Impact of Bypass Versus PTA on Foot Perfusion in Patients with Peripheral Artery Disease

Revascularization in patients with peripheral artery disease relies on open or endovascular approach. Current evidence favoring open/endovascular approach focuses on clinical endpoints; however, there is little evidence on the actual quantitative improvement in foot perfusion. This study aims to investigate the effect of percutaneous transluminal angioplasty (PTA) compared to bypass surgery on arterial foot perfusion using near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG).

This retrospective cohort study compared foot perfusion of patients with an occlusion of the superficial femoral artery or proximal popliteal artery who underwent PTA or bypass surgery. Perfusion measurements were conducted by NIRF-imaging pre-interventional and post-interventional. The intervention groups were compared on delta (Δ) normalized maximum slope (MaxSlope) and Δ time to maximum intensity (Tmax). NIRF parameters were also compared to clinical outcomes.

Thirty-five patients were included (17 PTA vs. 18 bypass surgery group). The bypass surgery group showed a significantly higher improvement compared to the PTA group in median Δ MaxSlope (+0.73%/s PTA vs. 4.40%/s bypass surgery, P = 0.002) and median Δ Tmax (-14.50s PTA vs. -56.55s bypass surgery, P = 0.005). In patients with improvement of clinical symptoms, median Δ Tmax improved by 31.90 sec compared to a Δ Tmax increase of 5.80 sec (P = 0.207). Median Δ MaxSlope improved by +2.14%/s in the group with clinical improvement, compared to a decrease of -1.29%/s in the group without clinical improvement (P = 0.041).

Bypass surgery seems to lead to a greater improvement in post-interventional arterial perfusion of the foot compared to PTA in patients with an occlusion. Furthermore, improvement in NIRF-imaging parameters appears to be an indicator of a positive clinical outcome.