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Quantitative Intra-arterial Fluorescence Angiography for Direct Monitoring of Peripheral Revascularization Effects

1. Introduction

Chronic limb-threatening ischemia (CLTI) is a severe form of peripheral artery disease that leads to reduced blood flow and high risks of limb loss. Accurate intraoperative assessment of tissue perfusion is crucial for optimizing revascularization outcomes. Quantitative fluorescence angiography with intra-arterial dye injection (Q-iaFA) is emerging as a promising technique for real-time evaluation of perfusion changes. This study investigates the feasibility of Q-iaFA in guiding revascularization and its potential to improve intraoperative decision-making in CLTI patients.

2. Quantitative Fluorescence Angiography (Q-iaFA) as a Perfusion Assessment Tool

Q-iaFA employs intra-arterial dye injection to generate intensity-time curves that provide critical insights into blood flow dynamics. Parameters such as time to peak (TTP) and normalized peak slope (PSnorm) help assess tissue perfusion changes before and after revascularization. This technique offers a real-time, quantitative approach to evaluating vascular interventions and has potential advantages over conventional imaging modalities.

3. Methodological Approach in Q-iaFA Evaluation

The study involved fourteen CLTI patients undergoing endovascular revascularization, with Q-iaFA measurements taken before and after intervention. The plantar foot was divided into five regions of interest (ROIs) for perfusion analysis. Changes in TTP and PSnorm were analyzed based on revascularization impact, classified as strong, moderate, or absent. These classifications were derived from intraoperative X-ray imaging and the Trans-Atlantic Inter-Society II standards.

4. Impact of Revascularization on Q-iaFA Parameters

Findings indicate that Q-iaFA parameters are directly influenced by the effectiveness of revascularization. In cases with strong revascularization impact, TTP significantly decreased while PSnorm increased, reflecting improved perfusion. Moderate improvements were observed in some patients but lacked statistical significance. In contrast, no improvements were seen in a patient with absent revascularization impact, highlighting the sensitivity of Q-iaFA in assessing treatment efficacy.

5. Clinical Feasibility and Advantages of Q-iaFA in Vascular Surgery

Q-iaFA was successfully implemented without complications, demonstrating its feasibility as an intraoperative perfusion assessment tool. Compared to conventional imaging methods, Q-iaFA provides a direct and quantifiable measure of tissue perfusion changes. Its ability to detect subtle variations in blood flow may assist surgeons in optimizing treatment strategies, potentially reducing the risk of post-procedural complications and improving patient outcomes.

6. Future Perspectives and Clinical Translation of Q-iaFA

While Q-iaFA shows promise, further refinement is needed to optimize quantification strategies and correlate perfusion metrics with long-term clinical outcomes. Future studies should focus on larger patient cohorts, standardizing measurement protocols, and integrating Q-iaFA with advanced computational models. If validated, Q-iaFA could become a standard tool for intraoperative guidance, enhancing precision in revascularization procedures and ultimately improving limb salvage rates in CLTI patients.

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