J Vasc Surg Cases Innov Tech. 2025 Mar 4;11(3):101770. doi: 10.1016/j.jvscit.2025.101770. eCollection 2025 Jun.
ABSTRACT
OBJECTIVE: To investigate the feasibility of quantitative fluorescence angiography with intra-arterial dye injection (Q-iaFA) for intraoperative guidance during revascularization procedures in patients with chronic limb-threatening ischemia (CLTI).
METHODS: In this observational cohort study, 14 patients with CLTI undergoing endovascular intervention were included. Q-iaFA was performed directly before and after revascularization. The parameters time to peak (TTP) and normalized peak slope (PSnorm) were derived from intensity-time curves that were measured on the plantar side of the foot in five regions of interest. The main outcome was defined as the change in these Q-iaFA parameters between pre- and postoperative measurements in the region of interest with the most inferior preoperative value. Expected impact of revascularization was classified into strong, moderate or absent, based on intraoperative radiographic imaging and the Trans-Atlantic Inter-Society II standards.
RESULTS: Q-iaFA was successful without complications in all patients. Revascularization impact was classified as strong in 8 (57%), moderate in 5 (36%), and as absent in 1 (7%) patients. In the strong impact group, a significant decrease in TTP and increase in PSnorm was observed (P = .004). The same trend was less pronounced in the moderate impact group, without statistical significance (P = .104 and P = .094). Conversely, in the patient with no expected revascularization impact, TTP increased and PSnorm decreased.
CONCLUSIONS: Q-iaFA is a feasible technique to evaluate peripheral tissue perfusion during vascular interventions. The extracted perfusion parameters are directly affected by revascularization of arterial lesions in patients with CLTI. This finding suggests that Q-iaFA may be useful to guide intraoperative decision making. Work is required to refine quantification strategies and relate Q-iaFA parameters to clinical outcomes.
PMID:40236913 | PMC:PMC11999592 | DOI:10.1016/j.jvscit.2025.101770
