Perioperative perfusion assessment to guide and improve decision-making in treatment of peripheral arterial diseases

Peripheral arterial disease (PAD) of the lower extremities, as severity advances, will increasingly comprise sufficient blood flow to the microcirculation. This microcirculation supplies individual cells with oxygen and nutrients. When increasingly affected, transitioning from asymptomatic PAD to symptomatic PAD, intermittent claudication (IC) or chronic limb threatening ischemia (CLTI) will be induced. With a high prevalence, increasing with age, PAD is a common and severe disease, with a high burden on the patient’s quality of life and healthcare and societal cost.

When experiencing CLTI, to relieve rest pain or prevent tissue loss, immediate revascularisation is most appropriate. Current options for revascularisation are open, endovascular or hybrid (combined open and endovascular) interventions. During endovascular and hybrid procedures, X-ray fluoroscopy and angiography imaging, the latter using fluoroscopy combined with a contrast agent to visualise the inside of the vascular tree, are nowadays used to guide the interventionalist in peroperative decision making. Although being the golden standard for many years, both imaging techniques are susceptible to subjective interpretation and inability to assess quantified tissue perfusion. As a result, a peroperative assumed successful revascularisation could therefore be accompanied with bad clinical patient outcomes.

To improve treatment outcomes and provide quantified support for the interventionalist, the aim of this thesis is to gain knowledge on the peroperative implementation of novel imaging techniques to enable tissue perfusion quantification in patients with lower extremity PAD.