Ulrich Rother1, Werner Lang2, Raymund E Horch3, Ingo Ludolph3, Alexander Meyer2, Susanne Regus2. 1. Department of Vascular Surgery, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg FAU, Erlangen, Germany. Electronic address: ulrich.rother@uk-erlangen.de. 2. Department of Vascular Surgery, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg FAU, Erlangen, Germany. 3. Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg FAU, Erlangen, Germany.
Abstract
BACKGROUND: Intact microperfusion of the foot in the critical ischemic limb remains a crucial condition for ulcer healing. Aim of this clinical study was to evaluate the immediate effect of tibial bypass surgery on the microcirculation by usage of fluorescence angiography. METHODS: Prospective analysis of 33 patients presenting with critical limb ischemia (Rutherford IV-VI) undergoing tibial bypass surgery was performed. Macroperfusion was investigated by measurement of ankle-brachial index. For assessment of microperfusion, intraoperative fluorescence angiography (SPY Elite, NOVADAQ) was undertaken during general anesthesia immediately before and after operation. For each investigation, a fluorescence dye (Indocyanine green) with an amount of 0.1 mg/kg was administered intravenously. Follow-up investigations were performed to assess the clinical outcome. RESULTS: The mean follow-up time was 8.28 (±4.46) months. The parameters Ingress (IN) and Ingress rate (InR) of the fluorescence dye representing the microcirculation showed a significant improvement to preoperative values and correlated with the ankle-brachial index significantly. Furthermore, a significant difference between the individual improvement of the microcirculation parameters (preoperative-postoperative) between patients with postoperative clinical improvement (wound healing, absence of rest pain) and those without could be demonstrated (InR: P = 0.039, IN: P = 0.036). CONCLUSIONS: The parameters IN and InR significantly reproduced the postoperative improvement of the microcirculation. An increased ankle-brachial index significantly correlated with increased microcirculation parameters. A better clinical outcome was found in those patients who had a higher relative improvement of microcirculation postoperatively.
BACKGROUND: Intact microperfusion of the foot in the critical ischemic limb remains a crucial condition for ulcer healing. Aim of this clinical study was to evaluate the immediate effect of tibial bypass surgery on the microcirculation by usage of fluorescence angiography. METHODS: Prospective analysis of 33 patients presenting with critical limb ischemia (Rutherford IV-VI) undergoing tibial bypass surgery was performed. Macroperfusion was investigated by measurement of ankle-brachial index. For assessment of microperfusion, intraoperative fluorescence angiography (SPY Elite, NOVADAQ) was undertaken during general anesthesia immediately before and after operation. For each investigation, a fluorescence dye (Indocyanine green) with an amount of 0.1 mg/kg was administered intravenously. Follow-up investigations were performed to assess the clinical outcome. RESULTS: The mean follow-up time was 8.28 (±4.46) months. The parameters Ingress (IN) and Ingress rate (InR) of the fluorescence dye representing the microcirculation showed a significant improvement to preoperative values and correlated with the ankle-brachial index significantly. Furthermore, a significant difference between the individual improvement of the microcirculation parameters (preoperative-postoperative) between patients with postoperative clinical improvement (wound healing, absence of rest pain) and those without could be demonstrated (InR: P = 0.039, IN: P = 0.036). CONCLUSIONS: The parameters IN and InR significantly reproduced the postoperative improvement of the microcirculation. An increased ankle-brachial index significantly correlated with increased microcirculation parameters. A better clinical outcome was found in those patients who had a higher relative improvement of microcirculation postoperatively.
Authors: Lauren N Goncalves; Pim van den Hoven; Jan van Schaik; Laura Leeuwenburgh; Cas H F Hendricks; Pieter S Verduijn; Koen E A van der Bogt; Carla S P van Rijswijk; Abbey Schepers; Alexander L Vahrmeijer; Jaap F Hamming; Joost R van der Vorst Journal: Life (Basel) Date: 2021-05-11
Authors: K Kahnert; M Föhrenbach; T Lucke; P Alter; F T Trudzinski; R Bals; J I Lutter; H Timmermann; S Söhler; S Förderreuther; D Nowak; H Watz; B Waschki; J Behr; T Welte; C F Vogelmeier; R A Jörres Journal: Respir Res Date: 2020-01-20
Authors: Ulrich Rother; Helena Müller-Mohnssen; Werner Lang; Ingo Ludolph; Andreas Arkudas; Raymund E Horch; Susanne Regus; Alexander Meyer Journal: Int Wound J Date: 2019-10-30 Impact factor: 3.315