Results of perioperative measurements of ankle-brachial index in popliteal artery entrapment syndrome

Abstract

Objective The purpose of this study was to demonstrate whether there is postoperative improvement in blood flow in the affected limb after surgical decompression in popliteal artery entrapment syndrome (PAES). For this purpose, the simple method of measuring Doppler ankle pressure with and without provocation was used preoperatively and postoperatively. Patients and methods Doppler ankle pressure was measured preoperatively and postoperatively in neutral position (n = 32) and with provocation (forced plantar flexion of the foot; n = 32) in 32 limbs in 23 patients with PAES (19 men, 4 women; average age, 38.24 ± 12.25 years) operated on between January 1, 1986, and December 31, 2000. The reference method was angiography with provocation in 18 patients and duplex ultrasound scanning in 14 patients. Results Patients were assigned to one of two groups (A and B) on the basis of ankle-brachial index (ABI) at rest. Group A (mean age, 38.19 ± 11.60 years) included all limbs (n = 24) with ABI >0.9 preoperatively, and group B (mean age, 42.39 ± 14.38 years) comprised all limbs (n = 8) with ABI <0.9. Improvement in ABI under provocation after operation (group A, P < .0001; group B, P < .0004) was highly significant. In group B there was also a highly significant difference in ABI in the neutral position before and after operation ( P = .0044); this could not be demonstrated in group A. Angiography or duplex sonography postoperatively did not provide any additional information. Conclusion Our results indicate that determination of ABI alone, with and without provocation, is sufficient as a postoperative follow-up examination to appraise decompression and for quality assurance of PAES. Compared with other more elaborate instrumental methods, measurement of ABI is relatively noninvasive, quick and easy to carry out, effective, and inexpensive.