Clinical Value of 2D Perfusion Angiography for Chronic Limb-Threatening Ischemia Revascularization

To evaluate the clinical utility of intraoperative 2D perfusion angiography (2DPA) in patients with chronic limb-threatening ischemia (CLTI) undergoing revascularization.

This single-center prospective observational cohort study included consecutive patients with CLTI who underwent endovascular or hybrid revascularization with intraoperative 2DPA. Perfusion angiography was performed before and after revascularization using a standardized contrast injection protocol. Quantitative perfusion parameters included arrival time (AT), time to peak (TTP), wash-in rate (WIR), mean transit time, width and area under the curve. Pre-post changes (Δ) in perfusion metrics were analyzed in relation to technical success and 12-month outcomes, including major adverse limb events (MALE) and major adverse cardiovascular events.

Seventy-four patients (mean age, 71.9 ± 11.5 years; 71.6% male) were included with technical success in 93.2% of procedures. After multivariable adjustment, revascularization was associated with significant improvements in AT (-1.44 seconds; P < 0.001), TTP (-3.6 seconds; P < 0.001), WIR (2.19 units; P = 0.022), and width (-2.8 seconds; P = 0.035). Greater postprocedural increases in TTP were independently associated with higher MALE risk (adjusted hazard ratio, 2.16; 95% confidence interval 1.19-3.90; P = 0.011). Increases in AT and WIR were associated with shorter and longer MALE-free survival, respectively, in univariable analyses, but lost significance after adjustment. No perfusion parameter was associated with major adverse cardiovascular events.

Intraoperative 2DPA quantitatively characterizes tissue perfusion changes after revascularization in CLTI. A limited reduction in TTP after the procedure is independently associated with subsequent MALE, suggesting that TTP may indicate residual ischemia and support postoperative risk stratification.