Doppler evaluation of the pedal arch

Area of Science:

• Vascular Surgery
• Diagnostic Imaging
• Noninvasive Vascular Testing

Background:

• A patent pedal arch is crucial for successful early distal bypass graft patency.
• Assessing pedal arch status often requires invasive intraoperative angiography.
• Noninvasive methods are needed for reliable preoperative evaluation.

Purpose of the Study:

• To evaluate the noninvasive use of an 8 mHz Doppler probe for assessing pedal arch patency.
• To determine the accuracy of Doppler evaluation compared to arteriography.
• To assess the utility of Doppler in selecting patients for distal bypass surgery.

Main Methods:

• An 8 mHz Doppler probe was used to evaluate the pedal arch in 62 patients with vascular disease.
• Doppler signals in the first metatarsal space indicated pedal arch patency.
• Digital pressure on tibial arteries assessed communication with the pedal arch.
• Findings were compared with preoperative or intraoperative arteriography in 22 patients.

Main Results:

• The Doppler probe correctly identified pedal arch patency in 52 patients and absence in 10.
• Doppler findings correlated with arteriography in 21 of 22 cases (96% accuracy).
• In one discordant case, Doppler provided additional flow contribution data.

Conclusions:

• Preoperative Doppler evaluation of the pedal arch is a highly accurate, noninvasive method.
• This technique improves patient selection for distal bypass grafts.
• Noninvasive Doppler assessment can guide surgical planning and potentially reduce the need for intraoperative angiography.