USE OF FRACTION FLOW RESERVE TO PREDICT CHANGES OVER TIME IN
MANAGEMENT OF SUPERFICIAL FEMORAL ARTERY
Amir S. Lotfi, M.D., Tufts University School of Medicine, Baystate Medical Center, Springfield, MA, USA
Background: Peripheral arterial disease (PAD) is a condition characterized by progressive narrowing of the arteries in the peripheral vascular bed which affect patient quality of life. The purposes of this study were to 1) establish the feasibility of performing peripheral FFR (pFFR) in the peripheral vascular circulation, 2) correlate post intervention pFFR with future restenosis, and 3) demonstrate an association between pFFR and peak systolic velocity measured by duplex ultrasound.
Method: The first 20 patients who met the criteria and consented were enrolled in the study from December 2007 to April 2009. The enrolled patients underwent baseline ankle brachial index, Doppler ultrasound of the extremity, renal function studies and Edinburgh claudication questionnaire. The patients were followed with three ABI recordings and Doppler ultrasound, using the General Electric (GE) Vivid 7 ultrasound machine, of the intervened extremity during the one year follow up period.
Results: The mean baseline pre intervention pFFR prior to adenosine was 0.79 ± 8 and post adenosine pre intervention pFFR was 0.71 ± 13. There was a correlation between pre intervention hyperemic pFFR and baseline PSV values. In patients with post-procedure FFR less than 0.95 there was a significant rise of PSV levels over time.
Conclusion: This is the first study to demonstrate that the peripheral vascular bed does respond to vasodilatation thereby supporting the use of FFR for this procedure. In our study, post-intervention FFR less than 0.95 predicts increased PSV over time which is a reasonably accepted surrogate for restenosis.