Prevalence of Tibial Artery and Pedal Arch Patency by Angiography in Patients With Critical Limb Ischemia and Noncompressible Ankle Brachial Index

Randhawa, Manjit; Reed, Grant W.; Grafmiller, Kevin; Gormik, H.L.; Shishehbor, Mehdi H.

doi:10.1016/j.jvs.2017.07.062

Cited by 10 publications

(14 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, determining the severity of PAD in patients with CLI can be challenging as a result of the presence of noncompressible arteries. 12 Sung et al 32 showed no consistent tendency of the influence of the compliance on the changes in peak systolic velocity, AT, or acceleration index, thus suggesting there is also no influence in ACC max when the compliance changes, as in a calcified vessel. Therefore, we conclude that ACC max can be clinically superior to other noninvasive measurements, particularly in patients with diabetes and/or CLI, as ACC max is measured distal to the stenosis.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, the waveform morphology measured using pulse volume recording is relatively insensitive for diagnosing CLI. 12 Thus, determining the severity of PAD using currently available noninvasive measurements can be challenging, particularly in patients with CLI and/or diabetes. A new noninvasive approach that is particularly promising for detecting and quantifying PAD is duplexderived maximal systolic acceleration (ACC max ).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Using maximal systolic acceleration to diagnose and assess the severity of peripheral artery disease in a flow model study

Brouwers

Doorn

Wissen

et al. 2020

Journal of Vascular Surgery

View full text Add to dashboard Cite

Background: Because of the presence of medial calcific sclerosis, both ankle-branchial index and toe pressure measures can yield misleading results when attempting to diagnose peripheral artery disease (PAD). A new ultrasound parameter, maximal systolic acceleration (ACC max ), can be an accurate tool for diagnosing PAD, including in diabetic patients. However, it has not been evaluated thoroughly. The aim of this study was to assess the feasibility of using ACC max to diagnose and assess the severity of PAD.Methods: The human circulatory system was simulated using an in vitro circulatory system driven by a pulsatile pneumatic pump. Arterial stenosis of various degrees (50%, 70%, 80%, and 90%) was simulated in order to investigate the change in several ultrasound parameters (including ACC max ), as well as the intraluminal mean arterial pressure gradient. In a separate set of measurements, interobserver variability was measured using two investigators who were unaware of the degree of stenosis.Results: ACC max significantly decreased (P < .001), and the pressure gradient increased (P < .001) as the degree of stenosis increased. Moreover, we found a strong correlation between ACC max and the pressure gradient (R 2 ¼ 0.937). Finally, interobserver variability with respect to ACC max was extremely low, with an intraclass correlation coefficient of 0.99. Conclusions:The results of this flow model study suggest that ACC max can be a valid, noninvasive tool for diagnosing PAD. Moreover, our finding that ACC max decreases as the severity of stenosis increases, together with the strong correlation between ACC max and the pressure gradient, suggests that ACC max may be useful as an alternative diagnostic tool for assessing the severity of PAD. These promising in vitro data warrant further study in a clinical setting. (J Vasc Surg 2020;71:242-9.)Clinical Relevance: Limb pressure measurements and the determination of pressure index values (ankle-branchial index and toe pressure) are commonly used in patients with symptoms consistent with peripheral arterial disease. However, ankle-branchial index and toe pressure can be falsely elevated or falsely normal due to medial calcific sclerosis. In this in vitro flow-model study, the maximal systolic acceleration (ACC max ) significantly decreased as the degree of stenosis increased. Furthermore, there was a strong correlation between ACC max and the intraluminal pressure gradient. These results suggest ACC max may provide a robust noninvasive technique for assessing the severity of peripheral arterial disease.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Using maximal systolic acceleration to diagnose and assess the severity of peripheral artery disease in a flow model study

Brouwers

Doorn

Wissen

et al. 2020

Journal of Vascular Surgery

View full text Add to dashboard Cite

show abstract

“…7,8 A major limitation of the exam is poor applicability to patients with poorly compressible or noncompressible arteries. 7,9,10 Diabetes and advanced chronic kidney disease are associated with medial wall calcification and subsequent poor arterial compressibility. The percentage of patients with noncompressible vessels reported in the literature has increased over time and may be attributable to the increase prevalence of diabetes.…”

Section: Ankle-brachial Indexmentioning

confidence: 99%

“…9 Even in compressible vessels, medial calcification artificially inflates the ABI, and the metric is considered unreliable in the diabetic population particularly those with isolated infrapopliteal disease. 10 Patients with history or physical exam findings suggesting PAD who have a normal ABI at rest should undergo further testing with measurement of a postexercise ABI. 12 Typically, exercise consists of walking on a treadmill for a short period of time such as 5 minutes.…”

Section: Ankle-brachial Indexmentioning

confidence: 99%

“…Digital arteries are less pervasively affected by medial wall calcification in diabetic patients than tibial vessels, and TBI is considered more reliable than ABI in these patients. 10 A TBI less than 0.7 is considered diagnostic of PAD. 6 Patients with foot ulceration, particularly those with diabetes, should be evaluated by measures additional to an ABI.…”

Section: Toe-brachial Indexmentioning

confidence: 99%

See 1 more Smart Citation

Noninvasive Arterial Testing: What and When to Use

Mittleider

2018

Semin intervent Radiol

View full text Add to dashboard Cite

Peripheral arterial disease (PAD) represents a growing public health issue that continues to be underdiagnosed. In its most severe form, critical limb ischemia, it contributes to expanding morbidity with minor and major limb amputations. PAD is strongly associated with increased mortality, as it is known to be concomitant with coronary and cerebrovascular disease. Diagnosis of PAD relies on noninvasive arterial testing, a class of tests that can provide physiologic or morphologic information. Physiologic tests such as ankle-brachial index, toe-brachial index, pulse volume recordings, and arterial duplex evaluation are the mainstay of gateway evaluation and surveillance. Morphologic exams such as computer tomographic angiography and magnetic resonance angiography are appropriate for preprocedural anatomic evaluation in patients with established vascular disease. This review focuses on physiologic exams.

show abstract

Analysis of IN.PACT DEEP trial on the association between changes in perfusion from pre‐ to postrevascularization and clinical outcomes in critical limb ischemia

Hammad

Zeller

Baumgartner

et al. 2017

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

Prevalence of Tibial Artery and Pedal Arch Patency by Angiography in Patients With Critical Limb Ischemia and Noncompressible Ankle Brachial Index

Abstract: and should be aware and guard against self-interest creeping into the decisions they make with their patients.

Cited by 10 publications

References 0 publications

Using maximal systolic acceleration to diagnose and assess the severity of peripheral artery disease in a flow model study

Using maximal systolic acceleration to diagnose and assess the severity of peripheral artery disease in a flow model study

Noninvasive Arterial Testing: What and When to Use

Analysis of IN.PACT DEEP trial on the association between changes in perfusion from pre‐ to postrevascularization and clinical outcomes in critical limb ischemia

Contact Info

Product

Resources

About