Quantitative intra-arterial fluorescence angiography for direct monitoring of peripheral revascularization effects
Harry G M Vaassen1,2, Daan J Lips3, Robert H Geelkerken2,3
1Fluorescence Imaging Lab, Department of Medical Technology, Medisch Spectrum Twente, Enschede, the Netherlands.
Insights
Quantitative fluorescence angiography with intra-arterial dye injection (Q-iaFA) is a feasible method for assessing tissue perfusion during revascularization for chronic limb-threatening ischemia (CLTI). Q-iaFA parameters effectively reflect revascularization impact, suggesting its utility in guiding surgical decisions.
Area of Science:
- Vascular Surgery
- Medical Imaging
- Interventional Cardiology
Background:
- Chronic limb-threatening ischemia (CLTI) poses a significant risk of amputation.
- Accurate intraoperative assessment of revascularization is crucial for successful outcomes.
- Current methods may not provide real-time, quantitative perfusion data.
Purpose of the Study:
- To evaluate the feasibility of quantitative fluorescence angiography with intra-arterial dye injection (Q-iaFA).
- To assess Q-iaFA's utility for intraoperative guidance in CLTI revascularization.
- To determine if Q-iaFA parameters correlate with revascularization success.
Main Methods:
- An observational cohort study involving 14 CLTI patients undergoing endovascular intervention.
- Q-iaFA performed pre- and post-revascularization, measuring time to peak (TTP) and normalized peak slope (PSnorm).
- Analysis focused on changes in Q-iaFA parameters in the foot's plantar regions.
Main Results:
- Q-iaFA was successfully and safely performed in all patients.
- Significant improvements in TTP and PSnorm were observed in patients with strong revascularization impact (P = .004).
- Trends in Q-iaFA parameters correlated with the degree of revascularization impact.
Conclusions:
- Q-iaFA is a feasible technique for evaluating peripheral tissue perfusion during vascular interventions.
- Q-iaFA-derived perfusion parameters are sensitive to revascularization of arterial lesions in CLTI.
- Q-iaFA shows potential as a tool for intraoperative decision-making in CLTI treatment.
Objective:
To investigate the feasibility of quantitative fluorescence angiography with intra-arterial dye injection (Q-iaFA) for intraoperative guidance during revascularization procedures in patients with chronic limb-threatening ischemia (CLTI).
Methods:
In this observational cohort study, 14 patients with CLTI undergoing endovascular intervention were included. Q-iaFA was performed directly before and after revascularization. The parameters time to peak (TTP) and normalized peak slope (PSnorm) were derived from intensity-time curves that were measured on the plantar side of the foot in five regions of interest. The main outcome was defined as the change in these Q-iaFA parameters between pre- and postoperative measurements in the region of interest with the most inferior preoperative value. Expected impact of revascularization was classified into strong, moderate or absent, based on intraoperative radiographic imaging and the Trans-Atlantic Inter-Society II standards.
Results:
Q-iaFA was successful without complications in all patients. Revascularization impact was classified as strong in 8 (57%), moderate in 5 (36%), and as absent in 1 (7%) patients. In the strong impact group, a significant decrease in TTP and increase in PSnorm was observed (P = .004). The same trend was less pronounced in the moderate impact group, without statistical significance (P = .104 and P = .094). Conversely, in the patient with no expected revascularization impact, TTP increased and PSnorm decreased.
Conclusions:
Q-iaFA is a feasible technique to evaluate peripheral tissue perfusion during vascular interventions. The extracted perfusion parameters are directly affected by revascularization of arterial lesions in patients with CLTI. This finding suggests that Q-iaFA may be useful to guide intraoperative decision making. Work is required to refine quantification strategies and relate Q-iaFA parameters to clinical outcomes.
