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Perfusion Patterns in Patients with Chronic Limb-Threatening Ischemia versus Control Patients Using Near-Infrared
Pim Van Den Hoven1, Lauren N Goncalves1, Paulus H A Quax1
1Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Insights
Near-infrared fluorescence imaging with indocyanine green (ICG) shows altered tissue perfusion in patients with chronic limb-threatening ischemia (CLTI). This technique offers a novel approach to assess lower extremity arterial disease (LEAD) severity.
Area of Science:
- Vascular Medicine
- Medical Imaging
- Biomedical Engineering
Background:
- Assessing lower extremity arterial disease (LEAD) severity relies on macrovascular flow, which is insufficient for chronic limb-threatening ischemia (CLTI).
- Current diagnostic methods lack regional tissue perfusion data, limiting their value in CLTI patients.
Purpose of the Study:
- To evaluate near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) for measuring tissue perfusion in CLTI patients.
- To compare perfusion parameters between CLTI patients and a control group using ICG NIR imaging.
Main Methods:
- A prospective cohort study involving 19 CLTI patients and 16 controls.
- ICG NIR fluorescence imaging was performed using the Quest Spectrum Platform.
- Time-intensity curves were analyzed using the Quest Research Framework, extracting 14 parameters.
Main Results:
- Time to maximum intensity was significantly lower in CLTI patients (90.5s vs. 143.3s, p=0.002).
- Inflow parameters, including maximum slope and normalized maximum slope, were significantly higher in the CLTI group.
- These findings suggest altered microcirculation in CLTI patients.
Conclusions:
- ICG NIR fluorescence imaging is a viable tool for assessing tissue perfusion in CLTI.
- Elevated inflow parameters in CLTI may indicate microcirculation regulatory damage, arterial stiffness, or transcapillary leakage.
Abstract:
In assessing the severity of lower extremity arterial disease (LEAD), physicians rely on clinical judgements supported by conventional measurements of macrovascular blood flow. However, current diagnostic techniques provide no information about regional tissue perfusion and are of limited value in patients with chronic limb-threatening ischemia (CLTI). Near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) has been used extensively in perfusion studies and is a possible modality for tissue perfusion measurement in patients with CLTI. In this prospective cohort study, ICG NIR fluorescence imaging was performed in patients with CLTI and control patients using the Quest Spectrum Platform® (Middenmeer, The Netherlands). The time-intensity curves were analyzed using the Quest Research Framework. Fourteen parameters were extracted. Successful ICG NIR fluorescence imaging was performed in 19 patients with CLTI and in 16 control patients. The time to maximum intensity (seconds) was lower for CLTI patients (90.5 vs. 143.3, p = 0.002). For the inflow parameters, the maximum slope, the normalized maximum slope and the ingress rate were all significantly higher in the CLTI group. The inflow parameters observed in patients with CLTI were superior to the control group. Possible explanations for the increased inflow include damage to the regulatory mechanisms of the microcirculation, arterial stiffness, and transcapillary leakage.
