Abstract

Aim: Peripheral arterial disease (PAD) is predisposed by many risk factors, including atherosclerosis, hypertension, diabetes, and smoking. Many clinical classifications, including the Fontaine classification, are used for the assessment of chronic ischemia. Ankle and Toe brachial indices are commonly used in clinical practice for staging of PAD. However, the Ankle Brachial Index (ABI) falls short in the assessment of patients with stiff vessels due to false negative results. Doppler ultrasound (DUS) is a highly sensitive imaging modality for the assessment and classification of lower limb ischemia, within which pedal artery acceleration time (PAT) represents an objective quantitative DUS technique. In this study, we evaluated PAT as a hemodynamic parameter for assessing lower limb ischemia, providing complementary sensitivity to existing clinical scoring classifications. The study aimed to assess the role of PAT in the evaluation of chronic lower limb ischemia.
Material and Methods: A cross-sectional study was conducted on 22 patients (44 limbs) diagnosed with peripheral vascular disease. Patients were classified according to the Fontaine clinical classification. ABI was measured when applicable, and DUS was performed to assess the lower limb arterial tree. PAT was measured in both the anterior circulation (arcuate and dorsalis pedis arteries) and the posterior circulation (medial and lateral plantar arteries). Appropriate statistical analyses were subsequently performed.
Results: Acceleration times of the medial and lateral plantar arteries were significantly prolonged in patients with higher Fontaine classifications, with statistically significant p values. Sensitivity analysis demonstrated that medial and lateral plantar artery acceleration times could reliably predict clinical stage IIB and higher, using a cutoff value of 0.075 s.
Conclusion: PAT is a reliable objective tool for assessing PAD, especially when ABI is not applicable, and can help distinguish mild from moderate-to-severe cases requiring more intensive management.

Key words: Doppler ultrasound, fontaine classification, pedal acceleration time, peripheral arterial disease, sensitivity