Abstract
BackgroundFoot perfusion has been recently implemented as a new tool for optimizing outcomes of peripheral endovascular procedures. A custom-made, two-dimensional perfusion digital subtraction angiography (PDSA) algorithm has been implemented to quantify outcomes of endovascular treatment of critical limb ischemia (CLI), assist intra-procedural decision-making, and enhance clinical outcomes.MethodsThe study was approved by the Hospital’s Ethics Committee. This prospective, single-center study included seven consecutive patients scheduled to undergo infrapopliteal endovascular treatment of CLI. Perfusion blood volume (PBV), mean transit time (MTT), and perfusion blood flow (PBF) maps were extracted by analyzing time-intensity curves and signal intensity on the perfused vessel mask. Mean values calculated from user-specified regions of interest (ROIs) on perfusion maps were employed to evaluate pre- and post-endovascular treatment condition. Measurements were performed immediately after final PDSA.ResultsIn total, five patients (aged 54 ± 16 years, mean ± standard deviation) were analyzed, as two patients were excluded due to significant motion artifacts. Post-procedural MTT presented a mean decrease of 19.1% for all patients and increased only in 1 of 5 patients, demonstrating in 4/5 patients an increase in tissue perfusion after revascularization. Overall mean PBF and PBV values were also analogously increased following revascularization (446% and 69.5% mean, respectively) and in the majority of selected ROIs (13/15 and 12/15 ROIs, respectively).ConclusionsQuantification of infrapopliteal angioplasty outcomes using this newly proposed, custom-made, intra-procedural PDSA algorithm was performed using PBV, MTT, and PBF maps. Further studies are required to determine its role in peripheral endovascular procedures (ClinicalTrials.gov Identifier: NCT04356092).
Highlights
Foot perfusion has been recently implemented as a new tool for optimizing outcomes of peripheral endovascular procedures
Perfusion blood volume (PBV), mean transit time (MTT), and perfusion blood flow (PBF) maps were extracted by analyzing time-intensity curves (TICs) and signal intensity on the perfused vessel mask
Among ten consecutive patients, seven fulfilled the selection criteria and five patients were included in the study, as image post-processing was not feasible in two patients due to significant motion artifacts produced during digital subtraction angiography (DSA), despite attempts to achieve an optimal target limb immobilization giving a technical success of 5/7 (71.5%)
Summary
Foot perfusion has been recently implemented as a new tool for optimizing outcomes of peripheral endovascular procedures. Tissue perfusion imaging approach could assist intra-procedural decision-making on whether perfusion has been adequately improved or revascularization of further arteries/lesions is required, and provide a significant measurable metric for the documentation of endovascular treatment outcomes that could be correlated with limb prognosis. Recent research on this field has produced encouraging results, while commercially available products have been developed [12, 13]
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