Noninvasive Diagnostic Methods for Better Screening of Peripheral Arterial Disease

Nirala, Neelamshobha; Periyasamy, R.; Kumar, Awanish

doi:10.1016/j.avsg.2018.03.018

Cited by 13 publications

(11 citation statements)

References 44 publications

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“…Further, we eliminated other factors that may have affected our final TcPO2 results by performing the test under tightly defined conditions, e.g. providing a calm environment and a sufficiently lengthy examination time, setting clearly defined leg elevations, maintaining an unvarying temperature in the room, and ensuring accurate probe placement (18,36). Another limitation could be a relatively small number of enrolled patients or evaluated angiosomes but based on study power analysis all assessed parameters had in our study sufficient powerf.e.…”

Section: Discussionmentioning

confidence: 99%

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Stimulation TcPO2 Testing Improves Diagnosis of Peripheral Arterial Disease in Patients With Diabetic Foot

et al. 2021

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BackgroundAll diagnostic procedures of peripheral arterial disease (PAD) in diabetic foot (DF) are complicated due to diabetes mellitus and its late complications.The aim of our study is to enhance diagnosis of PAD using a novel transcutaneous oximetry (TcPO2) stimulation test.MethodsThe study comprised patients with mild-to-moderate PAD(WIfI–I 1 or 2) and baseline TcPO2 values of 30-50 mmHg.TcPO2 was measured across 107 different angiosomes. Stimulation examination involved a modification of the Ratschow test. All patients underwent PAD assessment (systolic blood pressures (SBP), toe pressures (TP), the ankle-brachial indexes (ABI) and toe-brachial indexes (TBI), duplex ultrasound of circulation). Angiosomes were divided into two groups based on ultrasound findings: group M(n=60) with monophasic flow; group T(n=47) with triphasic flow. Large vessel parameters and TcPO2 at rest and after exercise (minimal TcPO2, changes in TcPO2 from baseline (Δ,%), TcPO2 recovery time) measured during the stimulation test were compared between study groups.ResultsDuring the TcPO2 stimulation exercise test, group M exhibited significantly lower minimal TcPO2 (26.2 ± 11.1 vs. 31.4 ± 9.4 mmHg; p<0.01), greater Δ and percentage decreases from resting TcPO2 (p=0.014 and p=0.007, respectively) and longer TcPO2 recovery times (446 ± 134 vs. 370 ± 81ms;p=0.0005) compared to group T. SBPs, TPs and indexes were significantly lower in group M compared to group T. Sensitivity and specificity of TcPO2 stimulation parameters during PAD detection increased significantly to the level of SBP, ABI, TP and TBI.ConclusionCompared to resting TcPO2, TcPO2 measured during stimulation improves detection of latent forms of PAD and restenosis/obliterations of previously treated arteries in diabetic foot patients.Clinical Trial RegistrationClinicalTrials.gov [https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0009V7W&selectaction=Edit&uid=U0005381&ts=2&cx=3j24u2], identifier NCT04404699

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Section: Discussionmentioning

confidence: 99%

“…Prior to measurement, subjects were required to rest in a quiet room maintained at a temperature of 20°C and to abstain from the use of tobacco and alcohol. TcPO 2 was subsequently measured in respective angiosomes (Figure 1) (18,19).…”

Section: Tcpo2mentioning

confidence: 99%

Stimulation TcPO2 Testing Improves Diagnosis of Peripheral Arterial Disease in Patients With Diabetic Foot

et al. 2021

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“…While healthy subjects have a slightly prolonged shape in the diastolic phase, people with diabetes usually have a bell-shaped PPG signal wave without a secondary peak. The arterial stiffness is caused by diabetes [29][30][31]. Stiffness index (SI) is a standard marker for significant arterial stiffness.…”

Section: Introductionmentioning

confidence: 99%

Non-Invasive Classification of Blood Glucose Level for Early Detection Diabetes Based on Photoplethysmography Signal

et al. 2022

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Monitoring systems for the early detection of diabetes are essential to avoid potential expensive medical costs. Currently, only invasive monitoring methods are commercially available. These methods have significant disadvantages as patients experience discomfort while obtaining blood samples. A non-invasive method of blood glucose level (BGL) monitoring that is painless and low-cost would address the limitations of invasive techniques. Photoplethysmography (PPG) collects a signal from a finger sensor using a photodiode, and a nearby infrared LED light. The combination of the PPG electronic circuit with artificial intelligence makes it possible to implement the classification of BGL. However, one major constraint of deep learning is the long training phase. We try to overcome this limitation and offer a concept for classifying type 2 diabetes (T2D) using a machine learning algorithm based on PPG. We gathered 400 raw datasets of BGL measured with PPG and divided these points into two classification levels, according to the National Institute for Clinical Excellence, namely, “normal” and “diabetes”. Based on the results for testing between the models, the ensemble bagged trees algorithm achieved the best results with an accuracy of 98%.

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“…6,7,8 Non invasive diagnostic modalities like measurement of Ankle Brachial Index (ABI), Doppler ultrasonography, CT angiogram are recommended to diagnose PAD and also Orginal Article know the spectrum of PAD. 9 For medical management, patient are usually prescribed with statins like Atorvastatin, antiplatelet agent like Aspirin and Cilastazole. 10,11 Major Adverse Limb Events (MALE) in LEAD was found to be 2% in one major trial.…”

Section: Introductionmentioning

confidence: 99%

Analysis/Spectrum of admitted cases of lower extremity arterial disease (LEAD) in University Hospital of Nepal

et al. 2021

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Introduction: Peripheral arterial disease is a condition due to partial or complete occlusion of arteries excluding that of heart and brain. Lower extremity arterial disease is specific to lower limbs. Some of the patients are asymptomatic while a majority present with claudication, rest pain, ulceration or even gangrene. Methods: We took all admitted cases of lower extremity arterial disease from January, 2015 to December 2018. ABI was used as the first clinical tool for the diagnosis of PAD in patients with history or physical examination findings suggestive of PAD as per AHA guidelines. Outpatient arterial Doppler ultrasonography complemented by lower limb CT angiogram was used as a confirmatory tool for the diagnosis and also to assess anatomical location and severity of stenosis. Results: Total of 54 cases of lower extremity arterial diseases were identified with a mean age of 59.2 years (S.D. 11.4). Right lower limb was involved in 35(50%). Mean age was 58 years(SD 13.1). Mean duration of symptom was 3.4 years (SD 3.3). Claudication was present in all the patients. 32(45.7%) had ulcers. Toe(44.3%) was most commonly involved. Decreased local temperature(91.4%) and color change(87.1%) were major symptoms. 35(50%) of the patients had gangrene. Mean peak systolic velocity was lowest in the peroneal artery. 16.6% patients got additional peripheral bypass surgery. Conclusion: Claudication, decreased local temperature and color change were very common findings of lower extremity arterial disease. Gangrene was present in half of the patients.

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Noninvasive Diagnostic Methods for Better Screening of Peripheral Arterial Disease

Cited by 13 publications

References 44 publications

Stimulation TcPO2 Testing Improves Diagnosis of Peripheral Arterial Disease in Patients With Diabetic Foot

Stimulation TcPO2 Testing Improves Diagnosis of Peripheral Arterial Disease in Patients With Diabetic Foot

Non-Invasive Classification of Blood Glucose Level for Early Detection Diabetes Based on Photoplethysmography Signal

Analysis/Spectrum of admitted cases of lower extremity arterial disease (LEAD) in University Hospital of Nepal

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