot exclude haemodynamically significant PAD.
The classic misread
- Calling a heavily calcified segment occluded because of blooming.