Ankle peak systolic velocity: new parameter to predict nonhealing in diabetic foot lesions

The objective of this study was to determine whether ankle peak systolic velocity (APSV) can predict nonhealing in diabetic foot lesions. Diabetic patients referred for duplex scanning of the lower extremity arteries were included if they had foot lesions such as ulcers, gangrene, or tissue necrosis and had no palpable pedal pulses. End points were healed or healing foot lesions, revascularization, major amputation, or death. One hundred consecutive limbs were included. Forty-three limbs with diabetic foot lesions reached the end point of adequate healing or complete healing, whereas 57 limbs had nonhealing lesions. The APSV was significantly higher in limbs with healed or healing lesions compared with limbs with nonhealed lesions: 53.0 cm/s (41.8-81.6) versus 19.2 cm/s (12.4-26.5), p < .0001. At a cutoff point of 35 cm/s, the APSV showed a sensitivity of 92.9% (95% confidence interval [CI] 82-97), a specificity of 90.6% (95% CI 76-96), a positive predictive value of 92.9%, and a negative predictive value of 90.6% in predicting nonhealing of diabetic foot lesions. There was a significant difference between the APSV before and after revascularization: 20.4 cm/s (12.4-26.3) versus 48.8 cm/s (36.1-80.8), p < .0001. APSV could predict nonhealing of diabetic foot lesions with a high degree of accuracy in this group of patients.