BackTable / VI / Podcast / Episode #90
Pedal Acceleration Time for Limb Salvage
with Jill Sommerset and Dr. Mary Costantino
Dr. Mary Costantino and Technical Director Jill Sommerset talk technique and utility of using Pedal Acceleration Time for pre- and post-procedure evaluation of CLI patients. They also discuss intra-procedure extravascular ultrasound guidance to aid in safe and effective endovascular interventions.
BackTable, LLC (Producer). (2020, October 19). Ep. 90 – Pedal Acceleration Time for Limb Salvage [Audio podcast]. Retrieved from https://www.backtable.com
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Jill Sommerset, RVT, FSVU
Jill Sommerset, RVT, FSVU performs outpatient and intraoperative Advanced Vascular Ultrasound at Advanced Vascular Centers in Portland, OR.
Dr. Mary Costantino
Dr. Mary Costantino is a practicing interventional radiologist with Advanced Vascular Centers in Portland, OR.
In this episode, Jill Sommerset joins Dr. Mary Costantino to discuss how she developed Pedal Acceleration Time (PAT) for limb salvage. She begins by talking about what got her into vascular ultrasound and the importance of vascular techs, especially for pre-operative planning.
We discuss how she invented the pedal acceleration time technique by tracking data from foot scans. Jill speaks about PAT classifications and how they correlate to ABI (Ankle-Brachial Index) numbers. We talk through how they use pedal acceleration time on a typical day and for some different types of patients.
We go over some of the limitations of PAT and some of the cases where it is extremely helpful. Jill discusses her role in the cath lab, how she is developing a platform for pedal acceleration time training, and why it is important for both the physician and vascular tech to learn about PAT.
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So, PAT not only stands for pedal acceleration time, but actually what it really stands for is perfusion, anatomy, and transducer, which is flow direction. So, we now have this really incredible insight to a patient's foot, especially in the setting of a wound where I can tell you, Dr. Costantino, that maybe this patient has an anatomical variation on the top of the foot, and they do not have a dorsal metatarsal artery. In fact, they have a huge lateral tarsal artery with no flow going to the great toe. Or I can tell you that the arcuate artery is retrograde or the lateral plantar is retrograde, and the perfusion is class IV.
So, when we can tell you the anatomy, the perfusion, and flow direction, it provides incredible insight to, number one, is the wound getting enough flow, but also in decision of surgical treatments. So, will this patient heal just a toe amputation? Or, do they truly need a transmetatarsal amputation? Or, if the pedal arch is not intact, maybe they need to be thoughtful of where they do their amputation.
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