Intraprocedural, Intra-Arterial CT Foot Perfusion Examination for Assessment of Endovascular Therapy in Patients With Critical Limb Ischemia: A Prospective Pilot Study

Thijs Urlings; Apoorva Gogna; Mark C Burgmans; Kiang Hiong Tay; Chow Wei Too; Ankur Patel; Shaun X Ju Min Chan; Leong Sum; Nanda Venkatanarasimah; Bien Soo Tan; Sivanathan Chandramohan; Cornelio Gutierrez; Farah Irani

doi:10.1177/15266028231185506

Intraprocedural, Intra-Arterial CT Foot Perfusion Examination for Assessment of Endovascular Therapy in Patients With Critical Limb Ischemia: A Prospective Pilot Study

J Endovasc Ther. 2023 Jul 11:15266028231185506. doi: 10.1177/15266028231185506. Online ahead of print.

Affiliations

¹ Haaglanden Medical Center, The Hague, The Netherlands.
² Singapore General Hospital, Singapore.
³ Leiden University Medical Center, Leiden, The Netherlands.

PMID: 37434379
DOI: 10.1177/15266028231185506

Abstract

Background: Current techniques to evaluate computed tomography (CT) foot perfusion in patients with critical limb ischemia use high contrast doses and cannot be used during endovascular procedures. CT perfusion of the foot with intra-arterial contrast injection during endovascular treatment in a hybrid angiography CT suite might solve these problems.

Purpose: The main objective of this study was to evaluate whether intra-arterial CT foot perfusion using a hybrid CT angiosystem is feasible during endovascular treatment for critical limb ischemia.

Material and methods: This prospective pilot study investigated intraprocedural, intra-arterial CT perfusion of the foot using a hybrid CT angiosystem in 12 patients before and after endovascular treatment for critical limb ischemia. Time to peak (TTP) and arterial blood flow were measured before and after treatment and compared using a paired t test.

Results: All 24 CT perfusion maps could be calculated adequately. The contrast volume used for one perfusion CT scan was 4.8 ml. The mean TTP before treatment was 12.8 seconds (standard deviation [SD] 2.8) and the mean TTP posttreatment was 8.4 seconds (SD 1.7), this difference being statistically significant (p=.001). Tendency toward increased blood flow after treatment, 340 ml/min/100 ml (SD 174) vs 514 ml/min/100 ml (SD 366) was noticed (p=.104). The mean effective radiation dose was 0.145 mSv per scan.

Conclusion: Computed tomography perfusion of the foot with low contrast dose intra-arterial contrast injection during endovascular treatment in a hybrid angiography CT suite is a feasible technique.

Clinical impact: Intra-arterial CT foot perfusion using a hybrid CT-angiography system is a feasible new technique during endovascular therapy for critical limb ischemia to assess the results of the treament. Future research is necessary in defining endpoints of endovascular treatment and establishing its role in limb salvage prognostication.

Keywords: 3D perfusion map; CT perfusion; contrast injection; hybrid angiography CT; lower limb ischemia.