‘Real Angiosome’ Assessment from Peripheral Tissue Perfusion Using Tissue Oxygen Saturation Foot-mapping in Patients with Critical Limb Ischemia

Kagaya, Yu; Ohura, Norihiko; Suga, Hirotaka; Eto, Hikaru; Takushima, Akihiko; Harii, Kiyonori

doi:10.1016/j.ejvs.2013.11.011

Cited by 51 publications

(59 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…12 It was observed that this new “angiosome” is more appropriate for detecting the ischemic areas on skin associated with foot ulcers than is the traditional angiosome model. This modified angiosome model, however, still only evaluates skin oxygenation.…”

mentioning

confidence: 99%

Oximetric angiosome imaging in diabetic feet

Zheng

Muccigrosso

Zhang

et al. 2016

Magnetic Resonance Imaging

View full text Add to dashboard Cite

Purpose To develop a noncontrast oximetric angiosome imaging approach to assess skeletal muscle oxygenation in diabetic feet. Materials and Methods In four healthy and five subjects with diabetes, the feasibility of foot oximetry was examined using a 3T clinical magnetic resonance imaging (MRI) scanner. The subjects’ feet were scanned at rest and during a toe-flexion isometric exercise. The oxygen extraction fraction of skeletal muscle was measured using a susceptibility-based MRI method. Our newly developed MR foot oximetric angiosome model was compared with the traditional angiosome model in the assessment of the distribution of oxygen extraction fraction. Results Using the traditional angiosome during the toe-flexion exercise, the oxygen extraction fraction in the medial foot of healthy subjects increased (4.9 ± 3%) and decreased (−2.7 ± 4.4%) in subjects with diabetes (difference = 7.6%; 95% confidence interval = −13.7 ± 1.4; P = 0.02). Using the oximetric angiosome, the percent difference in the areas of oxygen extraction fraction within the 0.7–1.0 range (expected oxygen extraction fraction during exercise) between rest and exercise was higher in healthy subjects (8 ± 4%) than in subjects with diabetes (4 ± 4%; P = 0.02). Conclusion This study demonstrates the feasibility of measuring skeletal muscle oxygen extraction fraction in the foot muscle during a toe-flexion isometric exercise. Instead of assessing oxygen extraction fraction in a foot muscle region linked to a supplying artery (traditional angiosome), the foot oximetric angiosome model assesses oxygen extraction fraction by its different levels in all foot muscle regions and thus may be more appropriate for assessing local ischemia in ulcerated diabetic feet.

show abstract

mentioning

confidence: 99%

Oximetric angiosome imaging in diabetic feet

Zheng

Muccigrosso

Zhang

et al. 2016

Magnetic Resonance Imaging

View full text Add to dashboard Cite

show abstract

“…Although the overall rest or exercise SMBF values were not significantly different between the participants with DM and without DM, the peri‐ulcer exercise SMBF (8.7 ± 3.9 ml/min/100g) around ulcers was significantly below the away‐ulcer exercise SMBF (12.7 ± 3.9 ml/min/100g, P = 0.02), per analysis of grids‐eye segments in the same DM group. This observation is consistent with a "real angiosome assessment" in foot ulcers, in which foot ulcers were always located around an area with relatively lower tissue oxygen saturation (StO 2 ), compared with StO 2 in other normal foot areas . The report explained the physiologic mechanism of the "real angiosome" associated with foot ulcers, but more experimental and clinical studies are needed for rigorous validation.…”

Section: Discussionmentioning

confidence: 99%

Intravenous contrast‐free standardized exercise perfusion imaging in diabetic feet with ulcers

Edalati

Hastings

Muccigrosso

et al. 2018

Magnetic Resonance Imaging

View full text Add to dashboard Cite

Background: Impaired foot perfusion is a primary contributor to foot ulcer formation. There is no existing device nor method that can be used to measure local foot perfusion during standardized foot muscle exercise in an MRI environment. Purpose: To develop a new MRI-compatible foot dynamometer and MRI methods to characterize local perfusion in diabetic feet with ulcers. Study Type: Prospective. Population/Subjects: Seven participants without diabetes and 10 participants with diabetic foot ulcers. Field Strength/Sequence: 3.0T, arterial spin labeling (ASL). Assessments: Using a new MRI-compatible foot dynamometer, all participants underwent MRI ASL perfusion assessment at rest and during a standardized toe-flexion exercise. The participants without diabetes were scanned twice to assess the reproducibility of perfusion measurements. The absolute perfusion and perfusion reserve values were compared between two groups and between regions near ulcers (peri-ulcer) and away from ulcers (away-ulcer). Statistical Tests: Bland–Altman methods for the calculation of coefficient of repeatability (CR) and two-sided and unpaired Student’s t-test to compare multiple differences. Results: The perfusion reserves measured had the best reproducibility (CR in medial region: 1.6, lateral region: 0.9). The foot perfusion reserve was significantly lower in the participants with diabetes compared with the participants without diabetes (1.34 ± 0.32, 95% confidence interval [CI]: 1.1, 1.58 vs. 1.76 ± 0.31, 95% CI: 1.53, 1.98, P = 0.02). Both peri-ulcer exercise perfusion (8.7 ± 3.9 ml/min/100g) and perfusion reserve (1.07 ± 0.39, 95% CI: 0.78, 1.35) were significantly lower than away-ulcer exercise perfusion (12.7 ± 3.8 ml/min/100g, P = 0.02) and perfusion reserve (1.39 ± 0.37, 95% CI: 1.11, 1.66, P = 0.03), respectively. Data Conclusion: This study demonstrates intravenous contrast-free methods for local perfusion in feet with ulcers by standardized exercise-based MRI. Ischemia regions around foot ulcers can be quantitatively distinguished from normal perfused muscle regions. Level of Evidence: 2 Technical Efficacy: Stage: 2

show abstract

“…Recent studies have used this technique to challenge the conventional angiosome geography, suggesting that "true angiosomes" are more variable and patient-dependent, likely due to collateralization and variations in microcirculation. 33 This technique shows excellent promise for use in preintervention and postintervention assessments of perfusion, as the probe could be left on the foot during the procedure, providing an immediate, real-time assessment for improvement in tissue saturation within the area surrounding the ulcer. This could allow interventionalists to determine whether further interventions are necessary following initial therapy, before the procedure has been completed.…”

Section: Newer Intraprocedural Technologiesmentioning

confidence: 99%