Back to Karmody Posters
Direct Angiosome Imaging Using Laser-Assisted Fluorescent Angiography in Patients with Critical Limb Ischemia
Mohamed A. Zayed, MD PhD, Elizabeth Hitchner, BS, Venita Chandra, MD, Vinit Varu, MD, Oliver Aalami, MD, Wei Zhou, MD.
Stanford University Medical Center, Stanford, CA, USA.
OBJECTIVES: Angiosomes are three-dimensional anatomical zones that are primarily perfused via specific distributions of cutaneous arteries. The plantar aspect of the foot has four specific angiosomes that are dependent on lower extremity outflow, and are hypothesized to affect foot perfusion and wound healing. We sought to directly evaluate angiosome perfusion pre- and post-revascularization in patients with critical limb ischemia (CLI) using laser-assisted fluorescent angiography (LAFA).
METHODS: Over 14 months, 32 patients with Rutherford Class 4 and 5 CLI were prospectively enrolled into an IRB approved study to determine plantar-pedal angiosome perfusion using LAFA. Angiographic SVS runoff scores and LAFA plantar-pedal angiosome perfusion (SPY Elite; Lifecell Corporation) were evaluated pre- and post-revascularization. Patient demographics and peri-operative ABIs were also collected. Statistical analysis was performed using Student’s T-test and Spearman’s Rho correlation.
RESULTS: The majority of patients enrolled had diabetes (72%), hypertension (97%), and hyperlipidemia (72%), and a mean age 66. Femoral-popliteal interventions (1 open, 31 endovascular), were performed in 75% of patients. Post-intervention ABIs were improved by 48% (P=0.004), and popliteal runoff scores were improved by 67% (P<0.001). LAFA-perfusion of the medial plantar, lateral plantar, and calcaneal peroneal distribution plantar-pedal angiosomes were increased by 76% (P<0.006), 56% (P=0.01), and 55% (P=0.07), respectively. Popliteal runoff had a mild correlation with ABIs (R2=0.5;P=0.04), and tibial runoff had mild correlation with calcaneal peroneal angiosome perfusion (R2=0.4;P=0.008).
CONCLUSIONS: Peri-procedural plantar-pedal angiosome perfusion can be reliably evaluated using LAFA. Angiosome perfusion has mild correlation with conventional vascular non-invasive and angiographic evaluations. Further clinical application of LAFA angiosome evaluations may provide important peri-procedural assessments for patients with CLI.
Back to Karmody Posters
|
