Success of arterial revascularization determined by contrast ultrasound muscle perfusion imaging Daniel Duerschmied, MD, Philipp Maletzki, MD, Gabriele.

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Presentation transcript:

Success of arterial revascularization determined by contrast ultrasound muscle perfusion imaging Daniel Duerschmied, MD, Philipp Maletzki, MD, Gabriele Freund, MD, Manfred Olschewski, MSc, Christoph Bode, MD, Christoph Hehrlein, MD Journal of Vascular Surgery Volume 52, Issue 6, Pages 1531-1536 (December 2010) DOI: 10.1016/j.jvs.2010.07.010 Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 1 Study population. Patients with lifestyle-limiting peripheral arterial disease (PAD) and previous conservative treatment failure were assigned to treatment by percutaneous transluminal intervention (PTA) or bypass surgery in a nonrandomized fashion. ABI, Ankle-brachial index; CEUS, contrast-enhanced ultrasound; PVR, pulse volume recording. Journal of Vascular Surgery 2010 52, 1531-1536DOI: (10.1016/j.jvs.2010.07.010) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 2 Simplified CEUS procedure. Calf muscle was visualized in a supine position at rest and a 4-cm diameter, round region of interest (ROI; upper inset) was placed over muscle tissue avoiding large vessels and bone. Contrast agent was injected into an antecubital vein, and distribution kinetics of contrast enhancement (lower inset) were detected after first appearance in the ROI. Journal of Vascular Surgery 2010 52, 1531-1536DOI: (10.1016/j.jvs.2010.07.010) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 3 Time from beginning to peak intensity of contrast enhancement (TTP) in the calf muscle and standard parameters all improved after successful revascularization. Clinical staging according to Fontaine (A), pulse volume recording (PVR) amplitude reduction (B), ankle-brachial index (ABI; C), and TTP (D) were assessed before (pre), directly after revascularization (post), and at follow-up. All P values for comparison to preintervention. Horizontal bar, median, box, interquartile range, whiskers, range, circle, outlier >1.5 box-lengths from box, asterisk, outlier >4 box-lengths from box. Journal of Vascular Surgery 2010 52, 1531-1536DOI: (10.1016/j.jvs.2010.07.010) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 4 Simplified contrast ultrasound muscle perfusion imaging is equivalent to standard methods in detecting successful revascularization. Ankle-brachial index (ABI) and time to peak intensity (TTP) performed not significantly different in detecting intervention success after transluminal angioplasty (circles, upper P value) or bypass (grey diamonds, lower P value) in a McNemar analysis (A). Equivalence analysis of the overall study population directly after revascularization (B). Two-sided 95% confidence intervals of subtraction of % correctly detected successful revascularization with pulse volume recording (PVR), PAD Fontaine stage, and ABI from % correctly detected with TTP are shown by horizontal bars. Dashed lines depict the predefined zone of clinical indifference. Journal of Vascular Surgery 2010 52, 1531-1536DOI: (10.1016/j.jvs.2010.07.010) Copyright © 2010 Society for Vascular Surgery Terms and Conditions