Chronic lower extremity peripheral vascular disease is associated with high morbidity and mortality. Although patient history and clinical examination contribute to the diagnostic process, exact visualization of the extent and severity of disease is crucial for diagnosis and optimal patient management and treatment. Computed tomography angiography (CTA) is an effective non-invasive imaging modality that provides the radiologist and vascular specialist a rapid, widely available, and accurate means to diagnose and grade the extent of vascular disease [1]. CTA utilizes intravenously administered contrast to visualize the vascular system during the arterial phase of enhancement while also providing additional information regarding osseous and soft-tissue pathologies and their relationship to blood vessels. Compared to alternate imaging techniques, such as digital subtraction angiography (DSA), CTA is significantly less expensive, less invasive, and allows for three-dimensional visualization from multiple angles and directions [2]. However, prior to imaging patients with CTA, the potential nephrotoxic effects of iodinated contrast material (CM) need to be considered. The use of CM in patients with normal renal function has been shown to be safe with no evidence of a decrease in glomerular filtration rate (GFR) [3]. To prevent further kidney damage in patients with impaired renal function, CM should only be given to patients with severe renal dysfunction (GFR <30 mL/min) or acute kidney injury on a case-by-case basis [3]. Magnetic resonance angiography (MRA) is an alternate non-invasive imaging modality for patients with poor renal function unable to undergo CTA due to the CM [4]. MRA is of particular value when imaging small arteries and venous studies due to its high signal-to-noise ratio, good spatial resolution, and lack of flow-related artifacts [3]. However, MRA studies are more expensive, require longer examination times, and are less widely available than CTA [3].

CTA is often used as the basis for further clinical decision-making with a direct impact on patient care, and therefore accurate and precise reporting by radiologists is imperative. CTA run-off reports are usually dictated in a free text form including pertinent positive and negative findings of various vascular pathologies with synoptic reporting occasionally performed [5]. Referring physicians may be unsure if a structure has been evaluated if it has not been explicitly mentioned in the report. A standardized CTA report of the lower extremity would comprise a list of essential anatomic structures that need to be stated. Vascular findings may include major the blood vessels; aorta, major visceral vessels (celiac axis; superior mesenteric artery; inferior mesenteric artery; renal arteries), common iliac artery, internal iliac artery, external iliac artery, common femoral artery, profunda femoris artery, superficial femoral artery, popliteal artery, anterior tibial artery, tibioperoneal trunk, posterior tibial artery, and peroneal artery. Nonvascular findings to be stated in the report include the liver, gallbladder and biliary tree, spleen, pancreas, adrenal glands, kidneys, bowel, pelvic organs, bones, soft tissues, and any other findings.

The purpose of this article was to detail the vascular anatomy and anatomic variants of the lower extremity, illustrates imaging findings of various chronic lower extremity vascular diseases, and outlines findings with important management implications for the interventional radiologist or vascular surgeon.