Schot, Benjamin Marinus Alexander (2026) PADPAT ‘Assessing the prognostic value of pedal acceleration time for wound healing in patients with chronic limb-threatening ischemia’ A retrospective study. thesis, Medicine.
Full text available on request.Abstract
Introduction: Peripheral artery disease (PAD) can progress to chronic limb-threatening ischaemia (CLTI), a condition characterized by severe perfusion impairment and elevated risk of tissue loss and major limb amputation (MLA). CLTI can be diagnosed based on clinical findings and non-invasive haemodynamic tests such as ankle-brachial index (ABI) and toe pressure (TP). However, these tests have their limitations. Pedal acceleration time (PAT), a duplex ultrasound measure of systolic acceleration time, is a promising alternative perfusion parameter. This study evaluated the prognostic value of PAT in wound healing, MLA and survival in patients with CLTI. Methods: This retrospective single-centre cohort study included CLTI patients presenting with a wound and who had duplex ultrasonography with PAT measurement between April 2022 and March 2026. Patient characteristics, wound characteristics, perfusion parameters and intervention details were collected. The primary outcome was wound healing. Secondary outcomes were MLA and death. Logistic regression assessed factors associated with wound healing. Kaplan-Meier analyses evaluated one-year amputation-free survival (AFS) and one-year overall survival (OS). Results: A total of 324 patients were included (mean age 75 years; 66.3% diabetes). A vascular intervention was performed in 45.1% and 54.9% were treated conservatively. Wound healing occurred in 64.8%. Older age, current smoking, contralateral MLA, higher WIfI wound grade, more wounds (on the same foot/limb) and a higher final PAT were independently associated with impaired wound healing (p<0.001) in the logistic regression analysis. One-year AFS was significantly lower in higher PAT classes (p=0.025), while PAT class was not significantly associated with one-year OS (p=0.098). Conclusion: PAT is a clinically meaningful, non-invasive perfusion parameter independently associated with wound healing and one-year AFS in CLTI. Future research could investigate standardized PAT protocols and clinically relevant PAT thresholds to guide revascularization strategies.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Stegge, Dr. W.B. aan de |
| Faculty: | Medical Sciences |
| Date Deposited: | 16 Oct 2026 10:14 |
| Last Modified: | 16 Oct 2026 10:14 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3972 |
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