Ultrasound Series: First Line Imaging for CLTI

Jill and Dr. Costantino describe the workflow at their practice and discuss how ultrasound findings can be translated to drawings that help with interventional planning. Dr. Costantino says that ultrasound is traditionally seen as a mundane part of radiology training, but it can be extremely useful if it is operated and interpreted by a skilled technologist. In fact, Dr. Costantino often relies solely on ultrasound to map CLTI patients, instead of diagnostic angiograms. She believes that ultrasound can provide more information about blood flow characteristics and cap morphology. Dr. Costantino also favors ultrasound over TBI and ABI measurements, since the latter values are usually inaccurate in diabetic patients.

We look at examples of successful cases where ultrasound results affected access points, how the cath lab setup, and the overall efficiency of the procedures.

Jill highlights the use of ultrasound in the immediate post-procedural period. This often shows immediate improvement in pedal acceleration time (PAT). Patients are also followed up after two weeks to ensure that the PAT is sustainable.

To end the episode, Jill discusses the current state of complex arterial duplex education. She recognizes the need for more technologists to be trained in this modality. Additionally, Jill describes how ultrasound findings can be used in the context of multidisciplinary limb salvage meetings in which interventional radiologists, interventional cardiologists, vascular surgeons, and podiatrists engage in cases together. Jill believes that the first step to integrating advanced ultrasound is to invest in training for vascular technologists.