Foot perfusion. Insights from an anatomically detailed arterial network model

Area of Science:

• Biomedical Engineering
• Vascular Biology
• Computational Fluid Dynamics

Background:

• Peripheral artery disease (PAD) impacts over 202 million people worldwide, necessitating effective revascularization strategies.
• Current diagnostic methods like the ankle-brachial index lack detailed tissue perfusion characterization.
• Advanced techniques like MRI perfusion are time-consuming and potentially uncomfortable for patients.

Purpose of the Study:

• To develop a computational model simulating foot perfusion during induced ischemia.
• To investigate the impact of arterial occlusions and collateral circulation on tissue perfusion in the foot.
• To compare the efficacy of angiosome-targeted versus best-vessel revascularization strategies in silico.

Main Methods:

• A 1D arterial network model of the foot and calf vasculature was created, comprising 154 segments.
• A baseline model represented healthy angiosome perfusion.
• 42 pathological scenarios were simulated by introducing arterial occlusions and varying collateral impairment levels.

Main Results:

• Collateral impairment significantly influences angiosome perfusion following single-artery occlusion, emphasizing blood redistribution.
• Occlusion of two major feeding arteries drastically reduces perfusion across all collateral impairment levels.
• The study highlights the critical role of collateral sufficiency in determining the optimal revascularization strategy.

Conclusions:

• In silico modeling provides a novel approach to evaluate revascularization strategies for peripheral artery disease.
• The findings suggest that both angiosome-targeted and best-vessel approaches can be effective, contingent on the patient's collateral circulation.
• This research offers mechanistic insights crucial for planning effective revascularization procedures in PAD patients.