This presentation introduces a targeted, foot-first duplex ultrasound approach that empowers vascular sonographers to map the most relevant arterial pathway for intervention in patients with CLTI and non-healing wounds.

Rather than beginning proximally, the exam focuses first at the wound bed by identifying the artery directly supplying the affected tissue. Pedal Acceleration Time (PAT) is used as an important physiologic marker to assess perfusion, flow direction, and arterial anatomy at the level where healing matters most.

Special emphasis is placed on the Peroneal Artery and its communicating branches to the anterior and posterior tibial arteries, which often serve as dominant sources of pedal perfusion in patients with diabetes, renal failure, and advanced tibial disease. Recognition of these pathways is critical when traditional tibial arteries are heavily diseased or occluded.

By integrating pedal anatomy, PAT-based hemodynamics, and disease-pattern recognition, this approach provides a focused physiologic roadmap to support pre-procedural planning for open bypass, endovascular revascularization, or deep venous arterialization, delivering efficient, clinically actionable information that directly supports limb-salvage decision-making.