Ankle brachial index and pneumoplethysmographic pulse-volume recordings for detection of peripheral arterial disease

VASA ◽  
2014 ◽  
Vol 43 (3) ◽  
pp. 202-208 ◽  
Author(s):  
Jürgen Jahn ◽  
Werner Zimmermann ◽  
Theodoros Moysidis ◽  
Knut Kröger
Keyword(s):  
Sensitivity And Specificity ◽  
Ankle Brachial Index ◽  
Small Variation ◽  
Arterial Disease ◽  
Lower Limbs ◽  
Specific Method ◽  
Pulse Volume ◽  
Straightforward Method ◽  
Peripheral Arterial ◽  
Low Sensitivity

Background: The measurement of the ankle-brachial index (ABI) is a straightforward method for the detection of atherosclerosis in the lower limbs. Pneumoplethysmographic pulse-volume recordings (PVR) investigations are supposed to be less valid. Thus we compared the sensitivity of ABI and PVR in detection of PAD and its improvement by combining both methods. Patients and methods: 122 consecutive patients admitted for PAD treatment were included. All patients (81 females; mean age 70 ± 15 years) had angiographic imaging of their peripheral arteries, a standardized personal interview and a determination of the ABI based on the highest (ABI high) and lowest (ABI low) ankle pressure. PVR parameters were oscillometric index (OI) and time to normalisation (TN) after exercise. Results: There was a small variation of ABI with different segmental manifestations of PAD. The OI did not vary with different segmental manifestations. TN was longest in iliac artery manifestation and got shorter with more distal manifestation. Correlation of TN and ABI high and ABI low was low. Sensitivity of ABI high in all legs was 78 %, but only 40 % in isolated crural manifestation. ABI low has higher sensitivities with 87 % in all legs, but a much lower specificity. Combining ABI and TN increases both sensitivity and specificity. The best sensitivity and specificity was seen using ABI low + TN in combination in all kinds of manifestations with 94 % and 96 %, respectively. Conclusions: Combined assessment of ABI low and TN in post-exercise PVR seems to be a highly sensitive but also specific method to look for PAD compared to ABI high alone.

scholarly journals To Study the Sensitivity and Specificity of Ankle Brachial Index in Diagnosis of Peripheral Arterial Disease in Diabetics With Coronary Artery Disease at a Large Tertiary Care Teaching Hospital

2020 ◽  
pp. 29-33
Author(s):  
Dr. Sajad Hussain Bhat ◽  
Dr. Adil Majeed ◽  
Dr. Mohd Yousuf Dar ◽  
Mohd Yousuf Dar
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Peripheral Arterial Disease ◽  
Sensitivity And Specificity ◽  
Teaching Hospital ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Diabetic Patients ◽  
Artery Disease ◽  
Peripheral Arterial

The aim of study was to determine the sensitivity and specificity of ankle brachial index in diagnosis of peripheral arterial disease in diabetics with coronary artery disease at a teaching hospital in North India. Materials and methods: All diabetic patients admitted with coronary artery disease who undergo coronary angiography irrespective of their presentation (stable angina, unstable angina, NSTEMI, STEMI) were included in the study. Systolic blood pressures of both arms at the brachial arteries and both lower limbs at the dorsalis pedis arteries were taken with the help of sphygmomanometer and a hand held doppler probe and recorded in the proforma. The higher of the two systolic pressures recorded at the ankle was divided by the highest of the systolic pressures recorded in the arms to get the ankle brachial index. The results of ABI were compared with peripheral angiography.

Abstract 3078: The Poor Prognosis of Diabetic Patients with High Ankle-Brachial Index Depends on the Presence of Masked Peripheral Arterial Disease

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Victor Aboyans ◽  
Minh Hoang Tran ◽  
Claire Salamagne ◽  
Francoise Archambeaud ◽  
Michael H Criqui ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Primary Endpoint ◽  
Poor Prognosis ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Lower Limbs ◽  
Diabetic Patients ◽  
Cvd Risk ◽  
The Poor ◽  
Peripheral Arterial

Background: A high ankle-brachial index (ABI >1.40) is associated with poor prognosis. An underlying peripheral arterial disease (PAD) is frequent in diabetic patients with high ABI, although it cannot be adequately diagnosed by the ankle pressure measurement, due to stiff arteries. We hypothesized that in diabetic patients, the poor cardiovascular disease (CVD) prognosis associated with high ABI would depend on the coexistence of masked PAD. Methods: We reviewed the data of 403 consecutive diabetic patients who had a Doppler assessment of their lower limbs between 1999 and 2000. They were classified as “normal” when Doppler waveform patterns (DWP) were normal and ABI within the 0.91–1.39 range, “PAD only” in case of ABI ≤0.90, “stiff only” if ABI ≥1.40 with normal DWP, and “mixed disease” when ABI ≥1.40 with abnormal DWP. Patients were followed until 04/2008. The primary endpoint was the occurrence of any of the following events: death, stroke or myocardial infarction. Results: The patients (age: 65.6 ± 13.2 yrs, 54.6% females; 90.2% type-2 diabetes) were classified as “normal” (14.4%), “PAD only” (48.4%), “stiff only” (16.4%) and “mixed disease” (20.8%). During a mean follow-up of 6.5 years, the event-free survival curves of “PAD only” and “mixed disease” groups showed poorer prognosis than the “stiff only” and “normal” groups (figure ). In a model adjusted for age, sex, diabetes type and duration, traditional CVD risk factors, renal failure and CVD history, only the presence of PAD was significantly associated with the primary endpoint (OR: 3.36 (1.25 – 4.44), p=0.008). Conclusions: In diabetic patients with high ABI (>1.40), only those with an associated PAD have a poorer prognosis.

scholarly journals Physiotherapeutic intervention in peripheral arterial disease by functional hyperemia in diabetic patients

2015 ◽  
Vol 28 (4) ◽  
pp. 731-740
Author(s):  
Cristiane Wichnieski ◽  
Flávia Natacha Salvatori Kirchhof ◽  
Pedro Cezar Beraldo ◽  
Luiz Bertassoni Neto ◽  
Christian Campos Jara
Keyword(s):  
Peripheral Arterial Disease ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Lower Limbs ◽  
Walking Distance ◽  
Diabetic Patients ◽  
Functional Hyperemia ◽  
Peripheral Vascular ◽  
Vascular Disorders ◽  
Peripheral Arterial

Abstract Introduction : Diabetes Mellitus (DM) is conceptualized as a public health problem with varying degrees of morbidity. The physical and functional alternatives for the treatment of circulatory complications of diabetes, such as intermittent claudication, are poorly explored. This indicates the need to search for ancillary techniques that can be used in the physical therapy treatment of diabetic patients. Objective : To investigate the effects of functional hyperemia on peripheral arterial disease in patients with diabetes. Materials and methods: This study was conducted with a group of five volunteers from the Diabetics Association of Parana (Associação Paranaense do Diabético , APAD ), who suffered from peripheral vascular disorders in the lower limbs. All subjects attended 10 sessions (twice weekly). Functional hyperemia was induced by programmed exercise therapy that consisted of walking on a treadmill. Results : There was a significant increase in mean activity time (F9,36 = 13.710; p < 0.001 ), mean walking distance (F9,36 = 27.689 ; p < 001), and mean speed (F9,36 = 15.638 ; p < .001). No statistically significant differences in the ankle-brachial index were noted. Conclusion : There was a significant increase in walking distance, time, and speed for diabetic subjects. Our findings indicate the importance of physical therapists in the supervised treatment of peripheral vascular disorders in diabetic patients.

scholarly journals PERIPHERAL ARTERIAL DISEASE

2012 ◽  
Vol 19 (04) ◽  
pp. 501-507
Author(s):  
ATIF SITWAT HAYAT ◽  
MOHAMMAD ADNAN BAWANY ◽  
GHULAM HUSSAIN BALOCH ◽  
NAILA Shaikh
Keyword(s):  
Peripheral Arterial Disease ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Lower Limbs ◽  
Foot Ulcers ◽  
Non Invasive ◽  
Type 2 Diabetics ◽  
Arterial Pulses ◽  
Peripheral Arterial

Background: The increase in prevalence of type 2 diabetes and its complications is alarming. The incidence of diabetic footulcers due to peripheral arterial disease, which leads to foot amputations far too often, is unacceptably high especially in developing countries.This study has been conducted to find out frequency and degree of peripheral arterial disease in type 2 diabetics having foot ulcers at tertiarycare settings in Abbottabad. Methods: This was a prospective descriptive study-being conducted at Northern Institue of Medical Sciences(NIMS) and Ayub teaching hospital Abbottabad from August 2009 to June 2010. Type 2 diabetics with non-healing foot ulcers lasting longer thanten days, were selected for this study by non-probability purposive sampling method. All study subjects have undergone for palpation ofperipheral arterial pulses in the lower limbs. Ankle-brachial index (ABI) is the ratio of the systolic blood pressure at the ankle to that in the arm.Peripheral arterial disease (PAD) was considered to be present if ABI was less than 0.90. It was further graded as mild, moderate and severeaccording to ABI values between 0.70-0.90, 0.50-0.69 and less than 0.49 respectively, as per recommendations of American DiabetesAssociation. Results: A total of 83 type 2 diabetics with foot ulcers were enrolled during eleven months period of this study. The mean age ofstudy subjects was 53.68±9.51 years. There were 33 (39.75%) males and 50 (60.24%) females with M to F ratio of 1:1.51. Mean duration ofdiabetes was 13.67±5.80 years (ranging from 9-23 years). Majority 57 (68.67%) of our patients were obese having poor glycemic control.Peripheral arterial disease has been found in 35(42.16%) patients, out of them 18(51.42%) had mild PAD as their ABI values remained between0.70-0.90, 15(42.85%) had moderate PAD due to their ABI values between 0.50-0.69 and 2 (5.71%) had severe PAD as their ABI values liebelow 0.49. Conclusions: Ankle-brachial index is a non-invasive, inexpensive and office-based diagnostic tool for peripheral arterial diseasein type 2 diabetics having foot ulcers, Healthcare professionals must be trained about early referral and regular feet care of these patients.

scholarly journals Non-invasive assessment of peripheral arterial disease: Automated ankle brachial index measurement and pulse volume analysis compared to duplex scan

2016 ◽  
Vol 4 ◽  
pp. 205031211665908 ◽  
Author(s):  
Jane EA Lewis ◽  
Paul Williams ◽  
Jane H Davies
Keyword(s):  
Peripheral Arterial Disease ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Disease Diagnosis ◽  
Waveform Analysis ◽  
Duplex Scan ◽  
Cross Sectional ◽  
Pulse Volume ◽  
Index Measurement ◽  
Peripheral Arterial

Objectives: This cross-sectional study aimed to individually and cumulatively compare sensitivity and specificity of the (1) ankle brachial index and (2) pulse volume waveform analysis recorded by the same automated device, with the presence or absence of peripheral arterial disease being verified by ultrasound duplex scan. Methods: Patients (n=205) referred for lower limb arterial assessment underwent ankle brachial index measurement and pulse volume waveform recording using volume plethysmography, followed by ultrasound duplex scan. The presence of peripheral arterial disease was recorded if ankle brachial index <0.9; pulse volume waveform was graded as 2, 3 or 4; or if haemodynamically significant stenosis >50% was evident with ultrasound duplex scan. Outcome measure was agreement between the measured ankle brachial index and interpretation of pulse volume waveform for peripheral arterial disease diagnosis, using ultrasound duplex scan as the reference standard. Results: Sensitivity of ankle brachial index was 79%, specificity 91% and overall accuracy 88%. Pulse volume waveform sensitivity was 97%, specificity 81% and overall accuracy 85%. The combined sensitivity of ankle brachial index and pulse volume waveform was 100%, specificity 76% and overall accuracy 85%. Conclusion: Combining these two diagnostic modalities within one device provided a highly accurate method of ruling out peripheral arterial disease, which could be utilised in primary care to safely reduce unnecessary secondary care referrals.

Pole Test and Ankle-Brachial Index by Using Doppler Ultrasound for Peripheral Arterial Disease in End-Stage Renal Disease Patients

2020 ◽  
Vol 19 (4) ◽  
pp. 359-363
Author(s):  
Nutthanun Tungsrirut ◽  
Krittitee Taptiang ◽  
Kairawee Charoenkarn ◽  
Pavarit Piyachon ◽  
Pitipong Srisittipoj ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
End Stage Renal Disease ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Peripheral Arterial ◽  
Low Sensitivity ◽  
Stage Renal Disease ◽  
End Stage ◽  
Sensitivity Specificity ◽  
Esrd Patients

Peripheral arterial disease (PAD) causes great disability in end-stage renal disease (ESRD). Pole test is a simplified test utilizing the basis of Doppler ultrasound invented to correct false elevation in ankle-brachial index (ABI) in diabetic patients with severe calcification of the tibial artery. However, the role of pole test in ESRD patients is still unclear. The aim of this study was to explore the sensitivity, specificity, and overall utility of pole tests in such patients. One hundred and four patients were recruited and examined with 3 tests: pole test, ABI, and toe-brachial index, the latter serving as the gold standard. Receiver operating characteristic analysis was performed using SPSS version 22.0. The sensitivity, specificity, and other diagnostic values of ABI and pole tests were calculated. There were 104 ESRD patients enrolled. Pole tests showed to have low probability to provide accurate results (area under the curve = 0.505, standard error = 0.042). Low sensitivity of ABI (34.96%) can be observed in ESRD patients. Specificity, positive predictive value, and negative predictive value of ABI in all cases were, respectively, 85.91%, 81.13%, and 43.26%. It is concluded that pole test accuracy seemed to be limited in ESRD patients. ABI was found to be confounded by medial arterial calcification, resulting in low sensitivity as well. The results of this study permit the observation that an optimal tool for screening peripheral arterial disease in ESRD patients remains to be discovered.

Correlation between ankle-brachial index and thermography measurements in patients with peripheral arterial disease

Vascular ◽  
2021 ◽  
pp. 170853812199657
Author(s):  
Jesus Antônio de Carvalho Abreu ◽  
Rauirys Alencar de Oliveira ◽  
Airton Abrahão Martin
Keyword(s):  
Peripheral Arterial Disease ◽  
Strong Correlation ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Lower Limbs ◽  
Wilcoxon Test ◽  
Arterial Calcification ◽  
The Mean ◽  
Peripheral Arterial ◽  
Spearman’S Correlation

Objectives To correlate the ankle-brachial index and photographic thermography findings in patients with peripheral arterial disease. Methods Photographic thermography was performed at the foot level, and ankle-brachial index was measured in 72 lower limbs of 53 patients with peripheral arterial disease who were divided into calcified artery, patients with an ankle-brachial index greater than 1.4; and non-calcified artery classified as asymptomatic, mild, moderate, and severe on the basis of peripheral arterial disease severity. Fisher’s exact test was used for categorical data, and Wilcoxon test was used for numerical data. Results Spearman’s correlation analysis showed a strong correlation (R = 0.7) between the ankle-brachial index and the mean plantar temperature in patients without lower limb artery calcification. Linear regression yielded the predictor equation Y = 3.296 × X + 29.75, wherein ankle-brachial index (X) can be predicted on the basis of temperature values. Spearman’s correlation test showed no significance ( p = 0.2174) in patients with arterial calcification. Kruskal–Wallis test with post hoc analysis using Dunn’s test for multiple comparisons showed that the mean plantar temperature was lower in patients with arterial calcification. Conclusion Photographic thermography findings show a strong correlation with ankle-brachial index in patients with non-calcified arteries.

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