Duplex Ultrasound Defined Angiosome With the Use of Pedal Acceleration Time as a Predictor to Wound Healing

Abstract

We have established that pedal acceleration time (PAT) in nondiabetic limbs are highly correlative with ankle-brachial indices. We propose that PAT can be utilized in diabetic patients with noncompressible vessels and is an excellent predictor of wound healing. We performed a retrospective analysis in a prospective data base of diabetic patients with chronic limb-threatening ischemia (CLTI). We focused on patients with diabetes and isolated infrapopliteal arterial occlusive disease. Fifty-four limbs with WIFI score and documented CLTI who underwent angiographic interventions were analyzed. A complete pedal arch duplex was performed, PAT (milliseconds) was measured in the arcuate artery, dorsal metatarsal artery, medial, lateral, and deep plantar arteries. These measurements correspond to the angiosome of tissue loss which were obtained before and after interventions. A Fisher's exact test was used for data analysis. Based on previous report, PAT was categorized into four classes (Table). All CLTI patients were in class 4, which is defined as a PAT of greater than 225 ms. Of the 54 diabetic limbs, 44 achieved wound healing and 10 required higher level amputation. Patients with wounds prior to intervention had a mean PAT 237.6 + ms in the targeted artery of the foot. Complete wound healing was associated with a mean PAT of 114.2+ ms in the target angiosomic artery of the foot, regardless of direct or in-direct revascularization of the tibial arteries (P < .001). Limb loss was associated with a mean PAT of 278.4+ ms (P < .001) following intervention. Our group established that PAT demonstrates a high correlation with ABI in patients with compressible arteries. Based on current data, PAT is also a reliable noninvasive examination for patients with CLTI. This novel use of duplex-specific angiosome in the area of foot wounds demonstrate high predictability of wound healing. We conclude that duplex imaging of the pedal vessels, using PAT in particular, should be performed in all CLTI patients to aid in treatment of these complex patients.TablePedal acceleration time (PAT) classificationNo ischemia class 1Mild ischemia class 2Moderate ischemia class 3Severe ischemia class 4Clinical SymptomsAsymptomatic>2 blocks claudication>2 blocks claudicationCritical Limb Ischemia (Tissue loss, rest pain)PAT20-120 ms121-180 ms181-224 msGreater than 225 msABI1.3-0.900.89-0.690.68-0.500.49-0.00 Open table in a new tab