Abstract
Critical limb ischemia (CLI) remains a challenge for an interdisciplinary therapeutic team due to chronic nonhealing wounds. Against this background, there is a necessity of quality control after revascularization. Beside the isolated evaluation of the macrocirculation by Ankle-Brachial or Toe-Brachial Index measurements, the microcirculation as an additional important factor of wound healing often remains underestimated. The following article gives an overview about the current investigation methods for noninvasive perfusion control of the CLI patient. Therefore, transcutaneous oxygen pressure (tcpO2), the “oxygen-to-see” method which is a combination of white light tissue spectrometry and laser-Doppler flowmetry, fluorescence angiography with indocyanine green, and multispectral optoacoustic tomography will be described.
Highlights
Despite advances in treatment methods, chronic critical limb ischemia (CLI) remains a challenge for the interdisciplinary team
A number of studies have shown a correlation between measurements of the ankle-brachial index, the toe-brachial index, TcpO2 measurements, and perfusion data from fluorescence angiography
In view of the reporting standards of chronic lower extremity peripheral artery disease recently published by the Society of Vascular Surgery and the multitude of options to analyze microcirculatory perfusion, any examination of microcirculation in patients with CLI should be accompanied by a determination of the macrocirculation using the ankle-brachial index and duplex sonography in order to obtain an overall picture of perfusion status [35]
Summary
Despite advances in treatment methods, chronic critical limb ischemia (CLI) remains a challenge for the interdisciplinary team. This technique enables three parameters to be mapped: oxygen saturation (sO2), relative hemoglobin (rHb) and blood flow (flow) This measurement method irradiates tissue with a broad band light source as well as light from a laser source. Absolute values are available for the determination of amputation levels, whereby a cure can be expected here if, after repeated measurements, mean resting sO2 levels are 30% and no values should fall below 15% [12] This technique is used for periprocedural perfusion measurements in the foot following balloon angioplasty. The substances currently used for this include fluorescein and indocyanine green (ICG), which can be administered intravenously [17, 18] They are used to visualize tissue perfusion. A number of studies have shown a correlation between measurements of the ankle-brachial index, the toe-brachial index, TcpO2 measurements, and perfusion data from fluorescence angiography
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