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Published on: September 22, 2020
Development of the Medial Calcaneal Artery-to-Posterior Tibial Artery Diameter Ratio as a Predictor of Response after
Mehmet Tonkaz1, Ertugrul Cakir1, Duygu Erkal1
1Department of Radiology, Faculty of Medicine, Giresun University, Giresun, Turkey.
Purpose:
To evaluate whether the medial calcaneal artery (MCA)-to-posterior tibial artery (PTA) diameter ratio predicts pain reduction after superselective MCA embolization in chronic plantar fasciitis.
Materials And Methods:
Thirty-eight patients (mean age, 46.8 years [SD ± 10.2]; 63.2% women) with chronic plantar fasciitis refractory to ≥6 months of conservative treatment and baseline visual analog scale (VAS) of ≥6 were included in this single-center retrospective study. After superselective MCA catheterization, embolization was performed with imipenem/cilastatin. Preprocedural digital subtraction angiography was used to measure MCA and PTA diameters and calculate the MCA:PTA ratio. The primary end point was VAS change at 1 month. Predictive performance was assessed with receiver-operating characteristic analysis and linear mixed models.
Results:
Mean VAS decreased from 8.2 (SD ± 0.9) at baseline to 2.2 (SD ± 0.6) at 1 month (P < .001) and 2.9 (SD ± 0.7) at 6 months. The MCA:PTA ratio had a strong effect on VAS (β = -8.97; P < .001) with a significant time × ratio interaction (P < .001). The ratio predicted clinical success (VAS ≤ 3 at 1 month), with an area under the curve of 0.91 (95% CI, 0.80-0.99; P = .001). The optimal cutoff was 0.48 (sensitivity, 100%; specificity, 84.2%). High-ratio patients (>0.48) showed sustained pain relief through 6 months, whereas low-ratio patients experienced recurrence. Interobserver agreement was excellent.
Conclusions:
The MCA:PTA diameter ratio is associated with early and durable pain relief after superselective MCA embolization. A cutoff of 0.48 shows promise as an angiographic predictor but requires prospective multicenter validation.
Insights
The medial calcaneal artery (MCA) to posterior tibial artery (PTA) diameter ratio effectively predicts pain reduction after embolization for chronic plantar fasciitis. A ratio above 0.48 indicates sustained pain relief, suggesting its utility as an angiographic predictor.
Area of Science:
- Vascular Interventional Radiology
- Podiatric Medicine
- Medical Imaging
Background:
- Chronic plantar fasciitis is a common cause of heel pain, often refractory to conservative treatments.
- Superselective embolization of the medial calcaneal artery (MCA) is an emerging treatment option.
- Predictive markers for treatment success are needed to optimize patient selection.
Purpose of the Study:
- To determine if the ratio of the medial calcaneal artery (MCA) to posterior tibial artery (PTA) diameter predicts pain reduction after MCA embolization.
- To assess the predictive performance of this ratio for clinical success in chronic plantar fasciitis.
Main Methods:
- Retrospective study of 38 patients with chronic plantar fasciitis undergoing superselective MCA embolization.
- Preprocedural angiography was used to measure MCA and PTA diameters and calculate the MCA/PTA ratio.
- Visual analog scale (VAS) was used to assess pain reduction at 1 and 6 months post-procedure.
Main Results:
- Mean VAS scores significantly decreased from baseline (8.2) to 1 month (2.2) and 6 months (2.9).
- The MCA/PTA ratio strongly predicted VAS reduction (β = -8.97, p < .001).
- An MCA/PTA ratio cutoff of 0.48 demonstrated high sensitivity (100%) and specificity (84.2%) for predicting clinical success (VAS ≤3 at 1 month), with an AUC of 0.91.
Conclusions:
- The MCA/PTA diameter ratio is a significant predictor of early and sustained pain relief following superselective MCA embolization for chronic plantar fasciitis.
- An MCA/PTA ratio >0.48 is associated with durable pain reduction, while lower ratios may indicate a risk of recurrence.
- This ratio shows promise as an angiographic biomarker but requires prospective validation.