Assessment of peripheral vascular disease in diabetes. Report and recommendations of an international workshop sponsored by the American Diabetes Association and the American Heart Association September 18-20, 1992 New Orleans, Louisiana.

Abstract

on behalf of the participants R ecognizing the considerable excess burden of both cerebrovascular and lower extremity arterial disease suffered by persons with insulindependent or non-insulin-dependent diabetes mellitus,1,2 a workshop was convened to 1. Provide a current review of the knowledge pertaining to the prevalence, incidence, and risk factor associations of cerebral and peripheral vascular disease in diabetes and 2. Review and make recommendations about the methodology for identifying and quantifying lower extremity arterial disease in either the clinical or research setting.The workshop focused on the specific problems of, and the need for a standard approach to, measurement of peripheral vascular disease in diabetes to ensure appropriate care and facilitate comparability of research findings across studies and over time. Recommendations for the measurement of lower extremity arterial disease (LEAD) in a primary care setting and for epidemiological studies were developed, along with recommendations for more detailed assessment after referral to a vascular clinic. Specific recommendations for the assessment of cerebrovascular disease were not addressed. The detection and appropriate measurement of LEAD was determined to be of great importance, not only in terms of the disease, but also for the strong predictive power that LEAD has for subsequent cardiovascular mortality.3The workshop started with a series of presentations, which are briefly summarized below, followed by the development of specific recommendations. This report has been written on behalf of all the participants who subsequently reviewed, revised, and approved the final version.

Ankle-brachial index, toe-brachial index, and cardiovascular mortality in persons with and without diabetes mellitus

“…19,12 In contrast, the TBI evaluates systolic blood pressure in the great toe and digital arteries may be more susceptible to vasoconstriction and increased resistance in response to colder ambient temperature. 19 While the test-retest correlation of the TBI is less well studied 20 if vasospasm and greater susceptibility to temperature fluctuations lowers its reproducibility, this may have biased the association of the TBI with CVD mortality towards the null, and may have led to weaker associations of the TBI with CVD mortality relative to the ABI with the same outcome. 19,13,14 Another plausible explanation for weaker hazard ratios for the TBI may be because we set the intermediate TBI category (0.62–1.08) as our reference group.…”

“…19 While the test-retest correlation of the TBI is less well studied 20 if vasospasm and greater susceptibility to temperature fluctuations lowers its reproducibility, this may have biased the association of the TBI with CVD mortality towards the null, and may have led to weaker associations of the TBI with CVD mortality relative to the ABI with the same outcome. 19,13,14 Another plausible explanation for weaker hazard ratios for the TBI may be because we set the intermediate TBI category (0.62–1.08) as our reference group. This was done to provide a subgroup with comparable prevalence to those with “normal” ABIs, to allow comparisons across the two diagnostic tests.…”

Comparison of Ankle-Brachial Index and Brachial-Ankle Pulse Wave Velocity between Patients with Chronic Kidney Disease and Hemodialysis

“…ABI <0.9 has been established as a good marker for PAOD with high sensitivity and specificity [20]. However, falsely elevated pressures or incompressible arteries at ankle level are common among patients with extensive vascular calcification of the lower extremities, which may occur in those with diabetes or in treatment with hemodialysis [21, 22]. Hence, markedly high ABI value was also abnormal.…”

Peripheral Arterial Disease as an Independent Predictor for Excess Stroke Morbidity and Mortality in Primary-Care Patients: 5-Year Results of the getABI Study

“…Doppler measurements were done with the Kranzbühler 8-MHz device, General Electrics, Solingen, Germany. Blood pressure measurements and ABI calculations were performed according to the recommendations of the American Heart Association [23,24]. The ABI was calculated separately for each leg by dividing the higher of the 2 systolic pressures (tibial posterior and anterior artery) above the ankle, by the average of the right and left brachial artery pressures.…”