SPY technology as an adjunctive measure for lower extremity perfusion

Area of Science:

• Vascular Surgery
• Medical Imaging
• Regenerative Medicine

Background:

• Critical limb ischemia (CLI) management is challenged by the lack of reliable outcome measures, potentially leading to suboptimal interventions.
• SPY technology, employing laser-assisted fluorescence angiography (LAFA), is increasingly used by surgeons to evaluate tissue perfusion.

Purpose of the Study:

• To evaluate SPY technology as a reliable outcome measure for vascular interventions in patients with CLI.
• To compare SPY-derived perfusion data with the ankle-brachial index (ABI).

Main Methods:

• Prospective recruitment of 93 patients undergoing revascularization for claudication or CLI from June 2012 to August 2014.
• LAFA using SPY technology was performed pre- and post-revascularization.
• Quantitative perfusion measures at plantar surfaces were analyzed and compared with ABI.

Main Results:

• SPY technology demonstrated significant improvements in plantar perfusion post-intervention, with increased ingress, peak perfusion, and egress (P < .001 for ingress and peak, P = .035 for egress).
• Ankle-brachial index also improved significantly from 0.60 to 0.84 (P < .001).
• Procedure-related digital embolization was noted in some patients, despite normal angiographic findings.

Conclusions:

• SPY technology is a valuable tool for real-time visualization of peripheral vascular intervention outcomes.
• LAFA provides additional, useful information on regional tissue perfusion, potentially improving patient management.
• Further research is needed to standardize outpatient use and establish predictive values for wound healing.