This set of diagnostic angiograms illustrates a case of acute limb ischemia and the subsequent management using embolectomy and intra-arterial thrombolysis. (A) Angiogram of the thigh shows a patent superficial femoral artery with no signs of atherosclerosis. (B) Image of the knee and upper calf shows a patent popliteal artery, but reveals acute distal occlusion of the posterior tibial artery and chronic occlusion of the anterior tibial and peroneal arteries. (C) Follow-up angiogram of the ankle/foot after mechanical embolectomy with a Fogarty catheter shows restored flow in the posterior tibial artery, yet persistent distal occlusion with no contrast filling in the plantar arch. (D) Final angiogram 24 hours after adjunctive intra-arterial administration of recombinant tissue plasminogen activator (rtPA) demonstrates complete restoration of distal perfusion, with excellent filling of both the posterior tibial artery and the plantar arch. This progression highlights the combined efficacy of surgical and pharmacological interventions in treating peripheral arterial embolism and restoring microvascular patency.

This composite diagnostic image consists of three digital subtraction angiogram (DSA) frames (A, B, and C) illustrating the endovascular revascularization of a right upper limb following acute thrombotic occlusion. Frame A shows the brachial artery post-thrombolysis with restored patency in the main vessel and visible collateral branching, though distal opacification remains incomplete. Frame B is an intra-procedural fluoroscopic image showing the elbow joint (distal humerus and proximal radius/ulna) with a distal access catheter (DAC) positioned for thromboaspiration. Frame C demonstrates the successful final result, showing complete recanalization and robust contrast filling of the distal arterial network, including the radial and ulnar arteries and the deep and superficial palmar arches in the hand. The series illustrates key steps in managing acute limb ischemia: the transition from initial pharmacological thrombolysis to mechanical thromboaspiration, ending with definitive restoration of distal perfusion. The visualization of the intricate palmar arterial anatomy in Frame C serves as the clinical endpoint for successful recanalization.

This diagnostic image is a peripheral digital subtraction angiogram (DSA) of the left foot, demonstrating post-intervention revascularization in a patient with peripheral artery disease (PAD) and critical limb ischemia. The image shows the distal anterior tibial artery and the dorsalis pedis artery with clear contrast opacification. A guidewire and an interventional balloon catheter are visible within the arterial lumen, positioned for balloon angioplasty to resolve a previous occlusion. The angiogram illustrates the restoration of flow into the plantar arch and smaller pedal branches. The vessel diameter appears relatively smooth and patent following the atherectomy and angioplasty procedure, with no evidence of residual high-grade stenosis or acute occlusion in the visualized field. This educational material highlights the interventional management of infrapopliteal arterial disease and the technical execution of pedal revascularization to improve distal perfusion.

This figure consists of two computed tomography (CT) angiogram images highlighting vascular pathology in the right upper extremity and mediastinum. Image A is a maximum intensity projection (MIP) reconstruction showing the right upper limb arterial supply. A red arrow points to an occlusion at the distal bifurcation of the brachial artery. There is a conspicuous absence of contrast enhancement in the radial and ulnar arteries, indicating distal ischemia and lack of flow. Image B is an axial CT scan of the chest at the level of the aortic arch. A red arrow identifies a localized filling defect within the origin of the right innominate (brachiocephalic) artery, consistent with a small mural thrombus. The surrounding vessel walls and mediastinal structures appear otherwise unremarkable. These images serve as educational examples of arterial embolism or thrombosis leading to acute limb ischemia, emphasizing the importance of recognizing filling defects and abrupt vascular cut-offs in cross-sectional imaging.