An elevated ankle-brachial index is not a valid proxy for peripheral medial arterial calcification

Objective: We conducted a prospective pilot study in patients with diabetes to analyse the interobserver reliability of the ankle–brachial index, toe–brachial index and distal pulse palpation depending on the training of the professional involved. Materials and Methods: The ankle–brachial index, toe–brachial index and distal pulses were assessed by three clinicians with different levels of experience on the same day. Measurements were supervised and recorded by a fourth clinician. Results: Twenty-one patients (42 ft) were included in this study. We observed moderate agreement between clinicians in the palpation of posterior tibial arteries (K = 0.45, p < 0.001) and low agreement in dorsalis pedis arteries (K = 0.33, p < 0.001). The measurement of ankle–brachial index had moderate agreement between clinicians in patients with medial arterial calcification (K = 0.43, p < 0.001) and low agreement in patients with normal ankle–brachial index (K = 0.4, p < 0.001). The measurement of toe–brachial index had moderate agreement between clinicians in patients with a normal toe–brachial index (K = 0.4, p < 0.001) and in patients with medial arterial calcification (K = 0.60, p < 0.001). Conclusion: Palpation of distal pulses, ankle–brachial index and toe–brachial index determination in patients with diabetes are not highly reproducible and reliable between clinicians with different levels of experience under routine conditions.

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Aortoiliac and femoropopliteal lesions in patients with concomitant peripheral arterial disease and medial arterial calcification

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/s-2007-988963 ◽

2007 ◽

Vol 28 (S 1) ◽

Author(s):

S Crisan ◽

D Crisan ◽

S Vesa ◽

M Chirila ◽

C Pestrea ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Arterial Disease ◽

Arterial Calcification ◽

Peripheral Arterial ◽

Medial Arterial Calcification

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Effect of medial arterial calcification on O2 supply to exercising diabetic feet

Diabetes ◽

10.2337/diabetes.39.8.938 ◽

1990 ◽

Vol 39 (8) ◽

pp. 938-941 ◽

Cited By ~ 4

Author(s):

E. Chantelau ◽

X. Y. Ma ◽

S. Herrnberger ◽

C. Dohmen ◽

P. Trappe ◽

...

Keyword(s):

Arterial Calcification ◽

O2 Supply ◽

Medial Arterial Calcification

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Association of infrapopliteal medial arterial calcification with lower-limb amputations in high-risk patients: A systematic review and meta-analysis

Vascular Medicine ◽

10.1177/1358863x20979738 ◽

2020 ◽

pp. 1358863X2097973

Author(s):

Fabrizio Losurdo ◽

Roberto Ferraresi ◽

Alessandro Ucci ◽

Anna Zanetti ◽

Giacomo Clerici ◽

...

Keyword(s):

Risk Factor ◽

High Risk ◽

Lower Limb ◽

Fixed Effects ◽

Meta Analysis ◽

Arterial Calcification ◽

High Risk Patients ◽

Patients With Diabetes ◽

Risk Patients ◽

Medial Arterial Calcification

Medial arterial calcification (MAC) is a known risk factor for cardiovascular morbidity. The association between vascular calcifications and poor outcome in several vascular districts suggest that infrapopliteal MAC could be a risk factor for lower-limb amputation (LLA). This study’s objective is to review the available literature focusing on the association between infrapopliteal MAC and LLA in high-risk patients. The PubMed and Embase databases were systematically searched. We selected original studies reporting the association between infrapopliteal MAC and LLAs in patients with diabetes and/or peripheral artery disease (PAD). Estimates were pooled using either a fixed-effects or a random-effects model meta-analysis. Heterogeneity was evaluated using the Q and I2 statistics. Publication bias was investigated with a funnel plot and Egger test. The trim-and-fill method was designed to estimate the possibly missing studies. Influence analysis was conducted to search studies influencing the final result. Test of moderators was used to compare estimates in good versus non-good-quality studies. Fifteen articles satisfied the selection criteria ( n = 6489; median follow-up: 36 months). MAC was significantly associated with LLAs (pooled adjusted risk ratio (RR): 2.27; 95% CI: 1.89–2.74; I2 = 25.3%, Q-test: p = 0.17). This association was kept in the subgroup of patients with diabetes (RR: 2.37; 95% CI: 1.76–3.20) and patients with PAD (RR: 2.48; 95% CI: 1.72–3.58). The association was maintained if considering as outcome only major amputations (RR: 2.11; 95% CI: 1.46–3.06). Our results show that infrapopliteal MAC is associated with LLAs, thus suggesting MAC as a possible new marker of the at-risk limb.

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Medial Arterial Calcification

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2021.06.049 ◽

2021 ◽

Vol 78 (11) ◽

pp. 1145-1165

Author(s):

Peter Lanzer ◽

Fadil M. Hannan ◽

Jan D. Lanzer ◽

Jan Janzen ◽

Paolo Raggi ◽

...

Keyword(s):

Arterial Calcification ◽

Medial Arterial Calcification

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Abstract 3115: Ankle Brachial Pressure Index (ABI) Is A Better Predictor Of Cardiovascular Mortality Than Toe-Brachial Index (TBI) Or Abnormal Doppler Flow Curves In Both Diabetic And Non-diabetic Subjects: The Hoorn Study.

Circulation ◽

10.1161/circ.116.suppl_16.ii_698-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Maya S Huijberts ◽

Isabel Ferreira ◽

Nicolaas C Schaper ◽

Jacqueline M Dekker ◽

Giel Nijpels ◽

...

Keyword(s):

High Risk ◽

Cardiovascular Mortality ◽

Proportional Hazards ◽

Independent Predictor ◽

Ankle Brachial Index ◽

Cox Proportional Hazards ◽

Arterial Calcification ◽

Flow Curves ◽

Doppler Flow ◽

Toe Brachial Index

Introduction: Individuals with peripheral arterial disease (PAD) have a high risk of future cardiovascular events. Many studies have demonstrated that low (<0.9) Ankle Brachial Index (ABI) predicts cardiovascular mortality in both diabetic and non-diabetic subjects. However, in diabetic subjects the measurement of the ABI is complicated by the presence of medial arterial calcification which results in falsely elevated ABI-values despite the presence of significant PAD. Therefore, we investigated whether the Toe-Brachial Index (TBI) or abnormal Doppler flow curves would be better predictors of PAD-associated cardiovascular mortality (CVM). Methods: Associations between measures of PAD and CVM were studied in an age-, sex,- and glucose tolerance stratified sample (n = 631) of a population based cohort aged 50 –75 years followed for 15 years. Measures included Doppler assisted ABI, flow velocity tracings of the femoral, popliteal and crural arteries and measurement of the TBI. Predictors of CVM were determined by Cox proportional hazards multiple regression analysis. Results are described as hazards ratios (HR) and 95% confidence intervals (CI). Results : At baseline ABI < 0.9 was present in 10.5% (6.9% in non-diabetic vs 17.2% in diabetic individuals), TBI < 0.7 was present in 21.0% (18.9% vs 24.3%), and abnormal Doppler flow curves in 20.3% (16.0% vs 29.3%). After 15 years of follow-up 141 patients had died of cardiovascular causes. After adjusting for age, sex, hypertension, total and HDL-cholesterol, triglycerides, BMI and smoking, HR (95% CI) were 3.19 (1.91–5.34) P<0.001 for ABI<0.9, 2.80 (0.97– 8.05) P=0.056 for presence of abnormal flow-curves, and 1.58 (0.97 – 2.57) P=0.068 for TBI<0.7. When entering the three measures simultaneously in the regression model only ABI<0.9 was an independent predictor of CVM, HR=2.81 (1.47 – 5.39) P=0.002. In diabetic individuals this effect was as least as strong, HR=3.30 (1.39 – 7.99) P=0.007. Conclusion: Although an ABI< 0.9 may underestimate the presence of PAD in individuals with type 2 diabetes, this measure is a powerful independent predictor of CVM in both diabetic and non-diabetic subjects. Assessment of the ABI should be used more often to identify high-risk patients, especially in the diabetic population.

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