TOPOGRAPHICAL EVALUATION OF SKIN PERFUSION PATTERNS IN PERIPHERAL ARTERIAL OCCLUSIVE DISEASE BY MEANS OF COMPUTER-ASSISTED FLUORESCEIN PERFUSOGRAPHY

Objective: To evaluate the clinical impact of computer-assisted fluore scein perfusography in peripheral arterial occlusive disease (PAOD). D esign: Foot and calf skin perfusion was visualised by intravenous fluo rescein injection. Fluorescein influx was recorded photographically an d converted into functional images of fluorescein appearance times (AT ) by means of digital film processing. Setting: Vascular Laboratory of Clinic for Vascular Disease. Materials: 249 patients with PAOD. Among 481 limbs studied, 83 legs presented with patent arteries, 70 with as ymptomatic obstructions (Stage I), 170 with claudication (Stage II) an d 158 with rest pain and skin lesions (Stage III/IV). Chief outcome me asures: Forefoot and calf mean ATs and standard deviations (SD) served as arbitrary measures of regional skin perfusion rates and their homo geneity respectively. Main results: In the control legs, a homogeneous and fast fluorescence appearance was observed (medians at the foot: A T33.4 s, SD 3.6). In stage II disease, AT (39.9 s, SD 5.6) were slight ly impaired as compared to limbs with patent arteries or stage I disea se (p < 0.01). Ninety-seven out of the 158 legs in stage III(/IV could be managed by conservative therapy. According to fluorescein-perfusog raphy, they did not differ from stage II disease (AT 38.8 s, SD 6.1). Sixty-one limbs were clinically affected by critical ischaemia. They e xhibited a markedly delayed and heterogenous fluorescein influx at the foot (AT 77.3 s, SD 26.5, p < 0.01 vs all other groups). Non-fluoresc ent areas occurred in 53% compared to only 1% of limbs with and withou t critical ischaemia, respectively. Retrospectively, predictive values of fluorescein perfusography in identifying a critical limb ischaemia (accuracy 93%) were superior to the ankle systolic material pressure determination (accuracy 80%). Conclusions: Fluorescein perfusography s eems to be of diagnostic and prognostic use in PAOD in stage III/IV wh ere inflammatory and ischaemic patterns of dye appearance can be disti nguished