Arterial spectral waveform analysis in the prediction of diabetic foot ulcer healing.

Pasha Normahani,Viknesh Sounderajah,Katarzyna Powezka,Patrick Musonda,Prodromos Tsinaslanidis,Usman Jaffer,Zaheer Mehar,Vasiliki Bravis,Mohammed Aslam,Rishi Agrawal

doi:10.1177/0267659120957849

Abstract

Objective:We assessed the association between (1) severity of vessel wall calcification, (2) number of patent vessels at the ankle and (3) arterial spectral waveform features, as assessed on a focused ankle Duplex ultrasound (DUS), and healing at 12-months in a cohort of patients who had their diabetic foot ulcers conservatively managed.Research design and methods:Scans performed on 50 limbs in 48 patients were included for analysis. Patient health records were prospectively reviewed for 12-months to assess for the outcome of ulcer healing.Results:We identified that the number of waveform components, peak systolic velocity, systolic rise time and long forward flow as well as the number of vessels patent at the ankle on DUS, may be useful independent predictors of healing, as noted by the trend towards statistical significance.Conclusion:Arterial spectral waveform features may be useful in predicting the chance of diabetic foot ulcer healing.

Highlights

Peripheral arterial disease (PAD) is an important independent predictor of lower limb ulcer healing in patients with diabetes
Duplex Ultrasound (DUS) is well-established practice in determining the anatomical distribution of arterial disease and it has been postulated that the arterial spectral waveform at the ankle can provide useful information regarding the upstream and downstream state of the vasculature in addition to assessing the burden of arterial calcification
This is the first study to investigate the association between arterial spectral waveform features and the likelihood of diabetic foot ulcer healing

Summary

Introduction

Peripheral arterial disease (PAD) is an important independent predictor of lower limb ulcer healing in patients with diabetes. Wound classification systems such as WiFi have been validated for this purpose.[2] Bedside tests assessing flow and perfusion to the foot have been demonstrated to have some utility in stratifying risk.[3] little is known regarding the usefulness of arterial spectral waveform analysis.

Results

Conclusion