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Top Things to Know:
Perfusion Assessment in Critical Limb Ischemia

By Sanjay Misra, MD, FAHA, FSIR, Professor of Radiology, Mayo Clinic College of Medicine,
Edwin Takahashi, MD, Division of Vascular and Interventional Radiology, Mayo Clinic, and
Mehdi H. Shishehbor, DO, MPH, PhD, Professor of Medicine, Case Western Reserve School of Medicine

  1. Limb perfusion assessment is important for timely diagnosis of critical limb ischemia (CLI) and may reduce unnecessary invasive procedures in patients with adequate blood flow.
  2. This statement reviews the limitations of current methods of perfusion assessment and discusses newer techniques and novel devices.
  3. Transcutaneous oximetry (TcPO2), near-infra-red spectroscopy, and hyperspectral imaging are useful adjunctive tests that provide regional information on tissue oxygen content and delivery.
  4. Intraprocedural perfusion guidance allows for more efficient procedures including assessment of the need for revascularization of the angiosome-related artery, pedal arch and vessels, and multivessel intervention.
  5. At present, only intraprocedural angiographic endpoints are available to subjectively evaluate the completeness and adequacy of perfusion.
  6. There is promising, albeit limited data on perfusion imaging such as perfusion computed tomography, arterial spin labeling and blood oxygen level dependent magnetic resonance imaging in CLI patients.
  7. Novel devices such as implantable biosensors may enable intraoperative perfusion assessment and are appraised in this statement.
  8. There are opportunities to identify sex- and ethnicity-based differences in lower extremity perfusion.
  9. There is a need for more evidence on the economic impact of perfusion assessment in CLI patients.
  10. This statement highlights the importance of incorporating perfusion assessment into the care of CLI patients.

View the full Science News coverage for Perfusion Assessment in Critical Limb Ischemia

Citation

Misra S, Shishehbor MH, Takahashi EA, Aronow HD, Brewster LP, Bunte MC, Kim ESH, Lindner JR, Rich K, on behalf of the American Heart Association Council on Peripheral Vascular Disease, Council on Clinical Cardiology, and Council on Cardiovascular and Stroke Nursing. Perfusion assessment in critical limb ischemia: principles for understanding and the development of evidence and evaluation of devices: a scientific statement from the American Heart Association [published online ahead of print August 12, 2019]. Circulation. doi: 10.1161/CIR.0000000000000708.