Resistance Index as a Prognostic Factor for Patency in Distal Lower Limb Arterial Revascularization

Background

Critical limb ischemia (CLI) of the lower limbs (LLs) is a severe condition caused by peripheral arterial obstructive disease (PAOD). Surgical planning for CLI requires the study of limb circulation, and the vascular resistance index (RI) measured by Doppler ultrasound (US) has been used to aid in surgical decision-making. The objective is to correlate the RI of recipient arteries with the patency of LL revascularization surgeries in patients with CLI.

Methods

Prospective cohort study conducted from July 2021 to March 2023. The RI of the recipient arteries was evaluated preoperatively by US in 58 patients with CLI who underwent infrainguinal open or endovascular revascularizations, hospitalized in the Vascular Surgery Department of the Hospital das Clínicas of Empresa Brasileira de Serviços Hospitalares/Universidade Federal de Pernambuco. After 30 days of surgery, all patients were evaluated for the presence of pulses in the revascularized limb and the ankle brachial index (ABI) was measured in all cases. Statistical analysis was conducted with a 95% confidence level, and the Student's t-test was used to compare 2 independent samples.

Results

Clinical evaluation and ABI assessment of revascularization patency after 30 days revealed that infragenicular revascularizations that occluded had an average RI of 0.72 (SD ± 0.16), while patent revascularizations had a mean RI of 0.69 (SD ± 0.17) without statistical significance (P = 0.658).

Conclusions

Despite the lack of statistical significance, the study observed that a lower preoperative RI of the distal recipient artery was associated with greater patency of the revascularization surgery after 30 days.