Critical analysis and limitations of resting ankle-brachial index in the diagnosis of symptomatic peripheral arterial disease patients and the role of diabetes mellitus and chronic kidney disease

AbuRahma, Ali F.; Adams, Elliot; AbuRahma, Joseph; Mata, Luis Adolfo; Dean, Larry S.; Caron, Cristyn; Sloan, Jennifer L.

doi:10.1016/j.jvs.2019.05.050

Cited by 69 publications

(72 citation statements)

References 32 publications

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“…Our present study actually showed that %MAP was a predictor of total mortality and %MAP > 50% was a predictor of total and cardiovascular mortality in HD patients. In addition, although ABI < 0.9 was a good indicator of peripheral arterial occlusive disease, AbuRahma et al found that among symptomatic patients with PAD with 50% or greater stenosis on duplex ultrasound examination, 43% had normal resting ABI [17]. Ankle %MAP was reported to be a useful parameter for the diagnosis of peripheral artery disease in patients with normal ABI [7].…”

Section: Discussionmentioning

confidence: 99%

Association of Pulse Volume Recording at Ankle with Total and Cardiovascular Mortality in Hemodialysis Patients

Lee

Hsu

Huang

et al. 2019

JCM

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Pulse volume recording is an accurate modality for detecting arterial occlusion in the lower extremities. There are two indexes of pulse volume recording measured at ankle, percentage of mean arterial pressure (%MAP) and upstroke time (UT). The aim of the study was to examine the ability of %MAP and UT for the prediction of overall and cardiovascular mortality in hemodialysis (HD) patients. In 197 routine HD patients, ankle %MAP, ankle UT, and ankle-brachial index (ABI) were automatically measured by Colin VP-1000 instrument. Fourteen cardiovascular mortality and 29 overall mortalities were documented during 2.7 ± 0.6 years follow-up. In the univariate analysis, in addition to co-morbidities and traditional clinical parameters, increased total mortality was associated with decreased ABI, ABI < 0.9, increased %MAP and UT, %MAP > 50%, and UT > 169 ms (p ≤ 0.041) and increased cardiovascular mortality was associated with increased UT and %MAP > 50% (p ≤ 0.022). After multivariate analysis, increased %MAP and %MAP > 50% (p ≤ 0.047) were still the predictors of total mortality and %MAP > 50% (p = 0.024) was still the predictor of cardiovascular mortality. In HD patients, we found that ankle %MAP and %MAP > 50% could predict total mortality and ankle %MAP > 50% could predict cardiovascular mortality in the multivariate analysis. Hence, assessment of %MAP from pulse volume recording at ankle might be helpful in identifying the high-risk group for poor prognosis in HD patients.

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Section: Discussionmentioning

confidence: 99%

Association of Pulse Volume Recording at Ankle with Total and Cardiovascular Mortality in Hemodialysis Patients

Lee

Hsu

Huang

et al. 2019

JCM

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“…5 Nonetheless, as far as it is known, ABI alone has been proved to be insufficient for PAD diagnosis, particularly in patients with chronic kidney disease and DM, due to interfering false-elevation. 6,14-17 We demonstrated that the sensitivity of ABI in ESRD patients was low (34.96%), while the specificity was relatively high (85.91%). These findings discouraged ABI being used as a screening method due to low sensitivity.…”

Section: Discussionmentioning

confidence: 81%

“…Moreover, ABI may be normal around 50% of symptomatic PAD patients with diabetes or chronic kidney disease. 6 Therefore, TBI is recommended to establish the diagnosis of PAD only in the setting of noncompressible arteries (ABI >1.40). 5,7,8 Notably, TBI has been proved to be superior to ABI in patients with medial sclerosis or noncompressible arteries (demonstrated by ABI >1.40).…”

mentioning

confidence: 99%

Pole Test and Ankle-Brachial Index by Using Doppler Ultrasound for Peripheral Arterial Disease in End-Stage Renal Disease Patients

Tungsrirut

Taptiang

Charoenkarn

et al. 2020

The International Journal of Lower Extremity Wounds

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Peripheral arterial disease (PAD) causes great disability in end-stage renal disease (ESRD). Pole test is a simplified test utilizing the basis of Doppler ultrasound invented to correct false elevation in ankle-brachial index (ABI) in diabetic patients with severe calcification of the tibial artery. However, the role of pole test in ESRD patients is still unclear. The aim of this study was to explore the sensitivity, specificity, and overall utility of pole tests in such patients. One hundred and four patients were recruited and examined with 3 tests: pole test, ABI, and toe-brachial index, the latter serving as the gold standard. Receiver operating characteristic analysis was performed using SPSS version 22.0. The sensitivity, specificity, and other diagnostic values of ABI and pole tests were calculated. There were 104 ESRD patients enrolled. Pole tests showed to have low probability to provide accurate results (area under the curve = 0.505, standard error = 0.042). Low sensitivity of ABI (34.96%) can be observed in ESRD patients. Specificity, positive predictive value, and negative predictive value of ABI in all cases were, respectively, 85.91%, 81.13%, and 43.26%. It is concluded that pole test accuracy seemed to be limited in ESRD patients. ABI was found to be confounded by medial arterial calcification, resulting in low sensitivity as well. The results of this study permit the observation that an optimal tool for screening peripheral arterial disease in ESRD patients remains to be discovered.

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“…It’s a scientific fact that the presence of IDDM1 and ESKD are strongly related to accelerated development of atherosclerosis, and further development of PAD [ 2 , 8 , 17 ]. Patients with PAD have a significantly higher risk of cardiovascular and cerebrovascular events, resulting in significant decrease of quality of life and functional worsening [ 15 , 38 , 39 ]. However, data are limited regarding the prevalence and clinical effects of PAD, specifically on the basis of pre-transplantation ABI testing, on the long-term outcomes in SPKT recipients.…”

Section: Discussionmentioning

confidence: 99%

Pre-operative ankle-brachial index for cardiovascular risk assessment in simultaneous pancreas–kidney transplant recipients: a simple and elegant strategy!

et al. 2021

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Background Patients with insulin-dependent diabetes mellitus type 1 (IDDM1) and end-stage kidney disease (ESKD) undergoing simultaneous pancreas kidney transplantation (SPKT) are a population with diffuse atherosclerosis and elevated risk of cardio- and cerebrovascular morbidity and mortality. We aimed to investigate the feasibility of preoperative screening for peripheral arterial disease (PAD), specifically ankle-brachial index (ABI) testing, to predict peri- and postoperative outcomes in SPKT recipients. Methods Medical data (2000–2016) from all patients with IDDM and ESKD undergoing SPKT at our transplant center were retrospectively analyzed. The correlation between PAD (defined by an abnormal ABI before SPKT and graft failure and mortality rates as primary end points, and the occurrence of acute myocardial infarction, cerebrovascular and peripheral vascular complications as secondary end points were investigated after adjustment for known cardiovascular risk factors. Results Among 101 SPKT recipients in our transplant population who underwent structured physiological arterial studies, 17 patients (17%) were diagnosed with PAD before transplantation. PAD, as defined by a low ABI index, was an independent and significant predictor of death (HR, 2.99 (95% CI 1.00–8.87), p = 0.049) and pancreas graft failure (HR, 4.3 (95% CI 1.24–14.91), p = 0.022). No significant differences were observed for kidney graft failure (HR 1.85 (95% CI 0.76–4.50), p = 0.178). In terms of the secondary outcomes, patients with PAD were more likely to have myocardial infarction, stroke, limb ischemia, gangrene or amputation (HR, 2.90 (95% CI 1.19–7.04), p = 0.019). Conclusions Pre-transplant screening for PAD and cardiovascular risk factors with non-invasive ABI testing may help to reduce perioperative complications in high-risk patients. Future research on long-term outcomes might provide more in depth insights in optimal treatment strategies for PAD among SPKT recipients.

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Critical analysis and limitations of resting ankle-brachial index in the diagnosis of symptomatic peripheral arterial disease patients and the role of diabetes mellitus and chronic kidney disease

Cited by 69 publications

References 32 publications

Association of Pulse Volume Recording at Ankle with Total and Cardiovascular Mortality in Hemodialysis Patients

Association of Pulse Volume Recording at Ankle with Total and Cardiovascular Mortality in Hemodialysis Patients

Pole Test and Ankle-Brachial Index by Using Doppler Ultrasound for Peripheral Arterial Disease in End-Stage Renal Disease Patients

Pre-operative ankle-brachial index for cardiovascular risk assessment in simultaneous pancreas–kidney transplant recipients: a simple and elegant strategy!

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