Volume Flow and Peak Systolic Velocity of the Arteriovenous Circuit in Patients after Percutaneous Deep Venous Arterialization

Michiel A Schreve; Eline Huizing; Steven Kum; Jean-Paul P M de Vries; Gert J de Borst; Çağdaş Ünlü

doi:10.3390/diagnostics10100760

Volume Flow and Peak Systolic Velocity of the Arteriovenous Circuit in Patients after Percutaneous Deep Venous Arterialization

Diagnostics (Basel). 2020 Sep 28;10(10):760. doi: 10.3390/diagnostics10100760.

Authors

Michiel A Schreve¹, Eline Huizing¹, Steven Kum², Jean-Paul P M de Vries³, Gert J de Borst⁴, Çağdaş Ünlü¹

Affiliations

¹ Department of Surgery, Northwest Clinics, 1815 JD Alkmaar, The Netherlands.
² Vascular Service, Department of Surgery, Changi General Hospital, Singapore 529889, Singapore.
³ Division of Vascular Surgery, Department of Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands.
⁴ Department of Vascular Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands.

Abstract

Percutaneous deep venous arterialization (pDVA) is a developing technique for limb salvage in patients with chronic limb-threatening ischemia by creating an arteriovenous (AV) circuit. After pDVA, patency of the AV circuit is evaluated using duplex ultrasound (DUS) imaging. Peak systolic velocity (PSV) and volume flow (VF) values for maintaining a patent AV circuit are undefined; therefore, guidance about when a reintervention should be performed is lacking. The objective of this study was to interpret post-pDVA PSV and VF values in relation to AV circuit preservation. This was performed by analyzing DUS results of 22 post-pDVA patients. A total of 670 PSV and 623 VF measurements were collected. A PSV value of ≤55 cm/s and a VF value of ≤195 mL/min were found predictive for failure. The reliability of PSV and VF measurements in patent AV-circuits was good (intraclass correlation coefficient; PSV, 0.85; VF, 0.88). In conclusion, this study is the first to analyze DUS measurements in post-pDVA patients and showed that DUS can be used to anticipate for failure. The thresholds found can be used to help interpret DUS measurements in post-pDVA patients. More research in a larger patient population is needed to prospectively validate these thresholds.

Keywords: chronic limb threatening ischemia; duplex ultrasound; endovascular; peak systolic velocity; peripheral arterial disease; venous arterialization; volume flow.