Large Vessels

Assessment of peripheral arterial circulation consisted of foot pulse measurement and ultrasound of the peripheral arteries (16). Systolic blood pressure (SBP) in the peripheral arteries (DPA, Dorsalis pedis artery; PTA, posterior tibial artery) and digital arteries (TP, Toe pressure) was measured using a handheld Doppler ultrasound device with an 8 MHz probe (EDAN SD3 Vascular, DOTmed, NY, USA). The same technique was used to evaluate ankle-brachial indexes (ABI) and toe-brachial indexes (TBI).

Given the frequent inaccuracies associated with ABI, we used colour-coded duplex utrasound (DUS) as the gold standard for PAD detection. DUS was used to assess morphology and flow in the peripheral arteries (4-8 MHz probe, factory default setting, LOGIQ P7, GE HealthCare, USA). Pulse wave correction was set at 70 degrees as standard followed by appropriate adaptation of pulse repetition frequency. Monophasic waves were used to determine the presence of haemodynamically significant stenosis or obliteration with collateralisation. Those arterial lesions modifying pulse waveforms are considered to be clinically hemodynamic significant to reduce dramatically peripheral perfusion.