NHG-Standaard Perifeer arterieel vaatlijden

Bartelink, M. L.; Stoffers, H E J H; Boutens, EJ; Hooi, JD; Kaiser, V; Lj, Boomsma

doi:10.1007/978-90-313-8279-8_25

Cited by 4 publications

(7 citation statements)

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“…Since the national guideline suggests that GPs can initiate treatment of patients with intermittent claudication by exercise therapy and cardiovascular risk management, 15 it is not possible to say how many patients from these primary care practices were not referred to the vascular laboratory for an additional ABI measurement. Although it would be informative to investigate the number of missed diagnoses, the aim of the current study was to investigate the difference in ABI measurement as determined in primary care practice and in the vascular laboratory, not to assess patient outcome based on ABI measurement in primary care practice.…”

Section: Strengths and Limitations Of The Studymentioning

confidence: 99%

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Ankle brachial index measurement in primary care: are we doing it right?

Nicolaï

Kruidenier²,

Rouwet³

et al. 2009

Br J Gen Pract

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The reference standard for diagnosing peripheral arterial disease in primary care is the ankle brachial index (ABI). Various methods to measure ankle and brachial blood pressures and to calculate the index are described. AimTo compare the ABI measurements performed in primary care with those performed in the vascular laboratory. Furthermore, an inventory was made of methods used to determine the ABI in primary care. Design of studyCross-sectional study. SettingPrimary care practice and outpatient clinic. MethodConsecutive patients suspected of peripheral arterial disease based on ABI assessment in primary care practices were included. The ABI measurements were repeated in the vascular laboratory. Referring GPs were interviewed about method of measurement and calculation of the index. From each patient the leg with the lower ABI was used for analysis. Results Ninety ConclusionThis study demonstrates that the ABI is often not correctly determined in primary care practice. This phenomenon seems to be due to inaccurate methods for both blood pressure measurements and calculation of the index. A guideline for determining the ABI with a hand-held Doppler, and a training programme seem necessary.

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Section: Strengths and Limitations Of The Studymentioning

confidence: 99%

“…Surprisingly, however, these guidelines do not provide step-by-step information about the correct method of ABI assessment. 2,7,15 Moreover, different modes of determination and calculation of the ABI are used and advised. 6,8 Klein and Hage found 39 different ways to calculate the ABI.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Ankle brachial index measurement in primary care: are we doing it right?

Nicolaï

Kruidenier²,

Rouwet³

et al. 2009

Br J Gen Pract

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“…Peripheral arterial disease (PAD) is a common disease [1][2][3][4]. The number of people with PAD worldwide has increased by 24% in the past 10 years [5].…”

Section: Introductionmentioning

confidence: 99%

“…Patients with PAD often suffer from decreased mobility, severe pain, lower quality of life, and multiple morbidities. Within 10 years after being diagnosed with PAD, 2% of the patients will undergo major limb amputation [3]. The first symptomatic stage of PAD is usually manifested by intermittent claudication, which progresses into chronic limbthreatening ischemia (CLI) in 15% of these patients.…”

Section: Introductionmentioning

confidence: 99%

A systematic review of diagnostic techniques to determine tissue perfusion in patients with peripheral arterial disease

Kirsten

Kleiss

Schuurmann

et al. 2019

Expert Review of Medical Devices

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“…A Dutch study found a PAD prevalence of 19.1% in subjects aged 55 and older, and this prevalence increased with age [ 1 ]. The clinical signs of PAD have a significant impact on quality of life, ranging from intermittent claudication to pain symptoms at rest, arterial ulceration, necrosis and even gangrene in the later stages [ 2 ]. In agreement with the approach followed by Fowkes et al [ 3 ] and by Schroll and Munck [ 4 ] PAD was considered present when the ABI was lower than 0.90 in at least one leg, a threshold value used in most studies [ 1 , 2 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

To screen or not to screen for peripheral arterial disease in subjects aged 80 and over in primary health care: a cross-sectional analysis from the BELFRAIL study

Bergiers¹,

Vaes

Degryse

2011

BMC Fam Pract

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BackgroundPeripheral arterial disease (PAD) is common in older people. An ankle-brachial index (ABI) < 0.9 can be used as an indicator of PAD. Patients with low ABI have increased mortality and a higher risk of serious cardiovascular morbidity. However, because 80% of the patients are asymptomatic, PAD remains unrecognised in a large group of patients. The aims of this study were 1) to examine the prevalence of reduced ABI in subjects aged 80 and over, 2) to determine the diagnostic accuracy of the medical history and clinical examination for reduced ABI and 3) to investigate the difference in functioning and physical activity between patients with and without reduced ABI.MethodsA cross-sectional study embedded within the BELFRAIL study. A general practitioner (GP) centre, located in Hoeilaart, Belgium, recruited 239 patients aged 80 or older. Only three criteria for exclusion were used: urgent medical need, palliative situation and known serious dementia. The GP recorded the medical history and performed a clinical examination. The clinical research assistant performed an extensive examination including Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15), Activities of Daily Living (ADL), Tinetti test and the LASA Physical Activity Questionnaire (LAPAQ). ABI was measured using an automatic oscillometric appliance.ResultsIn 40% of patients, a reduced ABI was found. Cardiovascular risk factors were unable to identify patients with low ABI. A negative correlation was found between the number of cardiovascular morbidities and ABI. Cardiovascular morbidity had a sensitivity of 65.7% (95% CI 53.4-76.7) and a specificity of 48.6% (95% CI 38.7-58.5). Palpation of the peripheral arteries showed the highest negative predictive value (77.7% (95% CI 71.8-82.9)). The LAPAQ score was significantly lower in the group with reduced ABI.ConclusionThe prevalence of PAD is very high in patients aged 80 and over in general practice. The clinical examination, cardiovascular risk factors and the presence of cardiovascular morbidity were not able to identify patients with a low ABI. A screening strategy for PAD by determining ABI could be considered if effective interventions for those aged 80 and over with a low ABI become available through future research.

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NHG-Standaard Perifeer arterieel vaatlijden

Cited by 4 publications

References 0 publications

Ankle brachial index measurement in primary care: are we doing it right?

Ankle brachial index measurement in primary care: are we doing it right?

A systematic review of diagnostic techniques to determine tissue perfusion in patients with peripheral arterial disease

To screen or not to screen for peripheral arterial disease in subjects aged 80 and over in primary health care: a cross-sectional analysis from the BELFRAIL study

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