Diabetic limb salvage using 2k flat detector imaging
“A new sense of confidence in working with small vessels.”
Got to see it, to treat it
“You have to see the vessel to identify and characterize the lesion in order to treat it,” says Dr. John Aruny, Assistant Professor, and Section Chief at Yale University School of Medicine, New Haven, Connecticut. “And you have to be able to guide smaller and smaller systems into these vessels. This is where the advantage of high-resolution imaging comes into play.”
For Dr. Aruny, use of the Philips Allura Xper FD-20 with 2k imaging has helped improve his ability to provide successful endovascular revascularization of vessels – as small as 2 millimeters.
“With 2K imaging, we’ve been able to see vessels down to the 2 millimeter size (we can see smaller ones but cannot intervene on them) and to navigate balloons and catheters into these vessels – not only below the knee but below the ankle. That’s remarkable.”
More and more detail Philips has re-engineered the processing pipeline for the Allura Xper FD20 to take advantage of the flat detector’s ability to acquire 2,048 by 2,048 or 4 mega pixels of information.
Instead of casting off 75% of this data as others do (given the limitations of their 1k by 1k image processing pipeline) the FD20 processes all pixel information for an effective final pixel size of 154 microns – and a resulting high-resolution “2k” image.
Yet, the real advantage for Dr. Aruny comes with use of the zoom mode. “I use the zoom feature often – particularly in the lower third of the leg and across the ankle. Now we can zoom right into the foot and get an immediate sense of the vasculature and the hyperemic blush of the contrast in the wound.”
1k versus 2k Standard monitors may display the initial image at only 1k of resolution, but when the zoom feature is activated the system calls to the stored image and delivers the full 2k resolution to the screen.
“With other systems you can zoom and see things larger but without the detail necessary to put a 010 or 014 wire into a small vessel,” describes Dr. Aruny. “With Philips 2k imaging you can zoom into the image and you don’t loose any detail. The picture remains sharp and well blended. You even get the impression that there’s less noise.”
Saving more limbs Dr. Aruny’s job is to get patients to walk out of the hospital and avoid major amputation. His fellow clinicians at Yale have a new sense that outcomes are indeed improving. And he agrees. “Our limb salvage rate has improved markedly. This is most likely because we’re able to do more angioplasty and thrombolysis.
The new system now allows us to intervene on vessels in the 2.0 to 3.5 millimeter range. These are the vessels that are often plugged with plaque brought on by the accelerated atherosclerosis associated with diabetes.”
Increased confidence It wasn’t always this easy. Dr Aruny recalls, “Before 2k imaging you really had to rely on your own physical skills to imagine where a wire might be going as opposed to actually being able to see it. Now I’m more confident the balloon I’m maneuvering is in exactly the right position.”
“If you depend on high image quality, and we do, there’s really not much of a question. The FD20 with 2k imaging is the machine to go with.”
