Sommerset Jill, Karmy-Jones Riyad, Dally Matthew, Feliciano Beejay, Vea Yolanda, Teso Desarom
PeaceHealth Thoracic and Vascular Surgery, Vancouver, WA.
PeaceHealth Thoracic and Vascular Surgery, Vancouver, WA; Division of Trauma, Legacy Emanuel Medical Center, Portland, OR.
Ann Vasc Surg. 2019 Oct;60:308-314. doi: 10.1016/j.avsg.2019.03.002. Epub 2019 May 8.
Arterial duplex ultrasound (DUS) and ankle-brachial indices (ABIs) are accepted methods for assessing lower limb arterial perfusion. However, in a significant number of diabetic patients, medial wall calcification often precludes an ABI measurement. Direct, noninvasive duplex imaging of the pedal arch in the setting of peripheral arterial disease (PAD) has not been well evaluated. Although plantar arch interrogation is new to vascular ultrasound, imaging the plantar arteries appears to be a reliable angiographic technique for critical limb ischemia. We sought to define the utility of Plantar Acceleration Time as a surrogate for ABIs.
Patients undergoing DUS including Plantar Acceleration Time for suspicion of PAD were retrospectively reviewed in a prospective database over a 1-year period. Two hundred fifty nondiabetic patients (499 limbs) with documented ABI were studied. Plantar Acceleration Time was calculated (milliseconds [msec]) in each limb in the lateral plantar artery. Statistical analyses were performed using linear regression and analysis of variance testing using Microsoft Excel database (version 2016; Microsoft Corp, Redmond, WA). Patients were then grouped into 4 classes based on their clinical symptoms and ABI. Plantar Acceleration Time was similarly grouped into 4 distinct classes and correlated with the clinical and ABI classes.
Plantar Acceleration Time correlated significantly with ABI (P < 0.001). There were significant differences in Plantar Acceleration Times between each class based on ABI and clinical presentation (P < 0.001 for each): Class 1 Plantar Acceleration Times 89.9 ± 15.5 msec; Class 2, 152.3 ± 28.4 msec; Class 3, 209.8 ± 25.5 msec, and Class 4, 270.2 ± 35.3 msec.
Plantar Acceleration Time demonstrates a high correlation with ABI in patients with compressible arteries. Based on our results we propose the following categories of Plantar Acceleration Time, which appear to correlate with both clinical and ABI findings. ABI of 0.90-1.3 correlates with a Plantar Acceleration Time of 0-120 msec, ABI of 0.69-0.89 correlates with a Plantar Acceleration Time of 121-180 msec, ABI of 0.40-0.68 correlates with a Plantar Acceleration Time of 181-224 msec, and an ABI of 0.00-0.39 correlates with a Plantar Acceleration Time of greater than 225 msec. Further studies are ongoing to confirm whether Plantar Acceleration Time may be a suitable substitute to ABIs in patients with noncompressible arteries that preclude meaningful ABIs and gives more information regarding targeted angiosome perfusion to the foot.
动脉双功超声（DUS）和踝肱指数（ABI）是评估下肢动脉灌注的公认方法。然而，在相当数量的糖尿病患者中，内侧壁钙化常常使ABI测量无法进行。在外周动脉疾病（PAD）情况下对足弓进行直接、无创的双功成像尚未得到充分评估。尽管足底弓检查对血管超声来说是新的，但对足底动脉成像似乎是一种用于严重肢体缺血的可靠血管造影技术。我们试图确定足底加速时间作为ABI替代指标的效用。
在一个前瞻性数据库中，对1年内因怀疑PAD而接受包括足底加速时间测量的DUS检查的患者进行回顾性研究。研究了250例有记录ABI的非糖尿病患者（499条肢体）。计算每条肢体外侧足底动脉的足底加速时间（毫秒[msec]）。使用Microsoft Excel数据库（2016版；微软公司，华盛顿州雷德蒙德）进行线性回归和方差分析。然后根据患者的临床症状和ABI将其分为4类。足底加速时间也类似地分为4个不同类别，并与临床和ABI类别相关联。
足底加速时间与ABI显著相关（P < 0.001）。基于ABI和临床表现的每类之间足底加速时间存在显著差异（每类P < 0.001）：1类足底加速时间为89.9 ± 15.5毫秒；2类为152.3 ± 28.4毫秒；3类为209.8 ± 25.5毫秒，4类为270.2 ± 35.3毫秒。
在动脉可压缩性的患者中，足底加速时间与ABI高度相关。基于我们的结果，我们提出以下足底加速时间类别，其似乎与临床和ABI结果相关。ABI为0.90 - 1.3与足底加速时间0 - 120毫秒相关，ABI为0.69 - 0.89与足底加速时间121 - 180毫秒相关，ABI为0.40 - 0.68与足底加速时间181 - 224毫秒相关，ABI为0.00 - 0.39与足底加速时间大于225毫秒相关。正在进行进一步研究以确认在动脉不可压缩而无法进行有意义的ABI测量的患者中，足底加速时间是否可能是ABI的合适替代指标，并提供更多关于足部靶向血管区域灌注的信息。
