Normal Lower Extremity Duplex Findings in Patients with Left Ventricular Assist Devices: A Basis for Vascular Laboratory Interpretation

Abstract Introduction and Objectives: Left ventricular assist devices (LVADs) have been shown to cause changes in carotid artery duplex-derived flow velocity waveforms; however, possible effects on lower extremity arterial duplex (LEAD) findings have not been characterized. We sought to characterize LEAD findings in patients with LVADs to establish a basis for vascular laboratory interpretation of LEAD in patients with LVADs. Methods Retrospective single institution review of all patients with LEAD performed after LVAD implantation from 2003-2014. Peak systolic velocity (PSVs) of common femoral (CFA), superficial femoral (SFA), popliteal, and posterior tibial arteries (PTA) in asymptomatic extremities in patients with LVADs were compared to a control group of patients at our institution without LVADs who underwent LEAD for nonischemic indications. ABIs and CFA waveform acceleration times (AT) and end diastolic velocity (EDV) were also measured. Results There were 248 LVAD patients, 29 had LEAD of at least one lower extremity (34 extremities, 22 asymptomatic, 12 symptomatic) during the study period and 136 control limbs. Mean PSVs (cm/s) in the control CFA, mid SFA, popliteal, and PTA were 137 +/- 4.8, 104.2 +/- 4.5 , 65.2 +/- 2.8 , and 64.6 +/-3.2. Mean PSVs were significantly decreased in the LVAD patients: 49.5 +/- 4.9 , 40.6 +/-3.7, 27.2 +/-2.2 and 25.5 +/- 2.3, p < 0.001 for each comparison. Average ABI for control limbs was 0.91 +/- 0.05 compared to 1.17 +/- 0.35 in LVAD extremities (P