Evaluation of Distal Hemodynamic Changes of Lower Extremity after Endovascular Treatment: Correlation between Measurements of Color-Coded Quantitative Digital Subtraction Angiography and Ankle-Brachial Index.
OBJECTIVE
To confirm the feasibility of using time-to-peak (TTP) measurements derived from color-coded digital subtraction angiography (ccDSA) imaging to assess improvements in distal circulation in relation to the ankle-brachial index (ABI).


METHODS
Nineteen patients who underwent percutaneous transluminal angioplasty and/or stent placement (in 20 lower extremities) were evaluated. A region of interest (ROI) at the proximal superficial femoral artery (SFA) was selected for a reference TTP for quantitative assessments. The ROI measurements of the TTP interval between medial and lateral plantar/dorsalis pedis relative to the reference was regarded as the ΔTTP and used to assess distal hemodynamic improvement achieved by the revascularization. The ABI was obtained with a handheld Doppler ultrasound machine with a manually operated blood-pressure cuff. Correlation between the two methods was analyzed.


RESULTS
The ABI improved significantly from 0.44 ± 0.18 to 0.79 ± 0.20 (t = 10.11; P < .0001) after the intervention. TTP, which reflected the blood flow time from the proximal SFA to the foot, became much faster, from 11.86 seconds ± 4.26 to 6.75 seconds ± 2.03 (t = 6.57; P < .001). A good correlation was observed between the improvement ratios of ΔTTP and ABI (r = 0. 863).


CONCLUSIONS
TTP measurements derived from ccDSA provide an easy and objective method for assessment of distal hemodynamic changes after endovascular treatment of lower-extremity peripheral arterial disease (PAD). It may provide a quantitative method to assess the adequacy of endovascular interventions and provide more objective suggestions for procedure endpoints, with potentially better clinical outcomes for patients with PAD.
Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Rd., Nanjing 210006, China.
Wen-Sheng
WS
Lou
Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Rd., Nanjing 210006, China.
Hao-Bo
HB
Su
Clinical Research Collaboration, Siemens China Shanghai Branch, Shanghai, China.
Kai-Yi
KY
Huang
Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Rd., Nanjing 210006, China.
Xu
X
He
Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Rd., Nanjing 210006, China.
Liang
L
Chen
Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Rd., Nanjing 210006, China.
Guo-Ping
GP
Chen
Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Rd., Nanjing 210006, China.
Wan-Yin
WY
Shi
Clinical Research Collaboration, Siemens China Shanghai Branch, Shanghai, China.
Jing-Feng
JF
Han
Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Rd., Nanjing 210006, China. Electronic address: cjr.gujianping@vip.163.com.
Jian-Ping
JP
Gu
D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods*; D000800:Angioplasty, Balloon / Q000295:instrumentation; D055109:Ankle Brachial Index; D001783:Blood Flow Velocity; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D020127:Recovery of Function; D012039:Regional Blood Flow; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler