Pedal Flow Hemodynamics in Patients With Chronic Limb-Threatening Ischemia

Abstract

Ankle-brachial index (ABI) and duplex ultrasound (DUS) are accepted standardized tests performed on patients with suspected peripheral arterial disease. In the nondiabetic patient, ABIs can be a reliable test for disease above the level of the ankle. Toe brachial index (TBI) is also an accepted modality to test for small vessel disease. However, ABIs and TBIs fall short in providing a complete evaluation of arterial flow especially in pedal arteries in the setting of noncompressible arteries. Direct duplex ultrasonography can provide a comprehensive evaluation of arterial flow hemodynamics in the lower extremity. However, we wanted to understand the role of arterial collateral flow to the foot in the setting of tibial vessel occlusion. Using DUS, we sought to define the changes that occur in the arterial flow hemodynamics in the foot in relation to occlusions of specific tibial inflow vessels.