Limitations of the femoral artery pulsatility index with aortoiliac artery stenosis: An experimental study

Abstract

Relationships between femoral artery pulsatility index (PI) (a number calculated from Doppler-derived arterial blood velocity waveforms) and three directly measured physiologic parameters (proximal artery stenosis, blood pressure index (BPI), and blood flow) were studied in a canine model. All combinations of stenoses were constructed, including 0%, 25%, 50%, 75%, and 90% reduction in a cross-sectional area in the infrarenal aorta and/or left common iliac artery of 14 animals. PIs, BPIs, and mean blood flows were measured for each stenosis pattern at both the right (control) and left femoral arteries. Three groups were studied--group I, the left femoral artery remained open; group II, the left femoral artery was ligated; and group III, a left femoral arteriovenous fistula was constructed. Correlations between reductions in femoral artery PI and increasing arterial stenosis as well as decreasing BPI and blood flow were obtained. However, positive correlations were weak and only recognized when high-grade stenoses were present. Moreover, these correlations were further influenced by the multiplicity of stenoses present as well as flow velocity into the distal arterial bed. These data suggest that PI lacks the sensitivity to be a clinically useful diagnostic test.

Reliability of common femoral artery hemodynamics in assessing the severity of aortoiliac inflow disease

“…[40][41][42][43][44][45][46][47] Most of these indices require off-line processing and com-plex calculations, 41,47,48 while other techniques are affected by distal outflow disease. 41,42,47,49,50 We investigated the diagnostic accuracy of CDU-derived CFA hemodynamics, ie, peak systolic velocity (PSV) and waveform contour, alone or in combination, in detecting hemodynamically significant aortoiliac occlusive disease and predicting its severity (Ն50% stenosis vs occlusion), while accounting for other anatomic variables such as bilateral iliac and distal outflow disease.…”

Is routine preoperative aortoiliac arteriography necessary in the treatment of lower extremity ischemia?

“…Common femoral artery acceleration time has demonstrated the best results among many indirect noninvasive tests that have been studied, and it is simple to calculate. [10][11][12][13][14][15][16] Acceleration time demonstrated reasonable accuracy (89%) and NPV (94%) in this study and it was not significantly affected by runoff status (Table II). These findings are consis-tent with those in a study by Burnham et al 10 in which acceleration time had an accuracy of 94% and a NPV of 97%.…”

“…[2][3][4][5]8,9 Among the many indirect noninvasive tests of inflow evaluated, common femoral artery acceleration time demonstrated a reasonable degree of accuracy and was not significantly affected by the status of the runoff arteries. [10][11][12][13][14][15][16] An algorithm is proposed that combines these noninvasive modalities in an effort to guide the selective use of aortoiliac arteriography.…”

Screening Algorithm for Aortoiliac Occlusive Disease Using Duplex Ultrasonography–Acquired Velocity Spectra from the Distal External Iliac Artery

“…20,23,24,26,29 However, others have not had such good results in using this vessel for interrogation. 23,[35][36][37][38] We chose to study the DEIA for several reasons. The insonation of this vessel is quick and easy with a 3.5 MHz curved array probe placed in a longitudinal fashion.…”