Ankle Peak Systolic Velocity
Ankle Peak Systolic Velocity
The objective of this study was to determine whether ankle peak systolic velocity (APSV) can predict nonhealing in diabetic foot lesions. Diabetic patients referred for duplex scanning of the lower extremity arteries were included if they had foot lesions such as ulcers, gangrene, or tissue necrosis and had no palpable pedal pulses. End points were healed or healing foot lesions, revascularization, major amputation, or death. One hundred consecutive limbs were included. Forty-three limbs with diabetic foot lesions reached the end point of adequate healing or complete healing, whereas 57 limbs had nonhealing lesions. The APSV was significantly higher in limbs with healed or healing lesions compared with limbs with nonhealed lesions: 53.0 cm/s (41.8-81.6) versus 19.2 cm/s (12.4-26.5), p < .0001. At a cutoff point of 35 cm/s, the APSV showed a sensitivity of 92.9% (95% confidence interval [CI] 82-97), a specificity of 90.6% (95% CI 76-96), a positive predictive value of 92.9%, and a negative predictive value of 90.6% in predicting nonhealing of diabetic foot lesions. There was a significant difference between the APSV before and after revascularization: 20.4 cm/s (12.4-26.3) versus 48.8 cm/s (36.1-80.8), p < .0001. APSV could predict nonhealing of diabetic foot lesions with a high degree of accuracy in this group of patients.
The ankle-brachial index (ABI) is widely used for the assessment of the degree of peripheral ischemia. However, this parameter is not accurate in the presence of arterial wall calcification as it gives falsely high results. The toe-brachial index (TBI) has been used as an alternative because digital arteries are less affected by calcification. However, the incidence of digital artery calcification among diabetics is still significant. In addition, it is impossible to measure toe pressures in a substantial number of patients presenting with diabetic foot lesions because the toes are affected by ulcers or gangrene or have been amputated, which makes the TBI invalid or impossible to use.
We have previously described a new alternative parameter for the assessment of degree of peripheral ischemia: ankle peak systolic velocity (APSV). The rationale of APSV is based on the observation that in ischemic limbs, blood moves at much slower velocity in the distal leg arteries compared with blood in nonischemic limbs. This is noted on angiography as well as on duplex ultrasonography studies. The purpose of this new parameter is to measure the degree of foot perfusion through measurement of blood velocity in the main arteries supplying the foot, namely, the distal anterior tibial artery and the distal posterior tibial artery at the ankle level.
APSV is the mean of the peak systolic velocities measured across the distal tibial arteries at the ankle level. We showed that APSV strongly correlates with the ABI and with the TBI whenever those can be reliably measured. We also demonstrated that APSV correlates well with the clinical classification of peripheral ischemia as described by Rutherford. APSV is not affected by vessel calcification and can be measured in the presence of toe gangrene or amputation; therefore, APSV is advantageous in those situations. APSV is measured during arterial duplex scanning of the lower extremities, which is routinely performed in most centers for the assessment of peripheral ischemia. APSV takes no extra time and adds no extra cost to that of the routine arterial duplex scan.
The objective of the current study was to determine whether APSV could be used to predict nonhealing of diabetic foot lesions.
Abstract and Introduction
Abstract
The objective of this study was to determine whether ankle peak systolic velocity (APSV) can predict nonhealing in diabetic foot lesions. Diabetic patients referred for duplex scanning of the lower extremity arteries were included if they had foot lesions such as ulcers, gangrene, or tissue necrosis and had no palpable pedal pulses. End points were healed or healing foot lesions, revascularization, major amputation, or death. One hundred consecutive limbs were included. Forty-three limbs with diabetic foot lesions reached the end point of adequate healing or complete healing, whereas 57 limbs had nonhealing lesions. The APSV was significantly higher in limbs with healed or healing lesions compared with limbs with nonhealed lesions: 53.0 cm/s (41.8-81.6) versus 19.2 cm/s (12.4-26.5), p < .0001. At a cutoff point of 35 cm/s, the APSV showed a sensitivity of 92.9% (95% confidence interval [CI] 82-97), a specificity of 90.6% (95% CI 76-96), a positive predictive value of 92.9%, and a negative predictive value of 90.6% in predicting nonhealing of diabetic foot lesions. There was a significant difference between the APSV before and after revascularization: 20.4 cm/s (12.4-26.3) versus 48.8 cm/s (36.1-80.8), p < .0001. APSV could predict nonhealing of diabetic foot lesions with a high degree of accuracy in this group of patients.
Introduction
The ankle-brachial index (ABI) is widely used for the assessment of the degree of peripheral ischemia. However, this parameter is not accurate in the presence of arterial wall calcification as it gives falsely high results. The toe-brachial index (TBI) has been used as an alternative because digital arteries are less affected by calcification. However, the incidence of digital artery calcification among diabetics is still significant. In addition, it is impossible to measure toe pressures in a substantial number of patients presenting with diabetic foot lesions because the toes are affected by ulcers or gangrene or have been amputated, which makes the TBI invalid or impossible to use.
We have previously described a new alternative parameter for the assessment of degree of peripheral ischemia: ankle peak systolic velocity (APSV). The rationale of APSV is based on the observation that in ischemic limbs, blood moves at much slower velocity in the distal leg arteries compared with blood in nonischemic limbs. This is noted on angiography as well as on duplex ultrasonography studies. The purpose of this new parameter is to measure the degree of foot perfusion through measurement of blood velocity in the main arteries supplying the foot, namely, the distal anterior tibial artery and the distal posterior tibial artery at the ankle level.
APSV is the mean of the peak systolic velocities measured across the distal tibial arteries at the ankle level. We showed that APSV strongly correlates with the ABI and with the TBI whenever those can be reliably measured. We also demonstrated that APSV correlates well with the clinical classification of peripheral ischemia as described by Rutherford. APSV is not affected by vessel calcification and can be measured in the presence of toe gangrene or amputation; therefore, APSV is advantageous in those situations. APSV is measured during arterial duplex scanning of the lower extremities, which is routinely performed in most centers for the assessment of peripheral ischemia. APSV takes no extra time and adds no extra cost to that of the routine arterial duplex scan.
The objective of the current study was to determine whether APSV could be used to predict nonhealing of diabetic foot lesions.
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