Pre‐ and Post‐Interventional Hemodynamic Characterization of the Femoropopliteal Artery Using Vector Flow Imaging in Peripheral Arterial Occlusive Disease

OBJECTIVES: The femoropopliteal (FP) artery is the most frequently revascularized segment in peripheral artery disease (PAD), followed by the iliac segment. Wall shear stress (WSS) is a key local factor implicated in both atherosclerotic plaque formation and restenosis after angioplasty. However, WSS is not routinely assessed in peri-interventional clinical practice. This exploratory study aimed to assess the feasibility and potential utility of measuring WSS in the FP artery segment using ultrasound. METHODS: In this prospective, single-center study, we included patients with symptomatic PAD and evaluated their hemodynamic parameters before and after iliac or FP revascularization. In addition to standard ultrasound examinations-including B-mode, color Doppler, and pulse-wave (PW) Doppler-we performed sonographic vector flow imaging (VFI) and assessed volume flow and the WSS-derived oscillatory shear index (OSI) at 3 predefined segments along the FP axis. RESULTS: Following iliac or FP revascularization, PW-derived median volume flow increased significantly at all 3 FP sites: in the common femoral artery (CFA) from 211 to 270 mL/minute (p < .01), in the superficial femoral artery (SFA) from 104 to 138 mL/minute (p < .01), and in the popliteal artery (PA) from 37 to 73 mL/minute (p < .001). Median WSS values also increased significantly: in the CFA from 0.69 to 0.93 Pa (p < .001), in the SFA from 0.78 to 1.04 Pa (p < .05), and in the PA from 0.78 to 0.91 Pa (p < .001). By contrast, OSI values showed no significant changes (range 0.0-0.12, all p > .3). CONCLUSIONS: Iliac or FP revascularization procedures result in measurable hemodynamic changes in FP blood flow and vessel wall interaction, which can be readily assessed using peri-interventional ultrasound. The clinical relevance of increased WSS along the FP axis warrants further investigation.