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Changes in peripheral hemodynamics after percutaneous transluminal angioplasty
S X Salles-Cunha1, G Andros, L B Dulawa
1Vascular Laboratory, Saint Joseph Medical Center, Burbank, CA 91505.
Insights
Percutaneous transluminal angioplasty improved blood flow and pressure in most patients with peripheral artery disease. Ankle/arm pressure index and flow measurements help confirm the procedure
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiovascular Medicine
Background:
- Peripheral artery disease (PAD) significantly impacts patient mobility and quality of life.
- Claudication, rest pain, and critical limb ischemia are common symptoms of PAD.
- Percutaneous transluminal angioplasty (PTA) is a common revascularization technique for PAD.
Purpose of the Study:
- To evaluate the effectiveness of PTA in improving ankle/arm pressure indexes and blood flow rates in patients with PAD.
- To determine the correlation between pre-procedural ankle/arm pressure indexes and post-procedural hemodynamic improvements.
- To assess the utility of magnetic resonance (MR) blood flow scanning in conjunction with pressure measurements for evaluating PTA outcomes.
Main Methods:
- 36 extremities with PAD underwent PTA.
- Ankle/arm pressure indexes and leg blood flow rates were measured before and after PTA.
- Blood flow was quantified using magnetic resonance (MR) blood flow scanning.
- Patients presented with claudication, gangrene, ulceration, or rest pain.
Main Results:
- In legs with pre-PTA ankle/arm pressure indexes < 0.80 (n=19), 14 showed significant improvement in both pressure and flow.
- In legs with pre-PTA ankle/arm pressure indexes 0.81-1.09 (n=17), abnormal flow was detected in 15; post-PTA flow increased significantly in 12 (71%).
- Pressure or flow measurements corroborated PTA benefits in legs with low pre-procedural indexes, while flow measurements were more indicative of hemodynamic changes in those with near-normal indexes.
Conclusions:
- PTA is effective in improving hemodynamic parameters in patients with PAD.
- Ankle/arm pressure index and MR blood flow measurements are valuable tools for assessing PTA outcomes.
- The interpretation of PTA success should consider both pressure and flow data, especially in cases with near-normal baseline pressure indexes.
Abstract:
We measured ankle/arm pressure indexes and blood flow rates before and after performing percutaneous transluminal angioplasty in 36 extremities. Flow rates through the leg were determined with a magnetic resonance blood flow scanner. All patients had claudication; one had gangrene, another had an ulcer, and two complained of rest pain. The median age was 65 years, and 72% were men. There were 25 dilations of the iliac artery, 12 of the superficial femoral artery, and eight of the popliteal arteries; nine patients had two arterial segments dilated. Nineteen legs had ankle/arm pressure indexes before percutaneous transluminal angioplasty of less than 0.80 (range 0.51 to 0.75); their flow rates averaged 40 +/- 20 (SD) ml/min. After percutaneous transluminal angioplasty flow and pressure increased significantly in 14 of these 19 legs, and three had no hemodynamic improvement; in one leg only pressure and in another only flow increased significantly. The remaining 17 extremities had ankle/arm pressure indexes before percutaneous transluminal angioplasty ranging from 0.81 to 1.09; their flow rates averaged 53 +/- 27 (SD) ml/min. Abnormal flow rates were detected in 15 of these 17 extremities. With near-normal ankle/arm pressure indexes no significant increase in pressure was anticipated. Flow rates augmented to 75 +/- 28 (SD) ml/min after percutaneous transluminal angioplasty; a significant increase in flow was noted in 12 legs (71%). For patients with ankle/arm indexes before percutaneous transluminal angioplasty of less than 0.80, either pressure or flow measurements should corroborate the benefits of the operation, whereas if the ankle arm index is greater than 0.80, flow measurements are most likely to substantiate changes in peripheral hemodynamics.