Skip to main content

Advertisement

SpringerLink
Log in

Evaluation of a novel 2D perfusion angiography technique independent of pump injections for assessment of interventional treatment of peripheral vascular disease

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

To evaluate a novel 2D-perfusion angiography (2D-PA) technique allowing pro- and retrospective flow analysis based on a proximal reference region of interest (ROI) and distal target ROI in patients treated for peripheral arterial disease. 2D-PA allows quantifying blood flow by post-processing of digital subtraction angiography (DSA). 2D-PA was performed pre and post interventional treatment of peripheral arterial disease (PAD; n = 24; 13 angioplasties, 11 stents) in 21 patients (17 men, 72 ± 9y) with Fontaine stage IIB / III. Time-to-peak (TTP), peak density (PD) and area-under-the-curve (AUC) were calculated. Ratios reference/target ROI (TTPOUTFLOW/TTPINFLOW; PDOUTFLOW/PDINFLOW; AUCOUTFLOW/AUCINFLOW) were calculated and correlated to changes in the ankle-brachial-index (ABI). 2D-PA was technically feasible in all cases. A significant increase in ABI was seen after interventional treatment (+39%; p < 0.0001). ABI increase was accompanied by an increase of 36% of PDOUTFLOW/PDINFLOW (p < 0.0001), a 52% decrease of TTPOUTFLOW/TTPINFLOW (p = 0.0007) and a 69% increase of AUCOUTFLOW/AUCINFLOW (p < 0.0001). The difference of TTP pre- and post-intervention showed a correlation with the difference in ABI (r = −0.53, p = 0.0081). The other measured parameters failed to demonstrate significant correlation with improved ABI. The presented 2D-PA technique allows quantitative assessment of arterial flow before, during and after interventional treatment in PAD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

2D-PA:

2D-Perfusion angiography

ABI:

Ankle-brachial index

AUC:

Area-under-the-curve

DSA:

Digital subtraction angiography

IR:

Interventional radiology

PAD:

Peripheral arterial disease

PD:

Peak density

PTA:

Percutaneous transluminal angioplasty

ROI:

Region of interest

TTP:

Time-to-peak

References

  1. Krause D, Burghaus I, Thiem U et al (2016) The risk of peripheral artery disease in older adults–seven-year results of the getABI study. VASA 45:403–410. doi:10.1024/0301-1526/a000556

    Article  PubMed  Google Scholar 

  2. Diehm C, Allenberg JR, Pittrow D et al (2009) Mortality and vascular morbidity in older adults with asymptomatic versus symptomatic peripheral artery disease. Circulation 120:2053–2061. doi:10.1161/CIRCULATIONAHA.109.865600

    Article  PubMed  Google Scholar 

  3. Fowkes FGR, Rudan D, Rudan I et al (2013) Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. The Lancet 382:1329–1340. doi:10.1016/S0140-6736(13)61249-0

    Article  Google Scholar 

  4. Banerjee S, Sarode K, Mohammad A, Brilakis ES (2015) Drug-coated balloon and stent therapies for endovascular treatment of atherosclerotic superficial femoral artery disease. Curr Cardiol Rep 17:36–39. doi:10.1007/s11886-015-0586-8

    Article  PubMed  Google Scholar 

  5. Thukkani AK, Kinlay S (2015) Endovascular intervention for peripheral artery disease. Circ Res 116:1599–1613. doi:10.1161/CIRCRESAHA.116.303503

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Hardman RL, Jazaeri O, Yi J et al (2014) Overview of classification systems in peripheral artery disease. Semin Intervent Radiol 31:378–388. doi:10.1055/s-0034-1393976

    Article  PubMed  PubMed Central  Google Scholar 

  7. Norgren L, Hiatt WR, Dormandy JA et al (2007) Inter-society consensus for the management of peripheral arterial disease (TASC II). Int J Vasc Surg 33(1):S5–S67

    Article  Google Scholar 

  8. Jens S, Marquering HA, Koelemay MJW, Reekers JA (2015) Perfusion angiography of the foot in patients with critical limb ischemia: description of the technique. Cardiovasc Intervent Radiol 38:201–205. doi:10.1007/s00270-014-1036-5

    Article  PubMed  Google Scholar 

  9. Reekers JA, Koelemay MJW, Marquering HA, van Bavel ET (2016) Functional imaging of the foot with perfusion angiography in critical limb ischemia. Cardiovasc Intervent Radiol 39:183–189. doi:10.1007/s00270-015-1253-6

    Article  PubMed  Google Scholar 

  10. Murray T, Rodt T, Lee MJ (2016) Two-dimensional perfusion angiography of the foot: technical considerations and initial analysis. J Endovasc Ther 23:58–64. doi:10.1177/1526602815621289

    Article  PubMed  Google Scholar 

  11. Aboyans V, Criqui MH, Abraham P et al (2012) Measurement and interpretation of the ankle-brachial index A scientific statement from the American Heart Association. Circulation 126:2890–2909. doi:10.1161/CIR.0b013e318276fbcb

    Article  PubMed  Google Scholar 

  12. Benitez E, Sumpio BJ, Chin J, Sumpio BE (2014) Contemporary assessment of foot perfusion in patients with critical limb ischemia. Semin Vasc Surg 27:3–15. doi:10.1053/j.semvascsurg.2014.12.001

    Article  PubMed  Google Scholar 

  13. Wintermark M, Sesay M, Barbier E et al (2005) Comparative overview of brain perfusion imaging techniques. J Neuroradiol 32:294–314. doi:10.1161/01.STR.0000177884.72657.8b

    Article  CAS  PubMed  Google Scholar 

  14. Eriksson S, Nilsson J, Sturesson C (2014) Non-invasive imaging of microcirculation: a technology review. Med Devices (Auckl) 7:445–452. doi:10.2147/MDER.S51426

    Google Scholar 

  15. Yeung DKW, Griffith JF, Li AFW et al (2013) Air pressure-induced susceptibility changes in vascular reactivity studies using BOLD MRI. J Magn Reson Imaging 38:976–980. doi:10.1002/jmri.23926

    Article  PubMed  Google Scholar 

  16. Micari A, Sbarzaglia P, Meeks MDME et al (2015) New imaging modalities in peripheral interventions. Eur Heart J Suppl 17:A18–A22. doi:10.1093/eurheartj/suv006

    Article  Google Scholar 

  17. Prasad A (2015) CO2 angiography for peripheral arterial imaging: the good, bad, and ugly. Catheter Cardiovasc Interv 85:878–879. doi:10.1002/ccd.25882

    Article  PubMed  Google Scholar 

  18. Hawkins IF, Caridi JG (1998) Carbon dioxide (CO2) digital subtraction angiography: 26-year experience at the University of Florida. Eur Radiol 8:391–402. doi:10.1007/s003300050400

    Article  CAS  PubMed  Google Scholar 

  19. Penzkofer T, Slebocki K, Grommes J et al (2014) High-pitch carbon dioxide contrasted CT angiography: pilot study. Cardiovasc Intervent Radiol 37:362–370. doi:10.1007/s00270-013-0834-5

    Article  PubMed  Google Scholar 

  20. Baradaran H, Fodera V, Mir D et al (2015) Evaluating CT perfusion deficits in global cerebral edema after aneurysmal subarachnoid hemorrhage. AJNR Am J Neuroradiol 36:1431–1435. doi:10.3174/ajnr.A4328

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Schoenfeld C, Cebotari S, Hinrichs J et al (2016) MR imaging-derived regional pulmonary parenchymal perfusion and cardiac function for monitoring patients with chronic thromboembolic pulmonary hypertension before and after pulmonary endarterectomy. Radiology 279:925–934. doi:10.1148/radiol.2015150765

    Article  PubMed  Google Scholar 

  22. Forsythe RO, Hinchliffe RJ (2016) Assessment of foot perfusion in patients with a diabetic foot ulcer. Diabetes Metab Res Rev 32(Suppl 1):232–238. doi:10.1002/dmrr.2756

    Article  CAS  PubMed  Google Scholar 

  23. Ankle Brachial Index Collaboration, Murray GD, Butcher I et al (2008) Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. JAMA 300:197–208. doi:10.1001/jama.300.2.197

    Article  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany

    Jan B. Hinrichs, Frank K. Wacker & Thomas Rodt

  2. Department of Diagnostic and Interventional Radiology, Beaumont Hospital, Dublin, Ireland

    Tim Murray & Michael Lee

  3. Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany

    Muharrem Akin & Micheal Ulrich Brehm

  4. Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hanover, Germany

    Mathias Wilhelmi

Authors
  1. Jan B. Hinrichs
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tim Murray
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Muharrem Akin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Micheal Ulrich Brehm
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mathias Wilhelmi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Frank K. Wacker
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Thomas Rodt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jan B. Hinrichs.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest concerning this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hinrichs, J.B., Murray, T., Akin, M. et al. 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 33, 295–301 (2017). https://doi.org/10.1007/s10554-016-1008-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-016-1008-8

Keywords

Search

Navigation