Advanced Imaging in Limb Salvage

The evaluation of patients at risk for limb loss secondary to peripheral arterial disease begins with a complete history and physical exam, and noninvasive studies in the vascular lab, including duplex ultrasonography. However, successful revascularization depends on high-quality, accurate imaging of the lower extremity vasculature. The traditional gold standard for vascular imaging, digital subtraction angiography, has been improved upon as technologic advances have enabled high-quality alternatives for preoperative (i.e., computed tomography [CT] angiography and magnetic resonance angiography [MRA]) and intraoperative imaging (i.e., intravascular ultrasound [IVUS], cone beam CT, and CO₂ angiography). Here we describe these advanced invasive and noninvasive imaging alternatives and their utility in limb salvage procedures.