title: Physiologic Guidance of Infrainguinal Vascular Interventions Using the Pressure Wire.
abstract: OBJECTIVE
  To assess the relationship between the resting (RG) and hyperemic (HG) translesional peripheral gradients, with the functional and anatomic parameters before and after an infrainguinal endovascular procedure.
  
  
  BACKGROUND
  RGs and HGs are objective tools in defining the hemodynamic significance of an arterial stenosis.
  
  
  METHODS
  In 25 subjects with infrainguinal arterial stenosis, RG and HG were measured via a pressure wire before and after angioplasty. Before and after the procedure, all subjects had an ankle-brachial index (ABI) and Duplex ultrasound evaluation, recording prelesion and in-lesion peak systolic velocity (PSV-L), and calculating a peak systolic velocity ratio (PSV-R). A Pearson R correlation coefficient was calculated.
  
  
  RESULTS
  The mean age was 73 ± 12 years, 70% were men, median Rutherford class 3. At baseline and after angioplasty, mean ABI was 0.78 ± 0.2 and 0.99 ± 0.1, mean PSV-L was 459 ± 110 cm/s and 126 ± 35 cm/s, and mean PSV-R was 6.7 ± 4 and 1.2 ± 0.5, respectively. RG and HG significantly improved (P<.001) from baseline to after angioplasty (28.7 ± 20.5 mm Hg to 5 ± 13 mm Hg and 40.2 ± 21.4 mm Hg to 10 ± 13 mm Hg, respectively). RG before and after the procedure correlated well with ABI (r = -0.58; r = -0.41), PSV-L (r = 0.40; r = 0.52), and PSV-R (r = 0.46; r = 0.42). An improvement of 9 mm Hg in RG predicted a change of 0.1 in ABI.
  
  
  CONCLUSIONS
  Improvement in RG during endovascular intervention in superficial femoral artery correlates well with the improvement in ABI, PSV-L, and PSV-R. A postprocedural decrease in RG of 9 mm HG predicts an improvement in ABI of 0.1.
authors.affiliation: New York University Medical Center, Cardiovascular Medicine New York, Cardiovascular Associates, Medicine, 275 7th Ave 3rd Floor, New York, NY 10001 USA. Cezar.staniloae@nyumc.org.
authors.forename: Cezar S
authors.initials: CS
authors.lastname: Staniloae
authors.forename: Lori
authors.initials: L
authors.lastname: Vales
authors.forename: Seol Young
authors.initials: SY
authors.lastname: Han
authors.forename: Jan
authors.initials: J
authors.lastname: Sloves
authors.forename: Arzhang
authors.initials: A
authors.lastname: Fallahi
mesh_terms: D000368:Aged; D000792:Angiography; D055109:Ankle Brachial Index; D001783:Blood Flow Velocity; D057510:Endovascular Procedures / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D012039:Regional Blood Flow / Q000502:physiology*; D012307:Risk Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex