Purpose: Patients with peripheral arterial disease (PAD) or critical limb ischemia (CLI) require revascularization. Traditionally, endovascular therapy (EVT) is performed with iodinated contrast agent (ICM), which can provoke potential deterioration in renal function. CO2 is a safe negative contrast agent to guide vascular procedures, but interpretation of CO2 angiography is challenging. Changes in blood flow following iodine-aided EVT are assessable with 2D-perfusion angiography (2D-PA). The aim of this study was to evaluate 2D-PA as a tool to monitor blood flow changes during CO-aided EVT.
Material And Methods: 2D-PA was performed before and after ten EVTs (nine stents; one endoprosthesis; 10/2012-02/2020) in nine patients (six men; 65 ± 10y) with Fontaine stage IIb (n = 8) and IV (n = 1). A reference ROI (ROI) was placed in the artery before the targeted obstruction and a target ROI (ROI) distally. Corresponding ROIs were used pre- and post-EVT. Time to peak (TTP), peak density (PD) and area under the curve (AUC) were computed. The reference/target ROI ratios (TTP/TTP; PD/PD; AUC/AUC) were calculated.
Results: 2D-PA was technically feasible in all cases. A significant increase of 82% in PD/PD (0.44 ± 0.4 to 0.8 ± 0.63; p = 0.002) and of 132% in AUC/AUC (0.34 ± 0.22 to 0.79 ± 0.59; p = 0.002) was seen. A trend for a decrease in TTP/TTP was observed (- 24%; 5.57 ± 3.66 s-4.25 ± 1.64 s; p = 0.6).
Conclusion: The presented 2D-PA technique facilitates the assessment of arterial flow in CO2-aided EVTs and has the potential to simplify the assessment of immediate treatment response.
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| http://dx.doi.org/10.1007/s00270-020-02722-z | DOI Listing |
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Article Synopsis
- The study assesses the effectiveness of 2D perfusion angiography in evaluating outcomes of endovascular interventions for acute limb ischemia (ALI), which is challenging due to difficulties in measuring limb blood flow.
- An analysis of 47 ALI patients showed significant improvements in transcutaneous oxygen (TcPO2) levels and ankle-brachial index (ABI) after treatment, indicating enhanced limb perfusion.
- Results revealed that the time to peak (TTP) for blood flow improved post-intervention, with faster TTP in the knee and ankle areas compared to pre-treatment, particularly among patients who responded positively to the intervention.
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