CardioVascular and Interventional Radiology

, Volume 36, Issue 3, pp 797–802 | Cite as

Three-Dimensional Rotational Angiography of the Foot in Critical Limb Ischemia: A New Dimension in Revascularization Strategy

  • Sjoerd JensEmail author
  • Pierleone Lucatelli
  • Mark J. W. Koelemay
  • Henk A. Marquering
  • Jim A. Reekers
Technical Note



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).


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.

Materials and 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.


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.


3DRA of the foot contains valuable additional real-time information to better guide peripheral vascular interventions in patients with CLI and nonhealing tissue lesions.


Critical limb ischemia Rotational angiography Three-dimensional imaging 



There was no grant support for this article.

Conflict of interest

The authors have no conflicts of interest to disclose.

Supplementary material

Total rotational view of 3DRA without and with subtraction in a 70-year-old patient. (MP4 1301 kb)


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Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2012

Authors and Affiliations

  • Sjoerd Jens
    • 1
    Email author
  • Pierleone Lucatelli
    • 2
  • Mark J. W. Koelemay
    • 3
  • Henk A. Marquering
    • 4
  • Jim A. Reekers
    • 5
  1. 1.Department of RadiologyAcademic Medical CenterAmsterdamThe Netherlands
  2. 2.Vascular and Interventional Radiology Unit, Department of Radiological Sciences“Sapienza” University of RomeRomeItaly
  3. 3.Department of SurgeryAcademic Medical CenterAmsterdamThe Netherlands
  4. 4.Department of RadiologyAcademic Medical CenterAmsterdamThe Netherlands
  5. 5.Department of RadiologyAcademic Medical CenterAmsterdamThe Netherlands

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