Quantitative analysis of digital subtraction angiography 2D perfusion in patient with critical limb ischemia

To determine quantitative values of digital subtraction angiography (DSA) 2D perfusion before and after percutaneous transluminal angioplasty (PTA) in midfoot and hindfoot regions. Case report: The patient was admitted to Riga East University Hospital Interventional Radiology ward with critical limb ischemia that resulted in night pain, ulcer in the posterior tibial artery angiosome region, and claudication of 50 meters. DSA showed long anterior tibial artery occlusion, distal posterior tibial artery occlusion, and patent interosseal artery. DSA 2D perfusion angiography images were acquired before and after anterior tibial artery angioplasty. After anterior tibial artery recanalization and qualitative assessment of foot perfusion, there was increased contrast media flow rate to the site of the ulcer. Quantitative parameters that were analyzed included arrival time (AT), the area under the curve (AuC), peak density (PD), and time to peak (TTP). Data were measured at the site of the midfoot (at the localization of the arcuate artery and deep plantar artery) and at the site of the ulcer (lateral hindfoot region). At the site of midfoot, there was a decrease of AT by 7.6%, an increase of AuC by 35.4%, an increase of PD by 40.3%, and a decrease of TTP by 13.4%. At the site of the lateral hindfoot region, there was no improvement in AT, PD, and AuC, depicting significance of angiosome conecpt, but there was an improvement of TTP by 46.3%. DSA 2D perfusion angiography allows quantitative assessment of affected limb that can aid interventional radiologists and vascular surgeons in clinical decision making.