Abstract
Objective: To investigate the feasibility of serial radiotracer-based imaging as a noninvasive approach for quantifying volumetric changes in microvascular perfusion within angiosomes of the foot following lower extremity revascularization in the setting of critical limb ischemia (CLI).Approach: A CLI patient with a nonhealing foot ulcer underwent single-photon emission computed tomography (SPECT)/computed tomography (CT) imaging of the feet before and after balloon angioplasty of the superficial femoral artery (SFA) and popliteal artery. SPECT/CT imaging was used to evaluate serial changes in angiosome perfusion, which was compared to quantitative changes in peripheral vascular anatomy and hemodynamics, as assessed by standard clinical tools that included digital subtraction angiography (DSA), ankle-brachial index (ABI), and toe-brachial index (TBI).Results: Following revascularization, upstream quantitative improvements in stenosis of the SFA (pre: 35.4% to post: 11.9%) and popliteal artery (pre: 59.1% to post: 21.7%) shown by DSA were associated with downstream angiosome-dependent improvements in SPECT microvascular foot perfusion that ranged from 2% to 16%. ABI measurement was not possible due to extensive arterial calcification, while TBI values decreased from 0.26 to 0.16 following revascularization.Innovation: This is the first study to demonstrate the feasibility of assessing noninvasive volumetric changes in angiosome foot perfusion in response to lower extremity revascularization in a patient with CLI by utilizing radiotracer-based imaging.Conclusion: SPECT/CT imaging allows for quantification of serial perfusion changes within angiosomes containing nonhealing ulcers and provides physiological assessment that is complementary to conventional anatomical (DSA) and hemodynamic (ABI/TBI) measures in the evaluation of lower extremity revascularization.
Highlights
IntroductionIs a progressive atherosclerotic disease of the lower extremities affecting more than 200 million people globally.[1] Critical limb ischemia (CLI) represents a Ting-Heng Chuo et al, 2019; Published by Mary Ann Liebert, Inc. is a progressive atherosclerotic disease of the lower extremities affecting more than 200 million people globally.[1] Critical limb ischemia (CLI) represents a Ting-Heng Chuo et al, 2019; Published by Mary Ann Liebert, Inc
Peripheral arterial disease (PAD)is a progressive atherosclerotic disease of the lower extremities affecting more than 200 million people globally.[1]
The gains in mean lesion diameter were 1.71 mm and 1.17 mm (SFA), respectively, which could be visualized on digital subtraction angiography (DSA) images (Fig. 3)
Summary
Is a progressive atherosclerotic disease of the lower extremities affecting more than 200 million people globally.[1] Critical limb ischemia (CLI) represents a Ting-Heng Chuo et al, 2019; Published by Mary Ann Liebert, Inc. is a progressive atherosclerotic disease of the lower extremities affecting more than 200 million people globally.[1] Critical limb ischemia (CLI) represents a Ting-Heng Chuo et al, 2019; Published by Mary Ann Liebert, Inc
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have