Critical Limb Ischemia

Golden, Michael A.; Ullery, Brant W.

doi:10.1007/978-1-4939-1326-8_7

Cited by 2 publications

(3 citation statements)

References 90 publications

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“…Many characteristics are considered when devising an optimal revascularization strategy: arterial anatomy, atherosclerotic lesion morphology, localization, extent, and foot tissue perfusion [ 6 ]. Intra-arterial digital subtraction angiography (IADSA) has been the gold standard for examining small and highly calcified arteries, providing morphological and hemodynamic information [ 7 ]. Although wound healing is impacted by perfusion deficits and assessing it could be used to evaluate foot ulcers and determine whether revascularization is required, IADSA does not provide information on tissue perfusion.…”

Section: Introductionmentioning

confidence: 99%

“…Although wound healing is impacted by perfusion deficits and assessing it could be used to evaluate foot ulcers and determine whether revascularization is required, IADSA does not provide information on tissue perfusion. Additionally, lesions are only evaluated in 2D projections, leading to potential underestimations of occlusive severity due to superposition errors [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Combined evaluation of blood flow and tissue perfusion in diabetic feet by intra-arterial dynamic 4DCT imaging

et al. 2023

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Critical limb ischemia is associated with high mortality and major amputations. Intra-arterial digital subtraction angiography (IADSA) has been the reference standard but has some shortcomings including the two-dimensional projection and the lack of tissue perfusion information. The aim of this exploratory study is to examine four-dimensional computed tomography (4DCT) angiography and perfusion imaging using low-volume intra-arterial contrast injections for an improved anatomic and hemodynamic assessment in patients with foot ulcers. Three patients underwent a low-volume (2 mL) intra-arterial contrast-enhanced 4DCT examination combined with a diagnostic IADSA. An automated assessment of blood flow and tissue perfusion from the 4DCT data was performed. Vascular structures and corresponding blood flows were successfully assessed and correlated well with the IADSA results. Perfusion values of the affected tissue were significantly higher compared to the unaffected tissue. The proposed 4DCT protocol combined with the minimal usage of contrast agent (2 mL) provides superior images compared to IADSA as three phases (arterial, perfusion, and venous) are captured. The obtained parameters could allow for an improved diagnosis of critical limb ischemia as both the proximal vasculature and the extent of the perfusion deficit in the microvasculature can be assessed.Relevance statementIntra-arterial 4DCT allows for assessing three phases (arterial, perfusion and venous) using minimal contrast (2 mL). This method could lead to an improved diagnosis of critical limb ischemia as both proximal vasculature and the extent of the perfusion deficit are assessed.Trial registrationISRCTN, ISRCTN95737449. Registered 14 March 2023—retrospectively registered, https://www.isrctn.com/ISRCTN95737449Key points• Three phases (arterial, perfusion, and venous) are obtained from 2 mL intra-arterial 4DCT.• The obtained hemodynamic parameters correlated well with the IADSA findings.• 4DCT surpassed IADSA in terms of assessment of venous blood flow and inflammatory hyperperfusion.• The assessment of tissue perfusion could lead to optimizing the revascularization strategy. Graphical Abstract

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Combined evaluation of blood flow and tissue perfusion in diabetic feet by intra-arterial dynamic 4DCT imaging

et al. 2023

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“…It is estimated that two million Americans suffer from critical limb ischemia (CLI) caused by peripheral arterial disease, chronic kidney disease, and severe diabetes [1–3]. CLI occurs when there is a poor supply of oxygenated blood to the lower extremities of the body due to artery blockage.…”

Section: Introductionmentioning

confidence: 99%

Endothelial sprouting and network formation in collagen- and fibrin-based modular microbeads

et al. 2016

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A modular tissue engineering approach may have advantages over current therapies in providing rapid and sustained revascularization of ischemic tissue. In this study, modular protein microbeads were prepared from pure fibrin (FIB) and collagen-fibrin composites (COL-FIB) using a simple water-in-oil emulsification technique. Human endothelial cells and fibroblasts were embedded directly in the microbead matrix. The resulting microbeads were generally spheroidal with a diameter of 100–200 μm. Cell viability was high (75–80% viable) in microbeads, but was marginally lower than in bulk hydrogels of corresponding composition (85–90% viable). Cell proliferation was significantly greater in COL-FIB microbeads after two weeks in culture, compared to pure FIB microbeads. Upon embedding of microbeads in a surrounding fibrin hydrogel, endothelial cell networks formed inside the microbead matrix and extended into the surrounding matrix. The number of vessel segments, average segment length, and number of branch points was higher in FIB samples, compared to COL-FIB samples, resulting in significantly longer total vessel networks. Anastomosis of vessel networks from adjacent microbeads was also observed. These studies demonstrate that primitive vessel networks can be formed by modular protein microbeads containing embedded endothelial cells and fibroblasts. Such microbeads may find utility as prevascularized tissue modules that can be delivered minimally invasively as a therapy to restore blood flow to ischemic tissues.

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Critical Limb Ischemia

Cited by 2 publications

References 90 publications

Combined evaluation of blood flow and tissue perfusion in diabetic feet by intra-arterial dynamic 4DCT imaging

Combined evaluation of blood flow and tissue perfusion in diabetic feet by intra-arterial dynamic 4DCT imaging

Endothelial sprouting and network formation in collagen- and fibrin-based modular microbeads

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