Comparison of preoperative and postoperative ct foot perfusion in patients undergoing infrapopliteal bypass for peripheral arterial disease

INTRODUCTION: The evaluation of revascularization at the tissue level in patients undergoing infrapopliteal bypass is challenging due to the unreliability of ankle-brachial index (ABI) measurements in patients with widespread arterial disease. This study investigated the potential of dynamic volume foot computed tomografhy (CT) perfusion to quantitatively assess surgical revascularization at the tissue level. MATERIALS AND METHODS: This study retrospectively reviewed 20 patients who underwent infrapopliteal bypass between January 2023 and November 2024. Of the 13 patients had chronic limb-threatening ischemia (CLTI), and 7 patients had plantar claudication. Dynamic volume perfusion CT scans were performed 1-3 days before and 7-30 days after the surgical procedure. Blood flow (BF), blood volume (BV), mean transit time (MTT), and time to maximum (Tmax) were quantitatively assessed in six different angiographic regions of the leg. Clinical findings were compared with ABI and perfusion parameters. RESULTS: Following surgical revascularization, mean BF increased by approximately 140% and BV increased by approximately 150% (p < 0.001 for all). A significant decrease in Tmax was observed (mean 1.72 s; p < 0.001). No significant change was observed in MTT (p = 0.267). Significant improvement was seen in BF, BV, and Tmax parameters in both the CLTI and plantar claudication groups. Although postoperative ABI values increased significantly (p < 0.001) no significant correlation was found between ABI and perfusion parameters. The improvement in perfusion parameters was consistent with clinical improvement. CONCLUSION: Dynamic volume perfusion CT can quantitatively demonstrate tissue-level improvement after infrapopliteal bypass. It can be used as a supportive tool in postoperative evaluation and clinical decision-making by providing data consistent with clinical findings, especially in patients where ABI measurement is unreliable.