Association Between the Effectiveness and Magnitude of Foot Microcirculation Assessed by Radionuclide Angiography and One Year Limb Outcomes in Patients with Chronic Limb Threatening Ischaemia

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum Pub Date : 2025-01-01 DOI:10.1016/j.ejvsvf.2024.11.002

Takuya Hashimoto , Yoshitaka Kumakura , Kenichi Ichikawa , Satoshi Yamamoto , Takashi Endo , Masaya Sano , Osamu Sato , Juno Deguchi

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引用次数: 0

Abstract

Objective

Microcirculation focused evaluations may provide physiological insights that complement those of the established clinical criteria for patients with chronic limb threatening ischaemia (CLTI), since complex treatments are needed in this high risk population. However, current methods for quantitatively assessing foot microcirculation are limited. Thus, in this study, the aim was to demonstrate a proof of concept non-invasive method with novel parameters for assessing foot microcirculation.

Methods

This was a single centre prospective cohort pilot study. The lower limbs of 13 patients diagnosed with CLTI were evaluated by radionuclide (RN) angiography with ^99mTc-tetrofosmin two weeks after revascularisation or non-revascularisation procedures. Novel parameters (pedal transit time and peak pedal count) were derived by processing the time–activity curves of the detected tracers in each region of interest in the limbs. The Mann–Whitney U test was used for the analysis of associations between these two parameters and limb fate at one year, and Pearson and Spearman tests were used to analyse associations with transcutaneous partial oxygen pressure (tcPO₂), a conventional perfusion test result.

Results

The mean pedal transit time of the affected limbs in the non-healing group was longer than that in the healing group (19.1 ± 18.6 vs. 2.9 ± 2.1 seconds, p = .001). The mean peak pedal count of nucleotides in the non-healing group was lower than that in the healing group (24.4 ± 19.0 vs. 72.0 ± 36.1 counts/sec/GBq, p = .008). The pedal transit time and peak pedal count showed little to no correlation with the conventional tcPO₂ at the midfoot (r = 0.26 for pedal transit time; r = −0.11 for peak pedal count).

Conclusion

Two novel microcirculation parameters derived from RN angiography were associated with one year limb outcomes in patients with CLTI. Non-invasive radiotracer imaging derived parameters may provide an additional dimension to indices of pathophysiological microcirculation in CLTI.

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以微循环为重点的评估可能为慢性肢体威胁性缺血（CLTI）患者的既定临床标准提供生理学见解，因为在这一高风险人群中需要复杂的治疗。然而，目前定量评估足部微循环的方法是有限的。因此，在本研究中，目的是展示一种具有新参数的概念验证无创方法来评估足部微循环。方法本研究为单中心前瞻性队列先导研究。13例诊断为CLTI的患者在进行血管重建或非血管重建手术两周后，采用放射性核素（RN）血管造影术（99mTc-tetrofosmin）对下肢进行评估。通过处理检测到的示踪剂在四肢各感兴趣区域的时间-活性曲线，得到了新的参数（踏板传递时间和峰值踏板计数）。使用Mann-Whitney U检验分析这两个参数与一年后肢体命运之间的关系，使用Pearson和Spearman检验分析与经皮分氧压（tcPO2）的关系，这是一项常规灌注试验结果。结果未愈合组患肢平均踏板传递时间较愈合组长（19.1±18.6 vs 2.9±2.1 s, p = .001）。未愈合组的平均峰值核苷酸计数低于愈合组（24.4±19.0比72.0±36.1计数/秒/GBq， p = 0.008）。踏板传递时间和峰值踏板计数与常规中足tcPO2几乎没有相关性（r = 0.26）；峰值踏板计数R =−0.11)。结论两项新微循环参数与CLTI患者1年肢体预后相关。无创放射性示踪成像衍生参数可以为CLTI病理生理微循环指标提供额外的维度。

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