RR9. Characterization of Tibial Velocities by Duplex Ultrasound in Severe Peripheral Arterial Disease and Healthy Controls

Abstract

The relationship between tibial velocities and peripheral arterial disease (PAD) severity is not well understood. We sought to characterize tibial velocities in patients with critical limb ischemia (CLI) or lifestyle-limiting claudication (LLC) and in healthy control patients without PAD. Patients with an arterial duplex ultrasound (DUS) with PAD (CLI or LLC) evaluated over a 5-year period were retrospectively compared with controls, patients without PAD, and a normal ankle-brachial index (ABI; 0.9-1.2). Control duplex ultrasound images were collected sequentially over a 60-month period. LLC was defined as short-distance claudication, objective PAD, and symptoms warranting revascularization. CLI was defined as ischemic rest pain or nonhealing ulcer/gangrene. For each artery, measurements were obtained at the proximal, middle, and distal portion of the vessel and averaged for each artery. Mean peak systolic velocities (PSV in cm/s), ABIs, peak ankle velocity (PAV), defined as the maximum PSV of any portion of the posterior tibial (PT) or anterior tibial (AT) artery, and average ankle velocity (AAV, the mean of the AT and PT PSV) were compared using independent t-tests. Preoperative DUS was available in 90 patients with PAD (54 CLI, 36 LLC) and 71 healthy controls. Mean ABI in the PAD group was 0.66 compared with 1.08 in controls. Mean PSV in PAD was significantly lower than controls at the popliteal (63.6 vs 76.2, P = .020), peroneal (33.9 vs 53.8, P < .001), AT (43.2 vs 65.4, P < .001), and PT artery (42.9 vs 74.1, P < .001). PAV (56.5 vs 89.2, P < .001) and AAV (43.5 vs 69.7, P < .001) were also significantly lower in the PAD group than in controls, whereas velocities in the profunda femoris artery were significantly higher in PAD group (132.1 vs 96.2, P = .001). From this, 95% confidence interval reference ranges were established for severe PAD and healthy controls (Table). This is the first study to characterize lower extremity arterial PSVs, PAVs and AAVs in severe PAD and healthy, non-PAD patients. These early criteria establish reference ranges to guide clinical decision-making and vascular lab interpretation.TableConfidence intervals in critical limb ischemia (CLI) and lifestyle-limiting claudication (LLC) compared with healthy nonperipheral arterial disease (PAD) patientsCLI and LLC (cm/s)Healthy controls (cm/s)PArtery Common femoral116.9-146.8111.3-133.0NS Profunda femoris115.0-149.285.5-106.9.001 Superficial femoral103.3-137.296.4-113.5NS Popliteal55.5-71.869.1-83.2<.001 Anterior tibial36.6-49.759.4-71.3<.001 Peroneal28.3-39.648.3-59.4<.001 Posterior tibial34.2– 51.666.9-81.3<.001Alternate parameters PAV AT46.6-69.470.4-86.1<.001 PAV PT41.3-71.879.4-99.0<.001 PAV Peroneal36.5-50.658.7-72.1<.001 AAV37.1-49.963.7-75.7<.001AAV, average ankle velocity; AT, anterior tibial; NS, not significant (P > .05); PAV, peak ankle velocity; PI, posterior tibial. Open table in a new tab