Diastolic versus systolic ankle-brachial pressure index using ultrasound imaging & automated oscillometric measurement in diabetic patients with calcified and non-calcified lower limb arteries

Abstract

BackgroundAnkle-brachial pressure index-systolic (ABI-s) can be falsely elevated in the presence of calcified lower limb arteries in some diabetic patients and therefore loses its value in this cohort of patients. We aim at investigating the feasibility of using the diastolic (ABI-d) instead of ABI-s to calculate the ABI in diabetic patients with calcified limb arteries.MethodsA total of 51 patients were chosen from the diabetic foot clinic. Twenty six of these patients had calcified leg arteries by Duplex scan (Group A) and 25 patients did not have calcifications in their leg arteries (Group B). Twenty five healthy volunteers were enrolled in the study for group C and they were matched with other participants from group B and A in age and sex. ABI measurement was performed using “boso ABI-system 100 machine”. Systolic ABI (ABI-s) and diastolic ABI (ABI-d) were calculated based on bilateral brachial and ankle oscillometric pressures. ABI is considered normal when it is ≥0.9. Repeated measures ANOVA test was used to test for comparing mean scores for ABI-s and ABI-d across the three groups. Statistical significance is considered when P < .05.ResultsThe mean age of all participants (±SD) was 64.30 ± 7.1 years (range, 50–82 years). ABI-s mean ± SD was 1.3 ± 0.10 (range, 1.18–1.58) in group A patients, 1.07 ± 0.05 (range, 1–1.16) in group B patients, and 1.06 ± 0.05 (range, 1–1.16) in group C volunteers. While ABI-d mean ± SD was 1.07 ± 0.05 (range, 1.1–1.17) in group A patients, 1.06 ± 0.05 (1–1.14) in group B patients, and 1.05 ± 0.04 (range, 1.01–1.14) in group C volunteers. In group A, repeated measures ANOVA test showed statistical significant difference between ABI-s and ABI-d (P < 0.001) whereas in group B & C was not (P > 0.05).ConclusionsABI-d may be helpful and can be used as a complementary measure instead of ABI-s in falsely elevated ABI caused by partial incompressible vessel.

Undiagnosed and Untreated Peripheral Complications of Diabetes: Findings from a Pilot Study on Diabetes-Related Foot Diseases (DFD) in Patients with Glycemic Disorders

“…ABI was diagnostically consistent with duplex ultrasound and angiography in patients with T2D [33,34]. Some authors report that automated oscillometric methods of measuring ABI are more reliable in diabetic patients than manual Doppler measurement [19,34,35]. In our analysis, the predictive value of both methods was similar.…”

“…Others, including TBI and TcPO2 were significantly predictive, but only in patients with more advanced disorders and higher DFD risk category. According to the authors, ABI is more specific for PAD than TBI (despite similar sensitivity) [21,[35][36][37]. In contrast, TcPO2 measurement is recommended more for predicting the healing process [12,37].…”

Ankle-Brachial Index Is a Predictor of In-Hospital Functional Status but Not of Complications in Hospitalized Elderly Patients

“…Having an ABI lower or equal to 0.9 corresponds to a diagnosis of PAD. The BOSO ABY-System has been previously validated [13,14] and clinically used in different populations [15,16]. It was validated among 2 different populations (Czech post-MON-ICA study with 839 subjects [13] and the population from the study of Járai et al [14] composed of 367 subjects) against classic DOI: 10.1159/000514450 Doppler ABI measurements.…”

Ozone therapy for diabetic foot

“…A study shows that instead of performing ABI-s one can perform ankle brachial pressure-diastolic (ABI-d). Asbeutah et al 22 had a size of 51 patients present with DFUs, 26 of which came present with calcified lower limbarteries and 25 of which did not present calcification. Another 25 persons were used as a control.…”

“…The use of analysis of variance (ANOVA) showed statistical significance among people with the use of ABI-s and ABI-d leading to the conclusion that ABI-d may be a better tool for patients with DFUs with calcified arteries. 22 More studies have been done to see whether other forms of non-invasive vascular assessment can be performed to asses PAD more significantly. Common device-based diagnostic testing for patients with DFU and possible PAD includes color duplex ultrasonography, MR angiography, radiography, capillaroscopy, phlebography, continuous wave Doppler (CWD) and toe-brachial index (TBI).…”