|
Back to 2017 Scientific Program ePosters
Prospective Study of Vascular Assessment with Laser Angiography of the Upper Extremity
Helen G Hui-Chou, MD1; Kenneth R Means Jr, MD2; James P Higgins, MD1
1Curtis National Hand Center, Baltimore, MD, 2Union Memorial Hospital, Baltimore, MD
Hypothesis: We hypothesized that Luna, an indocyanine green laser angiography imaging system, could replace or supplement clinical and Doppler examination for evaluation of upper extremity perfusion. Our goal was to demonstrate the immediate, accurate, and minimally-invasive evaluation of upper extremity tissue perfusion with the Luna.
Methods: This was an IRB-approved, prospective study using Luna imaging to evaluate perfusion in patients with upper extremity vascular compromise. We determined the Luna scan values of tissues that ultimately survive or are lost. All patients had Luna imaging pre-intervention, intra-operatively if applicable, and at 1 week, 2 weeks, and 2 months post-intervention. For each scan, we selected a standardized control area with normal skin perfusion to compare to the tissues being studied.
Results: Twelve patients (16 extremities) were evaluated. Mean patient age was 53 years. There were 7 men and 5 women; half were smokers. Etiologies of hand vascular compromise in this study included amputations, primary and secondary vasospastic disease, scleroderma, intravascular drug injection, ballistic trauma, and crush traumatic injury. Interventions included surgical repair or reconstruction including addressing vascular injuries as needed, botulinum toxin injections, and/or medications. A mixed-effects multilevel linear regression model was chosen to quantify the association between mean Luna score and study time point. We discovered a statistically significant improvement in perfusion, demonstrated by an increase in Luna score, by 2-weeks post-intervention when compared to pre-intervention scans. A multivariate logistic regression model was used to determine the independent association of Luna score on digit/tissue loss while controlling for smoking status and presence/absence of Doppler signal. Using this analysis, only the Luna score was statistically significantly correlated with digit/tissue loss. There was a reduction of approximately 50% in odds of digit/tissue loss per 10-point incremental increase in Luna score. A sustained value of 10% or less in Luna perfusion score, when compared to the normal control area, resulted in eventual tissue loss and/or amputations.
Conclusion: In this study the use of the Luna provided objective data to document improved tissue perfusion following surgical vascular interventions and chemical sympathectomy. When LUNA tissue perfusion value is less than 10%, tissue is severely threatened and will result in eventual loss if no interventions are performed.
Back to 2017 Scientific Program ePosters
|
