1430_Singh.pdf

1、Contemporary Evaluation of Perfusion in CLTIOverview of modalitiesNYEVS 2025 Twinkle Singh MBBS FACC FSCAI No relevant financial disclosures CLTI clinical relevance AHA/ACC guidelines for lower-extremity PAD6define CLI as the presence of ischemic rest pain,nonhealing wound/ulcer,or gangrene for 2 we

2、eks with associated evidence of hypoperfusion Among patients with known PAD,incidence of CLTI estimated to be between 11%and 20%.Responsible for most major and minor limb amputations related to PAD.Historically estimated 1-y mortality rate of 25%-35%and 1-y rate of amputation up to 30%among patients

3、 presenting with CLTI.Abu Dabrh et al J Vasc Surg 2015 Lower rates of mortality and amputation have been reported in patients with CLTI undergoing revascularization.Timely revascularization for CLI is a Class I indication.Abu Dabrh et al J Vasc Surg 2015 Role of perfusion assessment in CLTI Identify

4、 whether adequate blood is supplying the extremity to prompt timely wound healing Amputation timing prediction Reduces unnecessary invasive procedures in patients with adequate blood flow or among those with venous,neuropathic,or pressure ulcers Intra procedure assessment if endovascular revasculari

5、zation fails to achieve the hemodynamic target for likely wound healing,planning for alternative therapies or wound care strategies need not wait weeks or months to determine the fate of the limb.Most readily available ABI/TBI PVR Segmental pressures Systolic ankle pressure Toe pressure ABI of each

6、leg is the highest ankle systolic blood pressure(obtained by blood pressure cuff above the ankle and Doppler of both the dorsalis pedis and posterior tibial arteries)divided by the highest arm SBP.Ankle-Brachial Index ABI:First-line noninvasive diagnostic method for PADThe diagnostic performance of