Relação entre o índice de resistência vascular e o sucesso hemodinâmico de revascularizações distais dos membros inferiores
Vascular resistance index and the immediate hemodynamic success of lower limb distal artery revascularization
Rebecca Paes de Andrade Souza Caldas; Esdras Marques Lins; Gabriela de Oliveira Buril; Fernanda Appolônio Rocha; Emmanuelle Tenório Albuquerque Godoi Berenguer de Barros e Silva; Larissa Barbosa de Andrade; Camilla Lins da Cunha Cavalcanti; Guilherme Barros Alves de Carvalho
Resumo
Palavras-chave
Abstract
Background: Revascularization surgery is used to attempt to restore blood flow to the foot in patients with critical ischemia (CI) caused by peripheral arterial occlusive disease of the lower limbs (LL). Ultrasonography with Doppler (USD) SAH emerged in recent years as a highly valuable method for planning this surgical intervention
Objectives: To evaluate the relationship between the resistance index (RI), measured with USD, and immediate hemodynamic success of LL revascularization surgery in patients with CI.
Methods: The study design was a prospective cohort assessing 46 patients with LL CLI who underwent operations to perform infrainguinal revascularization by angioplasty or bypass from August 2019 to February 2022. All patients underwent preoperative clinical vascular assessment with USD including measurement of the RI of distal LL arteries, LL arteriography, and measurement of the ankle-brachial index (ABI). All patients had their ABI measured again in the immediate postoperative period.
Results: Forty-six patients were assessed, 25 (54.3%) of whom were male. Age varied from 32 to 89 years (mean: 67.83). Hemodynamic success was assessed by comparison of preoperative and postoperative ABI, showing that hemodynamic success was achieved in 31 (67.4%) patients after revascularization surgery (ABI increased by 0.15 or more). A positive correlation (p ≤ 0.05) was observed between the RI of the distal revascularized LL artery and immediate hemodynamic success assessed by ABI (lower RI and hemodynamic success).
Conclusions: This study observed a positive correlation between the resistance index of the distal artery and immediate hemodynamic success of lower limb revascularizations, as assessed by the ankle-brachial index, so that the lower the RI the greater the hemodynamic success achieved.
Keywords
Referências
1 Aboyans V, Ricco JB, Bartelink MLEL, et al. 2017 ESC Guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018;39(9):763-816.
2 Conte SM, Vale PR. Peripheral arterial disease. Heart Lung Circ. 2018;27(4):427-32.
3 Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(Suppl S):S5-67.
4 Conte MS, Bradbury AW, Kolh P, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. Eur J Vasc Endovasc Surg. 2019;58(1S):S1-109.e33.
5 Kim ESH, Sharma AM, Scissons R, et al. Interpretation of peripheral arterial and venous Doppler waveforms: a consensus statement from the Society for Vascular Medicine and Society for Vascular Ultrasound. Vasc Med. 2020;25(5):484-506.
6 Takahashi LA, França GJ, Del Valle CE, Ferreira LRC. Assessment of the pedal arteries with Duplex Scanning. J Vasc Bras. 2020;19:e20200068.
7 Arbeille P, Berson M, Achaibou F, Bodard S, Locatelli A. Vascular resistance quantification in high flow resistance areas using the Doppler method. Ultrasound Med Biol. 1995;21(3):321-8.
8 Katsuki T, Yamaji K, Tomoi Y, Hiramori S, Soga Y, Ando K. Clinical impact of improvement in the ankle–brachial index after endovascular therapy for peripheral arterial disease. Heart Vessels. 2020;35(2):177-86.
9 Moussa Pacha H, Mallipeddi VP, Afzal N, et al. Association of ankle-brachial indices with limb revascularization or amputation in patients with peripheral artery disease. JAMA Netw Open. 2018;1(8):e185547.
10 Jaff MR, White CJ, Hiatt WR, et al. An update on methods for revascularization and expansion of the TASC lesion classification to include below-the-knee arteries: a supplement to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Endovasc Ther. 2015;22(5):663-77.
11 Baubeta Fridh E, Andersson M, Thuresson M, et al. Amputation rates, mortality, and pre-operative comorbidities in patients revascularized for intermittent claudication or critical limb ischaemia: a population based study. Eur J Vasc Endovasc Surg. 2017;54(4):480-6.
12 Prenner SB, Chirinos JA. Arterial stiffness in diabetes mellitus. Atherosclerosis. 2015;238(2):370-9.
13 Potier L, Abi Khalil C, Mohammedi K, Roussel R. Use and utility of ankle brachial index in patients with diabetes. Eur J Vasc Endovasc Surg. 2011;41(1):110-6.
14 Tanno J, Gatate Y, Kasai T, et al. A novel index using ankle hemodynamic parameters to assess the severity of peripheral arterial disease: a pilot study. PLoS One. 2016;11(10):e0164756.
15 Je HG, Kim BH, Cho KI, Jang JS, Park YH, Spertus J. Correlation between patient-reported symptoms and ankle-brachial index after revascularization for peripheral arterial disease. Int J Mol Sci. 2015;16(5):11355-68.
16 Almasri J, Adusumalli J, Asi N, et al. Asystematic review and meta-analysis of revascularization outcomes of infrainguinal chronic limb-threatening ischemia. J Vasc Surg. 2018;68(2):624-33.
17 Morais D Fo, Miranda F, Peres MCJ, Barros N, Buriham E, Salles-Cunha S. Segmental waveform analysis in the diagnosis of peripheral arterial occlusive diseases. Ann Vasc Surg. 2004;18(6):714-24.
18 Rossi FH, Leão PP, Izukawa NM, Prakasan AK. Classificação angiográfica na revascularização do membro inferior isquêmico: pode a angiografia definir a resistência do leito receptor do enxerto? J Vasc Bras. 2009;8(3):207-13.
19 Moneta GL. Tibial artery velocities in the diagnosis and follow-up of peripheral arterial disease. Semin Vasc Surg. 2020;33(3-4):65-8.
20 Buril GO. Comparação entre o índice de resistência e a arteriografia na avaliação pré-operatória da isquemia crítica dos membros inferiores [dissertação]. Recife: Programa de Pós-graduação em Cirurgia, Centro de Ciências Médicas, Universidade Federal de Pernambuco; 2022.
Submetido em:
13/09/2023
Aceito em:
11/12/2023
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email