The importance of community screening of asymptomatic elderly for peripheral arterial disease by Doppler ultrasound and ankle-brachial index

Abstract

BackgroundPeripheral arterial disease is an atherosclerotic disease characterized by an increase in morbidity and mortality. For these reasons early diagnosis of peripheral arterial disease is important. Ankle-brachial systolic pressure index measurement is frequently used in screening studies. Evaluating waveforms of distal lower extremities with Doppler ultrasound can be used as a screening program and provides more accurate information on peripheral arterial disease.AimWe investigate the prevalence of peripheral arterial disease, compare the efficacy of Doppler ultrasound evaluation of distal lower extremity waveforms and ankle-brachial systolic pressure index measurement in screening programs, and discuss the importance of early diagnosis of asymptomatic cases.Material and methodsA total of 457 patients over the age of 65 (between 65 and 94, mean age: 71.4) including 270 males and 187 females were examined with Doppler ultrasound, had ankle-brachial systolic pressure index measurement taken and were screened for peripheral arterial disease. The correlation between Doppler ultrasound findings and ankle-brachial systolic pressure index was examined.ResultsAccording to the Doppler ultrasound findings, in the aortoiliac (r = 0.648) and femoropopliteal (r = 0.564) area, there is a medium level of correlation between severe stenosis and occlusions and a low ankle-brachial systolic pressure index value, and a low level of correlation between such abnormalities in the tibioperoneal region (r = 0.116) and a low ankle-brachial systolic pressure index value. Therefore, while the sensitivity of ankle-brachial systolic pressure index increases in proximal stenosis, it decreases in distal stenosis.ConclusionDespite the fact that ankle-brachial systolic pressure index is a diagnostic test commonly used in screening studies, evaluation of distal arteries by means of Doppler ultrasound provides more accurate information in terms of the identification of peripheral arterial disease.

Peripheral Artery Disease Diagnosed by Pulse Palpation as a Predictor of Coronary Artery Disease in Patients with Chronic Kidney Disease

“…We considered Doppler with stenosis ≥ 50% as the gold standard, as we were interested in verifying whether the palpation method could replace Doppler in the identification of patients with severe vasculopathy [ 19 ]. In the general population, both methods were used separately to diagnose PAD in individuals with subclinical arteriosclerosis [ 16 , 20 ]. To the best of our knowledge, this is the first study in the clinical area that compares the use of Doppler and pulse palpation in identifying PAD and predicting CAD.…”

“…A prespecified comprehensive cardiovascular investigation was performed, as has been reported [ 16 ]. Patients underwent a 12-lead resting EKG and a transthoracic echocardiogram as part of their evaluation.…”

“…Significant CAD was arbitrarily defined as luminal stenosis ≥70% in one or more epicardial arteries or a 50% narrowing of a main left coronary artery by visual estimation from two independent experts. PAD was defined as either absence of a pulse in at least one of the main distal arteries of the lower limb (anterior and posterior tibial arteries) according to the same investigator or at least a 50% narrowing on the same vessels, as assessed by arterial Doppler ultrasound performed by an examinator blinded on the clinical vascular condition of the patient using the standard methodology routinely applied in our institution [ 16 ].…”

“…The “gold standard” is angiography, which is indicated for those patients in whom a non-invasive test suggests significant vascular obstruction or when there is clear clinical evidence of severe disease [ 14 , 15 ]. Among the non-invasive methods, arterial Doppler ultrasound (USD) stands out as the most used due to its relatively low cost and availability in most services [ 16 ].…”

Oxidative Stress and Inflammation Markers Associated with Multiple Peripheral Artery Occlusions in Elderly Patients

“…In this research, we evaluated the relationships among oxidative stress, pro-inflammatory MIME/NF-κB/P53/TLR4 signaling pathway, and multiple peripheral artery occlusions in older patients. Studies show that peripheral artery occlusion occurs at an advanced stage of atherosclerosis and peripheral artery occlusion is defined as atherosclerotic occlusions of the lower limb arteries (chronic total occlusions of iliac, popliteal, and femoral arteries) 14,[66][67][68][69][70] presented with asymptomatic chronic total occlusions of lower limb arteries (the elderly patients with peripheral artery occlusions are often asymptomatic) 14,[66][67][68][69][70] and different clinical symptoms, including limb intermittent claudication, ischemic lower extremity pain, chronic ischemic rest pain, absence of lower limb arterial pulse, lower abdominal pain and lower limb swelling, or ischemic ulcers and gangrene in the lower extremities. 14,[66][67][68][69][70][71] Advanced atherosclerosis is further defined as artery chronic total occlusions with no antegrade artery blood flow that is present for >3 months and chronic total occlusive lesions are characterized by necrotic cores in atherosclerotic plaques, bifurcation occlusions, longer occlusive lesions, occlusions with calcification, and adverse arterial remodeling.…”