Use of Doppler Ultrasound to Assess Femoral Artery Adaptations in the Hemiparetic Limb in People with Stroke

Abstract

Background: A reduction in physical activity combined with decreased demand for leg oxygen consumption may affect blood flow to the hemiparetic lower extremity after stroke. The purpose of this study was to characterize femoral artery adaptations that occur in the hemiparetic leg in chronic stroke. A secondary goal was to examine intrarater reliability using Doppler ultrasound in people with hemiparesis after stroke. Methods: This descriptive study used a sample of convenience at 2 locations (urban medical center and rural university). Eighteen individuals (68.4 ± 3.7 years of age; 15 males) with chronic stroke (time since stroke: 5.7 ± 1.1 years; 12 with right-side hemiparesis) participated in the study. Femoral artery blood flow, diameter, velocity and vessel wall thickness in the bilateral lower extremities were assessed using Doppler ultrasound. Intrarater reliability was determined for femoral artery diameter and blood flow velocity. Results: Femoral artery blood flow, arterial diameter and blood flow velocity were significantly lower (p < 0.0001) in the hemiparetic limb when compared to the less affected limb. Femoral artery vessel wall thickness was significantly greater (p = 0.002) in the hemiparetic limb. Doppler ultrasound intrarater reliability was strong and significant (intraclass correlation coefficient_3,1 >0.94, p < 0.0001) for femoral artery diameter and blood flow velocity measurements. Conclusion: These data suggest that individuals with chronic stroke demonstrate vascular changes in the femoral artery of the hemiparetic limb.

The relationship of pro-inflammatory markers to vascular endothelial function after acute stroke

“…(9) In 2004, Ivey et al used strain gauge plethysmography to examine vascular endothelial function in the lower limbs in people with chronic stroke. (5) They reported findings similar to our previous work(6, 7) regarding between limb differences. Ivey and colleagues explored whether these alterations were a function of reduced lean muscle mass using dual energy X-ray absorptiometry.…”

“…Although we have observed unilateral changes resting blood flow and arterial diameter in the femoral artery of the hemiparetic leg in chronic stroke,(6, 7) it is unclear when these changes occur or the mechanisms involved. Vascular endothelial function via FMD in the brachial artery has been reported to be reduced in chronic(3) stroke when compared to controls.…”

“…Our prior work has suggested that between limb differences are present in the femoral artery diameter and blood flow in people with chronic stroke(6, 7) and in in subacute stroke, brachial artery FMD was lower in the stroke-affected limb when compared to the less affected side. (9) In 2004, Ivey et al used strain gauge plethysmography to examine vascular endothelial function in the lower limbs in people with chronic stroke.…”

Cardiovascular Response During Submaximal Underwater Treadmill Exercise in Stroke Patients

“…Many studies on stroke patients showed that the lower leg blood flow in the affected limb decreased during rest and exercise [25,26,27], and the blood flow in the femoral artery of the hemiparetic limb was significantly lower at rest when compared to the other limb [27]. Other studies have also reported that the structural vascular remodeling, characterized by a decreased diameter of vessel and blood flow in the femoral artery of the paralyzed side, may occur after stroke [26,28]. The literature suggests that impaired motor function and lower activity level after stroke reduce the needs for blood flow and muscular metabolic activity in the hemiparetic leg [25].…”

A Review of the Effectiveness of Aerobic Training in Increasing Endurance in Subacute Stroke Patients

“…Reduced exercise capacity is also supported to result from unilateral dysfunction of the paretic limb [7][8][9][10]. Adaptations that have been reported are reduction of femoral artery diameter [8,9], blood flow reduction [7,9,10], change in tissue composition [11][12][13], and vasomotor reactivity [9,10].…”