Abstract
The presence of medial arterial calcific sclerosis is known to cause inaccuracy in
the interpretation of noninvasive vascular testing. This substantially limits the
utility of an important baseline diagnostic test for peripheral arterial disease.
Therefore, the objective of this investigation was to derive a method to effectively
factor out calcification in the interpretation of the ankle and digital brachial indices.
The noninvasive vascular testing results of 160 subjects were stratified into the
absence of calcification, mild calcification, moderate calcification, and severe calcification
based on plain film radiographic findings of the infrageniculate vessels. Measurements
were then performed of the pulse volume recording (PVR) waveforms at brachial, ankle
and digital anatomic levels to include PVR wavelength and PVR upstroke length, with
a calculation of the ratio of PVR upstroke length to PVR wavelength. These measurements
were compared between groups and then correlated to the ankle and digital brachial
indices. A significant difference was observed in the PVR upstroke ratio between the
3 anatomic levels (0.1818 vs 0.2622 vs 0.3191; p < .001), but not between the 4 calcification groups (0.2457 vs 0.2363 vs 0.2694 vs
0.2631; p = .242). A significant negative correlation was observed between the PVR upstroke
ratio and the ankle brachial index (ABI) (Pearson -0.454; p = .002) with linear regression indicating the relationship is defined by the formula:
Effective ankle brachial index = 1.17 – (1.33 × PVR upstroke ratio at ankle level).
A significant negative correlation was also observed between the PVR upstroke ratio
and the digital brachial index (Pearson -0.553; p < .001) with linear regression indicating the relationship is defined by the formula:
Effective toe brachial index = 1.04 – (1.61 × PVR upstroke ratio at digital level).
The results of this investigation demonstrate the feasibility of, and provide equations
to approximate, the effective ankle brachial and toe brachial indices in the setting
of medial arterial calcification.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: September 08, 2021
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: Meyr serves on the ACFAS Board of Directors and as a JFAS section editor.
Identification
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