title: Diagnostic value of peripheral fractional flow reserve in isolated iliac artery stenosis: a comparison with the post-exercise ankle-brachial index.
abstract: OBJECTIVE
  To examine in claudicant patients with aortoiliac lesions the relationship between the post-exercise ankle-brachial index (ABI) and the peripheral fractional flow reserve (p-FFR), a physiological test that has heretofore been used to assess coronary and renal artery stenosis.
  
  
  METHODS
  Sixteen male patients (mean age 68.1±7.5 years) with isolated iliac artery lesions detected by ultrasound in 17 limbs were enrolled in this study. Resting ABI was measured and a treadmill test was administered to measure the post-exercise ABI. During angiography, the p-FFR was measured using a pressure guidewire after administration of papaverine to induce hyperemia. Changes in the ABI during exercise and p-FFR at hyperemia were calculated.
  
  
  RESULTS
  The mean resting ABI and post-exercise ABI were 0.87±0.12 and 0.65±0.24, respectively. There was no complication during the measurement of p-FFR. The mean p-FFR at hyperemia was 0.71±0.14. A significant linear correlation was observed between post-exercise ABI and p-FFR at hyperemia (r=0.857, p<0.001), which was stronger than the correlation between post-exercise ABI and peak-to-peak pressure gradient at hyperemia (r= -0.626, p=0.013).
  
  
  CONCLUSIONS
  Measuring p-FFR appears to be a feasible and safe procedure, and there is a significant linear correlation between post-exercise ABI and p-FFR in aortoiliac lesions. The p-FFR was more accurate than a peak-to-peak pressure gradient in assessing the physiological significance of a stenosis. Though larger studies are required, p-FFR might be used to physiologically assess stenosis in PAD patients with isolated aortoiliac lesions.
authors.affiliation: Department of Cardiovascular Disease, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Hioki
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Miyashita
authors.forename: Takashi
authors.initials: T
authors.lastname: Miura
authors.forename: Souichirou
authors.initials: S
authors.lastname: Ebisawa
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Motoki
authors.forename: Atsushi
authors.initials: A
authors.lastname: Izawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tomita
authors.forename: Jun
authors.initials: J
authors.lastname: Koyama
authors.forename: Uichi
authors.initials: U
authors.lastname: Ikeda
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D062186:Arterial Pressure; D003251:Constriction, Pathologic; D005080:Exercise Test; D005240:Feasibility Studies; D006439:Hemodynamics; D006801:Humans; D006940:Hyperemia / Q000000981:diagnostic imaging / Q000503:physiopathology; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D007383:Intermittent Claudication / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010208:Papaverine; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011859:Radiography; D012039:Regional Blood Flow; D012720:Severity of Illness Index; D014463:Ultrasonography; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D010208:Papaverine
keywords: exercise ankle-brachial index; hemodynamic assessment; isolated iliac artery stenosis; peripheral artery disease; peripheral fractional flow reserve; pressure gradient; stenosis; treadmill test