Ankle Systolic Pressure Index Research Articles

Ankle systolic pressure index in non-diabetic non-alcoholic fatty liver disease: A case-control study

Several studies have shown that mortality in Non-alcoholic Fatty Liver Disease (NAFLD) or metabolic steatopathy is more related to cardiovascular diseases than to hepatic complications. Our work aimed to verify the relationship between this liver disease and the ankle-brachial pressure index (ABPI), which is a good screening tool for peripheral arterial disease (PAD) and a reliable marker of cardiovascular risk. A prospective sex- and age-matched case-control study was conducted in non-diabetic patients aged 30 to 70 years. All patients underwent a clinical and biological evaluation. Hepatic steatosis was diagnosed by ultrasound. All participants had their ankle-brachial pressure index measured using a Dopplex® Pocket Doppler in addition to arterial ultrasound of the supra-aortic trunk and a carotid-femoral pulse wave velocity (CfPWV) measurement. An ABPI<0.9 was considered pathological (suggestive of PAD). Statistical analyses were performed using SPSS 21.0 software (IBM). In total, 213 NAFLD patients (100 men/113 women) with a mean age of 48.5±10.14 years were matched to 213 controls. Metabolic syndrome (MS) was more common in NAFLD than in controls, regardless of the International Diabetes Federation (IDF 2005) criteria used (P<0.001). Low ABPI (<0.90) was noted in 19 (8.9%) NAFLD patients vs. 5 (2.3%) in controls (P=0.003). The mean age of these patients was 48.8±8.6 years with a female predominance (20 patients). 62.5% reported dyslipidemia on questioning, 70.8% a metabolic syndrome according to the IDF and 12.5% (3/24) of them were active smokers. There were no records of mediacalcosis. PAD was significantly associated with NAFLD in univariate analysis (OR=4.0 CI 95% (1.4-11.1)). Factors independently associated with PAD in NAFLD patients were nocturnal systolic blood pressure, smoking, thigh circumference, and being a female. The findings of our study show a significant association between NAFLD and low ABPI, likely reflecting the high vascular risk of this patient population.

The long term results of profundaplasty in femoropopliteal arterial occlusion.

The long term results of profundaplasty in the treatment of femoropopliteal arterial occlusion have been reviewed. Fifty patients have been studied with a mean follow-up period of 4 years (range 6 months to 8 years). Intermittent claudication was abolished or substantially improved in 5 of the 25 cases (20 percent); rest pain was relieved in 10 of the 25 cases (40 per cent), the remainder requiring a major amputation. Lumbar sympathectomy produced little additional benefit in either group. The mortality rate in the rest pain group was high and only 5 patients survived for more than 3 years with both legs intact. The state of the distal 'run-off' and the degree of preoperative profunda stenosis appeared to have little influence on the clinical outcome. After operation pedal pulses were restored in 16 per cent of those presenting with claudication. Profundaplasty was without significant effect on the ankle systolic pressure index both in patients with claudication and those with rest pain.

The effect of body heating and cooling on the ankle and toe systolic pressures in arterial disease.

Although changes in body temperature alter limb blood flow, little information exists on the effect of body heating and cooling on systolic pressures in limbs with arterial disease. Ten patients with stable claudication were studied. Mean ankle systolic pressure index during body cooling (0.79 +/- 0.04) exceeded (p less than 0.01) both the value during routine test (0.69 +/- 0.03) and during heating (0.65 +/- 0.04). The individual, paired difference in ankle systolic pressure index between cooling and heating exceeded 0.15 in seven limbs and between cooling and routine test in five. Mean toe systolic pressure index during heating, but not during cooling, was lower than during routine test (p less than 0.01). There was no significant difference in the mean toe systolic pressure index between heating and cooling. However, compared with heating, toe systolic pressure index increased with cooling in 12 limbs and decreased in eight, including three with loss of measurable pressure. The paired difference in toe systolic pressure index between cooling and heating exceeded 0.15 in 10 limbs and between cooling and routine test in eight; whereas between heating and routine test the paired difference was within 0.15 in all but three limbs. The results indicate that changes in body temperature have significant effects on distal pressures in arterial disease. Preliminary warming in routine tests should improve reproducibility.

The effect of body heating and cooling on the ankle and toe systolic pressures in arterial disease

Although changes in body temperature alter limb blood flow, little information exists on the effect of body heating and cooling on systolic pressures in limbs with arterial disease. Ten patients with stable claudication were studied. Mean ankle systolic pressure index during body cooling (0.79 ± 0.04) exceeded (p < 0.01) both the value during routine test (0.69 ± 0.03) and during heating (0.65 ± 0.04). The individual, paired difference in ankle systolic pressure index between cooling and heating exceeded 0.15 in seven limbs and between cooling and routine test in five. Mean toe systolic pressure index during heating, but not during cooling, was lower than during routine test (p < 0.01). There was no significant difference in the mean toe systolic pressure index between heating and cooling. However, compared with heating, toe systolic pressure index increased with cooling in 12 limbs and decreased in eight, including three with loss of measurable pressure. The paired difference in toe systolic pressure index between cooling and heating exceeded 0.15 in 10 limbs and between cooling and routine test in eight; whereas between heating and routine test the paired difference was within 0.15 in all but three limbs. The results indicate that changes in body temperature have significant effects on distal pressures in arterial disease. Preliminary warming in routine tests should improve reproducibility.

Cystic myxomatous degeneration of the right common and external iliac artery

• Please address all correspondence to: W. E. Tuinebreijer, Vondellaan 13, Rode Kruis Ziekenhuis, 1942 LE Beverwijk, The Netherlands, tory of intermittent claudication affecting the right upper and lower leg. Her exercise tolerance, which was initially 100m, became normal with exercise therapy but two months before admission her complaints reappeared suddenly and worsened progressively. The patient had been a smoker until 12 months prior to admission (10-12 cigarettes a day), but otherwise there were no risk factors for atherosclerosis. On examination the pulse in the right groin was found to be diminished and no distal pulses were palpable. In the left leg normal peripheral pulses were palpable. The ankle systolic pressure index at rest was 0.55 in the right leg and 1.03 in the left leg. Arteriography showed a smooth walled stenosis of the right common iliac artery, and complete occlusion of the right external lilac and common femoral arteries (Fig. 1). At operation the right common and external iliac arteries and the common femoral artery were exposed and seen to contain a clear liquid and to be dilated. Through arteriotomies in the common femoral and common iliac arteries mucoid liquid under pressure escaped and the intima was found to be dissected by the fluid. An endarterectomy of the common femoral and iliac arteries was easily performed. At the distal end of the mucoid degeneration the intima was well attached. The arteriotomies were closed by direct suture. The patient remained symptom-free 20 months after the operation, with a normal arteriogram and a normal ankle systolic pressure index.

The Role of Percutaneous Transluminal Angioplasty and Femoropopliteal Bypass in Patients with Threatened Limb

Fifty-two patients with no history of percutaneous transluminal angioplasty (PTA) or vascular surgery presented with a threatened limb and arteriographic findings showing suitability for femoropopliteal arterial reconstruction. Twenty-seven patients were treated by PTA (Group 1) and 25 were treated by femoropopliteal bypass (Group 2). The technical success rate was 85% for PTA and 100% for surgery. The hemodynamic success rate was 63% for PTA and 88% for surgery; the mean increase in ankle systolic pressure index (ASPI) was 0.34 following PTA and 0.57 following surgery. Complications occurred in 11 % of patients following PTA and 32% of patients following surgery. Follow-up ranged from six months to five years with a mean of two years. A clinically successful result was evident in 67% of patients having PTA and 76% of oper ated patients. The overall amputation rate for Group 1 was 7.4% and for Group 2 was 20%. It is concluded that, in the management of femoropopliteal occlusive disease, surgery is more likely to be initially successful than PTA and will give rise to a greater increase in ASPI and a higher incidence of clinically successful outcome; however, because the complication rate is higher for surgery, and fail ure is more likely to lead to amputation, PTA should be considered as a first-line treatment, particularly in patients who are at increased risk for surgery.

Factors Determining the Patency of Femoropopliteal Bypass Grafts: An Analysis of 350 Procedures

In an attempt to define preoperatively assessed factors that might provide prognostic indications of early graft failure, a series of 350 consecutive femoropopliteal bypass operations have been analyzed with regard to various parameters. Data regarding sex, presence of diabetes and coronary heart disease, severity of symptoms, angiographic assessment of outflow vessels, hemodynamic investigations (ankle systolic pressure index and pulse volume recording), graft material and the site of the distal anastomosis were entered into a computer to study the influence of these factors alone and in combination on early patency rates. Among these factors only the ankle systolic pressure index (ASPI) and pulse volume recording (PVR) significantly affected patency and turned out to be of predictive value in graft prognosis. In particular, when these parameters were severely depressed (ASPI less than 0.40 and PVR less than 2) they became a valuable indicator of early graft thrombosis. By combining different variables we were not able to identify a specific pattern of characteristics for the patient whose graft would probably be doomed to occlusion. Considering the scarcity of accurate prognostic indicators in screening subjects from unsuccessful femoropopliteal reconstruction, we believe that a patient should not be a priori excluded from being considered for surgery if his hemodynamic features (ASPI and PVR) are not greatly reduced.

A COMPARISON OF PROXIMAL WITH DISTAL ARTERIAL RECONSTRUCTION IN THE TREATMENT OF ADVANCED LOWER LIMB ISCHAEMIA

Elective arterial surgery for lower limb ischaemia due to chronic occlusive disease has been performed in 212 patients over a five-year period. Of this group, 93 patients were treated for limb-threatening ischaemia. The remainder were treated for intermittent claudication. The clinical and haemodynamic responses to surgery are analysed in this series of 93 patients. The results of proximal reconstruction, in terms of a living patient with patent graft and functional limb, were significantly better (75%) at one year than in patients undergoing distal segment reconstruction (45%). Successful aortoiliac surgery was associated with a mean increase in the ankle systolic pressure index of 0.36, comparied with 0.46 in the distal reconstruction group.

Ankle systolic pressure index and early vein graft failure.

To the Editor. —The article by Corson et al in the August 1978 issue (113:932-935) bears comment relative to their finding of no correlation between the ankle systolic pressure index (ankle pressure divided by brachial pressure) and the incidence of early failure of saphenous vein grafts. The authors have correctly quoted our article 1 showing a highly significant correlation between low ankle pressure indices ( It can be argued that the ankle pressure indices in the 20 patients who had distal bypasses were probably concentrated in the

Ankle Systolic Pressure Index and Early Vein Graft Failure-Reply

In Reply. —Clearly there is a difference between Dr Dean's results and our results with regard to the incidence of early failure of femoropopliteal vein grafts when the preoperative ankle systolic pressure index (ASPI) is low. He found this failure rate to be prohibitive, 1 and we found it to be acceptable. 2 In his letter, Dr Dean suggests that this difference may be the result of the inclusion of femorotibial grafts along with femoropopliteal grafts in our study. As a result of his query, we have again reviewed our results in patients undergoing vein graft reconstruction where the preoperative ASPI was low (

Doppler ankle systolic blood pressure. Prognostic value in vein bypass grafts of the lower extremity.

The prognostic value of Doppler-derived ankle systolic pressure indices for predicting the patency of vein bypass grafts in the lower extremity was analyzed in 126 vein bypass grafts performed for limb salvage. Early or late graft failure was not found to correlate with the preoperative ankle systolic pressure index (ASPI). Intraoperative blood flow measurements did not correlate with the preoperative ASPI. An intraoperative graft flow of less than 0.7 at 24 to 48 hours, or an increase in ASPI of less than 0.4 were prognostic signs of early vein graft failure.