1. Do quantitative angiographic changes in infrageniculate perfusion predict clinical success following percutaneous revascularization?
- Author
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Garnet, D.J., Troiano, M.A., Mantell, M., Watts, M., and Clark, T.W.
- Abstract
Purpose: Percutaneous revascularization is increasingly utilized to optimize linfrageniculate perfusion in patients with critical limb ischemia. Quantitation of arterial perfusion using conventional angiographic techniques is challenging in CLI patients. We evaluated the potential utility of a quantitative angiogra
2 Podiatric Surgery, University of Pennsylvania, Philadelphia, PA; phic software system to predict clinical success following revascularization. Materials and Methods: A prospective QA database identified a cohort of 78 patients with CLI managed by a multidisciplinary wound care team who underwent 159 arterial lower extremity revascularization procedures (including angioplasty, stenting, stent-grafting and atherectomy) over a 36 month period. Of these, a subset of 24 patients with critical limb ischemia (CLI) had DSA angiograms that were post-processed and analyzed for changes in infrageniculate perfusion using a quantitative software system (i-Flow, Siemens Medical Systems). Time to peak perfusion (TTP), mean slope of perfusion increase (MSP) and area under the perfusion curve (AUC) were compared before and after intervention. These changes were then correlated with clinical outcome. A composite endpoint of (a) improved Rutherford level, (b) healed wound within target angiosome, (c) improved wound perfusion at time of operative debridement and/or (d) reduction in planned amputation level was used to assign clinical outcome for each revascularization as success/failure. Results: Technical success was 100%; clinical success was 75% (18/24). Mean changes in TTP, MSP and AUC for the study cohort were -16%, 350% and 494%, respectively. Patients with clinical success had significantly greater AUC than failures (672% vs. -16%, P = 0.028); a trend toward greater MSP among patients with clinical success was also observed (449% vs. 84%, P = 0.09). No significant changes in time to peak perfusion were seen between patients with clinical success or failure. Conclusion: In this preliminary study, quantitative angiographic increases in infrageniculate blood flow measured through area under the perfusion curve was associated with clinical success following percutaneous revascularization. Further assessment of this technique is warranted in a larger, prospective cohort. [Copyright &y& Elsevier]- Published
- 2014
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