Lower limb pulse rise time as a marker of peripheral arterial disease

Objective: The aim of the study was to show if pulse rise times (PRTs) extracted from photoplethysmographic (PPG) pulse waves (PWs) have an association with peripheral arterial disease (PAD) or its endovascular treatment, percutanoeus transluminal angioplasty (PTA) of the superficial femoral artery. Methods: Lower and upper limb PPG PWs were recorded and analyzed from 24 patients who suffered from PAD. The measurements were conducted before and after the treatment, and one month later by using transmission-mode PPG-probes placed in the index finger and second toe. Ankle-to-brachial pressure index and toe pressures were used as references in clinical patient measurements. PRTs, i.e., the time from the foot point to the peak point of the PW, were extracted from the PWs and compared bilaterally. The results from the PAD patients were also compared with 31 same-aged and 34 younger control subjects. Results: Statistically significant differences were found between the pretreatment PRTs of the treated limb of the PAD patients and the same-aged control subjects ( $p< 10^{-9}$ , Mann–Whitney U-test). The changes in the PRT of the treated lower limb were observed immediately after the PTA ( $p< 0.001$ , Student's t -test), and after one month ( $p< 0.0005$ ), whereas the PRTs of the non-treated lower limb and upper limb did not indicate changes between different examinations. Conclusion: Results show that a PRT greater than 240 ms indicates PAD-lesions in the lower limb. Significance: This proof-of-concept study suggests that the PRT could be an effective and easy-to-use indicator for PAD and monitoring the effectiveness of its treatment. acceptedVersion