Reply to "Arteries of the Lower Limb-Embryology, Variations, and Clinical Significance".

In their review, Qazi et al. provided a useful and comprehensive overview of arteries of lower limbs. If normal anatomy is well known to all radiologists, embryology and anatomic variants of arteries of lower limbs represent a more challengingtopic due to its rarity. In this scenario, Qazi et al. have supplied us with a deep and illustrated explanation of these arduous field potentially lessknown to radiologist. The authors also reported clinical presentation and key clinical considerations to improve radiological reports and management. In 2019, the European Society of Cardiovascular Radiology and the Society of Cardiovascular Computed Tomography published two different consensuses on imaging in the context of transcatheter Aortic Valve Implantation and Replacement (TAVI and TAVR, respectively). Since its introduction in 2002, there has been enormous development in the field due to technological advancements with an established role of computed tomography in clinical practice. In this type of minimally invasive surgery, arterial transfemoral access remains the approach of preference. CT provides a comprehensive and accurate assessment of access site, including vessel size, calcification, and tortuosity, providing great predictive value for vascular complication. The aforementioned expert consensuses highlighted the importance of a careful evaluation of iliac-femoral vessels with a review of the vessel anatomy and introduced a recommended standardized CT report in pre-TAVI/TAVR assessment. The same pre-operative CT evaluation should be performed in all the fields of minimally invasive cardiac surgery, including mitral and tricuspid valve surgery. In our opinion, a standardized CT report should customarily include an assessment of vascular access incorporating lower limb arteries variants to plan the access and improve patient outcome. In summary, as the minimally invasive cardiac surgery continues to grow, a CT report should highlight not only vessel size, calcification, and tortuosity but also the numerous anatomical variants of the lower limb arteries, which can impact the success of the endovascular intervention. Consequently, a potential improvement for pre-operative transcatheter valve implantation planning to consider is to create a standardized reporting template, that includes accurate evaluation of the lower limb arteries anatomy.