[Imaging of the lower limb arteries: when, how and why?]

Noninvasive screening of lower limb arterial disease has long been performed using color Doppler ultrasonography, whereas surgical or endovascular treatment planning relied on conventional angiography. With continued improvements of noninvasive imaging modalities, it is now possible to image the entire lower limb vasculature without arterial catheterization. Multidetector row helical CT angiography has the advantage of visualizing the arterial lumen and arterial wall calcifications, and nephrotoxicity is reduced by decreasing amounts of contrast medium. Three-dimensional MR angiography is a safe procedure, with high contrast sensitivity, and has recently benefited from step table technology that allows a single injection of contrast medium. The literature shows that both helical CT and MR angiography have high levels of accuracy, but outcome studies of their respective role in the setting of acute and chronic lower limb ischemia are lacking. These noninvasive techniques should play a major role in two main situations: first, in critical ischemia where therapeutic planning should ideally be achieved non invasively; second, in the follow-up of treated patients presenting with recurrent ischemia.