Two-Dimensional Perfusion Angiography of the Foot: Technical Considerations and Initial Analysis

To report the feasibility, technical considerations, and initial results of 2-dimensional (2D) perfusion angiography of the foot before and after endovascular interventions.

A retrospective single-center study involved 21 patients (mean age 73.4±10.5 years; 14 men) with severe peripheral vascular disease [Fontaine stage III (n=10) or IV (n=14)] who underwent lower limb digital subtraction angiography (DSA) prior to and following endovascular treatment of above- and/or below-knee lesions. A standardized contrast administration protocol (15 mL iodixanol 320 mg I/mL at 3 mL/s via a 5/6-F antegrade sheath) was applied during DSA using a 2D perfusion-enabled image intensifier. Representative hindfoot and forefoot regions of interest were analyzed, and representative numeric density values [time to peak (TTP), peak density value (PDV), and area under the (time-density) curve (AUC)] were calculated using 2D perfusion-enabled angiographic software to assess foot perfusion. Values were compared before and after angioplasty and by level of treatment (above or below knee). The parameters were correlated with disease severity (stenosis vs occlusion) and symptom level (Fontaine stage).

A clinically significant improvement (29.4%) in the AUC was noted following angioplasty, reaching statistical significance within the hindfoot (p=0.03). No significant change in TTP or PDV was detected following angioplasty. Foot movement remained problematic when measuring time-density values. No statistical difference in perfusion values was appreciable between above- and below-knee angioplasty.

Two-dimensional perfusion angiography of the foot allows quantitative evaluation using various density values with potential benefit for treatment planning and technical outcome analysis. Methodical restrictions currently remain, mainly regarding patient movement.