Evaluation of a novel 2D perfusion angiography technique independent of pump injections for assessment of interventional treatment of peripheral vascular disease

  • Jan B. Hinrichs
  • Tim Murray
  • Muharrem Akin
  • Michael Lee
  • Micheal Ulrich Brehm
  • Mathias Wilhelmi
  • Frank K. Wacker
  • Thomas Rodt
Original Paper


To evaluate a novel 2D-perfusion angiography (2D-PA) technique allowing pro- and retrospective flow analysis based on a proximal reference region of interest (ROI) and distal target ROI in patients treated for peripheral arterial disease. 2D-PA allows quantifying blood flow by post-processing of digital subtraction angiography (DSA). 2D-PA was performed pre and post interventional treatment of peripheral arterial disease (PAD; n = 24; 13 angioplasties, 11 stents) in 21 patients (17 men, 72 ± 9y) with Fontaine stage IIB / III. Time-to-peak (TTP), peak density (PD) and area-under-the-curve (AUC) were calculated. Ratios reference/target ROI (TTPOUTFLOW/TTPINFLOW; PDOUTFLOW/PDINFLOW; AUCOUTFLOW/AUCINFLOW) were calculated and correlated to changes in the ankle-brachial-index (ABI). 2D-PA was technically feasible in all cases. A significant increase in ABI was seen after interventional treatment (+39%; p < 0.0001). ABI increase was accompanied by an increase of 36% of PDOUTFLOW/PDINFLOW (p < 0.0001), a 52% decrease of TTPOUTFLOW/TTPINFLOW (p = 0.0007) and a 69% increase of AUCOUTFLOW/AUCINFLOW (p < 0.0001). The difference of TTP pre- and post-intervention showed a correlation with the difference in ABI (r = −0.53, p = 0.0081). The other measured parameters failed to demonstrate significant correlation with improved ABI. The presented 2D-PA technique allows quantitative assessment of arterial flow before, during and after interventional treatment in PAD.


2D-Perfusion angiography Endovascular treatment Peripheral arterial disease Percutaneous angioplasty Stent 



2D-Perfusion angiography


Ankle-brachial index




Digital subtraction angiography


Interventional radiology


Peripheral arterial disease


Peak density


Percutaneous transluminal angioplasty


Region of interest




Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest concerning this study.


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Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  • Jan B. Hinrichs
    • 1
  • Tim Murray
    • 2
  • Muharrem Akin
    • 3
  • Michael Lee
    • 2
  • Micheal Ulrich Brehm
    • 3
  • Mathias Wilhelmi
    • 4
  • Frank K. Wacker
    • 1
  • Thomas Rodt
    • 1
  1. 1.Department of Diagnostic and Interventional RadiologyHannover Medical SchoolHanoverGermany
  2. 2.Department of Diagnostic and Interventional RadiologyBeaumont HospitalDublinIreland
  3. 3.Department of Cardiology and AngiologyHannover Medical SchoolHanoverGermany
  4. 4.Department of Cardiothoracic, Transplantation and Vascular SurgeryHannover Medical SchoolHanoverGermany

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