TY - JOUR
T1 - Characterization of tibial velocities by duplex ultrasound in severe peripheral arterial disease and controls Presented as an oral presentation at the 2015 Vascular Annual Meeting of the Society for Vascular Surgery, Chicago, Ill, June 17-20, 2015.
AU - Crawford, Jeffrey D.
AU - Robbins, Nicholas G.
AU - Harry, Lauren A.
AU - Wilson, Dale G.
AU - McLafferty, Robert B.
AU - Mitchell, Erica
AU - Landry, Gregory J.
AU - Moneta, Gregory L.
N1 - Publisher Copyright:
© 2016 Society for Vascular Surgery.
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Background The relationship between tibiopopliteal velocities and peripheral arterial disease (PAD) severity is not well understood. We sought to characterize tibiopopliteal velocities in severe PAD and non-PAD control patients. Methods Patients with an arterial duplex ultrasound (DUS) examination with PAD evaluated during a 5-year period were retrospectively compared with non-PAD controls. Control DUS examinations were collected sequentially during a 6-month period, retrospectively. PAD patients included those with lifestyle-limiting intermittent claudication warranting revascularization and patients with critical limb ischemia, defined as ischemic rest pain, gangrene, or a nonhealing ischemic ulcer. For each, tibial and popliteal artery peak systolic velocity (PSV) was measured at the proximal, mid, and distal segment of each artery, and a mean PSV for each artery was calculated. Mean PSV, ankle-brachial indices, peak ankle velocity (PAV), average ankle velocity (AAV), mean tibial velocity (MTV), and ankle-profunda index (API) were compared between the two groups using independent t-tests. PAV is the maximum PSV of the distal peroneal, posterior tibial (PT), or anterior tibial (AT) artery; AAV is the average PSV of the distal peroneal, PT, and AT arteries; MTV is calculated by first averaging the proximal, mid, and distal PSV for each tibial artery and then averaging the three means together; API is the AAV divided by proximal PSV of the profunda. Results DUS was available in 103 patients with PAD (68 patients with critical limb ischemia and 35 patients with intermittent claudication) and 68 controls. Mean ankle-brachial index in the PAD group was 0.64 ± 0.25 compared with 1.08 ± 0.09 in controls (P =.006). Mean PSVs were significantly lower in PAD patients than in controls at the popliteal (64.6 ± 42.2 vs 76.2 ± 29.6; P =.037), peroneal (34.3 ± 26.4 vs 53.8 ± 23.3; P <.001), AT (43.7 ± 31.4 vs 65.4 ± 25.0; P <.001), and PT (43.4 ± 42.3 vs 74.1 ± 30.6; P <.001) and higher at the profunda (131.5 ± 88.0 vs 96.2 ± 44.8; P =.001). Tibial parameters including PAV (52.6 ± 45.0 vs 86.9 ± 35.7; P <.001), AAV (37.4 ± 26.4 vs 64.5 ± 21.7; P <.001), MTV (41.7 ± 30.4 vs 65.4 ± 21.7; P <.001), and API (0.43 ± 0.45 vs 0.75 ± 0.30; P <.001) were significantly lower in the PAD group than in controls. Nonoverlapping 95% confidence interval reference ranges were established for severe PAD and non-PAD controls. Conclusions This study aims to characterize lower extremity arterial PSVs and ankle parameters in severe PAD and non-PAD controls. These early criteria establish reference ranges to guide vascular laboratory interpretation and clinical decision-making.
AB - Background The relationship between tibiopopliteal velocities and peripheral arterial disease (PAD) severity is not well understood. We sought to characterize tibiopopliteal velocities in severe PAD and non-PAD control patients. Methods Patients with an arterial duplex ultrasound (DUS) examination with PAD evaluated during a 5-year period were retrospectively compared with non-PAD controls. Control DUS examinations were collected sequentially during a 6-month period, retrospectively. PAD patients included those with lifestyle-limiting intermittent claudication warranting revascularization and patients with critical limb ischemia, defined as ischemic rest pain, gangrene, or a nonhealing ischemic ulcer. For each, tibial and popliteal artery peak systolic velocity (PSV) was measured at the proximal, mid, and distal segment of each artery, and a mean PSV for each artery was calculated. Mean PSV, ankle-brachial indices, peak ankle velocity (PAV), average ankle velocity (AAV), mean tibial velocity (MTV), and ankle-profunda index (API) were compared between the two groups using independent t-tests. PAV is the maximum PSV of the distal peroneal, posterior tibial (PT), or anterior tibial (AT) artery; AAV is the average PSV of the distal peroneal, PT, and AT arteries; MTV is calculated by first averaging the proximal, mid, and distal PSV for each tibial artery and then averaging the three means together; API is the AAV divided by proximal PSV of the profunda. Results DUS was available in 103 patients with PAD (68 patients with critical limb ischemia and 35 patients with intermittent claudication) and 68 controls. Mean ankle-brachial index in the PAD group was 0.64 ± 0.25 compared with 1.08 ± 0.09 in controls (P =.006). Mean PSVs were significantly lower in PAD patients than in controls at the popliteal (64.6 ± 42.2 vs 76.2 ± 29.6; P =.037), peroneal (34.3 ± 26.4 vs 53.8 ± 23.3; P <.001), AT (43.7 ± 31.4 vs 65.4 ± 25.0; P <.001), and PT (43.4 ± 42.3 vs 74.1 ± 30.6; P <.001) and higher at the profunda (131.5 ± 88.0 vs 96.2 ± 44.8; P =.001). Tibial parameters including PAV (52.6 ± 45.0 vs 86.9 ± 35.7; P <.001), AAV (37.4 ± 26.4 vs 64.5 ± 21.7; P <.001), MTV (41.7 ± 30.4 vs 65.4 ± 21.7; P <.001), and API (0.43 ± 0.45 vs 0.75 ± 0.30; P <.001) were significantly lower in the PAD group than in controls. Nonoverlapping 95% confidence interval reference ranges were established for severe PAD and non-PAD controls. Conclusions This study aims to characterize lower extremity arterial PSVs and ankle parameters in severe PAD and non-PAD controls. These early criteria establish reference ranges to guide vascular laboratory interpretation and clinical decision-making.
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U2 - 10.1016/j.jvs.2015.08.112
DO - 10.1016/j.jvs.2015.08.112
M3 - Article
C2 - 26620716
AN - SCOPUS:84959280668
SN - 0741-5214
VL - 63
SP - 646
EP - 651
JO - Journal of vascular surgery
JF - Journal of vascular surgery
IS - 3
ER -