Non-Invasive Assessment of Neuroischemic Limb, What s New. Minimally-Invasive Assessment of Neuroischemic Limb, What s New
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1 Non-Invasive Assessment of Neuroischemic Limb, What s New Minimally-Invasive Assessment of Neuroischemic Limb, What s New Venita Chandra, MD Clinical Assistant Professor of Surgery Division of Stanford Medical School, Stanford, CA Venita Chandra, MD Clinical Assistant Professor of Surgery Division of Stanford Medical School, Stanford, CA UCSF Vascular Symposium April 16th, 2016 UCSF Vascular Symposium April 16th, 2016 I have no relevant disclosures 1
2 What s new ish? Indocyanine Green Angiography (ICGA) Hyperspectral imaging (HSI) SPECT/PET Microoxygen sensors (MOXY) Indocyanine Green Angiography (ICGA) Peak Desai N. JTCS. 132(3): Significant differences in perfusion rates in patients with severe or moderate PAOD compared to normal controls. More sensitive that conventional ABI to detect mild functional impairment ICGA after intervention Several patients without significant changes in ABI, but changes in ICGA values Vascular Colvard Surgeryet. al. SPY Technology as an Adjunctive Measure for Lower Extremity Perfusion JVS, In Print. 2
3 ICGA Pros: Quantitative and Qualitative data Topographic data across the region of interest Appears to be able to assess changes in perfusion Cons: Contraindicated in liver and kidney failure Requires IV access Added time Clinical impact unknown Hyperspectral Imaging (HSI) Scanning spectroscopy to construct a spatial anatomic map for tissue oxygenation using visual light Map generated by local molecular composition of oxyhemoglobin and deoxyhemoglobin levels based on wavelength selection HSI for PAD 65 PAD limbs vs. 92 non-pad limbs Significant difference in deoxyhemoglobin levels Significant differences between monophasic, biphasic and triphasic waveforms Chin et. al. JVS 2011 HSI shown to identify skin microcirculation in the neuroischemic limb High sensitivity (86%) and specificity (88%) in determining healing potential 3
4 HSI Pros: Noninvasive, Delivers finer assessment of perfusion by evaluation of oxy and deoxyhemoglobin levels Cons: Vulnerable to same weaknesses in terms of skin temperature/condition as TCO2 and/or SPP No well organized/planned prospective studies SPECT/PET Radioisotopes + nuclear imaging + high-resolution CT scan imaging Can visualize perfusion and process of angiogenesis Get both functional and structural information Hybrid 99mTc-tetrofosmin single photon emission tomography (SPECT)/CT Stacy Vascular MR,ZhouW,SinusasAJ.Radiotracerimagingof Surgery peripheral vasculardisease.jnuclmed2013;54: Angiogenesis SPECT/CT Increased activity in ischemic limb Pros: Noninvasive Can give a lot if specific/targeted information (i.e infection, angiogenesis) Cons: Expensive Require trained team of nuclear technicians Time Full potential of clinical applications unknown Adah Almutairi et al. PNAS 2009;106:
5 Microoxygen Sensors (Lumee *) Injectable, oxygen-sensitive micro sensor (0.5x0.5x0.5mm) Biocompatible hydrogel + NIR oxygen-sensitive molecule External light emitting diode detector Pulses of light excite microsensor and sends light signal back * Profusa Inc. South San Francisco First in man safety and feasibility study in CLI patients undergoing endovascular intervention Statistically significant increase in O2 concentration after intervention Microoxygen Sensors Conclusions Pros Live understanding of tissue perfusion/oxygenation Appears to be more reliable than other methods such as TcPo2 and pulse oximetry Cons Not FDA approved Permanent implant (although well tolerated) Very little clinical evidence Invasive True understanding of tissue perfusion, key in management of the neuroischemic limb Many new and exciting for the assessment of the neuroischemic limb Most need further study to best determine their clinical impact 5
6 Thank You! vascular.stanford.edu 6
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