Virtual ankle-brachial index – can the immediate outcome of femorodistal bypass surgery be predicted?

Dragan B. Sekulić; Aleksandar B. Tomić; Andreja Dimić; Aleksandar C. Mitrović; Lazar B. Davdović; Dragana S. Paunović; Dalibor D. Nikolić; Uroš M. Miladinović; Igor M. Sekulić; Nemanja K. Rančić; Momir M. Šarac; Ivan R. Marjanović; Ivan R. Leković; Boško I. Milev

doi:10.2298/VSP230516033S

Dragan B. Sekulić Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
Aleksandar B. Tomić Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Andreja Dimić University Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Aleksandar C. Mitrović University Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
Lazar B. Davdović University Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Dragana S. Paunović Military Medical Academy, Clinic for Vascular and Endovascular Surgery
Dalibor D. Nikolić University of Kragujevac, Faculty of Engineering Sciences, Kragujevac, Serbia
Uroš M. Miladinović Military Medical Academy, Institute for Radiology, Belgrade, Serbia
Igor M. Sekulić University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia; Military Medical Academy Institute for Radiology Belgrade, Serbia
Nemanja K. Rančić University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia; Military Medical Academy Institute for Radiology Belgrade, Serbia; Military Medical Academy Center for Clinical Pharmacology Belgrade, Serbia
Momir M. Šarac Military Medical Academy, Clinic for Vascular and Endovascular Surgery Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Ivan R. Marjanović Military Medical Academy, Clinic for Vascular and Endovascular Surgery Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Ivan R. Leković Military Medical Academy, Clinic for Vascular and Endovascular Surgery Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Boško I. Milev University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia; Military Medical Academy Clinic for General Surgery, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP230516033S

Keywords: arterial occlusive diseases, ankle brachial index, computed tomography angiography, finite element analysis, image interpretation, computer-assisted, leg, prognosis, ultrasonography

Abstract

Background/Aim. The best treatment for the occlusion of the largest artery in the thigh is a femorodistal (FD) bypass. Ankle-brachial index (ABI) and multidetector computed tomographic (MDCT) angiography are the gold standards for diagnosing peripheral arterial occlusive disease. The finite element analysis (FEA) method can help measure the quantity of blood flow and arterial pressure in the arteries in the leg. The aim of this study was to examine the possibility of using the FEA method in predicting the outcome of FD bypass surgery. Methods. The study involved 45 patients indicated for FD arterial reconstruction from December 1, 2021, to March 31, 2023. Each patient underwent pre- and postoperative MDCT angiography of the arteries of the lower extremities, on the basis of which, with the use of FEA, models were made for measuring ABI. All patients had their ABI measured preoperatively and postoperatively using the Doppler ultrasound and sphygmomanometer. Based on the findings of the preoperative MDCT angiography, postoperative virtual surgical models were created using the FEA method, on which ABI were also measured. The values of ABI were divided into five groups: ABI measured preoperatively (ABI pre-op), ABI measured postoperatively (ABI post-op), ABI measured on FEA models based on the MDCT findings [ABI (sim) pre-op], ABI sim post-op, and ABI measured on virtual surgery model [ABI sim post-op (virtual)]. The ABI of the models were statistically compared with preoperative and postoperative measurements done on patients. Results. The values based on the virtual ABI model did not show significant differences compared to the values obtained on patients and values obtained with the FEA method using MDCT angiography (p < 0.001). A strong statistically significant correlation was shown between the virtual ABI and the values obtained by the other two methods, measured on the postoperative MDCT angiography model and virtual postoperative model (p < 0.001). Conclusion. Virtual simulation based on the MDCT angiography parameters of peripheral blood vessels can be successfully used to predict the immediate outcome of the FD bypass surgery.

Author Biography

Igor M. Sekulić, University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia; Military Medical Academy Institute for Radiology Belgrade, Serbia

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