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The fate of extremities with flat lower calf pulse volume recordings
J L Kaufman1, K M Fitzgerald, D M Shah
1Department of Surgery, Albany Medical College.
Insights
Patients with flat pulse volume recordings (PVR) indicating severe vascular disease often require surgery. Limb jeopardy significantly increases the need for intervention, but clinical status, not just PVR class, dictates surgical timing.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Patient Prognosis
Background:
- Pulse volume recording (PVR) is a non-invasive method to assess peripheral arterial disease.
- Interpreting PVR findings, particularly flat (Class 5) and nearly flat (Class 4) tracings, is crucial for patient management.
- The correlation between PVR amplitude and ankle systolic blood pressure is established.
Purpose of the Study:
- To evaluate the prognosis of patients with Class 4 and Class 5 PVRs.
- To correlate PVR findings with clinical symptoms and signs of vascular disease.
- To determine the need for surgical reconstruction and mortality rates based on PVR classification.
Main Methods:
- Retrospective analysis of 517 patients with Class 4 or Class 5 PVRs.
- Assessment of limb jeopardy, symptoms, and signs of vascular disease.
- One-year follow-up for surgical intervention and mortality.
Main Results:
- 97.9% of Class 5 patients with jeopardized limbs required surgery versus 72.4% with minimal symptoms (p<0.001).
- 85.7% of Class 4 patients with jeopardized limbs required surgery versus 41.9% with minimal symptoms (p<0.001).
- One-year mortality in Class 5 patients was 43.2%; Class 5 required surgery more often than Class 4.
Conclusions:
- Severely abnormal PVRs (Class 4 and 5) strongly correlate with the need for surgical reconstruction.
- Limb jeopardy is a critical factor influencing surgical necessity in patients with abnormal PVRs.
- Surgical timing should prioritize clinical limb status over PVR classification alone.
Abstract:
The prognosis of patients with a flat (Class 5) or nearly flat (Class 4) pulse volume recording was studied in relation to the signs and symptoms of vascular disease in 517 patients. Within one year of follow up, 97.9% of 96 patients with jeopardized limbs and flat tracings required surgery, whereas 72.4% of 29 patients with no or minimal symptoms required reconstruction (p less than 0.001); 85.7% of patients with Class 4 tracings and jeopardized limbs required surgery, whereas 41.9% of those with minimal symptoms and Class 4 recordings developed need for reconstruction (p less than 0.001). The requirement for surgery Class 5 patients is significantly higher than in those with Class 4 tracings. The general trend of pulse volume recording amplitude to correlate with ankle systolic blood pressure was confirmed. One year mortality in Class 5 patients was 43.2%. The majority of patients with severely abnormal pulse volume recordings eventually come to surgical reconstruction. The timing of surgery is based on the clinical status of the jeopardized limb, not solely on the presence of a pulse volume tracing abnormality.