Predictive Parameters for Clinical Outcome in Patients with Critical Limb Ischemia Who Underwent Percutaneous Transluminal Angioplasty (PTA): A Systematic Review

Schreuder, Sanne M.; Hendrix, Yvette M G A; Reekers, Jim A.; Bipat, Shandra

doi:10.1007/s00270-017-1796-9

Cited by 7 publications

(5 citation statements)

References 34 publications

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“…This is in line with previous findings, in which the predictive value of successful recanalization is poor. 5 Moreover, the change in perfusion values was not different between the limbs classified as a good angiographic result and the limbs that were not. These findings reinforce the fact that conventional diagnostics, such as DSA, are not able to accurately detect changes in local tissue perfusion and the need for a non-invasive perfusion imaging technique such as HSI seems beneficial.…”

Section: Discussionmentioning

confidence: 83%

“…2 Even when technically successful target lesion revascularization is observed on DSA, clinical outcomes after revascularization are still rather unpredictable, with substantial rates of minor and major amputations and non-healing ulcers. [3][4][5] Other diagnostic techniques with a focus on tissue perfusion measurements may be used to assess the efficacy of revascularization therapy, although evidence is still scarce. 6,7 Hyperspectral imaging (HSI) and thermal imaging have been developed for non-invasive assessment of tissue perfusion.…”

Section: Introductionmentioning

confidence: 99%

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Detecting Changes in Tissue Perfusion With Hyperspectral Imaging and Thermal Imaging Following Endovascular Treatment for Peripheral Arterial Disease

et al. 2022

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Purpose Hyperspectral imaging (HSI) and thermal imaging allow contact-free tissue perfusion measurements and may help determine the effect of endovascular treatment (EVT) in patients with peripheral arterial disease. This study aimed to detect changes in perfusion with HSI and thermal imaging peri-procedurally and determine whether these changes can identify limbs that show clinical improvement after 6 weeks. Methods Patients with Rutherford class 2–6 scheduled for EVT were included prospectively. Hyperspectral imaging and thermal imaging were performed directly before and after EVT. Images were taken from the lateral side of the calves and plantar side of the feet. Concentrations of (de)oxyhemoglobin, oxygen saturation, and skin temperature were recorded. Angiographic results were determined on completion angiogram. Clinical improvement 6 weeks after EVT was defined as a decrease ≥ one Rutherford class. Peri-procedural changes in perfusion parameters were compared between limbs with and without good angiographic results or clinical improvement. To identify limbs with clinical improvement, receiver operating characteristic (ROC) curves were used to determine cutoff values for change in HSI. Results Included were 23 patients with 29 treated limbs. Change in HSI values and temperature was not significantly different between limbs with good and poor angiographic results. Change in peri-procedural deoxyhemoglobin, determined by HSI, at the calves and feet was significantly different between limbs with and without clinical improvement at 6 week follow-up (p=0.027 and p=0.017, respectively). The ROC curve for change in deoxyhemoglobin at the calves showed a cutoff value of ≤1.0, and ≤−0.5 at the feet, which were discriminative for clinical improvement (sensitivity 77%; specificity 75% and sensitivity 62%; specificity 88%, respectively). Conclusions HSI can detect changes in perfusion at the calves after EVT in patients with Rutherford class 2–6. Peri-procedural deoxyhemoglobin changes at the calves and feet are significantly different between limbs with and without clinical improvement. Decrease in deoxyhemoglobin directly after EVT may identify limbs that show clinical improvement 6 weeks after EVT.

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Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Detecting Changes in Tissue Perfusion With Hyperspectral Imaging and Thermal Imaging Following Endovascular Treatment for Peripheral Arterial Disease

et al. 2022

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“…In the present study, wound healing rate was 62% 3 months after balloon angioplasty. It should be noted that, in general, there is limited information on the factors that can predict wound healing after revascularization techniques (9,(12)(13)(14). Additionally, there is great heterogeneity among the studies regarding outcome measure assessment, wound characteristics, follow-up times, tests or variables of interest investigated, and so on.…”

Section: Discussionmentioning

confidence: 99%

Association between HBA1C, hyperlipidemia, ankle-brachial index (ABI), and toe-brachial index (TBI) with wound healing in diabetic foot ulcer after angioplasty

Sobhiyeh

Rai

Molavi

et al. 2022

Preprint

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Background Diabetic foot ulcer (DFU) is a serious complication of diabetes that can lead to severe consequences if left untreated. Revascularization with balloon angioplasty is a method of management of peripheral arterial disease, and factors that can affect wound healing are of interest. The aim of the present study was to investigate the association between HBA1C, hyperlipidemia, ankle-brachial index (ABI), and toe-brachial index (TBI) with wound healing after balloon angioplasty in patients with DFUs. Methods Ninety patients with DFUs who underwent balloon angioplasty were included. Baseline HBA1C, hyperlipidemia, ABI, and TBI were recorded. These were measured once more three months after angioplasty. Then, based on wound healing (satisfactory or failed wound healing) as the outcome measure, patients were divided into two groups and the gathered variables were compared. Results The wound healing rate at 3-month follow-up was 62.2% (56 out of 90 achieved healing of ulcer). There was no statistically significant difference between the two groups in terms of gender, age, and body mass index (BMI). Baseline values of HbA1c were significantly higher in those who failed wound healing (9.6 ± 1.2% vs. 9.0 ± 1.2%); P = 0.01. The average values of ABI (0.77 vs. 0.8; P = 0.04) and TBI (0.51 vs. 0.60; P < 0.001) were significantly lower in the group with failed ulcer healing. The similar findings were observed at three-month follow-up measurements. There was no significant difference between the groups regarding the frequency of hyperlipidemia. Conclusion Baseline and post-angioplasty measures of HbA1c, ABI, and TBI could affect wound healing in patients with DFU and lower limb ischemia undergoing balloon angioplasty.

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“…2 Clinical outcomes after a revascularisation procedure remain unpredictable when current imaging techniques are used. 4 These techniques mainly focus on assessment of the macrovasculature and do not include the assessment of the microvasculature, which is pivotal in patients with CLTI. Therefore, satisfactory results might be accompanied by poor clinical outcomes and early amputations.…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review and Critical Appraisal of Peri-Procedural Tissue Perfusion Techniques and their Clinical Value in Patients with Peripheral Arterial Disease

Wermelink¹,

Kirsten²,

Haalboom³

et al. 2021

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS Many techniques have been introduced to enable quantification of tissue perfusion in patients with peripheral arterial disease. These techniques should guide the vascular surgeon or interventionalist in real time during the revascularisation procedure and improve clinical outcomes. An overview is given of 10 techniques, focused on study protocols, research goals, and clinical outcomes. Evidence remains low regarding the clinical accuracy of the 10 included techniques, so prospective observational studies, to correlate peri-interventional assessments with clinical outcomes, are necessary as a first step for implementation into daily practice. The technique should be non-invasive, non-operator dependent, accurate, cost effective, and fast.Objective: Many techniques have been introduced to enable quantification of tissue perfusion in patients with peripheral arterial disease (PAD). Currently, none of these techniques is widely used to analyse real time tissue perfusion changes during endovascular or surgical revascularisation procedures. The aim of this systematic review was to provide an up to date overview of the peri-procedural applicability of currently available techniques, diagnostic accuracy of assessing tissue perfusion and the relationship with clinical outcomes. Data Sources: MEDLINE, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. Review Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines. Four electronic databases were searched up to 31 12 2020 for eligible articles: MEDLINE, Embase, CINAHL and the Cochrane Central Register of Controlled Trials. Eligible articles describing a perfusion measurement technique, used in a peri-procedural setting before and within 24 hours after the revascularisation procedure, with the aim of determining the effect of intervention in patients with PAD, were assessed for inclusion. The QUADAS-2 tool was used to assess the risk of bias and applicability of the studies. Results: An overview of 10 techniques found in 26 eligible articles focused on study protocols, research goals, and clinical outcomes is provided. Non-invasive techniques included laser speckle contrast imaging, microlightguide spectrophotometry, magnetic resonance imaging perfusion, near infrared spectroscopy, skin perfusion pressure, and plantar thermography. Invasive techniques included two dimensional perfusion angiography, contrast enhanced ultrasound, computed tomography perfusion imaging, and indocyanine green angiography. The results of the 26 eligible studies, which were mostly of poor quality according to QUADAS-2, were without exception, not sufficient to substantiate implementation in daily clinical practice. Conclusion: This systematic review provides an overview of 10 tissue perfusion assessment techniques for patients with PAD. It seems too early to appoint one of them as a reference standard. The scope of future research in this domain should therefor...

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Predictive Parameters for Clinical Outcome in Patients with Critical Limb Ischemia Who Underwent Percutaneous Transluminal Angioplasty (PTA): A Systematic Review

Cited by 7 publications

References 34 publications

Detecting Changes in Tissue Perfusion With Hyperspectral Imaging and Thermal Imaging Following Endovascular Treatment for Peripheral Arterial Disease

Detecting Changes in Tissue Perfusion With Hyperspectral Imaging and Thermal Imaging Following Endovascular Treatment for Peripheral Arterial Disease

Association between HBA1C, hyperlipidemia, ankle-brachial index (ABI), and toe-brachial index (TBI) with wound healing in diabetic foot ulcer after angioplasty

A Systematic Review and Critical Appraisal of Peri-Procedural Tissue Perfusion Techniques and their Clinical Value in Patients with Peripheral Arterial Disease

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