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Vascular flow reserve may aid in stratifying patients undergoing endovascular therapy
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Measuring vascular flow reserve was useful for predicting wound healing in a cohort of patients who underwent endovascular therapy for critical limb ischemia, in a recent study.
The researchers aimed to determine whether it is possible to apply the concept of coronary blood flow reserve in a cohort of 40 patients undergoing endovascular treatment for critical limb ischemia in isolated infrapopliteal lesions. The cohort included 25 men and 15 women, with a mean age of 73 years.
Clinicians used balloon angioplasty without stenting to treat all patients. They then positioned a pressure/temperature sensor-tipped guidewire in the proximal popliteal artery after successful endovascular therapy. The mean transit time was determined after injection of 3 mL saline at baseline and when intra-arterial papaverine-induced maximum hyperemia began.
The researchers calculated vascular flow reserve and defined wound healing as a wound completely closed by surgical or secondary intervention within 3 months of the endovascular procedure.
Successful wound healing was reported in 22 patients. Vascular flow reserve values were similar between the two groups prior to undergoing endovascular therapy (2.95; [IQR, 2.25-4.03] for the nonhealing group vs. 3.4; [IQR, 3.03-4.05] for the healing group; P= .29). Following the procedure, vascular flow reserve was 4.05 (interquartile range [IQR], 3.6-4.6) in the healed group and 2.4 (IQR, 2-3.08) in the unhealed group (P < .0001).
A vascular flow reserve value of more than 3.6 was determined to be the optimal threshold for complete wound healing after endovascular intervention, in an analysis of receiver operating characteristics (area under the curve = 0.86; 95% CI, 0.74-0.98; sensitivity, 77.3%; specificity, 88.9%). Univariate analysis indicated that post-procedural vascular flow reserve of more than 3.6 was predictive of wound healing (OR = 19.3; 95% CI, 3.05-237.6).
The researchers also observed similar resting and hyperemic mean transit times in the healing and nonhealing groups.
“Advanced lower limb clinical setting may be caused by a poor capability of microvasculature,” the researchers concluded. “[Vascular flow reserve], which is easily assessable, is useful in clinical risk stratification for patients with [critical limb ischemia] after [endovascular therapy] in the catheterization laboratory.” – by Rob Volansky
Disclosure: The researchers report no relevant financial disclosures.
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