This study aims to determine whether intraoperative physiologic measurements of blood flow to the leg during endovascular treatment of Peripheral Arterial Disease (PAD) can predict future clinical outcomes.
Lower extremity peripheral arterial disease (PAD) caused by atherosclerosis can cause cause leg pain, gangrene, and limb loss. PAD is a result of poor blood flow to the extremity, and the emerging most common initial method of interventional treatment is endovascular therapy, for example angioplasty or stenting. The poor blood flow to the extremity can be inferred by the hemodynamic pressure of blood in the leg. These toe or ankle pressure measurements are typically performed before surgery to diagnose PAD, and after surgery as surveillance. However, endovascular treatment has a high failure rate often exceeding 20% within a year. There is evidence that physiologic measurements prior to treatment and after treatment are closely related to clinical outcomes. This study introduces these physiologic measurements to the operating room, to determine if physiologic improvement can be detected instantaneously during endovascular revascularization. Patients will be followed for a year following surgery to detect hemodynamic and clinical outcomes. The rationale of these intraoperative measurements would be to potentially guide future surgery, by providing real-time hemodynamic feedback to the operator.
Study Type
OBSERVATIONAL
Enrollment
80
Secondary analyses will examine the Ankle-Brachial Index, and the absolute limb pressures. In addition, the changes in flow rate of contrast before- and after- intervention will be examined as an indicator of perfusion.
A secondary analysis will examine the rate of contrast flow during pre-intervention and post-intervention angiograms, and correlate these findings with hemodynamic measurements recorded during surgery.
The Ottawa Hospital, Civic Campus
Ottawa, Ontario, Canada
Major Adverse Limb Event (MALE)
Composite outcome of major amputation above the ankle, major re-intervention in the form of catheter-directed thrombolysis, open bypass or thrombectomy.
Time frame: 1 Year
Major Amputation
Any ipsilateral leg amputation performed above the joint of the ankle.
Time frame: 1 Year
Minor Amputation
Any ipsilateral leg amputation performed distal to the joint of the ankle.
Time frame: 1 Year
Target Vessel Re-Intervention
Endovascular, Open, Thrombectomy, Thrombolysis.
Time frame: 1 Year
Target Vessel Patency
Primary: Absence of target vessel occlusion or restenosis \>50% Primary Assisted: Patency requiring assistance of subsequent procedure to maintain patency of target vessel Secondary: Patency requiring assistance of subsequent procedure to restore patency of target vessel
Time frame: 1 Year
Improvement in Rutherford's Classification of Peripheral Vascular Disease
Maximal documented categorical state following index revascularization
Time frame: 1 Year
Post-Operative Hemodynamic Measurements
Correlation between intraoperative completion and immediate post-operative measurements, with longer-term surveillance measurements
Time frame: 1 - 3 Months
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