New imaging modalities in peripheral interventions

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Title:
New imaging modalities in peripheral interventions

Authors: 
Antonio Micari1, Paolo Sbarzaglia, M.D.M.E. Meeks, Armando Liso,
Marco Riina, Maria Letizia Lunetto, Giuseppe Roscitano, and Giuseppe Vadalà
Issue Number: 
European Heart Journal Supplements (2015) 17 (Supplement A), A18–A22

Abstract
The aim of this article is to evaluate the feasibility and results of our peripheral revascularization
where we used non-conventional intra-procedural imaging techniques.
Between January 2014 and September 2014, 45 patients were imaged with CO2 angiography
and/or optical coherence tomography (OCT) or 2D perfusion imaging. The scope
was to minimize the use of contrast and obtain additional information to improve the
outcome. CO2 angiography was used in all patients with impaired renal function. Twodimensional
perfusion was used in all patients with critical limb ischaemia before and
after revascularization to quantify angiosome blood supply improvement at wound
level. Optical coherence tomography was performed in superficial femoral arteries and
popliteal arteries to disclose vessel microstructure and characterize plaque structure. In
all patients, the invasive imaging was feasible and safe. In those patients studied with
CO2, the creatinine serum level after procedure increased by 0.11+0.05. None of the
patients received dialysis. The procedural success rate was 100% and was no different
from the historical sample of the cath lab. Procedural time was not significantly affected
by this supplemental technique. The 2D perfusion showed an incremental blood supply at
wound level and OCT provided encouraging details regarding dissections and their clinical
relevance. Our early experience with supplementary imaging techniques showed safety
and feasibility. The peripheral angioplasty success rate was not different fromthe historical
sample and the reduction of the contrast media dose resulted in an encouraging
outcome in terms of renal protection. Two-dimensional perfusion added objective information
regarding blood supply improvement and guided re-perfusion strategy.

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