Noninvasive localization of infrainguinal arterial occlusive disease in diabetics

Toursarkissian, Boulos; Mejía, Alejandro; Smilanich, Robert P.; Schoolfield, John; Shireman, Paula K.; Sykes, Mellick T.

doi:10.1007/bf02693804

Cited by 29 publications

(3 citation statements)

References 11 publications

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“…The International Consensus on the Diabetic Foot (ICDF) guidelines suggested that an ABPI of 1.15 be the upper limit above which measurements are deemed unreliable (6). The TBI is then an alternative test, but the influence of arterial calcification and neuropathy on toe pressures is uncertain (7)(8)(9)(10)(11).…”

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confidence: 99%

An Evaluation of the Efficacy of Methods Used in Screening for Lower-Limb Arterial Disease in Diabetes

2005

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OBJECTIVE -Foot-related disease is the most common cause for hospital admission among the diabetic population. Lower-limb peripheral arterial occlusive disease (PAOD) is a major risk factor in diabetic foot disease. Screening for PAOD commonly includes foot pulses and the ankle-brachial pressure index (ABPI) and/or the toe-brachial pressure index (TBI), but concerns persist regarding their accuracy. We evaluated the efficacy of several commonly used screening methods in different subject populations.RESEARCH DESIGN AND METHODS -We studied 130 limbs in 68 individuals with no critical ischemia over 8 months. Limbs were grouped on the basis of the presence or absence of diabetes, clinically detectable peripheral neuropathy, and PAOD identified on color duplex imaging. Comparative analyses of foot pulses, the ABPI, the TBI, and distal Doppler waveform analysis were performed.RESULTS -Foot pulses, the TBI, and qualitative waveform analyses were highly sensitive screening methods in individuals with and without diabetes. However, detectable peripheral neuropathy was associated with a reduced sensitivity and poor specificity of foot pulses, a reduction in sensitivity of the ABPI (71 to 38%), and a reduction in specificity of the TBI (81 to 61%) and qualitative waveform analysis (96 to 66%). Quantitative analysis failed to detect disease with severely damped and low-intensity signals.CONCLUSIONS -Screening tools that are effective in screening for lower-limb PAOD in the nondiabetic population are less efficacious in diabetes, particularly in the presence of detectable peripheral neuropathy. Qualitative waveform analysis and the TBI were demonstrated to be more effective screening methods than the ABPI and foot pulses particularly in high-risk limbs with detectable peripheral neuropathy. Diabetes Care 28:2206 -2210, 2005F oot-related disease is the most common cause for hospital admission among the diabetic population and is recognized as the most common cause of nontraumatic lower-limb amputation in the western world. People with diabetes are Ͼ20 times more likely to undergo an amputation than the rest of the population (1). The main risk factors for the development of diabetic foot disease are peripheral neuropathy and peripheral arterial occlusive disease (PAOD). The detection of significant arterial disease is vital to the prevention and treatment of foot disease. The unreliable nature of the symptoms and signs of lower-limb arterial insufficiency in diabetes means that noninvasive tests are essential to achieve effective screening (2,3). The European Working Group on Critical Leg Ischaemia recommends an additional, noninvasive vascular assessment for patients with diabetes and foot ulceration (4).Screening techniques commonly used in assessing lower-limb perfusion are the palpation of foot pulses and calculation of the ankle-brachial pressure index (ABPI) and/or the toe-brachial pressure index (TBI). There is continued debate regarding the influence of peripheral neuropathy and arterial calcification on the reliabil...

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An Evaluation of the Efficacy of Methods Used in Screening for Lower-Limb Arterial Disease in Diabetes

2005

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“…The Toe Brachial Index (TBI) is a possible alternative to ABPI, however the microvasculature is not immune from calcification 7,9 and the TBI is subject to the same limitations as ABPI when ulcers, calluses, fragile skin and toe amputations are present. 10 The late diagnosis or undetected progression of PAD can shorten the available window for preventative management having costly impacts upon a patient's quality of life and life expectancy, along with healthcare budgets; current estimates for diabetic care equate to 10% of NHS expenditure. 11 With the limitations of ABPI/TBI in mind, an alternative to cuff compression techniques is therefore ideal and the use of DUS derived blood waveform analysis may be the answer.…”

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confidence: 99%

Duplex ultrasound derived maximal systolic acceleration can be a reliable and rapid alternative to ankle brachial pressure indices for the diabetic population with lower extremity arterial disease; a prospective, observational cohort study

Williamson

Bartlett

Desai

2022

JRSM Cardiovascular Disease

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Objectives: Ankle brachial pressure index (ABPI) is limited for diabetic patients. This can have costly impacts upon patient's quality of life along with healthcare budgets, with diabetic care equating to approximately 10% of NHS expenditure.11 We aimed to determine whether ultrasound waveform parameters are an alternative for quantifying lower extremity peripheral arterial disease (PAD) where ABPI is unreliable. Design: This was a prospective, observational study. Waveform parameters, systolic rise time (SRT), maximal systolic acceleration (AccMax) and peak systolic velocity (PSV) were recorded at ankle and compared to the ABPI and an aorta-ankle duplex ultrasound scan (DUS) as gold standard. Setting: Measurements were obtained by a Clinical Vascular Scientist at the Royal Free Hospital. Participants: Participants (≥18yrs) with known PAD, but without previous vascular intervention were allocated to non-diabetic control ( n = 24) and diabetic test groups ( n = 22). Outcome measures: The primary outcome measure was the correlation of novel ultrasound derived indices to PAD severity. The secondary outcome was the efficacy of this correlation in the diabetic population. Results: AccMax was most powerful in detecting PAD in both groups when compared to ABPI in the controls ( r = 0.805; p < 0.01) and to DUS in control and test groups ( r = −0.633 to −0.643; p < 0.01). In the test group, PSV did not consistently quantify PAD. SRT measurements were inconclusive throughout. Conclusion: AccMax is a rapid alternative tool for diagnosing PAD in diabetic patients. With further research, this simple test may prove useful for monitoring PAD progression in patients unsuitable for ABPI, reducing the need for lengthy repeat duplex scans.

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Overview of Peripheral Arterial Disease of the Lower Extremity

AbuRahma

Campbell

2012

Noninvasive Vascular Diagnosis

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Noninvasive localization of infrainguinal arterial occlusive disease in diabetics

Cited by 29 publications

References 11 publications

An Evaluation of the Efficacy of Methods Used in Screening for Lower-Limb Arterial Disease in Diabetes

An Evaluation of the Efficacy of Methods Used in Screening for Lower-Limb Arterial Disease in Diabetes

Duplex ultrasound derived maximal systolic acceleration can be a reliable and rapid alternative to ankle brachial pressure indices for the diabetic population with lower extremity arterial disease; a prospective, observational cohort study

Overview of Peripheral Arterial Disease of the Lower Extremity

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