Methods:Ten patients who were presented with critical lower limb ischemia due to atherosclerotic peripheral arterial disease were included in the study. The average age was 60 ± 6.4 years. Two of the patients were female and eight were male. The patients did not have diabetes mellitus. Seven patients had rest pain and three patients had ischemic ulcer and neither popliteal nor distal pulses were palpated on physical examination. Preoperative mean ankle-brachial index (ABI) was 0.26 ± 0.07. Digital subtraction angiography revealed total occlusion of superficial femoral artery in four cases at the bifurcation level and in four cases at the level of Hunter cannel. The common femoral artery was detected to be totally occluded in one patient at the level of inguinal ligament and in one patient popliteal artery (PA) was totally occluded just at the knee level. No outflow was detected in all cases. We used CDU in order to examine vascular structures below the knee and to find if there is a suitable segment for surgical reconstruction.

Results: By using CDU a monophasic flow at the tibialis anterior artery (ATA) were detected in three patients. They were male with primarily complained of rest pain and without ischemic ulcer. Operative exploration showed patent lumen at the ATA level just in accordance with the CDU results. In two cases common femoro-ATA reversed saphenous vein bypass and in one case proximal PAATA reversed saphenous vein bypass were performed. Postoperative ABI measurements were 0.66 ± 0.06. There were no postoperative surgical complications.

Conclusions: CDU imaging can be used reliably for planning infrainguinal reconstruction strategies.