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Peripheral Arterial Disease (PAD)

With an increasing population of patients with diabetes that is often asymptomatic and with falsely normal or high ankle-brachial index (ABI) values due to calcified vessels, detecting Peripheral arterial disease (PAD) has changed in recent years. 20-30 % of diabetics have calcified vessels. For reliable non-invasive vascular tests, look instead to toe pressure, pulse volume recording (PVR) and transcutaneous oximetry (tcpO2).

PAD is a condition caused by obstruction of the peripheral arteries, leading to an increased risk for cardiovascular events and premature death. The classic PAD symptom is intermittent claudication or walking pain, but notably two-thirds of all patients are asymptomatic. Early diagnosis and treatment using noninvasive vascular tests are crucial to saving lives.

Diabetic foot disease, mainly due to neuropathy, peripheral arterial disease, and/or infection, often leads to ulceration and possible subsequent limb amputation. It is one of the most costly complications of diabetes.

Why is the diagnosis more complex in patients with diabetes?
  • Calcified vessels
  • Neuropathy
  • Longer & multiple lesions
  • Asymptomatic
  • Less collateral flow
  • Microcirculatory issues
  • Perfusion deficit in foot more severe
All-in-one simultaneous assessment

The PeriFlux 6000 Combined System offers the unique capability to simultaneously assess both Toe Pressure and PVR as well as measure Transcutaneous Oxygen in the tissue with one system saving limbs, lives, cost and reducing human suffering.

User-friendly software is guiding the user throughout the examination with a standardized measurement procedure for reliable and reproducible results.

A comprehensive report is instantly generated with all clinical information clearly stated with curves adding clarity. The report, as well as the workflow, can be customized to suit processes in clinical situations worldwide.

Perfusion imaging for PAD and diabetic foot ulcers

Perimed was the first company to commercialize laser-based microcirculation imaging and has over the past 40 years been the world leader in perfecting those techniques.

The PeriCam PSI provides a fast and accurate way to assess microcirculation in tissue by using laser speckle contrast analysis (LASCA or LSCI). It fits into the growing demand for non-invasive imaging techniques in diagnostics. All major guidelines [ref 1,2,3] on diagnosis and management of PAD and diabetic foot ulcers recognize the need for microcirculation assessment. The International Working Group on the Diabetic Foot (IWGDF) also highlights the need to investigate the role of novel methods of perfusion assessment [ref 3].

Recent expert reviews mentioned LSCI as a possible diagnostic technique to determine tissue perfusion in patients with PAD [ref 4] and/or diabetic foot ulcers [ref 5] and PeriCam PSI has shown to be a promising tool in these assessments [ref 6,7]. It can offer several advantages compared to other diagnostic techniques:

  • Non-invasive
    • No contact with patient needed
    • No need for injectable contrast agents
    • No ionizing radiation
  • Ease of use
    • Intuitive and powerful software for measurement setup, recording and analysis
    • Small format system offers great flexibility in busy and crowded environments
    • Easy to position due to flexible arm and ball head mount.
  • Fast
    • Real time imaging: up to ~100 images per second

The Pericam PSI Imaging system is clinically approved for measurement of microcirculation in the USA, Europe, China and many other markets.

References:

  1. Conte MS, Bradbury AW, Kolh P, et. al, Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia. Eur J Vasc Endovasc Surg. 2019 Jul;58(1S):S1-S109.e33. doi: 10.1016/j.ejvs.2019.05.006.
  2. Mills JL, Conte MS, Armstrong DG, et al. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: Risk stratification based on Wound, Ischemia, and foot Infection (WIfI). J Vasc Surg. 2014;59(1):220034.e1-2. DOI: 10.1016/j.jvs.2013.08.003
  3. Hinchliffe et al. Guideline on diagnosis, prognosis and management of peripheral artery disease among people with diabetes (IWGDF 2019 update). Diab Metab Res Rev. 2020. e3276 DOI: 10.1002/dmrr.3276
  4. Kirsten F. Ma, Simone F. Kleiss, Richte C.L. Schuurmann, Reinoud P.H. Bokkers, Çagdas Ünlü & Jean-Paul P.M. De Vries (2019) A systematic review of diagnostic techniques to determine tissue perfusion in patients with peripheral arterial disease, Expert Review of Medical Devices, 16:8, 697-710, DOI: 10.1080/17434440.2019.1644166
  5. Onno A. Mennes, Jaap J. van Netten, Riemer H.J.A. Slart and Wiendelt Steenbergen, “Novel Optical Techniques for Imaging Microcirculation in the Diabetic Foot”, Current Pharmaceutical Design (2018) 24: 1304. DOI: 10.2174/1381612824666180302141902
  6. Anne Humeau-Heurtier, Pierre Abraham, Samir Henni, Bi-dimensional variational mode decomposition of laser speckle contrast imaging data: A clinical approach to critical limb ischemia?, Computers in Biology and Medicine 86, 2017, 107-112 DOI: 10.1016/j.compbiomed.2017.05.012
  7. A. Mennes, J.J. van Netten, J.G. van Baal, W. Steenbergen, Assessment of microcirculation in the diabetic foot with laser speckle contrast imaging, Physiological Measurement 40 065002 DOI: 10.1088/1361-6579/ab2058
 PeriFlux 6000
Combined System –

Instructional Video
 PeriCam PSI NR –
Assessment of microcirculation
in the diabetic foot
ESVS Educational Video –
Professor Maarit Venermo
Peripheral Arterial Disease –
Diagnosis in patients
with diabetes
by Prof. R. Hinchliffe

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