Diagnostic Performance of the Maximal Systolic Acceleration for Detecting a Significant Stenosis in the Aortoiliac and Popliteal Pathway: A Retrospective Cohort Study.

Abstract

Introduction: Identifying peripheral arterial disease (PAD) remains challenging with currently used bedside tests. The maximal systolic acceleration (ACC_max) is a promising noninvasive parameter measured by duplex ultrasonography and reflects the arterial perfusion proximal to its measurement point. The principal aim of this study was to analyze the diagnostic accuracy of the ACC_max for detecting significant stenosis in different arterial segments, which could be useful in clinical decision-making.

Materials and methods: A retrospective cohort study was conducted in a tertiary referral hospital. Patients aged 18 years and older who underwent ACC_max measurement(s) alongside computed tomography angiography (CTA) of the abdominal aorta and lower extremities were qualified for inclusion. A significant stenosis was defined as a lumen reduction of more than 50% on CTA. Diagnostic accuracy of the ACC_max was investigated for the aortoiliac and popliteal arterial pathways.

Results: A total of 196 patients (373 limbs) were included in the study. Diagnostic performance of the ACC_max (cut-off value of 7.70 m/s²) to detect a significant stenosis in the aortoiliac pathway showed a sensitivity of 89%, specificity of 97%, positive likelihood ratio of 29.23 and negative likelihood ratio of 0.12 (area under the curve [AUC] 0.941). For the popliteal pathway (cut-off value of 6.30 m/s²), these results were 90%, 95%, 17.14 and 0.12, respectively, with an AUC of 0.958.

Conclusion: The ACC_max showed a promising diagnostic accuracy for detecting a significant stenosis in the aortoiliac and popliteal pathway.

Clinical impact: The maximal systolic acceleration (ACC_max) is a promising non-invasive parameter measured by duplex ultrasonography to diagnose peripheral arterial disease (PAD) and reflects the arterial perfusion proximal to its measurement point. This study focused on its diagnostic accuracy to detect a significant stenosis in the aortoiliac and popliteal pathway, which revealed to be promising with excellent sensitivity and specificity. These findings suggest that ACC_max measurements could play a key role in developing a new diagnostic approach for PAD.