Pedal Acceleration Time - A New Method Of Diagnosis And Prognosis In Peripheral Arteriopathy.

Introduction It is well recognized that the Ankle-Arm Index is unreliable in the diagnosis and prognosis of peripheral arteriopathy in patients with incompressible vessels, such as diabetics and chronic kidney patients. It is therefore important to define alternative strategies for assessing distal perfusion in this population. Arterial Doppler, a non-invasive technique available in any vascular laboratory, can be used to directly assess foot perfusion by interrogating the plantar arch and its nourishing arteries. This technique, recently described and still not widespread, can help to overcome the diagnostic limitations of ABI. Objectives This work aims to review the model and the results obtained with the evaluation of the Pedal Acceleration Time (PAT) as well as to evaluate its practical applicability. Materials and Methods In an initial phase, the recently published literature on the topic was analysed. Subsequently, the clinical applicability of the technique was tested in 2 non-diabetic and non- -revascularized patients, admitted to the Angiology and Vascular Surgery Service of our center. In both, the acceleration time of the systolic flow, measured in milliseconds, were evaluated in the Arched, Plantar Medial, Lateral Plantar and Deep Plantar Arteries. Results In patient A, with ABI of 0.27, the acceleration time in the 4 evaluated arteries varied between 210-260ms, values that according to standardization in the literature fall into a category of moderate to severe ischemia. Patient B, with a 0.35 ABI, had low-amplitude monophasic flows in all arteries, failing to obtain a correct measurement of the acceleration time. Thus, the morphology of the curve has become a limitation for the application of this modality. The technical complexity, time consuming, with an average duration of the exam of 30-40 minutes, were other limitations found, also revealing an exam with some discomfort for the patient with ischemic rest pain. Conclusions In patient A, the values obtained by measuring the PAT were comparable in severity of ischemia with the ABI, with the advantage of demonstrating with greater specificity the perfusion defects corresponding to each angiosome. However, it would be important to understand the reliability of this test in patients with incompressible arteries and the ease of its clinical application, taking into account their technical requirements.