Chronic limb threatening ischaemia (CLTI) is the end stage of peripheral arterial disease that results in symptomatic reduced blood supply which may include ischaemic rest pain, ischaemic ulcers or gangrene (Conte et al (2019). Clinical management is difficult as ulcers are recalcitrant to healing in the setting of inadequate vascular supply. Revascularisation treatment can involve repeated endovascular procedures, surgical options including bypass graft and amputation.
Currently, an established clinical algorithm using ankle brachial indices (ABI’s), toe pressures (TP’s) and clinical observation (WIFI classification (Teso et al (2021)), is used to determine a pretest probability of healing. ABI’s & toe pressures used are not always reliable or available and clinical assessment can be difficult and variable between observers.
Pedal colour duplex ultrasound (PCDU) has recently been proposed as a tool to significantly advance clinical management of CLTI by visualising the pedal arteries and quantitatively assessing spectral Doppler waveforms. Based on initial data currently available it is also reasonable to suggest that this assessment may also assist in measuring the impact of interventional procedures.
This workshop will combine discussion the evidence, techniques and use of pedal acceleration time (PAT) with live scanning demonstration of pedal artery anatomy and assessment.