Abstract
Abstract
Purpose
Patients with peripheral arterial disease (PAD) or critical limb ischemia (CLI) require revascularization. Traditionally, endovascular therapy (EVT) is performed with iodinated contrast agent (ICM), which can provoke potential deterioration in renal function. CO2 is a safe negative contrast agent to guide vascular procedures, but interpretation of CO2 angiography is challenging. Changes in blood flow following iodine-aided EVT are assessable with 2D-perfusion angiography (2D-PA). The aim of this study was to evaluate 2D-PA as a tool to monitor blood flow changes during CO2-aided EVT.
Material and Methods
2D-PA was performed before and after ten EVTs (nine stents; one endoprosthesis; 10/2012–02/2020) in nine patients (six men; 65 ± 10y) with Fontaine stage IIb (n = 8) and IV (n = 1). A reference ROI (ROIINFLOW) was placed in the artery before the targeted obstruction and a target ROI (ROIOUTFLOW) distally. Corresponding ROIs were used pre- and post-EVT. Time to peak (TTP), peak density (PD) and area under the curve (AUC) were computed. The reference/target ROI ratios (TTPOUTFLOW/TTPINFLOW; PDOUTFLOW/PDINFLOW; AUCOUTFLOW/AUCINFLOW) were calculated.
Results
2D-PA was technically feasible in all cases. A significant increase of 82% in PDOUTFLOW/PDINFLOW (0.44 ± 0.4 to 0.8 ± 0.63; p = 0.002) and of 132% in AUCOUTFLOW/AUCINFLOW (0.34 ± 0.22 to 0.79 ± 0.59; p = 0.002) was seen. A trend for a decrease in TTPOUTFLOW/TTPINFLOW was observed (− 24%; 5.57 ± 3.66 s–4.25 ± 1.64 s; p = 0.6).
Conclusion
The presented 2D-PA technique facilitates the assessment of arterial flow in CO2-aided EVTs and has the potential to simplify the assessment of immediate treatment response.
Funder
Medizinische Hochschule Hannover (MHH)
Publisher
Springer Science and Business Media LLC
Subject
Cardiology and Cardiovascular Medicine,Radiology Nuclear Medicine and imaging
Reference24 articles.
1. Stegemann E, Tegtmeier C, Bimpong-Buta NY, Sansone R, Uhlenbruch M, Richter A. Carbondioxide-aided angiography decreases contrast volume and preserves kidney function in peripheral vascular interventions. Angiology. 2016;67(9):875–81.
2. Hinrichs JB, Murray T, Akin M, Lee M, Brehm MU, Wilhelmi M. Evaluation of a novel 2D perfusion angiography technique independent of pump injections for assessment of interventional treatment of peripheral vascular disease. Int J Cardiovasc Imaging. 2017;33(3):295–301.
3. Krause D, Burghaus I, Thiem U, Trampisch US, Trampisch M, Klaassen-Mielke R. The risk of peripheral artery disease in older adults - seven-year results of the get ABI study. Vasa. 2016;45(5):403–10.
4. Fujihara M, Kawasaki D, Shintani Y, Fukunaga M, Nakama T, Koshida R. Endovascular therapy by CO2 angiography to prevent contrast-induced nephropathy in patients with chronic kidney disease: a prospective multicenter trial of CO2 angiography registry: EVT by CO2 angiography in CKD patients. Catheter Cardiovasc Interv. 2015;85(5):870–7.
5. Endorsed by: the European Stroke Organisation (ESO), Authors/Task Force Members, Tendera M, Aboyans V, Bartelink M-L, Baumgartner I, ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries * The Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J 2011;32(22):2851–906.
Cited by
3 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献