Perfusion Patterns in Patients with Chronic Limb-Threatening Ischemia versus Control Patients Using Near-Infrared Fluorescence Imaging with Indocyanine Green.

Pim Van Den Hoven,Abbey Schepers,Jaap F Hamming,Jan Van Schaik,Paulus H A Quax,Catharina S P Van Rijswijk,Alexander L Vahrmeijer,Lauren N Goncalves,Joost R Van Der Vorst

doi:10.3390/biomedicines9101417

Pim Van Den Hoven, Abbey Schepers + Show 7 more

Open Access

https://doi.org/10.3390/biomedicines9101417

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Journal: Biomedicines	Publication Date: Oct 9, 2021
Citations: 4	License type: CC BY 4.0

Affiliation: Leiden University Medical Center

Abstract

In assessing the severity of lower extremity arterial disease (LEAD), physicians rely on clinical judgements supported by conventional measurements of macrovascular blood flow. However, current diagnostic techniques provide no information about regional tissue perfusion and are of limited value in patients with chronic limb-threatening ischemia (CLTI). Near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) has been used extensively in perfusion studies and is a possible modality for tissue perfusion measurement in patients with CLTI. In this prospective cohort study, ICG NIR fluorescence imaging was performed in patients with CLTI and control patients using the Quest Spectrum Platform® (Middenmeer, The Netherlands). The time–intensity curves were analyzed using the Quest Research Framework. Fourteen parameters were extracted. Successful ICG NIR fluorescence imaging was performed in 19 patients with CLTI and in 16 control patients. The time to maximum intensity (seconds) was lower for CLTI patients (90.5 vs. 143.3, p = 0.002). For the inflow parameters, the maximum slope, the normalized maximum slope and the ingress rate were all significantly higher in the CLTI group. The inflow parameters observed in patients with CLTI were superior to the control group. Possible explanations for the increased inflow include damage to the regulatory mechanisms of the microcirculation, arterial stiffness, and transcapillary leakage.

Highlights

Introduction iationsLower-extremity arterial disease (LEAD) is most often caused by atherosclerosis [1,2].Subsequent hemodynamic alterations leading to hypoxia can trigger a cascade of events leading to macro- and microvascular changes in the affected limb [3]
As a first step in the quantification of tissue perfusion using indocyanine green (ICG) NIR fluorescence imaging, the aim of this study was to analyze the perfusion patterns seen in patients with chronic limb-threatening ischemia (CLTI) and to compare these to non-lower extremity arterial disease (LEAD) control patients
Nineteen patientsstage presented with LEAD, whom 28 patients limbs were classified as classified as Fontaine

Summary

Introduction

Introduction iationsLower-extremity arterial disease (LEAD) is most often caused by atherosclerosis [1,2].Subsequent hemodynamic alterations leading to hypoxia can trigger a cascade of events leading to macro- and microvascular changes in the affected limb [3]. Lower-extremity arterial disease (LEAD) is most often caused by atherosclerosis [1,2]. In the most advanced stage, chronic limb-threatening ischemia (CLTI), blood supply to the lower extremity is insufficient to meet metabolic needs [2,4]. For these patients, a common finding during physical examination of the lower extremities is the appearance of “dependent rubor” or “blanching”, which is presumably caused by dysfunction of the venoarteriolar reflex [5]. In assessing the severity of LEAD, physicians often rely on their clinical judgements of the extremities. The diagnosis is confirmed using conventional measurements of macrovascular blood flow including the ankle-brachial index (ABI), toe pressure measurement, computed tomography (CT) angiography, magnetic resonance angiography, and digital subtraction

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