Association Between the Effectiveness and Magnitude of Foot Microcirculation Assessed by Radionuclide Angiography and One Year Limb Outcomes in Patients with Chronic Limb Threatening Ischaemia
Objective: Microcirculation focused evaluations may provide physiological insights that complement those of the established clinical criteria for patients with chronic limb threatening ischaemia (CLTI), since complex treatments are needed in this high risk population. However, current methods for qu...
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Elsevier
2025-01-01
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| Series: | EJVES Vascular Forum |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666688X24001527 |
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| author | Takuya Hashimoto Yoshitaka Kumakura Kenichi Ichikawa Satoshi Yamamoto Takashi Endo Masaya Sano Osamu Sato Juno Deguchi |
| author_facet | Takuya Hashimoto Yoshitaka Kumakura Kenichi Ichikawa Satoshi Yamamoto Takashi Endo Masaya Sano Osamu Sato Juno Deguchi |
| author_sort | Takuya Hashimoto |
| collection | DOAJ |
| description | Objective: Microcirculation focused evaluations may provide physiological insights that complement those of the established clinical criteria for patients with chronic limb threatening ischaemia (CLTI), since complex treatments are needed in this high risk population. However, current methods for quantitatively assessing foot microcirculation are limited. Thus, in this study, the aim was to demonstrate a proof of concept non-invasive method with novel parameters for assessing foot microcirculation. Methods: This was a single centre prospective cohort pilot study. The lower limbs of 13 patients diagnosed with CLTI were evaluated by radionuclide (RN) angiography with 99mTc-tetrofosmin two weeks after revascularisation or non-revascularisation procedures. Novel parameters (pedal transit time and peak pedal count) were derived by processing the time–activity curves of the detected tracers in each region of interest in the limbs. The Mann–Whitney U test was used for the analysis of associations between these two parameters and limb fate at one year, and Pearson and Spearman tests were used to analyse associations with transcutaneous partial oxygen pressure (tcPO2), a conventional perfusion test result. Results: The mean pedal transit time of the affected limbs in the non-healing group was longer than that in the healing group (19.1 ± 18.6 vs. 2.9 ± 2.1 seconds, p = .001). The mean peak pedal count of nucleotides in the non-healing group was lower than that in the healing group (24.4 ± 19.0 vs. 72.0 ± 36.1 counts/sec/GBq, p = .008). The pedal transit time and peak pedal count showed little to no correlation with the conventional tcPO2 at the midfoot (r = 0.26 for pedal transit time; r = −0.11 for peak pedal count). Conclusion: Two novel microcirculation parameters derived from RN angiography were associated with one year limb outcomes in patients with CLTI. Non-invasive radiotracer imaging derived parameters may provide an additional dimension to indices of pathophysiological microcirculation in CLTI. |
| format | Article |
| id | doaj-art-8a2cd4e54a634783932f7c9bd6e16585 |
| institution | Kabale University |
| issn | 2666-688X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EJVES Vascular Forum |
| spelling | doaj-art-8a2cd4e54a634783932f7c9bd6e165852025-08-20T03:30:44ZengElsevierEJVES Vascular Forum2666-688X2025-01-0163111910.1016/j.ejvsvf.2024.11.002Association Between the Effectiveness and Magnitude of Foot Microcirculation Assessed by Radionuclide Angiography and One Year Limb Outcomes in Patients with Chronic Limb Threatening IschaemiaTakuya Hashimoto0Yoshitaka Kumakura1Kenichi Ichikawa2Satoshi Yamamoto3Takashi Endo4Masaya Sano5Osamu Sato6Juno Deguchi7Department of Vascular Surgery, Saitama Medical Centre, Saitama Medical University, Kawagoe, JapanDepartment of Diagnostic Radiology and Nuclear Medicine, Saitama Medical Centre, Saitama Medical University, Kawagoe, Japan; Isotope Science Centre, the University of Tokyo, Tokyo, JapanDepartment of Diagnostic Radiology and Nuclear Medicine, Saitama Medical Centre, Saitama Medical University, Kawagoe, JapanDepartment of Vascular Surgery, Saitama Medical Centre, Saitama Medical University, Kawagoe, JapanDepartment of Vascular Surgery, Saitama Medical Centre, Saitama Medical University, Kawagoe, JapanDepartment of Vascular Surgery, Saitama Medical Centre, Saitama Medical University, Kawagoe, JapanDepartment of Vascular Surgery, Saitama Medical Centre, Saitama Medical University, Kawagoe, JapanDepartment of Vascular Surgery, Saitama Medical Centre, Saitama Medical University, Kawagoe, Japan; Corresponding author. Department of Vascular Surgery, Saitama Medical Centre, 1981 Kamoda, Kawagoe, Saitama, 3508550, Japan.Objective: Microcirculation focused evaluations may provide physiological insights that complement those of the established clinical criteria for patients with chronic limb threatening ischaemia (CLTI), since complex treatments are needed in this high risk population. However, current methods for quantitatively assessing foot microcirculation are limited. Thus, in this study, the aim was to demonstrate a proof of concept non-invasive method with novel parameters for assessing foot microcirculation. Methods: This was a single centre prospective cohort pilot study. The lower limbs of 13 patients diagnosed with CLTI were evaluated by radionuclide (RN) angiography with 99mTc-tetrofosmin two weeks after revascularisation or non-revascularisation procedures. Novel parameters (pedal transit time and peak pedal count) were derived by processing the time–activity curves of the detected tracers in each region of interest in the limbs. The Mann–Whitney U test was used for the analysis of associations between these two parameters and limb fate at one year, and Pearson and Spearman tests were used to analyse associations with transcutaneous partial oxygen pressure (tcPO2), a conventional perfusion test result. Results: The mean pedal transit time of the affected limbs in the non-healing group was longer than that in the healing group (19.1 ± 18.6 vs. 2.9 ± 2.1 seconds, p = .001). The mean peak pedal count of nucleotides in the non-healing group was lower than that in the healing group (24.4 ± 19.0 vs. 72.0 ± 36.1 counts/sec/GBq, p = .008). The pedal transit time and peak pedal count showed little to no correlation with the conventional tcPO2 at the midfoot (r = 0.26 for pedal transit time; r = −0.11 for peak pedal count). Conclusion: Two novel microcirculation parameters derived from RN angiography were associated with one year limb outcomes in patients with CLTI. Non-invasive radiotracer imaging derived parameters may provide an additional dimension to indices of pathophysiological microcirculation in CLTI.http://www.sciencedirect.com/science/article/pii/S2666688X24001527Chronic limb threatening ischaemiaMicrocirculationPerfusion imagingPeripheral arterial diseaseRadionuclide angiographyTechnetium 99m tetrofosmin |
| spellingShingle | Takuya Hashimoto Yoshitaka Kumakura Kenichi Ichikawa Satoshi Yamamoto Takashi Endo Masaya Sano Osamu Sato Juno Deguchi Association Between the Effectiveness and Magnitude of Foot Microcirculation Assessed by Radionuclide Angiography and One Year Limb Outcomes in Patients with Chronic Limb Threatening Ischaemia EJVES Vascular Forum Chronic limb threatening ischaemia Microcirculation Perfusion imaging Peripheral arterial disease Radionuclide angiography Technetium 99m tetrofosmin |
| title | Association Between the Effectiveness and Magnitude of Foot Microcirculation Assessed by Radionuclide Angiography and One Year Limb Outcomes in Patients with Chronic Limb Threatening Ischaemia |
| title_full | Association Between the Effectiveness and Magnitude of Foot Microcirculation Assessed by Radionuclide Angiography and One Year Limb Outcomes in Patients with Chronic Limb Threatening Ischaemia |
| title_fullStr | Association Between the Effectiveness and Magnitude of Foot Microcirculation Assessed by Radionuclide Angiography and One Year Limb Outcomes in Patients with Chronic Limb Threatening Ischaemia |
| title_full_unstemmed | Association Between the Effectiveness and Magnitude of Foot Microcirculation Assessed by Radionuclide Angiography and One Year Limb Outcomes in Patients with Chronic Limb Threatening Ischaemia |
| title_short | Association Between the Effectiveness and Magnitude of Foot Microcirculation Assessed by Radionuclide Angiography and One Year Limb Outcomes in Patients with Chronic Limb Threatening Ischaemia |
| title_sort | association between the effectiveness and magnitude of foot microcirculation assessed by radionuclide angiography and one year limb outcomes in patients with chronic limb threatening ischaemia |
| topic | Chronic limb threatening ischaemia Microcirculation Perfusion imaging Peripheral arterial disease Radionuclide angiography Technetium 99m tetrofosmin |
| url | http://www.sciencedirect.com/science/article/pii/S2666688X24001527 |
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