Role of ankle peak systolic velocity as a hemodynamic predictor following infrainguinal arterial angioplasty

Background Infrainguinal arterial disease is a common vascular problem. It is associated with decreased quality of life and possible major limb loss. Critical limb ischemia (CLI) generally occurs in diabetics with extensive atherosclerotic disease of below-knee vessels. The optimal strategy for treating patients with CLI, however, has not been clearly defined yet. The outcome of medical therapy is unsatisfactory, and early aggressive percutaneous revascularization with the aim of obtaining direct flow to the foot is increasingly considered a first-line strategy. This study was carried out to evaluate ankle peak systolic velocity (APSV) as a hemodynamic predictor following endovascular intervention of those patients. Objective The aim of the study was to validate APSV as a predictor of success and a potential alternative to Ankle Brachial Index (ABI) as an objective performance measure following infrainguinal angioplasty. Patients and methods A total of 45 patients with CLI Rutherford stage 4-6 were enrolled in the study. This was a prospective nonrandomized cohort study conducted in EI-Sahel Teaching Hospital and Ain Shams Hospitals. All patients underwent full history taking, foot examination, and measurements of APSV and ABI. A total of 45 patients were included from the Vascular Surgery Department of Ain Shams University Hospitals, El Sahel Teaching Hospitals (and other authorized hospitals under supervision of thesis supervisors). All of them were subjected to the following: an assessment of full history; physical examination, including foot examination; Doppler examination; measurement of APSV, and ABI; and routine investigations. This was a prospective nonrandomized cohort study (interventional analytical clinical study). Results APSV shows significant increase of 86.50% after intervention than before intervention. It shows also a significant increase in follow-up at 6-month period following intervention. There was a significant difference of the APSV before and after revascularization (18.70 +/- 8.04 vs. 31.50 +/- 12.60 cm/s) P<0.001. Regarding mean ABI, there was no statistically significant difference when comparing postoperative and 6-month follow-up results with preoperative results. Of 29 patients, 23 patients reached the end point of adequate healing or complete healing. Patients with healed ulcer show mean +/- SD APSV (36.52 +/- 8.14) that is equal to ABI (0.93 +/- 0.17). Conclusion APSV could predict the healing of lesions in patients with CLI, with a high degree of accuracy. It can be used as an alternative parameter to ABI in following up the patients after infrainguinal arterial angioplasty, especially in the presence of arterial calcification.