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Hemodynamic effect of percutaneous transluminal angioplasty for lower limb atherosclerosis. A study based on pulsed
J J Jørgensen1, E Stranden, T Gjølberg
1Department of Vascular Surgery, Aker Sykehus, Oslo, Norway.
Insights
Pulsatility index (PI) measurements using Doppler ultrasound can effectively evaluate the success of percutaneous transluminal angioplasty (PTA). Increased PI after PTA correlates with improved clinical outcomes, offering a reliable functional assessment beyond symptoms.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Hemodynamics
Background:
- Percutaneous transluminal angioplasty (PTA) is a common intervention for peripheral artery disease.
- Assessing the functional success of PTA is crucial for patient outcomes.
- Symptomatic improvement alone can be an unreliable indicator of PTA success.
Purpose of the Study:
- To evaluate the utility of arterial flow velocity and pulsatility index (PI) measurements in assessing PTA success.
- To compare PI changes with clinical improvement after PTA in iliac and femoropopliteal arteries.
Main Methods:
- Doppler ultrasound was used to measure ankle pressure index (API) and arterial flow velocity, including PI.
- Measurements were taken before and after PTA in 89 limbs (75 patients).
- Hemodynamic success criteria included API increase or absence of pressure drop post-exercise.
Main Results:
- Hemodynamically successful iliac PTA showed a significant PI increase (4.2 to 8.6, p<0.001) with 91% clinical improvement.
- Successful femoropopliteal PTA also demonstrated significant PI increase (3.1 to 8.7, p<0.001) with 100% clinical improvement.
- Unsuccessful PTA, regardless of location, resulted in unchanged PI, with variable clinical improvement.
Conclusions:
- Arterial flow velocity and PI measurements are valuable supplements for evaluating PTA functional success.
- PI offers a more reliable assessment of PTA efficacy compared to symptomatic response alone.
- Doppler-derived PI can aid in differentiating successful from unsuccessful angioplasty interventions.
Abstract:
Measurements of ankle pressure index (API) and arterial flow velocity including calculation of pulsatility index (PI) from the common femoral and pedal arteries were performed in 89 limbs of 75 patients before and after percutaneous transluminal angioplasty (PTA) (63 iliac and 26 femoropopliteal). A pulsed wave Doppler ultrasound flowmeter was used. An increase of API at rest of at least 0.15 or the absence of pressure drop after exercise following PTA was used as criteria for a hemodynamically successful angioplasty. In patients with hemodynamically successful PTA of an iliac obstruction PI increased from 4.2 to 8.6 (p less than 0.001); 91 per cent of these patients improved clinically. When iliac angioplasty was hemodynamically unsuccessful, PI remained unchanged; 11 per cent of these patients improved clinically. All limbs with hemodynamically successful PTA of a femoropopliteal obstruction improved clinically and PI increased from 3.1 to 8.7 (p less than 0.001). After hemodynamically unsuccessful femoropopliteal PTA, PI remained unchanged though 25 per cent of these patients improved clinically. These results illustrate that measurement of arterial flow velocity with calculation of PI may be a useful supplement for the functional evaluation of the effect of PTA, since symptomatic response alone may be unreliable.