Falsely high ankle-brachial index predicts major amputation in critical limb ischemia

Silvestro, Antonio; Diehm, Nicolas; Savolainen, Hannu; Do, Do-Dai; Vögelea, Jolanda; Mahler, F; Zwicky, S N; Baumgartner, Iris

doi:10.1191/1358863x06vm678oa

Cited by 76 publications

(57 citation statements)

References 28 publications

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“…8,9 In a series of patients with PAD, with and without diabetes, an ABI > 1.3 increased amputation rates in both groups in a similar fashion. 22 Studies on the association between TP and patient outcome are scarce. A few studies have demonstrated the predictive effect of TBI on cardiovascular mortality and morbidity, irrespective of the diabetic status of the patient.…”

Section: Discussionmentioning

confidence: 99%

Toe Pressure and Toe Brachial Index are Predictive of Cardiovascular Mortality, Overall Mortality, and Amputation Free Survival in Patients with Peripheral Artery Disease

Wickström

Laivuori²,

Aro

et al. 2017

European Journal of Vascular and Endovascular Surgery

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Section: Discussionmentioning

confidence: 99%

Toe Pressure and Toe Brachial Index are Predictive of Cardiovascular Mortality, Overall Mortality, and Amputation Free Survival in Patients with Peripheral Artery Disease

Wickström

Laivuori²,

Aro

et al. 2017

European Journal of Vascular and Endovascular Surgery

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“…However, medial calcification does not necessarily cause arterial stenosis and reduced blood flow [8,9,18]. The exclusion of patients with incompressible arteries (defined by an ABI ≥1.3), a factor known to be associated with poorer outcome in patients with limb ischaemia, in a number of published studies makes it increasingly difficult to evaluate its diagnostic utility [12,22]. In contrast, detection of a triphasic pedal Doppler arterial waveform with a handheld Doppler appears to provide stronger evidence for the absence of PAD.…”

Section: Rationalementioning

confidence: 99%

IWGDF guidance on the diagnosis, prognosis and management of peripheral artery disease in patients with foot ulcers in diabetes

Hinchliffe

Brownrigg

Apelqvist

et al. 2016

Diabetes Metabolism Res

180

187

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Recommendations1. Examine a patient with diabetes annually for the presence of peripheral artery disease (PAD); this should include, at a minimum, taking a history and palpating foot pulses. (GRADE strength of recommendation: strong; quality of evidence: low) 2. Evaluate a patient with diabetes and a foot ulcer for the presence of PAD.Determine, as part of this examination, ankle or pedal Doppler arterial waveforms; measure both ankle systolic pressure and systolic ankle brachial index (ABI). (strong; low) 3. We recommend the use of bedside non-invasive tests to exclude PAD. No single modality has been shown to be optimal. Measuring ABI (with <0.9 considered abnormal) is useful for the detection of PAD. Tests that largely exclude PAD are the presence of ABI 0.9-1.3, toe brachial index ≥0.75 and the presence of triphasic pedal Doppler arterial waveforms. (strong; low) 4. In patients with a foot ulcer in diabetes and PAD, no specific symptoms or signs of PAD reliably predict healing of the ulcer. However, one of the following simple bedside tests should be used to inform the patient and healthcare professional about the healing potential of the ulcer. Any of the following findings increases the pre-test probability of healing by at least 25%: a skin perfusion pressure ≥40 mmHg, a toe pressure ≥30 mmHg or a transcutaneous oxygen pressure (TcPO 2 ) ≥25 mmHg. (strong; moderate) 5. Consider urgent vascular imaging and revascularisation in patients with a foot ulcer in diabetes where the toe pressure is <30 mmHg or the TcPO 2 <25 mmHg. (strong; low) 6. Consider vascular imaging and revascularisation in all patients with a foot ulcer in diabetes and PAD, irrespective of the results of bedside tests, when the ulcer does not improve within 6 weeks despite optimal management. (strong; low) 7. Diabetic microangiopathy should not be considered to be the cause of poor wound healing in patients with a foot ulcer. (strong; low) 8. In patients with a non-healing ulcer with either an ankle pressure <50 mmHg or ABI <0.5, consider urgent vascular imaging and revascularisation. (strong; moderate) 9. Colour Doppler ultrasound, computed tomography angiography, magnetic resonance angiography or intra-arterial digital subtraction angiography can each be used to obtain anatomical information when revascularisation is

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“…Evaluation of the macrocirculation using measurements of ankle-brachial index and ankle pressure can be falsely elevated because of excessive calcification of the tibial artery 21 and does not reflect blood flow below the ankle. With the limited use of macrocirculation assessment, intense evaluation of the microcirculation is essential in the setting of CLI.…”

Section: -13mentioning

confidence: 99%

Effect of Single Tibial Artery Revascularization on Microcirculation in the Setting of Critical Limb Ischemia

Kawarada

Yasuda

Nishimura

et al. 2014

Circ: Cardiovascular Interventions

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Background-Benefits of 2-dimensional (2D) angiosome-oriented infrapopliteal revascularization remain controversial.The aim of this retrospective study was to clarify the effect of single tibial artery revascularization on the dorsal and plantar microcirculation of critically ischemic limbs based on skin perfusion pressure (SPP). Methods and Results-Fifty-seven interventions that only involved either anterior tibial artery (ATA) or posterior tibial artery (PTA) revascularization were included in this study. SPP was measured on the dorsal side (theoretically ATA perfusion area) and the plantar side (theoretically PTA perfusion area) before and after the procedure. Dorsal and plantar SPP increased significantly, from 33 (IQR 23-40.5) to 52 (IQR 32.5-65) mm Hg (P<0.0001) and 31.6±16.1 to 44.8±19.2 mm Hg (P=0.001) after ATA revascularization, respectively, and from 29.3±14.0 to 42.4±19.7 mm Hg (P=0.003) and 29.3±9.8 to 43.5±15.9 mm Hg (P<0.001) after PTA revascularization, respectively. Both ATA and PTA revascularization were not associated with any significant differences in ΔSPP between the dorsal and the plantar regions of the foot. Only 64% and 58% of ATA revascularization cases showed higher post-SPP and ΔSPP on the dorsal side than on the plantar side, respectively. Also, only 47% and 40% of PTA revascularization cases showed higher post-SPP and ΔSPP on the plantar side than on the dorsal side, respectively. Conclusions-Single tibial artery revascularization, whether of the ATA or PTA, yielded comparable improvements in microcirculation of the dorsal and plantar foot. Approximately half of the feet revascularized had a change in microcirculation that was not consistent with the 2D angiosome theory. (Circ Cardiovasc Interv. 2014;7:684-691.)

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Falsely high ankle-brachial index predicts major amputation in critical limb ischemia

Cited by 76 publications

References 28 publications

Toe Pressure and Toe Brachial Index are Predictive of Cardiovascular Mortality, Overall Mortality, and Amputation Free Survival in Patients with Peripheral Artery Disease

Toe Pressure and Toe Brachial Index are Predictive of Cardiovascular Mortality, Overall Mortality, and Amputation Free Survival in Patients with Peripheral Artery Disease

IWGDF guidance on the diagnosis, prognosis and management of peripheral artery disease in patients with foot ulcers in diabetes

Effect of Single Tibial Artery Revascularization on Microcirculation in the Setting of Critical Limb Ischemia

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