The Utility of Two-Dimensional Perfusion Angiography in Critical Limb Ischemia: A Single Center Experience

Background: CLI is a combination of both decreased inflow to the foot (macrocirculation) and volume flow through the capillary bed (microcirculation) resulting in diminished oxygen concentration in the tissues. The goal of endovascular therapy in CLI is to recanalise the vessels to the foot, obtain better tissue perfusion, and to accelerate wound healing. 2D-PA is a new imaging algorithm to measure volume flow in the whole foot both in the macrocirculation and microcirculation utilizing data from plain old digital subtraction angiography. Method(s): A retrospective single-center study review of 21 patients from February, 2017 to August 2018 (mean age 84±42 years; 17 men, 8 women) with CLI who underwent lower limb digital subtraction angiography (DSA) A standardized contrast administration protocol was applied during DSA using a 2D perfusion–enabled image intensifier. Representative hindfoot and forefoot regions of interest were analyzed, and representative numeric density values [time to peak (TTP), mean transit time (MTT) and area under the (time-density) curve (AUC)] were calculated using 2D perfusion–enabled angiographic software to assess foot perfusion. Result(s): The numeric density values (mean change in TTP (0.75 s), MTT (0.85 s) and AUC (1835.53)) were compared before and after angioplasty and by level of treatment and these parameters were correlated with disease severity (Fontaine Classification (III=8; IV=16). Conclusion(s): In our initial experience, 2D-PA is a useful tool in critical limb ischemia evaluation and treatment by providing objective measurements of microvascular perfusion during and following endovascular procedures. This helps determining both the end point and outcome of revacularisation.

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Artikel online veröffentlicht:
11. Mai 2021