Can Maximal Systolic Acceleration be Useful in Screening for PAD and CLTI: Study #ActAgainstAmputation

Introduction

Peripheral arterial disease (PAD) is a critical health concern affecting millions of people worldwide. Prompt and accurate diagnosis is essential to manage this disease effectively and to improve patient outcomes. While traditional diagnostic methods like computed tomography angiography (CTA) offer some insights, they often come with a higher cost, invasiveness, or exposure to radiation. A recent study by Willems et al., published in 2023, brings forth an alternative diagnostic method: the measurement of maximal systolic acceleration (ACC max) through Doppler ultrasonography.

A Brief Overview of the Study

The research focused on assessing the diagnostic accuracy of ACC max in detecting PAD. It examined the data of 340 patients with a total of 618 limbs and categorized them based on various parameters like age, comorbidities, and PAD prevalence (determined through CTA). The study measured the ACC max of arteries such as Posterior Tibial, Anterior Tibial, and Peroneal. 50% stenosis was the reference standard.

Key Findings

1. High Diagnostic Accuracy: The Area Under the Curve (AUC) for these arteries ranged from 0.86 to 0.99, demonstrating high diagnostic performance.
2. Different Cut-off Values: The study found varying ACC max cut-off values for different arteries, leading to high levels of sensitivity and specificity.
3. Positive and Negative Likelihood Ratios (PLR and NLR): High PLR and low NLR indicated a strong diagnostic performance, especially for the Posterior and Anterior Tibial arteries.
4. Effective in Comorbid Conditions: The ACC max test performed well even among those with diabetes mellitus and chronic kidney disease, two groups that are at a higher risk for PAD.
5. Variability in Fontaine Classification: The diagnostic performance was consistent across different Fontaine stages of PAD, making it a versatile tool for PAD management.

Implications for Clinical Practice

1. Non-Invasive Method: Unlike CTA, the measurement of ACC max via Doppler ultrasonography is a non-invasive procedure, thereby eliminating the risks associated with radiation and invasive techniques.
2. Cost-Effective: Doppler ultrasonography is generally more affordable than other imaging methods, making it accessible for more patients.
3. Quick Decision Making: The high sensitivity and specificity of ACC max allow for faster and more accurate clinical decisions, thereby facilitating prompt intervention and management.
4. Applicability in Comorbid Conditions: The ability of this method to accurately diagnose PAD in patients with diabetes and chronic kidney disease could prove invaluable, as these groups often face challenges in PAD diagnosis.

Conclusion

The study by Willems et al. adds a significant dimension to our understanding and approach towards diagnosing PAD. With the advent of non-invasive, cost-effective, and accurate methods like ACC max, healthcare professionals are better equipped to offer timely and effective care to those suffering from PAD. If this can be validated against toe pressure, TCPO2, SPP and PAT for healing wounds (and not just 50% stenosis) then we are talking! Thanks to Flowmigo Prime Joseph LR Mills for his instant take on this manuscript.