Use of wave intensity analysis during peripheral revascularisation: Lessons from cases study

Background Wave propagation in arteries can be characterized by the wave-intensity approach. This has particularly well been studied in healthy ascending aortas, carotid, brachial and coronary arteries. However, wave propagation in diseased and peripheral arteries remains unknown. We performed wave intensity analysis in such conditions during endovascular and surgical procedures and described the changes after revascularisation. Methods Velocity and pressure measurements were performed simultaneously along the femoral axis using Combowire® (Volcano Corp) in 4 patients with peripheral vascular disease. Data were acquired before the lesion was treated and repeated just after. Procedures concern one femoral stenosis stenting, one femoral occlusion stenting and two femoro-popliteal bypasses. Results Forward wave intensity absorption was related to the severity of the arterial lesion. Stenting or surgical bypass restored forward wave intensity to the same extent. Persistent absorption of forward wave intensity was observed per-operatively in the bypass that showed abnormal decreased peak velocity at the post-procedural duplex examination. Conclusions Per-operative combined pressure and velocity measurement can be performed during vascular procedures. The characterization of wave intensity across the arterial axis provides crucial information not only regarding the severity of the arterial lesion but also the adequacy of revascularisation.