Validation study of automated oscillometric measurement of the ankle-brachial index for lower arterial occlusive disease by comparison with computed tomography angiography

Abstract

The ankle-brachial index (ABI) determined by the oscillometric method has been shown to reliably detect peripheral arterial disease (PAD), with highly correlations with the Doppler method. However, most of these studies were shown in cohorts with a small number of PAD patients, and no imaging studies have been performed. The purpose of this study is to evaluate the diagnostic accuracy and optimal threshold of oscillometric ABI for detecting PAD using computed tomography angiography (CTA) as a gold standard in a cohort that consists mostly of PAD patients. This retrospective study included 108 consecutive patients with 216 limbs. ABI measured by an oscillometric device was compared with CTA. The diagnostic accuracy of oscillometric ABI to detect ≥50% and ≥75% stenosis confirmed by CTA and the optimal ABI cutoff values were evaluated using receiver operating characteristic (ROC) curve analysis. The oscillometric ABI could not be measured in nine limbs. The mean ABI was 0.72±0.31. The areas under the ROC curves (AUCs) for detecting ≥50% and ≥75% stenosis with oscillometric ABI were 0.919 and 0.918, respectively. The optimal ABI cutoff values to detect these levels of stenosis were 0.99 (sensitivity, 90%: specificity, 85%) and 0.87 (sensitivity, 84%: specificity, 89%), respectively. If patients with diabetes mellitus (DM) were analyzed separately, the AUC for detecting ≥75% stenosis was 0.888. Oscillometric ABI had a high diagnostic accuracy to detect PAD using CTA as a gold standard. The diagnostic ability of ABI to detect PAD could be impaired by the presence of DM.

The accuracy of an oscillometric ankle-brachial index in the diagnosis of lower limb peripheral arterial disease: A systematic review and meta-analysis

“…In ours, only the Doppler ABI calculation based in standard formulas or not and diabetes achieved statistical significance in dOR to explain heterogeneity, in such a way that those studies with a standard Doppler calculation and those with a low prevalence of diabetes exhibited higher values of dOR. These findings emphasise the lack of accuracy of the oscillometric ABI in diabetic patients, as has been previously reported in studies using both ultrasound and angiographic confirmation . As meta‐regression analyses suggested, this lack of accuracy especially occurs at the expense of sensitivity, which emphasises the use of cut‐off values greater than 0.9 for diabetic patients (values between 1.0 and 1.1 have been suggested) .…”

“…previously reported in studies using both ultrasound and angiographic confirmation. 48,49 As meta-regression analyses suggested, this lack of accuracy especially occurs at the expense of sensitivity, which emphasises the use of cut-off values greater than 0.9 for diabetic patients (values between 1.0 and 1.1 have been suggested). 48 The physiological explanation seems to be calcification, which turns the artery wall rigid and poorly compressible, making ABI less reliable, especially for the oscillometric method.…”

Metabolomic signature of arterial stiffness in male patients with peripheral arterial disease

“…The AngSc is negatively correlated with maximum treadmill walking distance 12 and ankle-brachial pressure index (ABPI), 13 which is a functional measure of the severity of PAD. 14 Furthermore, AngSc is an independent risk factor for major amputation in diabetic subjects with PAD. 15 Previous studies have shown that PAD is associated with metabolic dysbalances 16 and AS.…”

Detection of peripheral arterial disease with an improved automated device: comparison of a new oscillometric device and the standard Doppler method

“…However, several publications have advised to use ABI ≤1 for oscillometric techniques. 14 – 17 In that case, MESI device reached 85% of sensitivity and 96% specificity to detect PAD in at least one leg.…”

“… 18 However, several authors have reported that using a cutoff value closer to 1 was better to diagnose PAD surely because of the systematic small overestimation of oscillometric method. 14 – 17 When using 1 as a cutoff value, the MESI ABPI MD device sensitivity was 85% and 96% for specificity showing excellent detection of PAD. In our study, PAD diagnosis was solely based on Doppler ABI results.…”