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A Diagnostic Comparison Study between Maximal Systolic Acceleration and Acceleration Time to Detect Peripheral
Siem A Willems1, Obrecht O van Bennekom1, Abbey Schepers1
1Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Annals of Vascular Surgery
|November 25, 2024
Summary
Maximal systolic acceleration (ACCmax) is more accurate than acceleration time (AT) for detecting peripheral arterial disease (PAD), especially in patients with diabetes mellitus or chronic kidney disease. ACCmax should be favored for diagnosing PAD.
Area of Science:
- Vascular Medicine
- Diagnostic Imaging
- Ultrasound Technology
Background:
- Peripheral arterial disease (PAD) detection is challenging in patients with diabetes mellitus (DM) or chronic kidney disease (CKD) due to medial arterial calcification (MAC).
- Traditional bedside tests like the ankle-brachial index have reduced accuracy in these specific patient groups.
- Point-of-care duplex ultrasound offers a potential alternative for PAD assessment.
Purpose of the Study:
- To evaluate the diagnostic accuracy of point-of-care duplex ultrasound parameters: maximal systolic acceleration (ACCmax) and acceleration time (AT).
- To compare the diagnostic performance of ACCmax and AT in detecting PAD.
- To assess accuracy in patients with or without medial arterial calcification (MAC).
Main Methods:
- Included patients suspected of PAD undergoing point-of-care duplex ultrasound (ACCmax, AT) of tibial arteries and computed tomography angiography (CTA).
- PAD defined as >50% stenosis on CTA; diagnostic accuracy of AT assessed using sensitivity, specificity, and likelihood ratios at various cut-offs.
- Compared ACCmax and AT using McNemar test, with subgroup analyses for patients prone to MAC (DM and/or CKD).
Main Results:
- ACCmax demonstrated superior diagnostic accuracy over AT in detecting PAD for both posterior tibial artery (PTA) and anterior tibial artery (ATA).
- This superiority was consistent in patients prone to medial arterial calcification (MAC).
- No significant difference was observed between ACCmax and AT in their ability to exclude PAD.
Conclusions:
- Maximal systolic acceleration (ACCmax) is a more accurate parameter than acceleration time (AT) for diagnosing PAD, including in patients with DM or CKD.
- ACCmax should be the preferred parameter in the diagnostic work-up for suspected PAD due to its enhanced ability to detect arterial stenosis.
- Both parameters showed similar accuracy in ruling out PAD.
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