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Multicenter Study
. 2020 Oct 1;96(4):904-912.
doi: 10.1002/ccd.29101. Epub 2020 Jun 29.

Direct transpedal pressure measurement during transpedal below-the-knee interventions in critical limb ischemia

Zoltán Ruzsa  1   2 , Ádám Csavajda  1 , Mónika Deák  1 , Óriás Viktor  1   2 , István Hizoh  2 , Balázs Nemes  2 , Olivier F Bertrand  3 , Béla Merkely  2 , Tak W Kwan  4   5
Affiliations
Multicenter Study

Direct transpedal pressure measurement during transpedal below-the-knee interventions in critical limb ischemia

Zoltán Ruzsa et al. Catheter Cardiovasc Interv. .

Abstract

Aim: The aim of this study was to assess the feasibility of the distal pressure measurement during transpedal below-the-knee interventions in chronic limb-threatening ischemia (CLTI) and to assess the hemodynamic response after percutaneous transluminal angioplasty.

Methods: The clinical and angiographic data of 137 consecutive patients treated via transpedal access in CLTI (Rutherford 4-6) were evaluated. Distal pedal pressure (PP) at the end of the pedal sheath was measured and the pedal-to-aortic pressure index (PAPI) was also calculated before and after the intervention.

Results: Good angiographic results was achieved in 131 patients (95.6%) in the femoro-popliteal and at least in one below-the-knee artery. Significant differences were found in PP and PAPI between before- and after-intervention values (103.2 ± 41.6 mmHg vs. 138.2 ± 37.8 mmHg and 0.74 ± 0.29 vs. 1.03 ± 0.34), respectively. Post-procedural PP and PAPI were significantly higher in patients who underwent good and borderline/unsuccessful intervention 141.7 [135.8-147.6] versus 82.6 [33.8-131.5] mmHg and 1.05 [1-1.1] versus 0.53 [0.2-0.8], respectively. PP's are significantly different in various Rutherford classification groups. Among the studied parameters, postprocedural PAPI was found to have the best discriminatory power to predict 3-month amputation (c-statistic: 0.749, 95% CI: 0.546-0.952, p = .016, sensitivity: 57.1%, specificity: 92.3% using the cut-off criterion ≤0.58). Major adverse event was detected in 17 patients at 3 months follow up (12.4%), including 7 major amputations (5.1%).

Conclusion: Transpedal pressure and pedal-to-aortic pressure index significantly increased during transpedal below-the-knee angioplasty and final pressure and index correlates significantly with limb salvage.

Keywords: critical limb ischemia; hemodynamics; peripheral intervention.

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REFERENCES

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