Assessment of Peripheral Vascular Disease in Diabetes: Report and Recommendations of an International Workshop Sponsored by the American Heart Association and the American Diabetes Association

Abstract

R ecognizing the considerable excess burden of both cerebrovascular disease and LEAD suffered by individuals with IDDM or NIDDM (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 cerebrovascular disease and PVD in diabetes, and 2) review and make recommendations about the methodology for identifying and quantifying LEAD in both clinical and research settings.The workshop focused on the specific problems of measurement of PVD in diabetes and the need for a standard approach to ensure appropriate care and facilitate comparability of research findings across studies and over time. Recommendations for the measurement of 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.

Emergency in Diabetic Foot

“…A value <0.4 identifies a severe ischemia. When ABI >1.3 it is possible there are several calcifications and we cannot exclude an ischemic disease [47,48]. TBI <0.50 indicates a CLI that usually requires a vascular treatment [49].…”

Association between Systolic Blood Pressure Difference ≥10 mm Hg and Ankle-Brachial Index

“…Ankle-brachial index (ABI) was classified into 3 groups: 0.9 ≤ ABI < 1.3 (group I); ABI < 0.9 (group II); and ABI ≥ 1.3 (group III). It was also classified into 2 groups: 0.9 ≤ ABI < 1.3 (group I) and ABI < 0.9 or ABI ≥ 1.3 (group IV) [11] [12]. The combined effects of |ΔSBP| ≥10 mm Hg according to obesity and ABI were classified into 4 groups: non-obesity + group I (Group A); obesity + group I (Group B); non-obesity + group IV (Group C); and obesity + group IV (Group D).…”

Prevention Conference VI: Diabetes and Cardiovascular Disease

“…34 The equipment needed consists of an ordinary blood pressure cuff and a Doppler ultrasonic sensor. With a standardized protocol, 35 systolic blood pressure is measured in both arms and at the left and right posterior tibial arteries and dorsalis pedis arteries. The ABI is calculated for each leg as a ratio of the higher of the 2 ankle systolic blood pressures (posterior tibial or dorsalis pedis) to the average of the right and left brachial artery systolic pressures.…”

“…35 Studies have shown that an ankle brachial difference in systolic blood pressure of Ն75 mm Hg has a positive predictive value of 100% for medial wall calcification. 35 This measure (ankle brachial difference of 75 mm Hg), however, is also highly predictive of both 10-year total mortality and CVD in type 1 diabetes (relative risks of 6.7 and 3.1, respectively). 77 It is therefore recommended that when ABI is performed, either an ABI Ͻ0.9 or an ankle brachial difference Ͼ75 mm Hg be considered abnormal and predictive of future events.…”