Pedal Acceleration Time: A Functional Indicator of Success in Revascularisation

Non-invasive measurement of foot perfusion is vital in the assessment of patients with peripheral artery disease. Pedal acceleration time (PAT) has emerged as a quick and effective analysis tool in the management of lower limb arterial insufficiency. This study aimed to investigate the validity of PAT in a functional measurement of foot perfusion pre- and post-revascularisation, including the differences in PAT post-revascularisation between diabetic and non-diabetic cohorts.

A prospective, observational study was performed, using STROBE guidelines, between 2020 and 2022 at a single centre in New Zealand. PAT was measured on multiple pedal arteries within the foot, and the best and worst PAT values of the three arteries in the foot (i.e., low and high measurements in milliseconds [ms], respectively) were assigned to the foot for analysis.

PAT measurements were performed on 443 patients during the study period, of whom 142 patients and limbs had revascularisation interventions and pre- and post-PAT measurements, and were included in the study. The mean (standard deviation [SD]) PAT at presentation were class 4 (245.2 ms ± SD 71.8 ms), and this improved to PAT class 2 (125.1 ms ± SD 45.4 ms) post-intervention. Patients with diabetes mellitus (DM) were found to have a smaller improvement in PAT post-revascularisation (difference between DM and without DM groups = 48.7 ms, 95% confidence interval 24.4-73; p < .001). Patients who underwent open revascularisation had a greater improvement in PAT compared with endovascular treatment.

PAT is a reliable tool to assess foot perfusion and can be used to quantify improvement post-revascularisation. The study showed that patients with DM have a smaller change in PAT post-revascularisation, and adds to the growing literature on the usefulness of PAT in arterial insufficiency management.