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

• Published in: Journal of vascular and interventional radiology Vol. 27; no. 6; pp. 852 - 858
• Main Authors: Lou, Wen-Sheng, MD, Su, Hao-Bo, MD, Huang, Kai-Yi, Dipl.-Ing, He, Xu, MD, Chen, Liang, MD, Chen, Guo-Ping, MD, Shi, Wan-Yin, MD, Han, Jing-Feng, PhD, Gu, Jian-Ping, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2016
• Subjects: Aged; Angiography, Digital Subtraction - methods; Angioplasty, Balloon - instrumentation; Ankle Brachial Index; Blood Flow Velocity; Feasibility Studies; Female; Femoral Artery - diagnostic imaging; Femoral Artery - physiopathology; Hemodynamics; Humans; Lower Extremity - blood supply; Male; Peripheral Arterial Disease - diagnostic imaging; Peripheral Arterial Disease - physiopathology; Peripheral Arterial Disease - therapy; Predictive Value of Tests; Radiographic Image Interpretation, Computer-Assisted; Radiology; Recovery of Function; Regional Blood Flow; Retrospective Studies; Stents; Time Factors; Treatment Outcome; Ultrasonography, Doppler; dorsalis pedis; common femoral artery; digital subtraction angiography; ABI; peripheral arterial disease; DP; FOV; field of view; ROI; SFA; TTP; PAD; percutaneous transluminal angioplasty; ccDSA; DSA; color-coded digital subtraction angiography; region of interest; superficial femoral artery; time to peak; PTA; ankle-brachial index; CFA
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2016.02.011

Abstract Purpose 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). Materials and 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.