A comparative study of geometry-based methods and intra-arterial pressure measurements to assess the hemodynamic significance of equivocal iliac artery stenoses

Stefan G.H. Heinen (Corresponding author), Wouter Huberts, Daniel A.F. van den Heuvel, Frans N. van de Vosse, Jean Paul P.M. de Vries, Tammo Delhaas

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objectives: To date, the ultimate decision to treat iliac artery stenoses in patients suffering from symptomatic peripheral arterial disease is based on the patient’s symptoms and on visual inspection of angiographical images. The primary aim of this study was to investigate the accuracy of geometry-based methods (i.e. visual inspection and quantitative vascular analysis (Viewforum version R7.2v1 Advanced vessel analysis, Philips Healthcare, Best, The Netherlands) of 3D rotational angiography) to identify the severity of equivocal iliac artery stenosis in peripheral arterial disease patients with intra-arterial hyperemic pressure measurements (gold standard) as a reference. Methods: Twenty patients with symptomatic iliac artery stenoses were subjected to 3D rotational angiography. Intra-arterial pressure measurements under hyperemic conditions were performed across 24 visually identified iliac artery stenoses. Three experienced interventional-radiologists retrospectively estimated the lumen diameter reduction by visual inspection. Furthermore, quantitative vascular analysis was performed on the 3D rotational angiography data. Geometry-based estimates were classified into two groups: lumen diameter reduction of <50% (non-significant) and diameter reduction ≥50% (significant), and compared to the intra-arterial hyperemic pressure gradients. A stenosis causing a pressure gradient (Δp) ≥10 mmHg was considered hemodynamically significant. Results: Visual inspection and quantitative vascular analysis correctly identified hemodynamically significant stenoses in, respectively, 83% and 67% of the 24 iliac artery stenoses. Quantitative vascular analysis-based identification of hemodynamic significant stenoses (Δp ≥ 10 mmHg) could be optimized by lowering the threshold to a 42% lumen diameter reduction which improved the accuracy from 67% to 83%. Conclusions: Visual inspection of 3D rotational angiography by experienced interventional-radiologists has an 83% accuracy to identify hemodynamic significant iliac artery stenoses (Δp ≥10 mmHg). The use of quantitative vascular analysis software did not improve accuracy.

LanguageEnglish
Pages119-127
Number of pages9
JournalVascular
Volume27
Issue number2
DOIs
StatePublished - 1 Apr 2019

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Iliac Artery
Arterial Pressure
Pathologic Constriction
Hemodynamics
Blood Vessels
Angiography
Peripheral Arterial Disease
Netherlands
Software
Delivery of Health Care
Pressure

Keywords

  • blood pressure measurements
  • iliac artery stenosis
  • Peripheral arterial disease
  • stenosis severity assessment

Cite this

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title = "A comparative study of geometry-based methods and intra-arterial pressure measurements to assess the hemodynamic significance of equivocal iliac artery stenoses",
abstract = "Objectives: To date, the ultimate decision to treat iliac artery stenoses in patients suffering from symptomatic peripheral arterial disease is based on the patient’s symptoms and on visual inspection of angiographical images. The primary aim of this study was to investigate the accuracy of geometry-based methods (i.e. visual inspection and quantitative vascular analysis (Viewforum version R7.2v1 Advanced vessel analysis, Philips Healthcare, Best, The Netherlands) of 3D rotational angiography) to identify the severity of equivocal iliac artery stenosis in peripheral arterial disease patients with intra-arterial hyperemic pressure measurements (gold standard) as a reference. Methods: Twenty patients with symptomatic iliac artery stenoses were subjected to 3D rotational angiography. Intra-arterial pressure measurements under hyperemic conditions were performed across 24 visually identified iliac artery stenoses. Three experienced interventional-radiologists retrospectively estimated the lumen diameter reduction by visual inspection. Furthermore, quantitative vascular analysis was performed on the 3D rotational angiography data. Geometry-based estimates were classified into two groups: lumen diameter reduction of <50{\%} (non-significant) and diameter reduction ≥50{\%} (significant), and compared to the intra-arterial hyperemic pressure gradients. A stenosis causing a pressure gradient (Δp) ≥10 mmHg was considered hemodynamically significant. Results: Visual inspection and quantitative vascular analysis correctly identified hemodynamically significant stenoses in, respectively, 83{\%} and 67{\%} of the 24 iliac artery stenoses. Quantitative vascular analysis-based identification of hemodynamic significant stenoses (Δp ≥ 10 mmHg) could be optimized by lowering the threshold to a 42{\%} lumen diameter reduction which improved the accuracy from 67{\%} to 83{\%}. Conclusions: Visual inspection of 3D rotational angiography by experienced interventional-radiologists has an 83{\%} accuracy to identify hemodynamic significant iliac artery stenoses (Δp ≥10 mmHg). The use of quantitative vascular analysis software did not improve accuracy.",
keywords = "blood pressure measurements, iliac artery stenosis, Peripheral arterial disease, stenosis severity assessment",
author = "Heinen, {Stefan G.H.} and Wouter Huberts and {van den Heuvel}, {Daniel A.F.} and {van de Vosse}, {Frans N.} and {de Vries}, {Jean Paul P.M.} and Tammo Delhaas",
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A comparative study of geometry-based methods and intra-arterial pressure measurements to assess the hemodynamic significance of equivocal iliac artery stenoses. / Heinen, Stefan G.H. (Corresponding author); Huberts, Wouter; van den Heuvel, Daniel A.F.; van de Vosse, Frans N.; de Vries, Jean Paul P.M.; Delhaas, Tammo.

In: Vascular, Vol. 27, No. 2, 01.04.2019, p. 119-127.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - A comparative study of geometry-based methods and intra-arterial pressure measurements to assess the hemodynamic significance of equivocal iliac artery stenoses

AU - Heinen,Stefan G.H.

AU - Huberts,Wouter

AU - van den Heuvel,Daniel A.F.

AU - van de Vosse,Frans N.

AU - de Vries,Jean Paul P.M.

AU - Delhaas,Tammo

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N2 - Objectives: To date, the ultimate decision to treat iliac artery stenoses in patients suffering from symptomatic peripheral arterial disease is based on the patient’s symptoms and on visual inspection of angiographical images. The primary aim of this study was to investigate the accuracy of geometry-based methods (i.e. visual inspection and quantitative vascular analysis (Viewforum version R7.2v1 Advanced vessel analysis, Philips Healthcare, Best, The Netherlands) of 3D rotational angiography) to identify the severity of equivocal iliac artery stenosis in peripheral arterial disease patients with intra-arterial hyperemic pressure measurements (gold standard) as a reference. Methods: Twenty patients with symptomatic iliac artery stenoses were subjected to 3D rotational angiography. Intra-arterial pressure measurements under hyperemic conditions were performed across 24 visually identified iliac artery stenoses. Three experienced interventional-radiologists retrospectively estimated the lumen diameter reduction by visual inspection. Furthermore, quantitative vascular analysis was performed on the 3D rotational angiography data. Geometry-based estimates were classified into two groups: lumen diameter reduction of <50% (non-significant) and diameter reduction ≥50% (significant), and compared to the intra-arterial hyperemic pressure gradients. A stenosis causing a pressure gradient (Δp) ≥10 mmHg was considered hemodynamically significant. Results: Visual inspection and quantitative vascular analysis correctly identified hemodynamically significant stenoses in, respectively, 83% and 67% of the 24 iliac artery stenoses. Quantitative vascular analysis-based identification of hemodynamic significant stenoses (Δp ≥ 10 mmHg) could be optimized by lowering the threshold to a 42% lumen diameter reduction which improved the accuracy from 67% to 83%. Conclusions: Visual inspection of 3D rotational angiography by experienced interventional-radiologists has an 83% accuracy to identify hemodynamic significant iliac artery stenoses (Δp ≥10 mmHg). The use of quantitative vascular analysis software did not improve accuracy.

AB - Objectives: To date, the ultimate decision to treat iliac artery stenoses in patients suffering from symptomatic peripheral arterial disease is based on the patient’s symptoms and on visual inspection of angiographical images. The primary aim of this study was to investigate the accuracy of geometry-based methods (i.e. visual inspection and quantitative vascular analysis (Viewforum version R7.2v1 Advanced vessel analysis, Philips Healthcare, Best, The Netherlands) of 3D rotational angiography) to identify the severity of equivocal iliac artery stenosis in peripheral arterial disease patients with intra-arterial hyperemic pressure measurements (gold standard) as a reference. Methods: Twenty patients with symptomatic iliac artery stenoses were subjected to 3D rotational angiography. Intra-arterial pressure measurements under hyperemic conditions were performed across 24 visually identified iliac artery stenoses. Three experienced interventional-radiologists retrospectively estimated the lumen diameter reduction by visual inspection. Furthermore, quantitative vascular analysis was performed on the 3D rotational angiography data. Geometry-based estimates were classified into two groups: lumen diameter reduction of <50% (non-significant) and diameter reduction ≥50% (significant), and compared to the intra-arterial hyperemic pressure gradients. A stenosis causing a pressure gradient (Δp) ≥10 mmHg was considered hemodynamically significant. Results: Visual inspection and quantitative vascular analysis correctly identified hemodynamically significant stenoses in, respectively, 83% and 67% of the 24 iliac artery stenoses. Quantitative vascular analysis-based identification of hemodynamic significant stenoses (Δp ≥ 10 mmHg) could be optimized by lowering the threshold to a 42% lumen diameter reduction which improved the accuracy from 67% to 83%. Conclusions: Visual inspection of 3D rotational angiography by experienced interventional-radiologists has an 83% accuracy to identify hemodynamic significant iliac artery stenoses (Δp ≥10 mmHg). The use of quantitative vascular analysis software did not improve accuracy.

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