Using maximal systolic acceleration to diagnose and assess the severity of peripheral artery disease in a flow model study

• Published in: Journal of vascular surgery Vol. 71; no. 1; pp. 242 - 249
• Main Authors: Brouwers, Jeroen J.W.M., van Doorn, Louk P., van Wissen, Rob C., Putter, Hein, Hamming, Jaap F.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2020
• Subjects: Doppler duplex ultrasound; In vitro techniques; Peripheral arterial disease; Vascular calcification; Peripheral arterial disease; Vascular calcification; Doppler duplex ultrasound; In vitro techniques
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2019.01.088

Because of the presence of medial calcific sclerosis, both ankle-branchial index and toe pressure measures can yield misleading results when attempting to diagnose peripheral artery disease (PAD). A new ultrasound parameter, maximal systolic acceleration (ACCmax), can be an accurate tool for diagnosing PAD, including in diabetic patients. However, it has not been evaluated thoroughly. The aim of this study was to assess the feasibility of using ACCmax to diagnose and assess the severity of PAD. The human circulatory system was simulated using an in vitro circulatory system driven by a pulsatile pneumatic pump. Arterial stenosis of various degrees (50%, 70%, 80%, and 90%) was simulated in order to investigate the change in several ultrasound parameters (including ACCmax), as well as the intraluminal mean arterial pressure gradient. In a separate set of measurements, interobserver variability was measured using two investigators who were unaware of the degree of stenosis. ACCmax significantly decreased (P < .001), and the pressure gradient increased (P < .001) as the degree of stenosis increased. Moreover, we found a strong correlation between ACCmax and the pressure gradient (R2 = 0.937). Finally, interobserver variability with respect to ACCmax was extremely low, with an intraclass correlation coefficient of 0.99. The results of this flow model study suggest that ACCmax can be a valid, noninvasive tool for diagnosing PAD. Moreover, our finding that ACCmax decreases as the severity of stenosis increases, together with the strong correlation between ACCmax and the pressure gradient, suggests that ACCmax may be useful as an alternative diagnostic tool for assessing the severity of PAD. These promising in vitro data warrant further study in a clinical setting. Limb pressure measurements and the determination of pressure index values (ankle-branchial index and toe pressure) are commonly used in patients with symptoms consistent with peripheral arterial disease. However, ankle-branchial index and toe pressure can be falsely elevated or falsely normal due to medial calcific sclerosis. In this in vitro flow-model study, the maximal systolic acceleration (ACCmax) significantly decreased as the degree of stenosis increased. Furthermore, there was a strong correlation between ACCmax and the intraluminal pressure gradient. These results suggest ACCmax may provide a robust noninvasive technique for assessing the severity of peripheral arterial disease.