Ankle-to-Brachial Ratio Index Underestimates the Prevalence of Peripheral Occlusive Disease in Diabetic Patients at High Risk for Arterial Disease

Non-invasive vascular assessment in the foot with diabetes: sensitivity and specificity of the ankle brachial index, toe brachial index and continuous wave Doppler for detecting peripheral arterial disease

“…Although the ankle-brachial index (ABI) is used more widely, it has been demonstrated to have significant limitations in the presence of diabetes-related PAD including inability to detect distally located PAD and poor accuracy in the presence of medial arterial calcification, a condition associated with diabetes resulting in incompressible lower leg arteries [8].…”

Peripheral arterial disease, type 2 diabetes and postprandial lipidaemia: Is there a link?

“…The prevalence of diabetes in the group with an ABI > 1.4 was 58%, compared with 18% and 48% in those with a normal ABI or those with an ABI < 0.9 [37] . It has long been known that the sensitivity of the ABI to correctly diagnose PAD is considerably reduced in the presence of arterial media calcification and that, clinically, this calcification is associated with the presence of peripheral neuropathy [38,39] . Accordingly, in the presence of peripheral neuropathy it is recommended to use an alternative method, such as flow wave analysis using Doppler colour ultrasound [40,41] .…”

Comparison of ankle brachial pressure index to arterial doppler USG in the diagnosis of peripheral vascular disease in diabetes mellitus

“…1 The treatment of patients with PAD can therefore be expensive, owing to need for a variety of diagnostic tests, therapeutic procedures, and hospitalizations. 2 PAD can be clinically identified by intermittent claudication and/or absence of peripheral pulsations in the lower extremities. With the use of doppler technology and ankle brachial pressure index measurement, peripheral artery disease can be identified non-invasively before clinical manifestations.…”