Hand acceleration time is a valuable ultrasonographic tool in hand perfusion as adjuvant evaluation for diagnosing chronic upper limb ischaemia.

Diagnosis of chronic upper limb ischaemia is mainly clinical. Although hand perfusion can be evaluated by different non-invasive methods (e.g., digital-brachial index, digital pressures, oxygen saturation measurements, and plethysmography), these have not been standardised for the diagnosis of chronic upper limb ischaemia. Initial reports suggested that the hand acceleration time (HAT) measured by duplex ultrasound could be a useful diagnostic tool. However, the HAT has neither been properly characterised nor validated. This study aimed to provide evidence that HAT is a sensitive diagnostic tool for chronic upper limb ischaemia. We conducted a prospective, single-centre, cross-sectional study with adult patients diagnosed with chronic upper limb ischaemia and healthy adult volunteers without cardiovascular risk factors. Hand vascular duplex ultrasound and HAT measurement were performed in four artery locations: princeps pollicis artery (HAT1), radialis indicis artery (HAT2), first common digital palmar artery (HAT3), and third common digital palmar artery (HAT4). It was also measured in the ulnar and radial arteries. Descriptive and exploratory analyses were performed between patients and healthy volunteers. Thirty participants were included, being 15 patients [median (SD) age: 51 (18) years; 47% women] and 15 healthy volunteers [median (SD) age: 35 (10) years; 60% women]. In total, 15 ischaemic and 30 non-ischaemic hands were analysed. Humeral artery stenosis/occlusion (n=6, 40.0%) and distal artery stenosis (n=5, 33.3%) were the main causes of ischaemia. Median (IQR) HAT measurements were significantly different between patients and healthy volunteers in the four hand arterial locations, the radial artery, and ulnar artery: HAT1: 164 (124 - 252) vs. 60 (40 - 88), p<0.001; HAT2: 176 (140 - 348) vs. 60 (36 - 80), p<0.001; HAT3: 180 (92 - 320) vs. 64 (36 - 88), p<0.001; HAT4: 180 (104 - 240) and 56 (44 - 92), p<0.001; radial artery: 156 (120 - 248) vs. 68 (55 - 76), p<0.001; ulnar artery: 152 (76 - 220) vs. 61 (48 - 76), p<0.001. Vascular duplex ultrasound with HAT measurement seems to be an easy-access, sensitive diagnostic tool for chronic upper limb ischemia. HAT provides valuable information on hand perfusion and may be complementary to current non-invasive methods.

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