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Intra-arterial Fractional Flow Reserve Measurements Provide an Objective Assessment of the Functional Significance of Peripheral Arterial Stenoses.

Authors
  • Albayati, Mostafa A1
  • Patel, Ashish1
  • Modi, Bhavik2
  • Saha, Prakash1
  • Karim, Lawen1
  • Perera, Divaka2
  • Smith, Alberto1
  • Modarai, Bijan3
  • 1 Academic Department of Vascular Surgery, Guy's & St Thomas' NHS Foundation Trust and King's College London, United Kingdom. , (United Kingdom)
  • 2 Department of Cardiology, School of Cardiovascular and Metabolic Medicine and Sciences, King's BHF Centre of Excellence, Guy's & St Thomas' NHS Foundation Trust and King's College London, United Kingdom. , (United Kingdom)
  • 3 Academic Department of Vascular Surgery, Guy's & St Thomas' NHS Foundation Trust and King's College London, United Kingdom. Electronic address: [email protected]. , (United Kingdom)
Type
Published Article
Journal
European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
Publication Date
Feb 01, 2024
Volume
67
Issue
2
Pages
332–340
Identifiers
DOI: 10.1016/j.ejvs.2023.07.035
PMID: 37500005
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Peripheral arterial stenoses (PAS) are commonly investigated with duplex ultrasound (DUS) and angiography, but these are not functional tests. Fractional flow reserve (FFR), a pressure based index, functionally assesses the ischaemic potential of coronary stenoses, but its utility in PAS is unknown. FFR in the peripheral vasculature in patients with limb ischaemia was investigated. Patients scheduled for angioplasty and or stenting of isolated iliac and superficial femoral artery stenoses were recruited. Resting trans-lesional pressure gradient (Pd/Pa) and FFR were measured after adenosine provoked hyperaemia using an intra-arterial 0.014 inch flow and pressure sensing wire (ComboWire XT, Philips). Prior to revascularisation, exercise ABPI (eABPI) and DUS derived peak systolic velocity ratio (PSVR) of the index lesion were determined. Calf muscle oxygenation was measured using blood oxygenation level dependent cardiovascular magnetic resonance prior to and after revascularisation. Forty-one patients (32, 78%, male, mean age 65 ± 11 years) with 61 stenoses (iliac 32; femoral 29) were studied. For lesions < 80% stenosis, resting Pd/Pa was not influenced by the degree of stenosis (p = .074); however, FFR was discriminatory, decreasing as the severity of stenosis increased (p = .019). An FFR of < 0.60 was associated with critical limb threatening ischaemia (area under the curve [AUC] 0.87; 95% CI 0.75 - 0.95), in this study performing better than angiographic % stenosis (0.79; 0.63 - 0.89), eABPI (0.72; 0.57 - 0.83), and PSVR (0.65; 0.51 - 0.78). FFR correlated strongly with calf oxygenation (rho, 0.76; p < .001). A greater increase in FFR signalled resolution of symptoms and signs (ΔFFR 0.25 ± 0.15 vs. 0.13 ± 0.09; p = .009) and a post-angioplasty and stenting FFR of > 0.74 predicted successful revascularisation (combined sensitivity and specificity of 95%; AUC 0.98; 0.91 - 1.00). This pilot study demonstrates that FFR can objectively measure the functional significance of PAS that compares favourably with visual and DUS based assessments. Its role as a quality control adjunct that confirms optimal vessel patency after angioplasty and or stenting also merits further investigation. Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.

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