定量动脉内荧光血管造影直接监测外周血运重建效果

IF 0.7 Q4 SURGERY

Journal of Vascular Surgery Cases Innovations and Techniques Pub Date : 2025-03-04 DOI:10.1016/j.jvscit.2025.101770

Harry G.M. Vaassen MSc , Daan J. Lips PhD , Robert H. Geelkerken MD , Bryan Wermelink PhD

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引用次数: 0

摘要

目的探讨定量荧光血管造影动脉内染料注射（Q-iaFA）在慢性肢体缺血（CLTI）患者血运重建术中指导的可行性。方法本观察性队列研究纳入14例行血管内介入治疗的CLTI患者。血运重建术前后直接行Q-iaFA。参数峰值时间（TTP）和归一化峰值斜率（PSnorm）来源于在足底侧五个感兴趣区域测量的强度-时间曲线。主要结局被定义为这些Q-iaFA参数在术前值最差的感兴趣区域的术前和术后测量值之间的变化。根据术中放射成像和跨大西洋协会II标准，将血运重建的预期影响分为强、中等或无。结果所有患者均成功，无并发症。8例（57%）患者的血运重建影响为强烈，5例（36%）患者为中度，1例（7%）患者为无影响。在强冲击组，TTP显著降低，PSnorm显著升高（P = 0.004）。同样的趋势在中度影响组较不明显，无统计学意义（P = 0.104和P = 0.094）。相反，在没有预期血运重建影响的患者中，TTP升高，PSnorm降低。结论q - iafa是血管介入术中外周组织灌注评价的一种可行技术。CLTI患者动脉病变血运重建直接影响提取的灌注参数。这一发现提示Q-iaFA可能有助于指导术中决策。需要改进量化策略并将Q-iaFA参数与临床结果联系起来。

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Quantitative intra-arterial fluorescence angiography for direct monitoring of peripheral revascularization effects

Objective

To investigate the feasibility of quantitative fluorescence angiography with intra-arterial dye injection (Q-iaFA) for intraoperative guidance during revascularization procedures in patients with chronic limb-threatening ischemia (CLTI).

Methods

In this observational cohort study, 14 patients with CLTI undergoing endovascular intervention were included. Q-iaFA was performed directly before and after revascularization. The parameters time to peak (TTP) and normalized peak slope (PS_norm) were derived from intensity-time curves that were measured on the plantar side of the foot in five regions of interest. The main outcome was defined as the change in these Q-iaFA parameters between pre- and postoperative measurements in the region of interest with the most inferior preoperative value. Expected impact of revascularization was classified into strong, moderate or absent, based on intraoperative radiographic imaging and the Trans-Atlantic Inter-Society II standards.

Results

Q-iaFA was successful without complications in all patients. Revascularization impact was classified as strong in 8 (57%), moderate in 5 (36%), and as absent in 1 (7%) patients. In the strong impact group, a significant decrease in TTP and increase in PS_norm was observed (P = .004). The same trend was less pronounced in the moderate impact group, without statistical significance (P = .104 and P = .094). Conversely, in the patient with no expected revascularization impact, TTP increased and PS_norm decreased.

Conclusions

Q-iaFA is a feasible technique to evaluate peripheral tissue perfusion during vascular interventions. The extracted perfusion parameters are directly affected by revascularization of arterial lesions in patients with CLTI. This finding suggests that Q-iaFA may be useful to guide intraoperative decision making. Work is required to refine quantification strategies and relate Q-iaFA parameters to clinical outcomes.

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来源期刊

Journal of Vascular Surgery Cases Innovations and Techniques SURGERY-

CiteScore

1.00

自引率

14.30%

发文量

219

审稿时长

29 weeks

期刊介绍： Journal of Vascular Surgery Cases and Innovative Techniques is a surgical journal dedicated to publishing peer review high quality case reports, vascular images and innovative techniques related to all aspects of arterial, venous, and lymphatic diseases and disorders, including vascular trauma, malformations, wound care and the placement and maintenance of arterio-venous dialysis accesses with an emphasis on the practicing clinician. The Journal seeks to provide novel and timely information to vascular surgeons, interventionalists, phlebologists, wound care specialists, and allied health professionals involved with the management of patients with the entire spectrum of vascular disorders.