Measurement of Pulse Reappearance Time in Diagnosis of Peripheral Vascular Disease in Diabetes

Abstract

Forty-eight patients (20 diabetic, 28 nondiabetic) with angiographically confirmed peripheral vascular disease (PVD) were examined to discover whether the measurement of pulse reappearance time (PRT) during reactive hyperemia is a more useful method than the measurement of peripheral systolic blood pressure (ankle pressure index; API) for making a specific diagnosis of PVD. Specific diagnosis refers to the degree and localization of occlusive atherosclerosis determined by Doppler ultrasound techniques for both measurements. We found that PRT and API both provided accurate qualitative proof of a peripheral blood flow deficit in diabetic and nondiabetic subjects. However, in relation to the angiographically defined degree and localization of sclerotic lesions, there were significant differences. The sclerotic degree of occlusive PVD in diabetic subjects was correlated with the results of the PRT (P less than .001), whereas the API was not (P greater than .05). The occlusion localization could only be distinguished by PRT measurements in both diabetic and nondiabetic subjects. Compared with control subjects (4.1 s) the half-maximum PRT of blood flow velocity was delayed in stenotic PVD to 5.7 s, in occlusive PVD of the upper leg to 14.3 s, in occlusive PVD of the lower leg to 29.6 s, and in multilevel disease to 45.0 s (P less than .0005 vs. control). The results show that Doppler sonographic measurement of the peripheral systolic blood pressure is only useful for an overall diagnosis of PVD in diabetic subjects, whereas PRT measurement, by quantifying the degree and localization of sclerotic lesions, can be used additionally either to confirm or to specify this diagnosis.

Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: a systematic review

“…Out of the 6629 studies, a total of ten observational studies reporting data from 2585 patients with diabetes met the study criteria and were included in the qualitative data synthesis (Table ) . A flow diagram depicting the overall search results is shown in Figure .…”

“…Criteria for the diagnosis of PAD using CDUS included the following: an increase in peak systolic velocity ≥100% (or defined as >50% stenosis) in four studies , monophasic waveforms in two studies , peak tibial artery velocity ≤10 cm/s in one study and a combination of significant velocity change and loss of reverse flow in a further study . The remaining two studies used DSA as a reference test , both using a cutoff of >50% reduction in vessel diameter to diagnose PAD. No study reported the performance of a test using CTA or MRA as a reference measure of PAD.…”

“…Among the included studies, index tests evaluated included the biomarker serum cystatin C concentration, and non‐invasive tests included audible Doppler waveform, ankle pressures, ABI, TBI, TcPO 2 , PRT and pulse oximetry used to measure the oxygen saturation of peripheral blood. The ABI was the most common index test evaluated; eight studies evaluated its performance . One study used lower and upper thresholds of a combination of <0.9 or >1.3 to define PAD , whereas the remaining seven studies used a cutoff <0.9 in isolation.…”

Hypoxia of diabetic feet with abnormal arterial blood flow

“…We excluded PVD by clinical check-up (assessment of claudication, pulse deficit of popliteal or peripheral arteries), by oscillography (resting and hyperemic blood flow) [17], and by Doppler ultrasound (pulse reappearance time). Only if the results of all three of these examinations were normal PVD was excluded.…”

“…The examinations were carried out in the same way as the measurement of the pulse reappearance time [17]. Therefore the half-maximum amplitude of the hyperemic ascent was evaluated manually and expressed in percentage of the amplitude of blood flow under resting conditions.…”