Ankle-Brachial index by oscillometry: A very useful method to assess peripheral arterial disease in diabetes

Abstract

Background:Peripheral Arterial Disease (PAD) remains the least recognized form of atherosclerosis. The Ankle-Brachial Index (ABI) has emerged as one of the potent markers of diffuse atherosclerosis, cardiovascular (CV) risk, and overall survival in general public, especially in diabetics. The important reason for the lack of early diagnosis is the non-availability of a test that is easy to perform and less expensive, with no training required.Objectives:To evaluate the osillometric method of performing ABI with regard to its usefulness in detecting PAD cases and to correlate the signs and symptoms with ABI.Materials and Methods:Two hundred diabetics of varying duration attending the clinic for a period of eight months, from August 2006 to April 2007, were evaluated for signs, symptoms, and risk factors. ABI was performed using the oscillometric method. The positives were confirmed by Doppler evaluation. An equal number of age- and sex-matched controls, which were ABI negative, were also assessed by Doppler. Sensitivity and Specificity were determined.Results:There were 120 males and 80 females. Twelve males (10%) and six females (7.5%) were ABI positive. On Doppler, eleven males (91.5%) and three females (50%) were true positives. There were six false negatives from the controls (three each). The Sensitivity was 70% and Specificity was 75%. Symptoms and signs correlated well with ABI positives. Hypertension was the most important risk factor.Conclusions:In spite of the limitations, the oscillometric method of performing ABI is a simple procedure, easy to perform, does not require training and can be performed as an outpatient procedure not only by doctors, but also by the paramedical staff to detect more PAD cases.

Ankle brachial index using an automatic blood pressure device in occupational medicine: relevance in routine examination and comparison with Framingham cardio-vascular risk score

“…It could be included in any clinical examination, as it appears very useful for determining ABI in a maximum number of settings where it would not otherwise be measured. This seems in line with the results of two studies recently performed (20,21) with an automatic oscillometric blood device which allows to determine correctly ABI mainly in diabetics. It can be also mentioned a study (22) in which ABI are measured by general physicians using an OMRON automatic blood pressure device and a Doppler device (after a short training for both techniques) in patients having angiography for peripheral artery disease, the calculated ABI by automatic method are well correlated with angiographic lesions.…”

Pulse palpation and limited joint mobility examination are better indicators than oscillometric measurement for diagnosing abnormal ankle-brachial index

“…Diehm et al (2009) found it useful in oligo-symptomatic non-diabetic patients with PAD but not in diabetic patients alike with our study [8]. Premanath and Raghunath found a sensitivity of 70% and a specificity of 75% using another Omron blood pressure device (HEM-7051-C) with diabetic patients [9]. In our study the sensitivity of the oscillometric method was significantly lower compared to their study.…”

“…This technique requires a trained performer and is not necessarily available as an outpatient procedure, which is the main reason for the lack of early diagnosis. In recent studies the usefulness of automated oscillometric blood pressure devices in measuring the ankle blood pressure, which would be an easier and less expensive method for measuring the ABI, has been clarified [8][9][10][11][12][13][14][15][16]. The aim of this study was to compare the oscillometric method and the traditional pulse palpation to the Doppler stethoscope in measuring ABI as a screening test in diabetic patients.…”

The accuracy of automated oscillometry compared to manual doppler in measuring ankle brachial index in suspected peripheral arterial disease patients: a systematic review

“…According to the result, Premanath et al, 5 Korno et al, 6 Beckman et al, 1 showed similar sensitivity ranging from 0.7; 0.71 and 0.73 respectively. As well stated in Table 2, all studies have a relatively high specificity.…”