Assessment of microcirculatory changes in local tissue oxygenation after revascularization for peripheral arterial disease with the Hyperview®,a portable hyperspectral imaging device

Abstract

Objectives

The Hyperview® is a hyperspectral camera, which can be used to assess the microcirculation of patients with peripheral arterial disease (PAD) and/or diabetes mellitus (DM). It measures local tissue oxygenation in concentrations of oxyhemoblobin (OXY), deoxyhemoglobin (DEOXY), and O₂-saturation (O2-SAT) in arbitrary units. The aim of this validation study is to assess whether the Hyperview® is able to monitor microcirculatory changes after revascularization in patients with PAD.

Methods

In this prospective observational cohort study, 50 patients with PAD were included who were scheduled for endovascular, hybrid, or open revascularization. The ankle-brachial index (ABI), systolic toe pressure (TP) (in case of DM), and a set of Hyperview® measurements of the plantar region were recorded before and after treatment. Changes in pre- and postoperative measurements were assessed with the paired t-test.

Results

Some 38 patients underwent endovascular revascularization and eight patients underwent hybrid or open vascular surgical revascularization. After revascularization, the ABI improved from 0.58 to 0.80 (p < 0.001). OXY increased from 72.6 to 77.8 (p = 0.134). DEOXY decreased from 69.1 to 55.0 (p < 0.001). O2-SAT increased from 51.3 to 58.1 (p < 0.001). TP improved from 50.6 to 61.9 mmHg (p = 0.065) but was measured in only 16 patients.

Conclusion

The Hyperview® is able to observe changes in the microcirculation after revascularization in terms of DEOXY and O2-SAT. The results of this study are a promising step into the validation of the Hyperview®.

Keywords

Hyperview hyperspectral imaging revascularization diabetes mellitus peripheral arterial occlusive disease chronic wounds

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References

Sobieszczyk

Eisenhauer

. Management of patients after endovascular interventions for peripheral artery disease. Circulation 2013; 128(7): 749–757.

Gerhard-Herman

Gornik

Barrett

, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: a report of the American college of cardiology/American heart association task force on clinical practice guidelines. Circulation 2017; 135(12): e686–e725.

Norgren

Hiatt

Dormandy

, et al. Inter-society consensus for the management of peripheral arterial disease. Int Angiol 2007; 26(2): 81–157.

Hirsch

Haskal

Hertzer

, et al. ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American association for vascular surgery/society for vascular surgery, society for cardiovascular angiography and interventions, society for vascular medicine and biology, society of interventional radiology, and the ACC/AHA task force on practice guidelines (writing committee to develop guidelines for the management of patients with peripheral arterial disease): endorsed by the American association of cardiovascular and pulmonary rehabilitation; national heart, lung, and blood institute; society for vascular nursing; trans Atlantic inter-society consensus; and vascular disease foundation. Circulation 2006; 113(11): e463–654.

Venermo

Sprynger

Desormais

, et al. Editor's choice-follow-up of patients after revascularisation for peripheral arterial diseases: a consensus document from the European society of cardiology working group on aorta and peripheral vascular diseases and the European society for vascular surgery. Eur J Vasc Endovasc Surg 2019; 58(5): 641–653.

Pardo

Alcaraz

Ramon Breijo

, et al. Increased transcutaneous oxygen pressure is an indicator of revascularization after peripheral transluminal angioplasty. Acta Radiol 2010; 51(9): 990–993.

Caselli

Latini

Lapenna

, et al. Transcutaneous oxygen tension monitoring after successful revascularization in diabetic patients with ischaemic foot ulcers. Diabet Med 2005; 22(4): 460–465.

Kleiss

Schuurmann

, et al. Hyperspectral imaging for noninvasive tissue perfusion measurements of the lower leg: review of literature and introduction of a standardized measurement protocol with a portable system. J Cardiovasc Surg (Torino) 2019; 60(6): 652–661.

Fei

. Medical hyperspectral imaging: a review. J Biomed Opt 2014; 19(1): 10901.

10.

van Schilt

Hollander

Veen

, et al. High inter- and intra-observer agreement for measuring tissue oxygenation of the plantar surface of the foot in healthy participants with the Hyperview(R): A pilot study. Vascular 2021; 30: 81–87.

11.

Khaodhiar

Dinh

Schomacker

, et al. The use of medical hyperspectral technology to evaluate microcirculatory changes in diabetic foot ulcers and to predict clinical outcomes. Diabetes Care 2007; 30(4): 903–910.

12.

Nouvong

Hoogwerf

Mohler

, et al. Evaluation of diabetic foot ulcer healing with hyperspectral imaging of oxyhemoglobin and deoxyhemoglobin. Diabetes Care 2009; 32(11): 2056–2061.

13.

Vallabhaneni

Kalbaugh

Kouri

, et al. Current accepted hemodynamic criteria for critical limb ischemia do not accurately stratify patients at high risk for limb loss. J Vasc Surg 2016; 63(1): 105–112.

14.

Chin

Wang

Kibbe

. Evaluation of hyperspectral technology for assessing the presence and severity of peripheral artery disease. J Vasc Surg 2011; 54(6): 1679–1688.

15.

Yudovsky

Nouvong

Schomacker

, et al. Monitoring temporal development and healing of diabetic foot ulceration using hyperspectral imaging. J Biophotonics 2011; 4(7–8): 565–576.

16.

Lee

Walters

Kennedy

, et al. Quantitative results of perfusion utilising hyperspectral imaging on non-diabetics and diabetics: a pilot study. Int Wound J 2020; 17(6): 1809–1816.

17.

Hamburg

Creager

. Pathophysiology of intermittent claudication in peripheral artery disease. Circ J 2017; 81(3): 281–289.