Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Sep 26, 2021; 13(9): 381-398
Published online Sep 26, 2021. doi: 10.4330/wjc.v13.i9.381
Quantifying tissue perfusion after peripheral endovascular procedures: Novel tissue perfusion endpoints to improve outcomes
Nikolaos-Achilleas Arkoudis, Konstantinos Katsanos, Riccardo Inchingolo, Ioannis Paraskevopoulos, Martin Mariappan, Stavros Spiliopoulos
Nikolaos-Achilleas Arkoudis, 2nd Radiology Department, Interventional Radiology Unit, Attikon University General Hospital, Athens 12461, Greece
Konstantinos Katsanos, Interventional Radiology Department, Patras University Hospital, PATRAS 26441, Greece
Riccardo Inchingolo, Interventional Radiology Unit, “F. Miulli” Regional General Hospital, Acquaviva delle Fonti 70021, Italy
Ioannis Paraskevopoulos, Department of Clinical Radiology, Interventional Radiology Unit, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen AB25 2ZN, United Kingdom
Martin Mariappan, Department of Clinical Radiology, Interventional Radiology Unit, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen AB15 5EY, United Kingdom
Stavros Spiliopoulos, 2nd Radiology Department, Interventional Radiology Unit, School of Medicine, National and Kapodistrian University of Athens, Athens 12461, Greece
Author contributions: All authors equally contributed to this paper with conception and design of the review, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: All the authors are aware of the content of the manuscript and have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Stavros Spiliopoulos, MD, PhD, Associate Professor, 2nd Radiology Department, Interventional Radiology Unit, School of Medicine, National and Kapodistrian University of Athens, 1st Rimini St, Chaidari, Athens 12461, Greece. stavspiliop@med.uoa.gr
Received: March 7, 2021
Peer-review started: March 7, 2021
First decision: May 6, 2021
Revised: May 11, 2021
Accepted: July 26, 2021
Article in press: July 26, 2021
Published online: September 26, 2021
Processing time: 194 Days and 13.3 Hours
Abstract

Peripheral artery disease (PAD) is a flow-limiting condition caused by narrowing of the peripheral arteries typically due to atherosclerosis. It affects almost 200 million people globally with patients either being asymptomatic or presenting with claudication or critical or acute limb ischemia. PAD-affected patients display increased mortality rates, rendering their management critical. Endovascular interventions have proven crucial in PAD treatment and decreasing mortality and have significantly increased over the past years. However, for the functional assessment of the outcomes of revascularization procedures for the treatment of PAD, the same tests that have been used over the past decades are still being employed. Those only allow an indirect evaluation, while an objective quantification of limb perfusion is not feasible. Standard intraarterial angiography only demonstrates post-intervention vessel patency, hence is unable to accurately estimate actual limb perfusion and is incapable of quantifying treatment outcome. Therefore, there is a significant necessity for real-time objectively measurable procedural outcomes of limb perfusion that will allow vascular experts to intraoperatively quantify and assess outcomes, thus optimizing treatment, obviating misinterpretation, and providing significantly improved clinical results. The purpose of this review is to familiarize readers with the currently available perfusion-assessment methods and to evaluate possible prospects.

Keywords: Peripheral arterial disease; Critical limb ischemia; Endovascular treatment; Peripheral angioplasty; Tissue perfusion; Quantification

Core Tip: Endovascular interventions have been proven critical in the treatment and management of peripheral artery disease-affected patients, by decreasing mortality and improving quality of life. However, currently available methods only allow an indirect evaluation of the functional assessment of treatment outcomes, while an objective quantification of limb perfusion is not feasible. This review aims to familiarize readers with currently available perfusion-assessment techniques that will allow vascular experts to intraoperatively quantify and evaluate outcomes, hence optimizing treatment, obviating misinterpretation, and providing significantly improved clinical results.