'Plantar Acceleration Time' for vascular assessment

NewsBot · May 11, 2019

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Plantar Acceleration Time: A Novel technique to Evaluate Arterial Flow to the Foot.
Sommerset J et al
Ann Vasc Surg. 2019 May 7.

BACKGROUND:
Arterial Duplex Ultrasound (DUS) and Ankle-Brachial Indices (ABI) 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, non-invasive duplex imaging of the pedal arch in the setting of Peripheral Arterial Disease (PAD) has not been well evaluated. While 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.

METHODS:
Patients undergoing DUS including Plantar Acceleration Time for suspicion of PAD were retrospectively reviewed in a prospective database over a 1-year period. 250 non-diabetic patients (499 limbs) with documented ABI were studied. Plantar Acceleration Time was calculated (milliseconds) in each limb in the Lateral Plantar Artery. Statistical analyses were performed using linear regression and ANOVA testing using Microsoft Excel database (version 2016; Microsoft Corp, Redmond, Washington). Patients were then grouped into four classes based on their clinical symptoms and ABI. Plantar Acceleration Time was similarly grouped into four distinct classes and correlated with the clinical and ABI classes.

RESULTS:
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 ms, Class 2 152.3 + 28.4 ms, Class 3 209.8 + 25.5 ms, and Class 4 270.2 + 35.3 ms.

CONCLUSION:
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 0-120ms, ABI of 0.69-0.89 correlates with a Plantar Acceleration Time of 121-180ms, ABI of 0.40-0.68 correlates with a Plantar Acceleration Time of 181-224ms, and an ABI of 0.00-0.39 correlates with a Plantar Acceleration Time of greater than 225ms. Further studies are ongoing to confirm whether Plantar Acceleration Time may be a suitable substitute to ABI's in patients with non-compressible arteries that preclude meaningful ABIs and gives more information regarding targeted angiosome perfusion to the foot.
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NewsBot · Dec 9, 2020

Pedal Acceleration Time - A New Method Of Diagnosis And Prognosis In Peripheral Arteriopathy
Andreia Pinelo et al
Rev Port Cir Cardiotorac Vasc. Oct-Dec 2020;27(4):297.

Introduction It is well recognized that the Ankle-Arm Index is unreliable in the diagnosis and prognosis of peripheral arteriopathy in patients with incompressible vessels, such as diabetics and chronic kidney patients. It is therefore important to define alternative strategies for assessing distal perfusion in this population. Arterial Doppler, a non-invasive technique available in any vascular laboratory, can be used to directly assess foot perfusion by interrogating the plantar arch and its nourishing arteries. This technique, recently described and still not widespread, can help to overcome the diagnostic limitations of ABI. Objectives This work aims to review the model and the results obtained with the evaluation of the Pedal Acceleration Time (PAT) as well as to evaluate its practical applicability. Materials and Methods In an initial phase, the recently published literature on the topic was analysed. Subsequently, the clinical applicability of the technique was tested in 2 non-diabetic and non- -revascularized patients, admitted to the Angiology and Vascular Surgery Service of our center. In both, the acceleration time of the systolic flow, measured in milliseconds, were evaluated in the Arched, Plantar Medial, Lateral Plantar and Deep Plantar Arteries. Results In patient A, with ABI of 0.27, the acceleration time in the 4 evaluated arteries varied between 210-260ms, values that according to standardization in the literature fall into a category of moderate to severe ischemia. Patient B, with a 0.35 ABI, had low-amplitude monophasic flows in all arteries, failing to obtain a correct measurement of the acceleration time. Thus, the morphology of the curve has become a limitation for the application of this modality. The technical complexity, time consuming, with an average duration of the exam of 30-40 minutes, were other limitations found, also revealing an exam with some discomfort for the patient with ischemic rest pain. Conclusions In patient A, the values obtained by measuring the PAT were comparable in severity of ischemia with the ABI, with the advantage of demonstrating with greater specificity the perfusion defects corresponding to each angiosome. However, it would be important to understand the reliability of this test in patients with incompressible arteries and the ease of its clinical application, taking into account their technical requirements.
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NewsBot · Apr 7, 2021

Pedal Acceleration Time (PAT): A Novel Predictor of Limb Salvage
Desarom Teso et al
Ann Vasc Surg. 2021 Apr 3;S0890-5096(21)00258-2

Background: In the setting of Peripheral Arterial Disease (PAD), pedal arch interrogation by ultrasound has not been well described. Patients with non-compressible vessels and/or open wounds of the foot may preclude the use of ankle-brachial indices, toe pressure measurements, or TcPO2, respectively. We propose that pedal artery interrogations with Pedal Acceleration Time (PAT) can be a predictor for limb salvage in patients with Chronic Limb-Threatening Ischemia (CLTI).

Methods: A retrospective review of a prospectively kept database was performed from 2018-2019. Patients with pending amputation due to severe infection (WIFI infection class 2 and 3) were excluded from the study. We identified 73 limbs with CLTI that fit the inclusion criteria. Data included WIFI classification, age, gender, cardiovascular risk factors, PAT, ABI, and TBI when reliable, were collected. PAT measurements were categorized into 4 classifications; 1 (40-120 msec), 2 (121-180 msec), 3 (181-224 msec), and 4 (Greater than 225 msec). Statistical analyses were performed.

Results: Seventy-three limbs with CLTI were included in our study. All patients underwent arterial revascularization with either percutaneous technique or arterial bypass. Limb salvage was achieved in 59 (81%) of the 73 limbs. All 59 limbs had a 2-classification improvement in their PAT following interventions. 14 (19%) limbs without improvement in their PAT underwent above ankle level amputations. An improvement in PAT classes to class 1 or 2 is associated with limb salvage.

Conclusion: Patients with non-compressible ankle pressures or non-obtainable toe pressures poses a challenge in the complete assessment of WIFI classification. Our group has shown that PAT can be used in the scoring system for severity of ischemia in conjunction with current WIFI classification. Our data suggests that limb salvage correlates with post procedure PAT in category 1 and 2. Therefore we propose that PAT be added as part of the WIFI classification
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NewsBot · Oct 5, 2021

Evaluation of Healing Potential in Diabetic Foot Ulcer With Pedal Acceleration Time
Kate Dell, Shoaib Shafique
Source

Objective
Predicting wound healing in diabetic patients is challenging owing to the presence of incompressible arteries. Recently, it has been shown that patients with diabetes mellitus are more likely to have calcification of the pedal arteries. The calcification can lead to spuriously high toe pressures, leading to a false assurance that the patient's ulcer will heal. Another limitation of toe pressures is that they cannot be measured in patients with toe amputations or painful toe ulcers. We studied the pedal acceleration time (PAT) as a predictive tool for healing potential.
Methods
We identified 19 patients with diabetic foot ulcers. All 19 patients had undergone duplex ultrasound with a GE logic E9 linear probe scanner and high-resolution scanner (GE Healthcare, Chicago, Ill). Patients with aortoiliac occlusive disease were excluded. The imaged pedal arteries included the arcuate, lateral plantar, medial plantar, deep plantar, and dorsal metatarsal arteries. Patients with a PAT of <180 ms were assigned to best medical therapy and wound care and given a 4- to 6-week follow-up appointment for close monitoring. Patients with a PAT of >180 ms were considered for endovascular or surgical revascularization with a 4-week follow-up visit to document clinical progress and the postprocedure PAT.
Results
Nineteen patients were enrolled in the present study. Of the 19 patients, 11 were treated conservatively because of a PAT of <180 ms. After 4 to 6 weeks of follow-up, the ulcers of 10 of the 11 patients had healed. One patient had not completely healed and osteomyelitis of the great toe was diagnosed. Eight patients had had a PAT of >180 ms and were assigned to the intervention group. Two of these patients had undergone surgical bypass and their ulcers healed, and six had undergone endovascular intervention. Of the latter six patients, one had died of an unrelated cause. The ulcers of the remaining five patients had healed after endovascular intervention.
Conclusions
The PAT can predict the healing potential of diabetic foot ulcers.
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NewsBot · Aug 24, 2023

This clinical trial was just registered:
Pedal Acceleration Time (PAT) as a Measure of Foot Perfusion (PAT)

To identify a correlation between Toe Brachial pressure Index (TBPI) and Acceleration time of the pedal vessels. The aim would then to use this data to design a clinical study assessing the relationship between PAT and wound healing in patients with PAD.
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NewsBot · Mar 26, 2024

Accuracy of maximal acceleration time of pedal arteries to diagnose critical limb ischemia
Jean-Eudes Trihan et al
Vasc Med. 2024 Mar 12:

Introduction: Maximal acceleration time of distal arteries of the foot (ATmax) is correlated to ankle-brachial index (ABI) and toe-brachial index (TBI), and seems very promising in diagnosing severe peripheral artery disease (PAD) and especially critical limb-threatening ischemia (CLTI). Our goal was to confirm the cut-off value of 215 ms to predict a toe pressure (TP) ⩽ 30 mmHg.

Methods: A 4-month retrospective study was conducted on patients addressed for suspicion of PAD. Demographic data, ABI, TBI, and Doppler ultrasound scanning parameters of the dorsal pedis and lateral plantar arteries (DPA and LPA) were recorded.

Results: A total of 137 patients with 258 lower limbs were included. ATmax was highly correlated to TBI (r = -0.89, p < 0.001). With the cut-off value of 215 ms, ATmax was effective to diagnose TP ⩽ 30 mmHg with a sensitivity of 93% [95% CI 77-99], a specificity of 96% [95% CI 92-98], a positive predictive value of 73% [95% CI 56-86], a negative predictive value of 99% [95% CI 97-100], and an area under the receiver operating characteristics curve of 0.99 [95% CI 0.98-1.00]. ATmax also showed promising results to rule out PAD in healthy patients.

Conclusion: ATmax is a reliable diagnostic tool to diagnose low TP and could be a new easily performed hemodynamic criterion for diagnosis of CLTI.
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