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Purpose <p>To determine whether contrast arrival time (AT) at the ankle joint—quantified by intra-procedural frame count (FC) during digital subtraction angiography (DSA)—predicts the time to complete ulcer healing (HT) in patients with chronic limb-threatening ischemia (CLTI).</p> Materials and Methods <p>This retrospective study, conducted between January 2020 and December 2022, incorporated 93 patients with CLTI classified as Rutherford category 5 or 6, treated via endovascular therapy. Pre-procedural and post-procedural DSA sequences were reviewed by two blinded interventional radiologists&#xa0;to determine&#xa0;the FC at which contrast first reached the ankle joint level in either the anterior tibial artery or the posterior tibial artery, whichever was earliest.&#xa0;AT was calculated as FC/3 from the final angiographic run after infrapopliteal revascularization and patients were followed until complete ulcer healing to document HT. Correlations between post-procedural AT and HT were assessed using the Pearson coefficient. The cutoff points to predict HT grouping (≤ 3&#xa0;months vs. &gt; 3&#xa0;months) were analyzed using a receiver operating characteristic (ROC) curve; outcomes are reported as the area under the curve (AUC) with 95% confidence interval (CI).</p> Results <p>Pearson correlation analysis showed that post-procedural AT was statistically associated with ulcer HT (r = 0.691, <i>P</i> &lt; 0.001). On multivariable linear regression, post-procedural AT remained independently associated with HT. Backward stepwise logistic regression revealed that post-procedural AT was independently associated with HT grouping (odds ratio (OR) 2.897; 95% CI 1.890–5.150; <i>P</i> &lt; 0.001). The AUC for AT in predicting HT grouping&#xa0;was&#xa0;0.939, and the optimal cut-off value of post-procedural AT for predicting ulcer healing within 3&#xa0;months was 4.5&#xa0;s.</p> Conclusions <p>Intra-procedural angiographic assessment using 2D perfusion angiography during endovascular therapy is technically feasible. Post-procedural AT was independently associated with ulcer HT, reflecting a trend whereby faster postoperative blood flow velocity—manifested as a shorter AT—may correlate with improved wound healing.</p> <p><i>Trial registration</i> Registration number: PJ-KS-KY-2023–31.</p> Graphical Abstract <p></p>

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Contrast Arrival Time at the Ankle as a Quantitative Perfusion Index for Ulcer Healing Prediction After Below-the-Knee Angioplasty in Chronic Limb-Threatening Ischemia

  • 期刊论文

  • 发表日期：

    2026年6月29日

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  • Mohan Zhou,
  • Tao Pan,
  • GuangZhao Zhu,
  • Jianyu Hou,
  • Qun Ma,
  • Siyi Zhong,
  • Longshuang Wang,
  • Donghua Ji

摘要

Purpose

To determine whether contrast arrival time (AT) at the ankle joint—quantified by intra-procedural frame count (FC) during digital subtraction angiography (DSA)—predicts the time to complete ulcer healing (HT) in patients with chronic limb-threatening ischemia (CLTI).

Materials and Methods

This retrospective study, conducted between January 2020 and December 2022, incorporated 93 patients with CLTI classified as Rutherford category 5 or 6, treated via endovascular therapy. Pre-procedural and post-procedural DSA sequences were reviewed by two blinded interventional radiologists to determine the FC at which contrast first reached the ankle joint level in either the anterior tibial artery or the posterior tibial artery, whichever was earliest. AT was calculated as FC/3 from the final angiographic run after infrapopliteal revascularization and patients were followed until complete ulcer healing to document HT. Correlations between post-procedural AT and HT were assessed using the Pearson coefficient. The cutoff points to predict HT grouping (≤ 3 months vs. > 3 months) were analyzed using a receiver operating characteristic (ROC) curve; outcomes are reported as the area under the curve (AUC) with 95% confidence interval (CI).

Results

Pearson correlation analysis showed that post-procedural AT was statistically associated with ulcer HT (r = 0.691, P < 0.001). On multivariable linear regression, post-procedural AT remained independently associated with HT. Backward stepwise logistic regression revealed that post-procedural AT was independently associated with HT grouping (odds ratio (OR) 2.897; 95% CI 1.890–5.150; P < 0.001). The AUC for AT in predicting HT grouping was 0.939, and the optimal cut-off value of post-procedural AT for predicting ulcer healing within 3 months was 4.5 s.

Conclusions

Intra-procedural angiographic assessment using 2D perfusion angiography during endovascular therapy is technically feasible. Post-procedural AT was independently associated with ulcer HT, reflecting a trend whereby faster postoperative blood flow velocity—manifested as a shorter AT—may correlate with improved wound healing.

Trial registration Registration number: PJ-KS-KY-2023–31.

Graphical Abstract