Journal of vascular and interventional radiology : JVIR · 2026
Development of the Medial Calcaneal Artery-to-Posterior Tibial Artery Diameter Ratio as a Predictor of Response after Superselective Embolization for Plantar Fasciitis: A Preliminary Derivation Study.
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Tonkaz Mehmet, Cakir Ertugrul, Erkal Duygu, Tonkaz Gokhan, Aslan Serdar, Bekci Tumay
Аннотация
PURPOSE: To evaluate whether the medial calcaneal artery (MCA)-to-posterior tibial artery (PTA) diameter ratio predicts pain reduction after superselective MCA embolization in chronic plantar fasciitis.
MATERIALS AND METHODS: Thirty-eight patients (mean age, 46.8 years [SD ± 10.2]; 63.2% women) with chronic plantar fasciitis refractory to ≥6 months of conservative treatment and baseline visual analog scale (VAS) of ≥6 were included in this single-center retrospective study. After superselective MCA catheterization, embolization was performed with imipenem/cilastatin. Preprocedural digital subtraction angiography was used to measure MCA and PTA diameters and calculate the MCA:PTA ratio. The primary end point was VAS change at 1 month. Predictive performance was assessed with receiver-operating characteristic analysis and linear mixed models.
RESULTS: Mean VAS decreased from 8.2 (SD ± 0.9) at baseline to 2.2 (SD ± 0.6) at 1 month (P < .001) and 2.9 (SD ± 0.7) at 6 months. The MCA:PTA ratio had a strong effect on VAS (β = -8.97; P < .001) with a significant time × ratio interaction (P < .001). The ratio predicted clinical success (VAS ≤ 3 at 1 month), with an area under the curve of 0.91 (95% CI, 0.80-0.99; P = .001). The optimal cutoff was 0.48 (sensitivity, 100%; specificity, 84.2%). High-ratio patients (>0.48) showed sustained pain relief through 6 months, whereas low-ratio patients experienced recurrence. Interobserver agreement was excellent.
CONCLUSIONS: The MCA:PTA diameter ratio is associated with early and durable pain relief after superselective MCA embolization. A cutoff of 0.48 shows promise as an angiographic predictor but requires prospective multicenter validation.
MATERIALS AND METHODS: Thirty-eight patients (mean age, 46.8 years [SD ± 10.2]; 63.2% women) with chronic plantar fasciitis refractory to ≥6 months of conservative treatment and baseline visual analog scale (VAS) of ≥6 were included in this single-center retrospective study. After superselective MCA catheterization, embolization was performed with imipenem/cilastatin. Preprocedural digital subtraction angiography was used to measure MCA and PTA diameters and calculate the MCA:PTA ratio. The primary end point was VAS change at 1 month. Predictive performance was assessed with receiver-operating characteristic analysis and linear mixed models.
RESULTS: Mean VAS decreased from 8.2 (SD ± 0.9) at baseline to 2.2 (SD ± 0.6) at 1 month (P < .001) and 2.9 (SD ± 0.7) at 6 months. The MCA:PTA ratio had a strong effect on VAS (β = -8.97; P < .001) with a significant time × ratio interaction (P < .001). The ratio predicted clinical success (VAS ≤ 3 at 1 month), with an area under the curve of 0.91 (95% CI, 0.80-0.99; P = .001). The optimal cutoff was 0.48 (sensitivity, 100%; specificity, 84.2%). High-ratio patients (>0.48) showed sustained pain relief through 6 months, whereas low-ratio patients experienced recurrence. Interobserver agreement was excellent.
CONCLUSIONS: The MCA:PTA diameter ratio is associated with early and durable pain relief after superselective MCA embolization. A cutoff of 0.48 shows promise as an angiographic predictor but requires prospective multicenter validation.