Projectdetails

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Validation of new, non-invasive tissue perfusion imaging techniques in patients with peripheral arterial disease.

Keywords:
cardiovascular vascular surgery

Researchers:
R.P.H. Bokkers
prof. dr. J.P.P.M. de Vries
dr. R.C.L. Schuurmann

Nature of the research:
Exploring new imaging modalities to determine tissue perfusion in patients with limb ischemia.

Fields of study:
surgery radiology

Background / introduction
Peripheral arterial disease (PAD) is a progressive and common disease. Symptoms and complications of PAD, including ulceration, are a result of impaired tissue perfusion. To detect and determine the severity of PAD, effective diagnostics are necessary. Current diagnostic methods used for PAD can only detect arterial inflow but do not measure tissue perfusion. It is essential to determine tissue perfusion because impaired perfusion of oxygenated blood is the direct cause of symptoms. Several CE-marked, non-invasive measurement techniques are available to detect tissue perfusion, but none of them has been used in the entire peri-procedural phase of PAD patients who undergo revascularisation of the lower extremity. Changes in tissue perfusion pre-, per- and post-revascularisation may be important to evaluate the clinical success of the interventions and should be implemented at hospital and in home setting.
Research question / problem definition
Two new, non-invasive imaging techniques to determine tissue perfusion in vascular patients will be validated in clinical practice.
These two techniques are hyperspectral imaging with a handheld system (the Hyperview camera) and the Enhanced Perfusion and Oxygen Saturation (EPOS) system. Both imaging modalities will be used in patients with different stages of perifpheral arterial disease like claudicants and patients suffering from ischemic wounds.
With this study we want to determine if both imaging techniques are of added value to the current standard diagnostic tools like computed tomography and magnetic resonance arteriography.
Workplan
10 patients suffering mild peripheral arterial ischemia (intermittent claudicants) and 30 patients with severe peripheral arterial ischemia (ulcers, wounds or pain at rest) will have standard vascular imaging work-up before treatment. Hyperspectral imaging and the EPOS system will be added as measurements. Patients will be measured at the outpatients clininc but also during endovascular interventions at the angiosuite or vascular operating theatre.
The hyperspectral imaging and EPOS measurements will be performed at the lower legs and feet of the patients.
Values of standard imaging and the two new tissue perfusion systemts will be compared. Moreover, tissue perfusion measurements will be correlated to clinical outcomes.
The student will be involved in including patients, performing measurements, analyzing data, and writing the manuscript.
References
1.Wang Z, Hasan R, Firwana B, et al. A systematic review and meta-analysis of tests to predict wound healing in diabetic foot. J Vasc Surg. 2016;63(2 Suppl):29S-36S.e1-2.
2. Chiang N, Jain JK, Sleigh J, Vasudevan T. Evaluation of hyperspectral imaging technology in patients with peripheral vascular disease. J Vasc Surg. 2017;66(4):1192-1201.
3. Brownrigg JR, Hinchliffe RJ, Apelqvist J, et al. Performance of prognostic markers in the prediction of wound healing or amputation among patients with foot ulcers in diabetes: A systematic review. Diabetes Metab Res Rev. 2016;32 Suppl 1:128-135.
4.
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