| Objectives:To investigate the feasibility of parametric color coding of digital subtraction angiography (Syngo iFlow)for hemodynamics assessment in patients with Symptomatic Lower Limb Ischaemia in pre-and post-endovascular therapy. To explore the correlation between Syngo iFlow and the conventional techniques.Methods:Clinical data of 40 patients with TASC II type B and type C femoropopliteal arteriosclerotic occlusive disease who were treated by percutaneous transluminal angioplasty and/or primary stent implantation in our hospital were analysed retrospectively. Of these patients there were 24 males and 16 females with a average age of (72.1 ±5.6) years (range from 58-85 years). The treatment efficacy was assessed by the variation of a series of clinical symptoms indexes (such as pain score, cold sensation score and intermittent claudication score), ankle braehial index(ABI) and transcutaneous oxygen pressure (TcPO2). Angiography was performed with the same protocol before and after treatment and parametric color coding of digital subtraction angiography were created by Syngo iFlow software on a dedicated workstation. The time to peak (TTP) of artery and tissue perfusion selected at the same regions of foot and ankle were measured and analyzed to evaluate the improvement of microcirculation and hemodynamics of the ischemic limb. Time to peak (TTP) of regions selected at common femoral artery bifurcation, popliteal artery bifurcation, dorsal pedal artery were measured, and the relative TTP from common femoral artery to popliteal and dorsal pedis were analyzed. The image quality between Syngo iFlow and DSA was qualitatively evaluated by two interventional radiologists and compared by using the Wilcoxon signed rank test. The correlations between Syngo iFlow and the traditional clinical evaluation methods were explored using the Spearman rank correlation test.Results:All patients (40 limbs) underwent successful endovaseular therapy. The mean pain score. cold sensation score. intermittent claudication score.ABI and TcPO2 before treatment were (1.88±1.62). (2.15± 1.25). (2.90±0.84).AB1 (0.35±0.08) and TcPO2(27.39±5.26) mmHg. While 1 week after treatment all above indicators were (0.22±0.42). (0.23±0.42). (0.63±0.59).AB1 (0.66±0.07) and TcPO2 (40.75±3.42) mmHg respectively. There were significant differences between pre-and post-treatment(P<0.05). The pre-and post-operative TTP of artery and tissue perfusion were (14.54±.89)s versus (10.40±1.98)s, (20.08±3.05) s versus (16.43±2.52) s. The pre-and postoperative TTP of common artery bifurcation, popliteal artery bifurcation, dorsal pedal artery and two relative TTP were (4.53±0.99)s and (4.56±1.01)s (P=0.377). (11.42±2.52)s and (8.61±1.51)s (P< 0.05), (20.08±3.05)s and (16.43±2.52)s (P<0.05),(6.88±1.90)s and (4.05±1.25)s (P <0.05),(8.66±1.79)s and (7.82±1.87)s (P<0.05) respectively. For assessment of hemodynamic changes during and after treatment, parametric color coding of digital subtraction angiography (Syngo iFlow) was assumed to shows the limb blood flow and perfusion were improved and the differences were statistically significant. The Spearman rank correlation test showed the TTP of artery was positively correlated with ABI,TcPO2 (r=0.53,0.33, P<0.05). the TTP of tissue perfusion was also positively con-elated with ABI, TcPO2 (r=0.63,0.41, P<0.05). In subjective evaluation of the image quality as a judgment method for the hemodynamic changes, the Syngo iFlow was higher than DSA significantly.Conclusions:Parametric color coding of digital subtraction angiography (Syngo iFlow) is a real-time, sensitive and quantitative tool that might provide additional support in the hemodynamics evaluation of endovascular treatment for patients with lower extremity peripheral arterial occlusion disease. |
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