PMID- 32066314
OWN - NLM
STAT- MEDLINE
DCOM- 20200720
LR  - 20200720
IS  - 1545-1550 (Electronic)
IS  - 1526-6028 (Linking)
VI  - 27
IP  - 2
DP  - 2020 Apr
TI  - Below-the-Ankle Arrival Time as a Novel Limb Tissue Perfusion Index: 
      Two-dimensional Perfusion Angiography Evaluation.
PG  - 198-204
LID - 10.1177/1526602820905527 [doi]
AB  - Purpose: To identify lower limb 2-dimensional (2D) perfusion angiographic 
      parameters that are related to skin perfusion pressure (SPP), a predictor of 
      wound healing in patients with chronic limb-threatening ischemia (CLTI) 
      undergoing below-the-knee (BTK) endovascular treatment (EVT). Materials and 
      Methods: Thirty-three consecutive patients (mean age 74.5 years; 18 men) with 47 
      isolated BTK lesions in 33 limbs (Rutherford category 3-5) underwent EVT. Dorsal 
      and plantar SPPs were measured before EVT and the day after. The indexed blood 
      flow below the ankle was measured using 2D perfusion angiography before and after 
      EVT to determine changes in perfusion parameters [arrival time (AT), time to 
      peak, wash-in rate, mean transit time, and width and area under the time-density 
      curve] at rest vs during hyperemia induced with a 20-mg intra-arterial papaverine 
      infusion. Correlations between the 2D perfusion parameters and SPPs were assessed 
      using the Pearson coefficient. The cutoff points to predict mean SPPs >40 mm Hg 
      were analyzed using a receiver operating characteristic curve; outcomes are 
      reported as the area under the curve (AUC) with 95% confidence interval (CI). 
      Results: After EVT at rest and during hyperemia, only AT was significantly 
      changed, although hyperemia produced significant changes in all the pre-/post-EVT 
      2D perfusion parameters except the wash-in rate. Dorsal and plantar SPPs after 
      EVT were significantly increased and correlated with hyperemic AT and the AT 
      ratio (hyperemia/at rest values) below the ankle. Hyperemic ATs <6.3 seconds and 
      AT ratios <0.78 were predictive factors for a mean SPP >40 mm Hg, with AUCs of 
      0.83 (95% CI 0.67 to 0.99) and 0.78 (95% CI 0.61 to 0.95), respectively. 
      Conclusion: Hyperemic ATs <6.3 seconds or AT ratios <0.78 below the ankle may be 
      essential to obtain sufficient SPPs for limb salvage in BTK lesions. Thus, the 
      use of 2D perfusion angiography enabled the monitoring of lower limb tissue 
      perfusion throughout EVT and may thereby optimize treatment of CLTI.
FAU - Ikeoka, Kuniyasu
AU  - Ikeoka K
AD  - Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan.
FAU - Watanabe, Tetsuya
AU  - Watanabe T
AD  - Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan.
FAU - Shinoda, Yukinori
AU  - Shinoda Y
AD  - Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan.
FAU - Minamisaka, Tomoko
AU  - Minamisaka T
AD  - Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan.
FAU - Fukuoka, Hidetada
AU  - Fukuoka H
AD  - Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan.
FAU - Inui, Hirooki
AU  - Inui H
AD  - Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan.
FAU - Ueno, Keisuke
AU  - Ueno K
AD  - Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan.
FAU - Hoshida, Shiro
AU  - Hoshida S
AUID- ORCID: 0000-0002-0268-9417
AD  - Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan.
LA  - eng
PT  - Journal Article
DEP - 20200218
PL  - United States
TA  - J Endovasc Ther
JT  - Journal of endovascular therapy : an official journal of the International 
      Society of Endovascular Specialists
JID - 100896915
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - *Angiography, Digital Subtraction
MH  - Angioplasty, Balloon
MH  - Ankle/*blood supply
MH  - Blood Flow Velocity
MH  - Female
MH  - Humans
MH  - Ischemia/*diagnostic imaging/physiopathology/therapy
MH  - Limb Salvage
MH  - Male
MH  - Perfusion Imaging/*methods
MH  - Peripheral Arterial Disease/*diagnostic imaging/physiopathology/therapy
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - Regional Blood Flow
MH  - Skin/*blood supply
MH  - Time Factors
MH  - Treatment Outcome
MH  - Wound Healing
OTO - NOTNLM
OT  - below-the-knee stenosis
OT  - chronic limb-threatening ischemia
OT  - endovascular treatment
OT  - limb salvage
OT  - occlusion
OT  - perfusion angiography
OT  - skin perfusion pressure
EDAT- 2020/02/19 06:00
MHDA- 2020/07/21 06:00
CRDT- 2020/02/19 06:00
PHST- 2020/02/19 06:00 [pubmed]
PHST- 2020/07/21 06:00 [medline]
PHST- 2020/02/19 06:00 [entrez]
AID - 10.1177/1526602820905527 [doi]
PST - ppublish
SO  - J Endovasc Ther. 2020 Apr;27(2):198-204. doi: 10.1177/1526602820905527. Epub 2020 
      Feb 18.