TBI or not TBI: that is the question. Is it better to measure toe pressure than ankle pressure in diabetic patients?

Brooks, Belinda; Dean, Richard T.; Patel, Sanjay; Wu, Bo; Molyneaux, Lynda; Yue, Dennis K.

doi:10.1046/j.1464-5491.2001.00493.x

Cited by 192 publications

(154 citation statements)

References 6 publications

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“…Reduction of ABI is widely used for screening lower-limb PAD (19). However, one of the limitations of this method is that PAD patients with arterial calcification show an increase, instead of decrease, in ABI (20). Combined measurements of ABI and baPWV may increase the diagnostic power in screening PAD.…”

Section: Discussionmentioning

confidence: 99%

Pulse Wave Velocity in Lower-Limb Arteries among Diabetic Patients with Peripheral Arterial Disease.

Yokoyama

Shoji

Kimoto

et al. 2003

JAT

116

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Objective: Patients with type 2 diabetes mellitus are at an increased risk of atherosclerosis including peripheral arterial disease (PAD). The purpose of this study was to examine the possible alteration in pulse wave velocity (PWV) in lower-limb arteries among diabetic patients with PAD. Methods: We measured brachial-ankle PWV (baPWV) using an automatic device in 101 healthy control subjects and 102 type 2 diabetic patients including those with PAD. Results: Diabetic patients without PAD showed a higher baPWV than the healthy control subjects. There was no significant difference in baPWV between the right and left legs in these groups. In contrast, among diabetic patients with PAD, baPWV was significantly lower in the affected legs than in the non-affected legs, and the reduction in baPWV was greater in those with lower ankle-brachial pressure index (ABI). In the patients with PAD who received percutaneous transluminal angioplasty, both baPWV and ABI were increased following successful vessel dilatation. Conclusions: These results suggest that baPWV is increased in diabetic patients, whereas it is decreased in the affected legs in diabetic patients with PAD. Widening of the right-left difference in baPWV may be a novel marker of PAD. J Atheroscler Thromb, 2003; 10: 253-258.

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Section: Discussionmentioning

confidence: 99%

Pulse Wave Velocity in Lower-Limb Arteries among Diabetic Patients with Peripheral Arterial Disease.

Yokoyama

Shoji

Kimoto

et al. 2003

JAT

116

View full text Add to dashboard Cite

show abstract

“…[72] Certainly its use in patients with diabetes mellitus has been criticized because arterial medial calcification may cause spuriously elevated ankle pressures, even more so in patients with ESRD. [70,71,73,74] This potential underestimation of peripheral arterial disease may be circumvented by measuring toe pressures, but such measurement requires more sophisticated equipment and trained personnel. [70,71,73,74] Transcutaneous oxygen pressure (TcPO 2 ), Duplex imaging, and angiography represent further modalities used in a more comprehensive evaluation of peripheral circulation, especially prior to revascularization.…”

Section: The Diabetic Foot In Renal Failure: Examination and Risk Estmentioning

confidence: 99%

“…[70,71,73,74] This potential underestimation of peripheral arterial disease may be circumvented by measuring toe pressures, but such measurement requires more sophisticated equipment and trained personnel. [70,71,73,74] Transcutaneous oxygen pressure (TcPO 2 ), Duplex imaging, and angiography represent further modalities used in a more comprehensive evaluation of peripheral circulation, especially prior to revascularization. [33,70,71] Diabetic neuropathy is also diagnosed clinically.…”

Section: The Diabetic Foot In Renal Failure: Examination and Risk Estmentioning

confidence: 99%

The Diabetic Foot in End Stage Renal Disease

et al. 2007

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Diabetic foot lesions remain a major cause of morbidity in patients with renal failure, especially those on dialysis. Foot complications are encountered at a more than twofold frequency in diabetic patients with end-stage renal disease, and the rate of amputations is 6.5-10 times higher in comparison to the general diabetic population. The causal pathways of the diabetic foot in renal failure are multiple and inter-related. Three major pathologies-neuropathy, ischemia, and infection-are the main contributory factors. Increased awareness of this condition and careful clinical examination are indispensable to avoid serious complications. Appropriate management needs to address all contributory factors. Treatment options include revascularization, off-loading to relieve high-pressure areas, and aggressive control of infection. Equally important is the collaboration between health care providers in a multidisciplinary foot care setting. Moreover, patient education on the measures required to achieve both primary and secondary prevention is of great value. Certainly, technical innovations have made considerable progress possible, but there is a need for further improvement to reduce the number of amputations.

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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).…”

mentioning

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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TBI or not TBI: that is the question. Is it better to measure toe pressure than ankle pressure in diabetic patients?

Cited by 192 publications

References 6 publications

Pulse Wave Velocity in Lower-Limb Arteries among Diabetic Patients with Peripheral Arterial Disease.

Pulse Wave Velocity in Lower-Limb Arteries among Diabetic Patients with Peripheral Arterial Disease.

The Diabetic Foot in End Stage Renal Disease

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

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