University of Twente, Multi-Modality Medical Imaging Group, TechMed Centre, Enschede, The Netherlands; Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.
Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Eur J Vasc Endovasc Surg. 2021 Dec;62(6):896-908. doi: 10.1016/j.ejvs.2021.08.017. Epub 2021 Oct 19.
Many techniques have been introduced to enable quantification of tissue perfusion in patients with peripheral arterial disease (PAD). Currently, none of these techniques is widely used to analyse real time tissue perfusion changes during endovascular or surgical revascularisation procedures. The aim of this systematic review was to provide an up to date overview of the peri-procedural applicability of currently available techniques, diagnostic accuracy of assessing tissue perfusion and the relationship with clinical outcomes.
MEDLINE, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials.
This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines. Four electronic databases were searched up to 31 12 2020 for eligible articles: MEDLINE, Embase, CINAHL and the Cochrane Central Register of Controlled Trials. Eligible articles describing a perfusion measurement technique, used in a peri-procedural setting before and within 24 hours after the revascularisation procedure, with the aim of determining the effect of intervention in patients with PAD, were assessed for inclusion. The QUADAS-2 tool was used to assess the risk of bias and applicability of the studies.
An overview of 10 techniques found in 26 eligible articles focused on study protocols, research goals, and clinical outcomes is provided. Non-invasive techniques included laser speckle contrast imaging, micro-lightguide spectrophotometry, magnetic resonance imaging perfusion, near infrared spectroscopy, skin perfusion pressure, and plantar thermography. Invasive techniques included two dimensional perfusion angiography, contrast enhanced ultrasound, computed tomography perfusion imaging, and indocyanine green angiography. The results of the 26 eligible studies, which were mostly of poor quality according to QUADAS-2, were without exception, not sufficient to substantiate implementation in daily clinical practice.
This systematic review provides an overview of 10 tissue perfusion assessment techniques for patients with PAD. It seems too early to appoint one of them as a reference standard. The scope of future research in this domain should therefore focus on clinical accuracy, reliability, and validation of the techniques.
许多技术已被引入，以实现对外周动脉疾病（PAD）患者组织灌注的定量。目前，这些技术中没有一种被广泛用于分析血管内或手术血运重建过程中实时组织灌注变化。本系统综述的目的是提供目前可用技术的围手术期适用性、评估组织灌注的诊断准确性以及与临床结果的关系的最新概述。
MEDLINE、Embase、CINAHL 和 Cochrane 对照试验中心注册库。
本系统综述按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行。截至 2020 年 12 月 31 日，四个电子数据库搜索了符合条件的文章：MEDLINE、Embase、CINAHL 和 Cochrane 对照试验中心注册库。评估了描述灌注测量技术的文章，这些技术在血管重建手术前后 24 小时内的围手术期使用，目的是确定干预对 PAD 患者的影响。使用 QUADAS-2 工具评估研究的偏倚风险和适用性。
综述了 26 篇符合条件的文章中 10 种技术的概述，重点介绍了研究方案、研究目标和临床结果。非侵入性技术包括激光散斑对比成像、微光纤分光光度法、磁共振成像灌注、近红外光谱、皮肤灌注压和足底热图。侵入性技术包括二维灌注血管造影、对比增强超声、计算机断层灌注成像和吲哚菁绿血管造影。根据 QUADAS-2，26 篇符合条件的研究的结果大多质量较差，无一例外地不足以证明在日常临床实践中实施这些技术。
本系统综述提供了外周动脉疾病患者 10 种组织灌注评估技术的概述。现在任命其中一种作为参考标准还为时过早。因此，该领域未来研究的范围应侧重于技术的临床准确性、可靠性和验证。
