0:00

All right. Next, we are going to discuss how to approach interpreting

0:04

all of these images that we just obtained.

0:07

Now, because this is a long Z-axis, it's really important

0:11

to interpret everything that's on your images because we're responsible for them.

0:15

And so we look at the whole entire abdomen, the pelvis,

0:19

all of the stuff that is other than the vessels, as well as the soft

0:23

tissues of the lower extremities.

0:26

And personally, my preference is to look at all of the non-vascular stuff

0:29

first, just like a normal CT that you might be interpreting, and

0:33

using a dedicated template and having a consistent

0:37

search pattern to fill in to provide a more comprehensive vascular

0:41

evaluation. A lot of these patients, they tend to be elderly.

0:44

You don't want to miss a cancer. Sometimes the ancillary findings give

0:48

clues to diagnosis. For example, if there are renal infarcts and splenic infarcts,

0:52

we might think that the etiology of any occlusion we might find might be embolic

0:56

in nature. So really, this is a snapshot for our

1:00

reporting template, where we assess each vessel on its

1:03

own and ascertain whether they're patent, they have mild stenosis, moderate

1:08

stenosis, severe stenosis, any anatomic variants,

1:12

if they're occluded. And then at the end, we talk about all of those

1:15

incidental findings.

1:18

When we give an impression, an impression is really just that.

1:21

We don't recapitulate all of the findings that we discussed in the narrative of the

1:24

report, but we synthesize what's going on.

1:27

We synthesize if we found a unifocal disease, multifocal disease, what are

1:31

the targets of revascularization?

1:33

And on each extremity, we basically just give what's the worst and

1:37

most significant rather than detailing all the non-obstructive

1:40

stenosis. And so I like having three lines, one about the

1:44

inflow, and then the second about each extremity.

1:47

So patent abdominal aorta and visceral vessels,

1:51

and then

1:52

patent iliofemoral or femoropopliteal arterial system with a

1:55

three-vessel runoff. It's important to also use

1:59

terminology such as three-vessel runoff with or without significant stenosis.

2:03

And if there's just one vessel runoff, then which is the vessel that's

2:07

actually doing all the work and is responsible for the runoff?

2:11

Next, we're going to go into the cases, and we have a whole bunch of cases

2:15

curated for you to go over. The

2:20

pathologies are going to range from anatomic variants

2:24

that have clinical implications to peripheral arterial disease.

2:27

There are patterns of disease going all the way from varying degrees of

2:31

stenosis to occlusion,

2:33

looking at embolic disease and aneurysms, appearances post an

2:37

intervention, whether it's intended or unintended,

2:41

or complications of looking at trauma and

2:45

its various manifestations, and then looking at non-atherosclerotic

2:49

diseases, which are rarer and most commonly really the

2:53

indication lands up being peripheral arterial disease, but nevertheless, are

2:56

important because they can go unrecognized.

2:59

And because CT is a primary diagnostic modality

3:03

in both an acute setting, whether it's in a blunt trauma, in

3:07

a penetrating trauma, leads to rapid triage of patients that

3:10

ultimately leads to quicker management and disposition

3:14

decisions,

3:15

as well as its role in assessing patency of grafts,

3:19

whether there's a superimposed infection, looking at preoperative

3:23

planning. We're going to focus this course on just

3:27

CT, but nevertheless, there's definitely a role for

3:31

the other various imaging modalities we've covered earlier

3:34

in all of these indications.