Accuracy of Acceleration Time of Distal Arteries to Diagnose Severe Peripheral Arterial Disease

Abstract

ContextAnkle-brachial index (ABI) and toe-brachial index (TBI) are the recommended tests for the diagnosis of lower extremity peripheral artery disease (PAD) and the assessment of its severity, whereas Doppler ultrasound (DUS) is usually used to localize vascular lesions. However, the performance of DUS as an alternative to TBI and ABI measurement is unknown.ObjectiveThe goals were (i) to evaluate the correlation between DUS parameters of distal arteries of the lower extremities with TBI in patients with PAD; (ii) to evaluate the correlation between DUS parameters of distal arteries with ABI; and (iii) to assess the diagnostic accuracy of maximal acceleration time of pedal arteries to detect toe pressure ≤30 mmHg.MethodsAn observational retrospective study was conducted for 1 year on patients with the diagnosis of PAD on DUS. Demographic data, ABI, TBI, and DUS parameters of the dorsal pedis and lateral plantar arteries (DPA and LPA) were recorded.ResultsSeventy-seven patients with 88 limbs were included, aged 69 [interquartile range: 11 years] with 28.6% of diabetic patients. The highest acceleration time of either DPA or LPA (ATmax) was the most correlated to TBI on both univariate (r = −0.78, p < 0.0001) and multivariate analysis (p < 0.0001). DUS parameters had a weaker correlation with ABI. ATmax > 215 ms showed high diagnosis accuracy to a toe pressure of 30 mmHg or less [sensitivity of 86% [0.57–0.98] and negative predictive value of 97% [0.89–1.00]].ConclusionATmax demonstrates a high correlation with TBI in patients with PAD, and high diagnostic accuracy for detection of critical limb ischemia. Based on these results, ATmax can represent the next step in evaluating PAD severity with DUS, in patients with advanced lower extremity PAD.

Effects of Lower Limb Revascularization on the Microcirculation of the Foot: A Retrospective Cohort Study

“…There was a moderate negative correlation (r 2 = 0.41, p = 0.002, n = 21) between ABI and AcT suggesting that 41% of the variability in AcT can be accounted for with ABI. These findings are in-line with previous work that has shown arterial acceleration time measured in the lateral plantar artery and dorsalis pedis artery to significantly correlate with ABIs and TBIs [ 14 , 15 ].…”

“…Their lack of correlation and non-significant changes in StO 2 in some studied angiosomes [ 24 ] suggest that changes in perfusion may take weeks after respective therapy to become apparent [ 25 ] and further validates the need to assess both macrovasculature and microvasculature. These findings combined with the findings of macrovascular agreement in the present study ( Figure 4 ) and previous reports [ 14 , 15 ] support the argument that macro- and microvasculature status may not be synonymous. These differences from macro- to micro- might be explained by ischemic reperfusion injury, initial arteriosclerotic occlusion of the respective terminal arteries, or a temporal delay in function [ 24 ].…”

“…Pearson correlation values for r 2 , p , and n are indicated on the graph. Results are comparable to previously published work [ 14 , 15 ]. AcT, acceleration time; ABI, ankle-brachial index.…”

“…Arterial Doppler ultrasound was used to evaluate medial and lateral tarsal artery acceleration times as previously described [ 14 , 15 ]. In a subset of patients ( n = 26), an additional macrovasculature assessment of ankle-brachial index (ABI) was taken prior to their interventions.…”

Accuracy of maximal acceleration time of pedal arteries to diagnose critical limb-threatening ischemia

“…More recently, several studies have highlighted the correlation between acceleration time (AT) on pedal arteries and either ABI or TBI, and so PAD severity. [10][11][12] More precisely, maximal AT between dorsalis pedis artery (DPA) and lateral plantar artery (LPA) (AT max ), with a cut-off value of 215 ms, has been shown to predict TP ⩽ 30 mmHg with a 86% sensitivity and a 82% specificity in patients with severe occlusive PAD. 10 Therefore, the aim of this study was to confirm the cut-off value of 215 ms to predict a TP ⩽ 30 mmHg in a broader population and the association to clinical signs of CLTI.…”