de Oliveira Buril Gabriela, Lins Esdras Marques, Albuquerque Godoi Berenguer de Barros E Silva Emmanuelle Tenório, Paes de Andrade Souza Caldas Rebecca, Rocha Fernanda Appolonio, Cavalcanti de Siqueira Charamba Juliana, Barbosa de Andrade Larissa, Ayres da Costa Filipe Moreno
Department of Surgery, Federal University of Pernambuco, Recife, Pernambuco, Brazil.
Post-Graduated Program in Surgery, Federal University of Pernambuco, Recife, Pernambuco, Brazil.
Ann Vasc Surg. 2025 Nov;120:181-189. doi: 10.1016/j.avsg.2025.05.002. Epub 2025 May 9.
Evaluation of the anatomy of the plantar arch (PA) is critical to the lower limb (LL) arterial revascularization. PA visualization in severely ill patients is often inadequate, even with digital subtraction angiography (DSA). Considering this, it is important to know if the resistance index (RI) obtained by Doppler ultrasonography (DU) is useful to evaluate the PA anatomy.
To evaluate whether the RI of the distal-leg arteries correlates with the angiographic anatomy of the PA in patients with LL peripheral arterial disease.
The study population consisted of 120 patients with critical limb ischemia, admitted for revascularization surgery at the Vascular Surgery Department of HC/EBSERH-UFPE between September 2019 and April 2022. The study design was cross-sectional. DU and DSA were performed on all patients. The RI was obtained via DU and calculated in a given tibial artery by the formula of (peak systolic velocity (PSV)-end-diastolic velocity)/PSV at a segment of artery which in line-flow across the ankle was present distally. The RI was compared with the angiographic anatomy of the PA using the Global Limb Anatomic Staging System classification. The Kolmogorov-Smirnov normality test showed that the sample followed a normal distribution. The Student's t-test was used to compare the types of PA and RI.
A statistically significant difference in the RI was observed in the anterior tibial artery (mean RI 0.48 for complete PA and 0.64; P = 0.018), fibular artery (mean RI 0.47 for complete PA and 0.70; P = 0.047), and dorsalis pedis artery (mean RI 0.42 for complete PA and 0.63; P = 0.008). No statistical significance was found when evaluating the posterior tibial artery (mean RI 0.53 for complete PA and 0.69; P = 0.111).
When evaluating tibial arteries which are both reconstituted via collaterals distal to a proximal occlusion and also have runoff onto the foot, lower resistive index corresponds to higher rates of PA patency. Therefore, in reconstituted tibial arteries with adequate runoff to the foot, a greater gap between the PSV and end diastolic velocity correlates to worse pedal compliance and runoff. The RI values obtained for the leg arteries was correlated with complete or incomplete PA anatomy visualized through DSA, thereby contributing to evaluate the distal arterial bed for revascularization surgery.
足底弓（PA）解剖结构的评估对下肢（LL）动脉血运重建至关重要。即使采用数字减影血管造影（DSA），重症患者的PA可视化效果往往也不理想。考虑到这一点，了解通过多普勒超声（DU）获得的阻力指数（RI）是否有助于评估PA解剖结构很重要。
评估LL外周动脉疾病患者小腿远端动脉的RI与PA血管造影解剖结构是否相关。
研究人群包括120例严重肢体缺血患者，于2019年9月至2022年4月在HC/EBSERH-UFPE血管外科接受血运重建手术。研究设计为横断面研究。对所有患者进行DU和DSA检查。通过DU获得RI，并在胫动脉的特定节段，根据（收缩期峰值流速（PSV）-舒张末期流速）/PSV的公式计算，该节段位于踝部顺行血流的远端。使用全球肢体解剖分期系统分类将RI与PA的血管造影解剖结构进行比较。Kolmogorov-Smirnov正态性检验表明样本呈正态分布。采用学生t检验比较PA类型和RI。
在前胫骨动脉（完全PA时平均RI为0.48，不完全PA时为0.64；P = 0.018）、腓动脉（完全PA时平均RI为0.47，不完全PA时为0.70；P = 0.047）和足背动脉（完全PA时平均RI为0.42，不完全PA时为0.63；P = 0.008）中观察到RI有统计学显著差异。评估胫后动脉时未发现统计学显著差异（完全PA时平均RI为0.53，不完全PA时为0.69；P = 0.111）。
在评估近端闭塞远端通过侧支循环重建且足部有血流灌注的胫动脉时，较低的阻力指数对应较高的PA通畅率。因此，在足部有足够血流灌注的重建胫动脉中，PSV与舒张末期流速之间的差距越大，足部顺应性和血流灌注越差。小腿动脉获得的RI值与通过DSA可视化的PA解剖结构完整或不完整相关，从而有助于评估血运重建手术的远端动脉床。
