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Vascular Innovation Spotlight: Pedal Acceleration Time (PAT) | New Predictor of Limb Salvage

Written by Kymberlie McNicholas, Founder of The Way to My Heart

“Passion, drive, and a desire to make a difference in patients’ lives is what drives me to discover new ways to help save life & limb,” explains Registered Vascular Technologist Jill Sommerset.


As part of our ongoing Vascular Innovation Series in conjunction with The Way to My Heart, Emmy Award-winning Journalist Kym McNicholas interviews Registered Vascular Technologist, Jill Sommerset.



Fifty-Seven-year-old Adam almost lost his foot when his vascular specialist told him, that despite revascularization, his latest Doppler indicated amputation was inevitable. Adam got a second opinion from his podiatrist who told him to not be hasty and wait a few weeks to see if his wounds on his foot would show signs of healing, and they did. Adam ultimately avoided amputation. His podiatrist explained that current imaging isn’t always the best predictor of limb salvage.

What if a new technique using current imaging could improve the prediction of limb salvage? A new study analyzes whether imaging the pedal arteries could be a reliable technique for Chronic Limb-Threatening Ischemia management. Pedal Acceleration Time: A Novel Predictor of Limb Salvage was published in The Annals of Vascular Surgery in April, 2021.  During an ultrasound, “Once the waveform is frozen, Acceleration Time is precisely measured, as time in milliseconds (msec), from the onset of systole to the peak of systole.” Peacehealth Thoracic & Vascular Surgery Technical Director & Registered Vascular Technologist Jill Sommerset is one of the authors of this retrospective study. In the video interview, she discusses the value in focusing on the direct, noninvasive duplex imaging of the pedal arch in the setting of limb salvage.


1. What is the story behind this approach to tackling CLTI? Where did it originate, why, and how?

Passion, drive, and a desire to make a difference in patients’ lives is what drives me to discover new ways to help save life & limb. I help lead the Multidisciplinary Limb Salvage Team at PeaceHealth in the State of Washington. We have been going strong for the last four years with a consistent monthly meeting reviewing complex patients at risk for limb loss. In 2017 I watched Dr. Howard Feldman loop a wire around the pedal arch and balloon it.  I was so curious about the technique that I imaged my own foot with ultrasound to see if I could see the arteries.  This led to the discovery of Pedal Acceleration Time.


2. Detail what PAT reveals that isn’t currently available? What gap does it fill?

Medial wall calcifications in the diabetic and/or renal failure patients can preclude the use of standard physiologic testing. This means ankle-brachial index (ABI) can be falsely elevated or un-reliable. We then look to toe-brachial index (TBI). If there was a toe amputation or a significant wound, this test may not be helpful.  PAT is direct visualization of the pedal arteries whether there is calcium or not, toes or no toes.  PAT fills the gap in non-invasive diagnostic ultrasound when our other diagnostic testing cannot provide enough information.


3. What is the potential for patient impact? 

The impact could be huge in terms of reducing unnecessary amputations. PAT is a quantifiable number providing objective data on foot perfusion.  We have many stories that PAT saved the limbs and lives of many patients.  The current testing may show decreased flow and amputation whereas PAT has proven differently and in our experience, has given all care providers, using it as an indicator, the confidence the wound would heal with time (outside of any major infection).


4. Where is this approach in terms of its possible use at scale? Who will use it and where will it face resistance or competition?

We are actively putting together learning modules and training programs to scale the education. Currently, we are teaching virtual sessions and technique validation around the world at a very small scale.


5. How can patients or advocates get involved?  

Advocates of all kinds can collaborate across disciplines, share research data, support new techniques, and be open minded to positive changes in non-invasive diagnostic ultrasound. Patients can ask their doctor about measuring their Pedal Acceleration Time to help raise awareness of this new technique that may give them an additional data point that improves decision-making for CLTI patients.


6. Anything else we should know? 

We are actively collaborating with colleagues around the world and have started exciting research studies. We hope to deepen our knowledge, correlate findings, and add valuable data with the hope to improve patient care.


Disclaimer:

This interview was produced by The Way To My Heart in partnership with Vascular Cures. Neither The Way To My Heart nor Vascular Cures endorse any specific products, entrepreneurs, companies, organizations, drug or device trials, and/or healthcare professionals, including diagnosis or treatment programs. The information, advice, and views shared in this interview are that of the individual speakers and are offered for educational and informational purposes only.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Don’t act on any information provided in this interview without the explicit consent of your own healthcare provider who knows your situation best.

If you think you are having a medical emergency, please go to the nearest emergency room or dial 911.


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