Angiology, Vascular and Endovascular Surgery Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
Clinical Research Support Unit, Clinical Pharmacology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
Ann Vasc Surg. 2024 Dec;109:187-196. doi: 10.1016/j.avsg.2024.05.045. Epub 2024 Jul 18.
Diagnosis of chronic upper limb ischemia is mainly clinical. Although hand perfusion can be evaluated by different noninvasive methods (e.g., digital-brachial index, digital pressures, oxygen saturation measurements, and plethysmography), these have not been standardized for the diagnosis of chronic upper limb ischemia. Initial reports suggested that the hand acceleration time (HAT) measured by duplex ultrasound could be a useful diagnostic tool. However, the HAT has neither been properly characterized nor validated. This study aimed to provide evidence that HAT is a sensitive diagnostic tool for chronic upper limb ischemia.
We conducted a prospective, single-center, cross-sectional study with adult patients diagnosed with chronic upper limb ischemia and healthy adult volunteers without cardiovascular risk factors. Hand vascular duplex ultrasound and HAT measurement were performed in 4 artery locations: princeps pollicis artery, radialis indicis artery, first common digital palmar artery, and third common digital palmar artery. It was also measured in the ulnar and radial arteries. Descriptive and exploratory analyses were performed between patients and healthy volunteers.
Thirty participants were included, being 15 patients (median [standard deviation] age: 51 [18] years; 47% women) and 15 healthy volunteers (median [standard deviation] age: 35 [10] years; 60% women). In total, 15 ischemic and 30 nonischemic hands were analyzed. Humeral artery stenosis/occlusion (n = 6, 40.0%) and distal artery stenosis (n = 5, 33.3%) were the main causes of ischemia. Median (interquartile range) HAT measurements were significantly different between patients and healthy volunteers in the 4 hand arterial locations, the radial artery, and ulnar artery: princeps pollicis artery: 164 (124-252) vs. 60 (40-88), P < 0.001; radialis indicis artery: 176 (140-348) vs. 60 (36-80), P < 0.001; first common digital palmar artery: 180 (92-320) vs. 64 (36-88), P < 0.001; third common digital palmar artery: 180 (104-240) vs. 56 (44-92), P < 0.001; radial artery: 156 (120-248) vs. 68 (55-76), P < 0.001; and ulnar artery: 152 (76-220) vs. 61 (48-76), P < 0.001.
Vascular duplex ultrasound with HAT measurement seems to be an easy-access, sensitive diagnostic tool for chronic upper limb ischemia. HAT provides valuable information on hand perfusion and may be complementary to current noninvasive methods.
慢性上肢缺血的诊断主要基于临床。尽管可以通过不同的无创方法（例如，数字-肱动脉指数、数字压力、氧饱和度测量和容积描记术）评估手部灌注，但这些方法尚未标准化用于慢性上肢缺血的诊断。初步报告表明，通过双功能超声测量的手部加速度时间（HAT）可能是一种有用的诊断工具。然而，HAT 既没有得到适当的描述，也没有得到验证。本研究旨在提供证据表明 HAT 是慢性上肢缺血的一种敏感诊断工具。
我们进行了一项前瞻性、单中心、横断面研究，纳入了患有慢性上肢缺血的成年患者和无心血管危险因素的成年健康志愿者。对 4 个手部动脉位置（拇指动脉、桡动脉指示动脉、第一掌指总动脉和第三掌指总动脉）和尺动脉、桡动脉进行手部血管双功能超声和 HAT 测量。还测量了尺动脉和桡动脉的 HAT。在患者和健康志愿者之间进行了描述性和探索性分析。
共纳入 30 名参与者，其中 15 名患者（中位数[标准差]年龄：51[18]岁；47%为女性）和 15 名健康志愿者（中位数[标准差]年龄：35[10]岁；60%为女性）。共分析了 15 只缺血手和 30 只非缺血手。肱动脉狭窄/闭塞（n=6，40.0%）和远端动脉狭窄（n=5，33.3%）是缺血的主要原因。在 4 个手部动脉位置、桡动脉和尺动脉中，患者与健康志愿者的 HAT 测量值存在显著差异：拇指动脉：164（124-252）比 60（40-88），P<0.001；桡动脉指示动脉：176（140-348）比 60（36-80），P<0.001；第一掌指总动脉：180（92-320）比 64（36-88），P<0.001；第三掌指总动脉：180（104-240）比 56（44-92），P<0.001；桡动脉：156（120-248）比 68（55-76），P<0.001；尺动脉：152（76-220）比 61（48-76），P<0.001。
HAT 似乎是一种易于获得、敏感的慢性上肢缺血诊断工具。HAT 提供了手部灌注的有价值信息，可能与当前的无创方法互补。
