[Ultrasonographic examination of hemodynamics in the feet of patients with chronic critical limb-threatening ischemia for planning and assessment of the outcomes of endovascular revascularization].

内容摘要

The problem of atherosclerotic lesions of lower limb arteries and chronic critical ischemia is currently important, requiring the development and implementation into clinical practice of modern, safe and accurate methods of examination, thus making it possible to more precisely plan and evaluate the outcomes of the operations performed. This study sought to determine the possibility of using the technique of ultrasound examination (duplex scanning) of the pedal arteries, measuring dopplerographic parameters of quantitative assessment of blood flow in the angiosomes of the foot in patients with chronic critical lower limb ischemia, depending on severity, and alterations therein following revascularization. We examined 31 patients with atherosclerotic occlusive lesions of lower extremity arteries. Of these, 3 patients had III stage chronic limb ischemia according to the Fontaine-Pokrovsky classification and 28 had IV stage ischemia. Twelve patients were diagnosed as having type 2 diabetes mellitus. The patients' age ranged from 56 to 93 years, with a male-to-female ratio of 26:5. The main dopplerographic parameters assessed were as follows: pulse waveform, ante- or retrograde blood flow in the artery examined, peak systolic blood flow velocity, maximal systolic acceleration, and acceleration time. We consider that the main advantage of using duplex scanning of the pedal arteries with measuring the maximal blood-flow acceleration is a possibility to assess namely the severity of foot ischemia. A strong inverse correlation was found between the maximum acceleration measured in pedal arteries and the severity of lower limb ischemia, as assessed according to the modified Rutherford scoring scheme (R2=0.78). It was shown that the proposed method of diagnosis is accurate and non-invasive, making it possible without additional devices and preparations to assess the result of revascularization in the operating room immediately after surgery. This pilot study allows us to conclude that duplex scanning of the pedal arteries with the measurement of the maximum blood flow acceleration is a promising rapid alternative method of diagnosing peripheral artery disease and assessing efficacy of revascularization performed, especially in patients with uninformative values of the ankle-brachial index and impossibility to measure the finger pressure index.