Characterizing tissue perfusion after lower extremity intervention using two-dimensional color-coded digital subtraction angiography

Abstract

The 2DP imaging allows measurement of blood flow in real time as an adjunct to DSA. The AT may be the most sensitive marker of perfusion change in the lower extremity. Quantitative thresholds based on 2DP hold promise for immediate treatment effectiveness assessment in patients with PAD.

Quantitative Evaluation of Peripheral Arterial Blood Flow Using Peri-Interventional Fluoroscopic Parameters: An In Vivo Study Evaluating Feasibility and Clinical Utility

“…e results of this study show that fluoroscopically measured AUC, FWHM, and TTP all demonstrate significant pre-to postinterventional changes at ROI 4 distal to the stenosis. A significant increase in AUC was observed at ROI 4, a result that is consistent with recent related work [12]. AUC represents the sum of the signals in a ROI, which generated the contrast agent flow.…”

“…Lou et al observed similar results using TTP in the evaluation of hemodynamic changes and treatment success for lower extremity arteries [15]. A related alternative approach was investigated by Kim et al, who demonstrated that the color-coded DSA-perfusion parameters AUC, TTP, and arrival time of contrast agent in the distal lower extremity are sensitive methods of treatment assessment in patients with upstream vessel stenoses [12]. ese and similar studies provide increasing evidence that the quantitative evaluation of hemodynamic change is a viable means of peri-interventionally assessing treatment success in patients with arterial lesions.…”

“…To date, color-coded quantitative DSA, rather than quantitative fluoroscopy, has been the subject of all clinical investigations resulting from these technical advances. ese studies have investigated a variety of functional parameters, with the aim of extracting objective hemodynamic data from DSA imaging during peripheral arterial and cerebrovascular interventions [6,9,12,[15][16][17][18][19]. Kostrzewa et al investigated FWHM and TTP as parameters for treatment evaluation of SFA and AP lesions, demonstrating that both parameters could be used to assess treatment success independent of ABI value [6].…”

“…Several studies have demonstrated that color-coded quantitative DSA is a useful tool in the evaluation and treatment of neurovascular pathology; however, the application of the technique to PAD stenoses remains experimental and is not a part of clinical routine [7][8][9][10][11]. In cases of PAD lesions affecting the superficial femoral artery (SFA) and popliteal artery (PA), investigations have been limited to comparing quantitative, color-coded DSA against CCDS and nonimaging modalities, specifically ankle-brachial index (ABI) [6,12]. Importantly, these studies limited their investigation to the evaluation color-coded DSA, which uses frame rates and order of magnitude slower (3-4 frames/s vs. ≥30 frames/s) and radiation exposure and order of magnitude higher (∼1 mSv/min vs. ∼0.1 mSv/min) than quantitative fluoroscopy, resulting in coarse time resolution and increased exposure to ionizing radiation [13].…”

Dynamics of below-the-knee arterial blood flow after endovascular revascularisation of peripheral arteries as a potential predictor of clinical outcomes during one-year follow-up

“…Also, slower blood flow in the calf vessels was generally detected among the healthier population. Multiple studies have proven that improvement of clinical symptoms is related to the acceleration of peripheral blood flow after endovascular treatment compared to preoperative condition [22]. It has also already been stated that patients without significant blood flow after endovascular treatment have worse cumulative outcomes [6].…”