Evaluation of Distal Hemodynamic Changes of Lower Extremity after Endovascular Treatment: Correlation between Measurements of Color-Coded Quantitative Digital Subtraction Angiography and Ankle-Brachial Index

Lou, Wensheng; Su, Haobo; Huang, Kaiyi; He, Xu; Chen, Liang; Chen, Guoping; Shi, Wanyin; Han, Junyong; Gu, Jianping

doi:10.1016/j.jvir.2016.02.011

Cited by 18 publications

(16 citation statements)

References 14 publications

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“…There have been several studies assessing the feasibility of using 2D imaging in detecting changes to perfusion after intervention in the brain [6][7][8] and in the peripheral vasculature. [10][11][12][13][14] This study attempts to validate the 2DP tool in a prospective manner. This study showed that improved flow to distal tissue is reflected by measurable changes in 2DP parameters.…”

Section: Discussionmentioning

confidence: 99%

“…It has been previously used in analysis of cerebral flow after an intervention [6][7][8][9] and in the peripheral vasculature. [10][11][12][13][14] Here in a prospective study, we sought to determine the feasibility of using the 2DP (Philips Healthcare, Andover, Mass) color-coded angiography to measure hemodynamic changes in the lower extremities after an endovascular intervention in patients with known PAD. We hypothesize that because contrast material would move more slowly down an extremity with severe PAD, two-dimensional (2D) parameters that reflect transit time, such as AT, transit time down the leg, and TTP, would increase, whereas parameters reflecting volume or velocity, such as SI, area under the curve (AUC), and WIR, would decrease.…”

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confidence: 99%

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Characterizing tissue perfusion after lower extremity intervention using two-dimensional color-coded digital subtraction angiography

Kim

Shevitz

Morrow

et al. 2017

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Characterizing tissue perfusion after lower extremity intervention using two-dimensional color-coded digital subtraction angiography

Kim

Shevitz

Morrow

et al. 2017

Journal of Vascular Surgery

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“…Kostrzewa et al investigated FWHM and TTP as parameters for treatment evaluation of SFA and AP lesions, demonstrating that both parameters could be used to assess treatment success independent of ABI value [6]. Lou et al observed similar results using TTP in the evaluation of hemodynamic changes and treatment success for lower extremity arteries [15]. A related alternative approach was investigated by Kim et al, who demonstrated that the color-coded DSA-perfusion parameters AUC, TTP, and arrival time of contrast agent in the distal lower extremity are sensitive methods of treatment assessment in patients with upstream vessel stenoses [12].…”

Section: Discussionmentioning

confidence: 95%

“…To date, color-coded quantitative DSA, rather than quantitative fluoroscopy, has been the subject of all clinical investigations resulting from these technical advances. ese studies have investigated a variety of functional parameters, with the aim of extracting objective hemodynamic data from DSA imaging during peripheral arterial and cerebrovascular interventions [6,9,12,[15][16][17][18][19]. Kostrzewa et al investigated FWHM and TTP as parameters for treatment evaluation of SFA and AP lesions, demonstrating that both parameters could be used to assess treatment success independent of ABI value [6].…”

Section: Discussionmentioning

confidence: 99%

Quantitative Evaluation of Peripheral Arterial Blood Flow Using Peri-Interventional Fluoroscopic Parameters: An In Vivo Study Evaluating Feasibility and Clinical Utility

Ghibes

Hefferman

Nikolaou

et al. 2020

BioMed Research International

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Purpose. The purpose of this study was to evaluate various objective, quantitative, time-resolved fluoroscopic imaging parameters for use in the peri-interventional evaluation of stenotic peripheral arterial disease lesions. Material and Methods. Ten patients (median age, 64; age range, 52 to 79; 8 males, 2 females) with high-grade stenoses of either the superficial femoral or popliteal arteries who underwent endovascular treatment were included. During each intervention, two series of intraprocedural fluoroscopic images were collected, one preintervention and one postintervention. For each imaging series, four regions of interest (ROIs) were defined within the vessel lumen, with two ROIs being proximal (ROIs 1 and 2) and two being distal (ROIs 3 and 4) to the stenosis. The time-density curve (TDC) at each ROI was measured, and the resulting area under the curve (AUC), full width at half maximum (FWHM), and time-to-peak (TTP) were then calculated. Results. The analysis of the TDC-derived parameters demonstrated significant differences between pre- and postinterventional flow rates in the ROI placed most distal to the stenosis, ROI 4. The AUC at ROI 4 (reported as a relative percentage of the AUC measured at ROI 1 proximal to the lesion) demonstrated a significant increase in the total flow (mean 67.84% vs. 128.68%, p=0.003). A significant reduction in FWHM at ROI 4 (mean 2.93 s vs. 1.87 s, p=0.015) was observed. A significant reduction in TTP at ROI 4 (2.43 s to 1.45 s, p=0.009) was also observed. A positive change in at least 1 of the 3 calculated parameters was seen in all patients after a successful intervention, with 7 of 10 patients showing improvement in all 3 parameters, 2 of 10 showing improvement in 2 parameters, and 1 patient showing improvement in 1 parameter. Conclusion. AUC, FWHM, and TTP are objective, reproducible, quantifiable tools for the peri-interventional fluoroscopic evaluation of vessel stenoses. When compared to the standard subjective interpretation of fluoroscopic imagery, AUC, FWHM, and TTP offer interventionalists the advantage of having an objective, complementary method of evaluating the success of a procedure, potentially allowing for more precisely targeted and quantitatively determined treatment goals and improved patient outcomes. This retrospective study was approved by the local ethics committee under the Number 372/2018BO2. The trial was registered at the German clinical trials register under the number DRKS00017813.

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“…To the best of our knowledge, in PAD this evolving technique has only be investigated by comparing color-coded DSA with ultrasound measurements and clinical examinations including ankle brachial index [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Reliability and Accuracy of Peri-Interventional Stenosis Grading in Peripheral Artery Disease Using Color-Coded Quantitative Fluoroscopy: A Phantom Study Comparing a Clinical and Scientific Postprocessing Software

Ghibes

Partovi

Grözinger

et al. 2018

BioMed Research International

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Purpose To assess quantitative stenosis grading by color-coded fluoroscopy using an in vitro pulsatile flow phantom. Methods Three different stenotic tubes (80%, 60%, and 40% diameter restriction) and a nonstenotic reference tube were compared regarding their different flow behavior by using contrast-enhanced fluoroscopy with a flat-detector system for visualisation purposes. Time-density curves (TDC), area under the curve (AUC), time-to-peak (TTP), and different ROI sizes were analyzed in three independent measurements using two different postprocessing software solutions. In addition, exemplary TDCs of a patient with a high-grade stenosis before and after stent angioplasty were acquired. Results Color-coded fluoroscopy enabled depiction of differences in AUC and TDC between high-grade (80%), middle (60%), low-grade (40%), and nonstenotic tubes. The best correlation between high-, middle-, and low-grade stenosis was appreciated in ROIs behind the stenosis. This effect was enhanced by using longer integration times (5s, 7s) and a maximum frame rate of image acquisition for analysis (correlation coefficient rho=0.9284 at 5s). TTP showed no significant differences between high- and low-grade stenosis. Conclusions Various clinical studies in the literature already demonstrated reproducible and reliable stenosis grading by analyzing TDCs acquired with color-coded fluoroscopy. In contrast to TTP, AUC values derived in ROIs behind the stenosis proved to be reliable parameters for stenosis grading. However, our results also demonstrate that several factors are able to significantly impact the evaluation of AUC values. More precisely, accuracy of acquired AUC values can be improved by choosing longer integration times, a large ROI size adapted to the vessel diameter, and a higher frame rate of image acquisition.

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Evaluation of Distal Hemodynamic Changes of Lower Extremity after Endovascular Treatment: Correlation between Measurements of Color-Coded Quantitative Digital Subtraction Angiography and Ankle-Brachial Index

Cited by 18 publications

References 14 publications

Characterizing tissue perfusion after lower extremity intervention using two-dimensional color-coded digital subtraction angiography

Characterizing tissue perfusion after lower extremity intervention using two-dimensional color-coded digital subtraction angiography

Quantitative Evaluation of Peripheral Arterial Blood Flow Using Peri-Interventional Fluoroscopic Parameters: An In Vivo Study Evaluating Feasibility and Clinical Utility

Reliability and Accuracy of Peri-Interventional Stenosis Grading in Peripheral Artery Disease Using Color-Coded Quantitative Fluoroscopy: A Phantom Study Comparing a Clinical and Scientific Postprocessing Software

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