Platonov S A, Zavatskiĭ V V, Kiselev M A, Avramenko A I, Novitskiĭ A S, Alimkhadzhiev I A, Kandyba D V, Savello V E, Dudanov I P
St. Petersburg Scientific Research Institute for Emergency Ambulance Care named after I.I. Dzhanelidze, St. Petersburg, Russia.
Department of Roentgenosurgical Methods of Diagnosis and Treatment, Municipal Mariinskaya Hospital, St. Petersburg, Russia.
Angiol Sosud Khir. 2017;23(2):19-24.
The authors assessed perfusion of the foot in patients presenting with lower limb critical ischaemia before and after endovascular revascularization, as well as analysed the interrelationship between the change of perfusion and the clinical result of treatment. The study includes a total of 15 patients presenting with ulcerative-necrotic defects of the foot. All patients underwent study of 2D-perfusion of the foot before and after the endovascular intervention. The '2D-perfusion' package was used within the framework of an angiographic examination, and required neither increase in the volume of the contrast medium nor radiation load. Four parameters of perfusion were evaluated: the time of ingress, the time of reaching the peak value, the peak value and the area under the curve. After the intervention, as compared with the baseline values there were statistically significant differences by the time of ingress (a 2.4-fold decrease; p<0.0001), the peak value (a 1.8-fold increase; p<0.0001) and the area under the curve (a 2.4-fold increase; p<0.0001). No statistically significant differences were revealed while comparing the time of reaching the peak value before and after the intervention (p=0.767). Trophic defects healed in 11 (73.3%) patients, and in 4 (26.7%) patients the process of healing continued with positive dynamics at the check-up examination. Hence, our first experience of using the assessment of 2D-perfusion demonstrates simplicity of the method with no increase of the radiation load and the dose of the contrast medium. The method makes it possible to obtain important data about the state of microcirculation of the foot in patients with lower limb critical ischaemia, to evaluate alterations after the endovascular intervention. Improvement of the parameters of perfusion is associated with a good clinical outcome.
作者评估了下肢严重缺血患者在血管内血运重建前后足部的灌注情况，并分析了灌注变化与治疗临床结果之间的相互关系。该研究共纳入15例足部有溃疡性坏死缺损的患者。所有患者均在血管内介入治疗前后接受了足部二维灌注研究。“二维灌注”软件包是在血管造影检查框架内使用的，既不需要增加造影剂的用量，也不需要增加辐射剂量。评估了四个灌注参数：进入时间、达到峰值的时间、峰值和曲线下面积。干预后，与基线值相比，进入时间（减少2.4倍；p<0.0001）、峰值（增加1.8倍；p<0.0001）和曲线下面积（增加2.4倍；p<0.0001）均有统计学显著差异。干预前后达到峰值的时间比较未发现统计学显著差异（p=0.767）。11例（73.3%）患者的营养性缺损愈合，4例（26.7%）患者在复查时愈合过程呈积极动态。因此，我们首次使用二维灌注评估的经验表明该方法简单，不增加辐射剂量和造影剂剂量。该方法能够获取有关下肢严重缺血患者足部微循环状态的重要数据，评估血管内介入治疗后的变化。灌注参数的改善与良好的临床结果相关。
