Non-invasive characterisation of angiopathy in the diabetic foot

Lepäntalo, Mauri; T, Kangas; Pietilä, J; Scheinin, T. M.

doi:10.1016/s0950-821x(88)80106-3

Cited by 9 publications

(9 citation statements)

References 18 publications

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“…However, falsely high ABI values caused by medical sclerosis and incompressible arterial walls are seen in patients with diabetes. Such calcification is rare in the walls of small arterioles; therefore, toe blood pressure measurements are used to detect PAOD in patients with medial sclerosis (9,16,19). In our material, 16% of patients with type 2 diabetes had PAOD.…”

Section: Risk Factors For Paodmentioning

confidence: 99%

“…Palpation of pulses and a history of claudication detect PAOD inadequately; therefore, PAOD should be assessed by objective noninvasive measurements (8). The ankle-brachial index (ABI) is the most documented of these methods, but in diabetic patients, calcification of artery walls (medial sclerosis) frequently causes falsely elevated ankle pressure values (9,10). A complementary method might be necessary to exclude medial sclerosis.…”

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confidence: 99%

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Development of New Peripheral Arterial Occlusive Disease in Patients With Type 2 Diabetes During a Mean Follow-Up of 11 Years

et al. 2003

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OBJECTIVE -To assess the occurrence and development of new peripheral arterial occlusive disease (PAOD), its risk factors, and the outcome in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS-A total of 130 type 2 diabetic patients (mean age 58 years) were examined at baseline and after a mean follow-up of 11 years (range 7-14). The ankle-brachial index (ABI) and toe-brachial index were used to detect PAOD. Blood and urine samples were taken at baseline, and a history of cardiovascular events was recorded during follow-up.RESULTS -PAOD was diagnosed in 21 (16%) patients at baseline. During follow-up, 21 of 89 (24%) patients developed new PAOD. There were 29 patients who died, 21 (72%) of them from cardiovascular disease. Patients with PAOD suffered an excess mortality compared with patients without PAOD (58 vs. 16%; P Ͻ 0.001). Logistic regression analysis showed that PAOD at baseline was associated with age, duration of diabetes, smoking, and urinary albumin excretion rate. Patients who developed new PAOD during follow-up had higher serum LDL cholesterol concentrations and lower HDL cholesterol concentrations and were older than the patients who remained free of PAOD.CONCLUSIONS -Objectively measured PAOD is frequent in type 2 diabetic patients. It presents the early clinical signs of atherosclerosis and is strongly associated with cardiovascular death. The risk factor pattern for PAOD was different at baseline and after a mean follow-up of 11 years. We consider routine ABI measurements and modification of risk factors necessary also in patients with asymptomatic PAOD. Diabetes Care 26:1241-1245, 2003I n patients with type 2 diabetes, peripheral arterial occlusive disease (PAOD) is a major contributor to diabetic foot problems. Identification of PAOD is essential because, in many cases, appropriate treatment saves the diabetic foot (1). Further, prevention of foot problems may be easier than treating foot problems. For this purpose, specific risk factors for the development of PAOD need to be recognized.Follow-up studies on risk factors for objectively measured PAOD in patients with type 2 diabetes are few, and the follow-up times are short (2-4 years) (2-4). Some evidence suggests that general risk factors of atherosclerosis such as systolic hypertension, smoking, dyslipidemia, and age are also risk factors for progression of PAOD (2,4). A recent study proposed that HbA 1c , LDL cholesterol, and smoking are risk factors for development of new PAOD in patients with type 1 diabetes (5), but no similar data are available for type 2 diabetes.Objectively measured PAOD predicts cardiovascular death and morbidity both in the general population and the diabetic population (2,6,7). Therefore, the following question arises: Could objectively measured PAOD be the first clinical sign of cardiovascular disease?The diagnosis of PAOD is critical. Palpation of pulses and a history of claudication detect PAOD inadequately; therefore, PAOD should be assessed by objective noninvasive measurements (8). The ankle-brachial...

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Section: Risk Factors For Paodmentioning

confidence: 99%

mentioning

confidence: 99%

Development of New Peripheral Arterial Occlusive Disease in Patients With Type 2 Diabetes During a Mean Follow-Up of 11 Years

et al. 2003

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“…[26][27][28][29][30][31][32][33][34] Non-invasive vascular testing, digital plethysmography, angiography and transcutaneous partial pressures of oxygen, are often helpful in deciding on the level of amputation.…”

Section: Vascular Assessmentmentioning

confidence: 99%

Soft tissue considerations in partial-foot amputations

Jolly¹,

Zgonis²

2012

Lower Extremity Soft Tissue &Amp; Cutaneous Plastic Surgery

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“…Numerous studies showed that systolic toe blood pressure is very useful in the screening of ischemic leg disease (1, 10-13, 15, 19, 28, 34, 40, 43, 45), because it reflects the overall obstruction of the arterial tree proximal to the digits (13,37,45). It can predict more reliably than ankle pressure the chance for healing in diabetic foot ulcers (2,11,32,40) and prior to amputation (4,9,38,40,42). Ankle pressure, though simpler to measure than toe pressure, is often misleading, because it does not take into account arterial disease localized distally in the vessels of the foot (13,40), nor can it detect isolated obstruction of one or even two branches of the popliteal artery (13,45).…”

Section: Sommairementioning

confidence: 99%

“…Ankle pressure, though simpler to measure than toe pressure, is often misleading, because it does not take into account arterial disease localized distally in the vessels of the foot (13,40), nor can it detect isolated obstruction of one or even two branches of the popliteal artery (13,45). Moreover, ankle pressures are falsely elevated when the walls of the tibial and peroneal arteries are calcified, which is found in a high percentage of patients with diabetes mellitus or renal insufficiency (2,9,11,32,45). For these reasons, measurement of the systolic toe blood pressure has been re-commended in the routine assessment of patients with arterial occlusive disease by several consensus conferences in the past (14,37,41).…”

Section: Sommairementioning

confidence: 99%

Arterial audiophotoplethysmography

Gammal¹,

Lambotte²,

Gammal³

et al. 2003

Phlebologie

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SummaryBackground: Digital blood pressure is an important prognostic parameter in peripheral arterial disease. However, it is rarely determined in clinical routine because the methods available are too cumbersome. Patients and methods: Arterial audiophotoplethysmography (APPG) uses an in-built audio output. The systolic pressure corresponds to the reappearance of a pulssynchrone beep during deflation of the pressure cuff (25 mm wide on fingers and toes) after suprasystolic inflation. Measurements can be performed either in transmission or reflection mode. 50 healthy volunteers (age: 23-75 years) were examined in supine position. Blood pressure was taken at the A. brachialis, A. ulnaris, A. radialis, A. poplitea, A. tibialis anterior and posterior using ultrasound Doppler (USD), at the A. brachialis, fingers 1-5, A. poplitea and toes 1-3 using APPG. Results: Regarding the A. brachialis and poplitea, we found an excellent correlation between values obtained by USD and APPG in transmission mode (r: 0.92-0.99), the correlation with the reflection mode-values was slightly lower (r: 0.81- 0.93). The values obtained in reflection mode were significantly lower than in transmission mode (average 5.2 mmHg on the arms, 12.9 mmHg on the legs). Finger pressure was identical with A. brachialis-pressure. Toe/- brachial index was 0.81-0.86 (transmission) and 0.72- 0.78 (reflection). No significant difference was found between any of the fingers, respectively the toes. Conclusions: APPG is a reliable method for determination of digital blood pressure, which can be easily performed. Measurements in transmission mode should be preferred.

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Non-invasive characterisation of angiopathy in the diabetic foot

Cited by 9 publications

References 18 publications

Development of New Peripheral Arterial Occlusive Disease in Patients With Type 2 Diabetes During a Mean Follow-Up of 11 Years

Development of New Peripheral Arterial Occlusive Disease in Patients With Type 2 Diabetes During a Mean Follow-Up of 11 Years

Soft tissue considerations in partial-foot amputations

Arterial audiophotoplethysmography

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