Physiologic Guidance of Infrainguinal Vascular Interventions Using the Pressure Wire

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Hemodynamics

Background:

• Resting (RG) and hyperemic (HG) gradients are objective measures for assessing arterial stenosis severity.
• These hemodynamic parameters are crucial for defining the functional significance of arterial blockages.

Purpose of the Study:

• To evaluate the correlation between resting (RG) and hyperemic (HG) translesional peripheral gradients.
• To assess the relationship of these gradients with functional and anatomic parameters before and after infrainguinal endovascular procedures.

Main Methods:

• 25 patients with infrainguinal arterial stenosis underwent RG and HG measurements using a pressure wire before and after angioplasty.
• Ankle-brachial index (ABI) and Duplex ultrasound (peak systolic velocity, PSV-L; PSV ratio, PSV-R) were performed pre- and post-procedure.
• Pearson R correlation coefficients were calculated to analyze relationships.

Main Results:

• RG and HG significantly improved post-angioplasty (P<.001).
• RG demonstrated significant correlations with ABI (r=-0.58 to -0.41), PSV-L (r=0.40 to 0.52), and PSV-R (r=0.46 to 0.42).
• A 9 mm Hg decrease in RG predicted a 0.1 increase in ABI.

Conclusions:

• Improvement in RG during endovascular treatment of superficial femoral artery stenosis correlates with enhanced ABI, PSV-L, and PSV-R.
• A postprocedural RG reduction of 9 mm Hg is a reliable predictor of a 0.1 improvement in ABI.