Detection of peripheral vascular stenosis by assessing skeletal muscle flow reserve
Thanjuvar Bragadeesh, MB, ChB,
Ibrahim Sari, MD,
Marco Pascotto, MD,
Antonio Micari, MD,
Sanjiv Kaul, MD, FACC and
Jonathan R. Lindner, MD, FACC*
Cardiovascular Imaging Center, Cardiovascular Division, University of Virginia School of Medicine, Charlottesville, Virginia
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Figure 1 Relation between the stenotic pressure gradient at rest and femoral artery blood flow normalized to baseline values. Data points at a pressure gradient of 0 to 1 mm Hg represent baseline values in the absence of a stenosis.
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Figure 2 Examples of background (BG)-subtracted color-coded contrast-enhanced ultrasound images of the quadricep muscle group at increasing pulsing intervals (PI), and corresponding PI versus acoustic intensity curves in the absence of a stenosis and in the presence of a severe stenosis. Data are shown at rest (solid lines) and during contractile exercise (dashed lines). Exer = contractile exercise.
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Figure 3 Skeletal muscle blood flow measured by contrast-enhanced ultrasound at rest, and during either contractile exercise or adenosine. Values are normalized to baseline values at rest. *p < 0.05 compared with no stenosis;  p < 0.05 compared with moderate stenosis. Open bars = rest; solid bars = contractile exercise; ruled bars = adenosine.
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Figure 4 Relation between stenotic pressure gradient and mean flow reserve in skeletal muscle measured by contrast-enhanced ultrasound during contractile exercise (open circles) or adenosine (solid circles). *p < 0.05 compared with no stenosis; p < 0.05 compared with moderate stenosis.
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Figure 5 Percent change in (A) microvascular blood volume (A value) and (B) microvascular red blood cell velocity (VRBC) (ß value) compared with baseline for contractile exercise and intravenous adenosine. *p < 0.05 compared with no stenosis; p < 0.05 compared with mild stenosis.
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Figure 6 Schematic illustration depicting potential sources of limb skeletal muscle blood flow. Besides inflow from the major limb feeding artery (1), muscle perfusion can be derived from proximal large vessel collateral circuits (2), redistribution from other limb tissues (3), or redistribution from nonnutritive sources that may be extramuscular or intramuscular (4).
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