Peripheral & Visceral Angiography

What it does

Peripheral & Visceral Angiography reads digital subtraction angiography outside the heart and the head: aorto-iliac and lower-limb runoff studies, renal and mesenteric runs, and the runs recorded during embolisation for bleeding. Upload the whole study; its runs are grouped and read as one arterial map.

The result is a per-segment patency map from the iliac arteries to the pedal arch, with each stenosis and occlusion graded and measured, the number of patent tibial vessels, an anatomic stage for limb ischaemia, and, on visceral and trauma runs, the site and vessel of active contrast extravasation.

Intended use

Decision support for physicians who plan or perform peripheral and visceral interventions. A structured patency map and stage help choose between endovascular treatment and bypass in chronic limb-threatening ischaemia, and a located extravasation documents the bleeding source on emergency and embolisation runs. Every lesion and bleeding site links to the run and frame that show it.

Who it is for

Interventional radiologists, vascular surgeons, interventional cardiologists who treat peripheral disease, and the residents and fellows who prepare the case. Vascular registries use the same structured staging.

Accepted input

• DSA runs: multi-frame X-Ray Angiographic Image objects (including Enhanced XA), subtracted or native, or a zip of the single-frame instances of one run.
• Whole studies: a patient CD or study folder with a DICOMDIR; aorto-iliac, femoropopliteal, below-the-knee, pedal, renal, mesenteric and embolisation runs are read together.

Requirements per run

Requirement	Why
At least 16 frames	Opacification of each segment is followed over time
Not a rotational or cone-beam acquisition	These runs cannot be read as fixed projections and are excluded
Pixel spacing with source distances (or a magnification factor)	Lesion length and diameters in millimetres; without it, lengths stay in pixels and are flagged
Late frames down to the foot on runoff runs	Tibial runoff and the pedal arch fill late

Stepping-table and stitched runs, patient motion and overlapping tibial vessels lower the confidence of the affected segments; those segments are named in the result instead of being graded silently.

Optional context

The indication (claudication, chronic limb-threatening ischaemia, acute ischaemia, gastrointestinal or trauma bleeding), the treated side and prior interventions can be passed in clinical_context.

The result

One structured result per study with findings, measurements and stages, each linked to the run and frame it came from.

Section	Content
Arterial segmentation	Arterial tree mask with segment labels: iliac, femoral, popliteal, tibial and pedal; renal and mesenteric on visceral runs
Stenoses and occlusions	Each lesion per arterial segment with percent stenosis or occlusion and its length
Runoff and anatomic staging	Patent tibial vessels to the foot, pedal arch, runoff score, TASC II class and GLASS stage
Active extravasation	Site and feeding vessel of contrast extravasation on visceral and trauma runs
Draft report	Opt-in (options.report): an English narrative that interprets the result for the reader (findings, impression, limitations); every number is checked against the findings

Standards

• DICOM: SR Measurement Report TID 1500 for lesions and measurements; SEG for the arterial masks; Secondary Capture key frames with overlays. Segments are coded with CID 12109 Lower Extremity Artery and CID 12125 Abdominopelvic Vessel.
• Staging: TASC II classification with its 2015 below-the-knee extension, and GLASS staging from the Global Vascular Guidelines on chronic limb-threatening ischaemia (Conte, 2019).

Staging notes

The runoff score, TASC II class and GLASS stage are derived by a versioned rule from the measured lesions of the stenosis section, so each stage can be traced to the lesions that set it.