Relationship of Pedal Acceleration Time (PAT) with Angiographic Findings
Kevin Engledow, Caryn Covella, Lori Pounds, Clay Quint
Audie L. Murphy VA Medical Center, San Antonio, TX
BACKGROUND: Evaluation of pedal arteries via noninvasive duplex ultrasound has as of recently become a new method for evaluating pedal perfusion with limited knowledge pertaining to its utility. We propose that pedal artery interrogation can directly correlate to angiogram findings with the potential to offer value in assessing limb salvage.
METHODS: A single institution, retrospective review, of patients who underwent a pedal acceleration time study between April 2021and September 2021.
RESULTS: Twenty-four patients with chronic limb threatening ischemia (CLTI) were included in our study. All underwent a PAT study with three patients evaluated pre- and post-intervention. Fifteen of the patients had findings of dry gangrene, osteomyelitis or a non-healing wound that required further investigation with angiography. Data was extracted from twenty-seven PAT studies and compared to angiographic findings. Nine patients had no angiogram available for comparison. Of the 18 remaining studies, 13 had in-line arterial flow visualized on angiogram prior to their PAT study. When in-line flow was present, 11 out of 13 limbs met PAT class II or less (mild ischemia and no ischemia) within their respective angiosome, while 8 out of 13 met PAT class I (no ischemia). Angiosomes with PAT class I findings (20-120ms) had a positive predictive value of 90.9% for direct in-line flow to that respective angiosome. Of the 3 patients who underwent PAT before and after intervention, 2 of them were found to have a two or greater PAT class improvement following intervention.
CONCLUSIONS: A pedal acceleration time (PAT) classification II or less is strongly suggestive of in-line perfusion via at least one vessel to the foot. PAT class I findings are strongly predictive for direct in-line flow to the respective angiosome. With arterial-brachial index (ABI) and toe-brachial index (TBI) being unobtainable or inaccurate in patients with severe tibial/pedal artery calcification, PAT could prove to be a useful adjunct in the work-up and evaluation of patients with CLTI.
Back to 2022 Posters