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.

Highlights

  • Lower extremity peripheral artery disease (PAD) is a major burden worldwide, with a steady and significant increase in prevalence over the last decades [1, 2]

  • Ankle-brachial index (ABI), ankle-brachial index;Acceleration time (AT), acceleration time; ATmax, highest acceleration time between pedal arteries; Dorsalis pedis artery (DPA), dorsalis pedis artery; Doppler waveforms (DWs), duplex waveform; MI, myocardial infarction. †Active tobacco use was defined by active smokers or tobacco cessation for

  • This study demonstrates that the highest value of ATmax of either DPA or LPA is highly correlated to toe-brachial index (TBI) and can be used to diagnose toe pressure lower or equal to 30 mmHg, one of the criteria used to defined critical limb ischemia (CLI) [22]

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Summary

Introduction

Lower extremity peripheral artery disease (PAD) is a major burden worldwide, with a steady and significant increase in prevalence over the last decades [1, 2]. Ankle-brachial index (ABI) and toe-brachial index (TBI) are both accepted methods for diagnosing and assessing PAD severity, as a reflection of lower extremity perfusion [4]. TBI is not limited by calcified arteries but the technique is less widely used because of longer acquisition and higher cost. The place of DUS with Doppler waveforms (DWs) analysis to estimate distal perfusion remains poorly known even if many consider it a helpful tool to evaluate PAD severity through distal perfusion. Sommerset et al have emphasized the correlation of acceleration time of the lateral plantar artery (LPA) with ABI [8] and its relationship to critical limb ischemia [9]. The relationship of the acceleration time with TBI is unknown

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