Improving outcomes for peripheral arterial disease with novel diagnostics

In this thesis, we investigated different novel diagnostics that can be of added value in the entire peri-procedural process and during follow-up of endovascular revascularization of patients with peripheral arterial disease (PAD).

Patients with PAD have an inevitable high risk of amputation and/or mortality. Nowadays, endovascular treatment (EVT) of stenotic or occluded femoro-popliteal arteries will not always lead to sufficient blood flow to the arterioles and capillaries in the skin, which is necessary for oxygen delivery and nutritional supply. Adequate assessment of tissue perfusion with novel diagnostics is therefore potentially one of the key factors to predict clinical outcomes such as wound healing and pain relief. The first objective of this thesis was to investigate novel diagnostic techniques that measure tissue perfusion for adequate assessment of PAD and to detect changes in tissue perfusion before, during, and after EVT.

An important known prognostic factor in PAD patients is frailty, which is an indicator of fitness and physiological reserve. Sarcopenia and myosteatosis, the presence of low muscle mass and intermuscular fat infiltration, are major components of frailty. Both are most often assessed by segmenting the total muscle area at the level of the intervertebral disk space of the third lumbar vertebral body, however, in patients with PAD, walking ability, function, and physical strength is dependent on the muscles of the lower extremities. The second objective was to investigate the association of a novel diagnostic technique by measuring skeletal muscle atrophy and myosteatosis of the lower extremity to postoperative outcomes, such as reintervention and amputation-free survival.