Abstract
In peripheral arterial disease (PAD) of the lower extremities, the presence of flow-limiting stenoses can be objectively detected by the ankle-brachial index (ABI). However, the severity of ischemic symptoms is not necessarily associated with the ABI value. Atherosclerotic plaque in lower extremity PAD induces ankle arterial stiffness and reduces ankle vascular resistance, which may decrease ankle blood flow and cause ischemic symptoms. We hypothesized that the ankle hemodynamic index (AHI), defined as the ratio of ankle arterial stiffness to ankle vascular resistance, could be used to assess the blood supply deficiency in a diseased lower limb in patients with PAD. The 85 consecutive patients with PAD who were retrospectively analyzed in this study had Rutherford grade 1 to grade 6 ischemia diagnosed as PAD and significant stenotic lesions (>50% diameter stenosis) of the lower extremity on contrast angiography. The AHI was calculated as the product of the ankle pulse pressure and the ratio of heart rate to ankle mean arterial pressure (ankle pulse pressure × heart rate/ankle mean arterial pressure). The Rutherford grade was significantly correlated with the AHI (r = 0.50, P < 0.001), but not with the ABI (r = 0.07, P = 0.52). Multiple ordinal regression analysis showed that anemia (odds ratio 0.66, P = 0.002) and AHI (odds ratio 1.04, P = 0.02) were independently associated with Rutherford grade. Our study shows that AHI, a novel parameter based on the ABI measurement, is well correlated with ischemic symptoms, and may be a useful means to assess the arterial blood supply of the lower extremities of patients with PAD.
Highlights
Peripheral arterial disease (PAD) is a significant public health concern; worldwide more than 202 million adults have been diagnosed with the disease
The major findings of the present study are: 1) ankle hemodynamic index (AHI), but not ankle-brachial index (ABI), is significantly correlated with the Rutherford grade and 2) anemia and increased AHI are independently associated with a higher Rutherford grade, as determined
We found that anemia, higher C-reactive protein (CRP) level, and higher AHI were significantly associated with a higher Rutherford grade
Summary
Peripheral arterial disease (PAD) is a significant public health concern; worldwide more than 202 million adults have been diagnosed with the disease. It poses a significant economic burden, reflecting the treatment of advanced disease, the alleviation of symptoms, and the prevention and treatment of ischemic events [1, 2]. PAD of the lower extremities, in which the blood supply is obstructed mainly by atherosclerosis [3], ranges in severity from claudication to critical limb ischemia with tissue loss. The severity of lower limb ischemia among patients with PAD is most commonly classified according to the Rutherford and Fontaine classification systems, both of which are symptombased [6,7,8]. The Rutherford classification system has been used to determine the revascularization potential of lower extremities with ischemia [8, 9]
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