Optical coherence tomography angiography enables visualization of microvascular patterns in chronic venous insufficiency

Abstract

Chronic venous insufficiency (CVI) is a global health concern with significant public health and individual impact. Currently available diagnostic methods cannot visualize microvenous pathologies that have shown to result in severe forms of CVI and also affect the skin. Optical coherence tomography angiography (OCTA) may close the CVI diagnostic gap by providing a fast, label-free, and non-invasive solution to visualize cutaneous microvasculature. The study enlisted 66 subjects, including 53 CVI patients spanning all clinical-etiology-anatomic-pathophysiologic (CEAP) C stages and 13 healthy controls. The high spatial resolution OCTA system used was specifically designed for skin imaging. Significant microangiographic pattern variations emerged, both in qualitative and quantitative terms. OCTA provided valuable insights into cutaneous microvascular changes among different CVI stages. Thereby, OCTA may enable the selection of patient populations at risk for disease progression in the future.

Keywords: Health sciences; Optical imaging; Vascular anatomy.

Graphical abstract

Figure 1

OCTA volumes of CEAP C0-C4 showing distinct microvascular patterns Depth-color-coded en face images of (A) three individuals with healthy skin, (B) three individuals with telangiectasias, (C) three individuals with varices, (D) three individuals with purpura jaune d’ocre, (E) three individuals with lipodermatosclerosis, and (F) three individuals with corona phlebectatica. Each OCTA en face image corresponds to the squared region on the photo of the patient’s lower extremity. Scale bar represents 1 mm.

Figure 2

OCTA volumes of skin at the border of healed and active venous leg ulcers Depth-color-coded OCTA en face images showing the cutaneous microvasculature at the border of (A) three individuals with healed venous leg ulcers and (B) three individuals with active ulcers. Each OCTA en face image corresponds to the squared region on the photo of the patient’s lower extremity. Scale bar represents 1 mm.

Figure 3

OCTA volumes of venous leg ulcers showing distinct microvascular patterns Depth-color-coded OCTA en face images showing locations at varying distances from the lesion of venous leg ulcers. Each OCTA en face image corresponds to the squared region on the photo of the patient’s lower extremity. Scale bar represents 1 mm.

Figure 4

Quantitative analysis of OCTA volumes (A) maximum vessel radius, (B) vascular density, (C) mean vessel length, (D) mean inflection count metric measuring vessel tortuosity. Each box of the boxplot displays the median at its center, whereas its lower and upper boundaries represent the 25^th and 75^th percentiles. Extended from the box are whiskers that reach the maximum and minimum values of the distribution. Only the statistically significant CVI stages for each extracted parameter are reported and considered in the quantitative analysis. ∗ = statistically significant (two-sample t test).