High tolerance of progressive elastic compression in peripheral 					arterial disease

Summary. Background: Theoretically progressive compression stockings, which produce a higher compression at the calf than at the ankle level, improve venous return flow without exacerbating peripheral arterial insufficiency (PAD). We aimed to evaluate the short-term tolerance of elastic progressive compression stockings on peripheral arterial vascularisation in patients with symptomatic PAD and associated mild venous insufficiency. Patients and methods: Monocentric, prospective, open pilot study of 18 patients (acceptability study, 6 x 6 plan) evaluating the short-term tolerance of progressive compression stockings (18 ± 2 mmHg at calf and 8 ± 2 mmHg at ankle level) in patients with PAD (ankle brachial index ABI > 0.60 < 0.75) and chronic venous insufficiency (C1s–C4 stages of the CEAP classification). Day 15 tolerance was evaluated by a composite primary criteria comprising: no decrease > 15 % of ABI on each side, no decrease > 15 % of toe brachial index (TBI) on each side and no decrease > 25 % of the number of active plantar flexions performed while standing. Results: The proportion of men was 77.8 %, mean age was 77.3 ± 7.5 years and no patient were diabetic. At inclusion, the mean low ABI was 0.60 ± 0.04 and the mean high ABI was 0.77 ± 0.18. The mean low TBI was 0.32 ± 0.09 and the mean high TBI 0.46 ± 0.15. The mean number of active standing plantar flexions was 33.0 ± 5.0. The majority of the patients were classified in CEAP C2s and C3 classes (class 2: 16.7 %, class C2s: 27.8 %, class C3: 44.4 %, class C4: 5.6 % and class C4s: 5.6 %). Poor tolerance occurred in no patient. By day 30, no patient had worsening of their arterial and venous symptoms. No adverse events occurred during the study. Conclusions: These results suggest a high tolerance of progressive elastic stockings (18 ± 2 mmHg at calf and 8 ± 2 mmHg at ankle level) in symptomatic PAD.

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Supervised exercise therapy in the management of peripheral arterial disease – an assessment of compliance

VASA ◽

10.1024/0301-1526/a000612 ◽

2017 ◽

Vol 46 (3) ◽

pp. 219-222 ◽

Cited By ~ 6

Author(s):

Thomas M. Aherne ◽

Elrasheid A. H. Kheirelseid ◽

Michael Boland ◽

Shane Carr ◽

Thekra Al-Zabi ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Exercise Therapy ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Symptomatic Improvement ◽

Smoking History ◽

Supervised Exercise ◽

Exercise Compliance ◽

The Mean ◽

Peripheral Arterial

Abstract. Background: Supervised exercise therapy (SET) is an effective option in the management of peripheral arterial disease (PAD). Unfortunately, poor compliance remains prevalent. This study aimed to assess patient exercise compliance and to identify factors influencing symptomatic improvement and SET participation. Patients and methods: Data regarding attendance at SET for this cohort study were extracted from a prospectively maintained database of patients with claudication attending SET at Dublin City University. All patients had ankle brachial index confirmed PAD with associated intermittent claudication. Exercise performance and symptomatic data were gathered retrospectively using patient charts and interviews. Results: Ninety-eight patients were referred for SET during the study period. The mean age was 69.2 (± 10.1) with 18 % being female. Median follow-up was 25.1 months (IQ range 17.0–31.6). Overall, the mean number of sessions attended per patient was 19.5. Exercise compliance was associated with a significant improvement in symptoms (p = 0.001). Other factors including anatomical level of claudication (P = 0.042) and educational level (p = 0.007) were found to affect the outcome of SET. Multivariate analysis revealed hypertension as a predictor of symptomatic outcome after SET (p = 0.045). Furthermore, ex-smokers (p = 0.021) and those previously diagnosed with hypercholesterolaemia (p = 0.020) or ischaemic heart disease (p = 0.029) had superior exercise compliance. Using linear regression, smoking history (p = 0.024) was identified as a predictor of compliance to SET. Conclusions: Establishing exercise compliance remains challenging in the PAD cohort. Pre-exercise patient education and personalised exercise prescriptions may result in improvements in function and compliance.

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

Vascular ◽

10.1177/1708538121996573 ◽

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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Can ankle-brachial index be used as a predictor for carotid artery shunt application during carotid endarterectomy?

Turkish Journal of Vascular Surgery ◽

10.9739/tjvs.2021.924 ◽

2021 ◽

Vol 30 (2) ◽

pp. 102-106

Author(s):

Mehmet Akif Önalan ◽

Didem Melis Öztaş ◽

Ayşenur Önalan ◽

Metin Onur Beyaz ◽

Siraslan Bahseliyev ◽

...

Keyword(s):

Carotid Artery ◽

Peripheral Arterial Disease ◽

Carotid Endarterectomy ◽

Regional Anesthesia ◽

Medical Records ◽

Odds Ratio ◽

Ankle Brachial Index ◽

Arterial Disease ◽

The Mean ◽

Peripheral Arterial

Objectives: This study aims to investigate the possible relationship between low ankle-brachial index (ABI) and shunt requirement during carotid endarterectomy (CEA) operations. Patients and methods: Medical records of a total of 56 patients (40 males, 16 females; mean age: 65.6±8.4 years; range, 48 to 82 years) who underwent CEA between January 2013 and December 2016 were retrospectively reviewed. The ABI was measured in all patients at the time of hospital admission. Peripheral arterial disease was defined as having an ABI of ≤0.90 in either leg. Selective carotid artery shunt strategy was applied to all patients who underwent CEA under regional anesthesia. Results: Forty-eight (85.8%) patients were symptomatic. Peripheral arterial disease was diagnosed in 25 (44.6%) patients with ABI measurements. Eleven (19.6%) patients required shunt placement due to neurological deterioration during the carotid clamping test. The mean ABI of 11 (19.6%) patients was 0.8±0.15, while the ABI was less than 0.90 in 10 (17.8%) patients. There was a statistically significant correlation between perioperative shunt usage and peripheral arterial disease (odds ratio [OR]: 19.68, 95% confidence interval [CI]: 2.3-164.4; p=0.001). Conclusion: Low ABI appears to be related to a higher rate of shunt requirement in patients undergoing CEA under regional anesthesia with a selective shunt strategy in our modest cohort.

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Predictive value of the ankle brachial index in patients with acute ischemic stroke

VASA ◽

10.1024/0301-1526/a000328 ◽

2014 ◽

Vol 43 (1) ◽

pp. 55-61 ◽

Cited By ~ 10

Author(s):

Konstantinos Tziomalos ◽

Vasilios Giampatzis ◽

Stella Bouziana ◽

Athinodoros Pavlidis ◽

Marianna Spanou ◽

...

Keyword(s):

Ischemic Stroke ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Ankle Brachial Index ◽

Arterial Disease ◽

National Institutes Of Health ◽

Limited Data ◽

Severe Stroke ◽

Hospital Outcome ◽

Peripheral Arterial

Background: Peripheral arterial disease (PAD) is frequently present in patients with acute ischemic stroke. However, there are limited data regarding the association between ankle brachial index (ABI) ≤ 0.90 (which is diagnostic of PAD) or > 1.40 (suggesting calcified arteries) and the severity of stroke and in-hospital outcome in this population. We aimed to evaluate these associations in patients with acute ischemic stroke. Patients and methods: We prospectively studied 342 consecutive patients admitted for acute ischemic stroke (37.4 % males, mean age 78.8 ± 6.4 years). The severity of stroke was assessed with the National Institutes of Health Stroke Scale (NIHSS)and the modified Rankin scale (mRS) at admission. The outcome was assessed with the mRS and dependency (mRS 2 - 5) at discharge and in-hospital mortality. Results: An ABI ≤ 0.90 was present in 24.6 % of the patients whereas 68.1 % had ABI 0.91 - 1.40 and 7.3 % had ABI > 1.40. At admission, the NIHSS score did not differ between the 3 groups (10.4 ± 10.6, 8.3 ± 9.3 and 9.3 ± 9.4, respectively). The mRS score was also comparable in the 3 groups (3.6 ± 1.7, 3.1 ± 1.8 and 3.5 ± 2.3, respectively). At discharge, the mRS score did not differ between the 3 groups (2.9 ± 2.2, 2.3 ± 2.1 and 2.7 ± 2.5, respectively) and dependency rates were also comparable (59.5, 47.6 and 53.3 %, respectively). In-hospital mortality was almost two-times higher in patients with ABI ≤ 0.90 than in patients with ABI 0.91 - 1.40 or > 1.40 but this difference was not significant (10.9, 6.6 and 6.3 %, respectively). Conclusions: An ABI ≤ 0.90 or > 1.40 does not appear to be associated with more severe stroke or worse in-hospital outcome in patients with acute ischemic stroke.

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Ankle Brachial Pressure Index and compression application: Review summary

Wound Practice and Research ◽

10.33235/wpr.27.2.74-77 ◽

2019 ◽

Vol 27 (2) ◽

pp. 74-77

Author(s):

Victoria Team ◽

Georgina Gethin ◽

John D Ivory ◽

Kimberley Crawford ◽

Ayoub Bouguettaya ◽

...

Keyword(s):

Content Analysis ◽

Clinical Practice ◽

Venous Insufficiency ◽

Arterial Disease ◽

Leg Ulcers ◽

Current Clinical Practice ◽

Ankle Brachial Pressure Index ◽

Arterial Circulation ◽

Pressure Index ◽

Peripheral Arterial

Venous leg ulcers (VLUs) are a significant complication amongst persons with chronic venous insufficiency (CVI) that frequently follow a cycle of healing and recurrence. Current clinical practice guidelines (CPGs) recommend applying below knee compression to improve VLU healing. Compression could be applied if the Ankle Brachial Pressure Index (ABPI) rules out significant arterial disease, as sufficient peripheral arterial circulation is necessary to ensure safe compression use. We conducted a content analysis of 13 global CPGs on the accuracy of recommendations related to ABPI and compression application. Eight CPGs indicated that compression is recommended when the ABPI is between 0.8 and 1.2 mmHg. However, this review found there is disagreement between 13 global VLU CPGs, with a lack of clarity on whether or not compression is indicated for patients with ABPIs between 0.6 and 0.8 mmHg. Some CPGs recommend reduced compression for treatment of VLUs, while others do not recommend any type of compression at all. This has implications for when it is safe to apply compression, and the inconsistency in evidence indicates that specialist advice may be required at levels beyond the ABPI “safe” range listed above.

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Hallucal thenar index: A new index to detect peripheral arterial disease using laser speckle flowgraphy

Vascular ◽

10.1177/1708538120938935 ◽

2020 ◽

pp. 170853812093893

Author(s):

Kazuhiro Tsunekawa ◽

Fumio Nagai ◽

Tamon Kato ◽

Ikkei Takashimizu ◽

Daisuke Yanagisawa ◽

...

Keyword(s):

Blood Flow ◽

Peripheral Arterial Disease ◽

Operating Characteristic ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Laser Speckle ◽

Laser Speckle Flowgraphy ◽

Skin Perfusion ◽

Peripheral Arterial ◽

Cutaneous Blood

Objectives Laser speckle flowgraphy is a technology using reflected scattered light for visualization of blood distribution, which can be used to measure relative velocity of blood flow easily without contact with the skin within a short time. It was hypothesized that laser speckle flowgraphy may be able to identify foot ischemia. This study was performed to determine whether laser speckle flowgraphy could distinguish between subjects with and without peripheral arterial disease. Materials and methods All subjects were classified based on clinical observations using the Rutherford classification: non-peripheral arterial disease, class 0; peripheral arterial disease group, class 2–5. Rutherford class 6 was one of the exclusion criteria. Laser speckle flowgraphy measured the beat strength of skin perfusion as an indicator of average dynamic cutaneous blood flow change synchronized with the heartbeat. The beat strength of skin perfusion indicates the strength of the heartbeat on the skin, and the heartbeat strength calculator in laser speckle flowgraphy uses the blood flow data to perform a Fourier transform to convert the temporal changes in blood flow to a power spectrum. A total of 33 subjects with peripheral arterial disease and 40 subjects without peripheral arterial disease at a single center were prospectively examined. Laser speckle flowgraphy was used to measure hallucal and thenar cutaneous blood flow, and the measurements were repeated three times. The hallucal and thenar index was defined as the ratio of beat strength of skin perfusion value on hallux/beat strength of skin perfusion value on ipsilateral thenar eminence. The Mann–Whitney U-test was used to compare the median values of hallucal and thenar index and ankle brachial index between the two groups. A receiver operating characteristic curve for hallucal and thenar index of beat strength of skin perfusion was plotted, and a cutoff point was set. The correlation between hallucal and thenar index of beat strength of skin perfusion and ankle brachial index was explored in all subjects, the hemodialysis group, and the non-hemodialysis (non-hemodialysis) group. Results The median value of the hallucal and thenar index of beat strength of skin perfusion was significantly different between subjects with and without peripheral arterial disease (0.27 vs. 0.87, respectively; P < 0.001). The median value of ankle brachial index was significantly different between subjects with and without peripheral arterial disease (0.8 vs. 1.1, respectively; P < 0.001). Based on the receiver operating characteristic of hallucal and thenar index, the cutoff was 0.4416 and the sensitivity, specificity, positive predictive value, and negative predictive value were 68.7%, 95%, 91.7%, and 77.6%, respectively. The correlation coefficients of all subjects, the hemodialysis group, and the non-hemodialysis group were 0.486, 0.102, and 0.743, respectively. Conclusions Laser speckle flowgraphy is a noninvasive, rapid, and widely applicable method. Laser speckle flowgraphy using hallucal and thenar index would be helpful to determine the differences between subjects with and without peripheral arterial disease. The correlation between hallucal and thenar index of beat strength of skin perfusion and ankle brachial index indicated that this index was especially useful in the non-hemodialysis group.

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CT perfusion in peripheral arterial disease—hemodynamic differences before and after revascularisation

European Radiology ◽

10.1007/s00330-021-07692-5 ◽

2021 ◽

Author(s):

Patrick Veit-Haibach ◽

Martin W. Huellner ◽

Martin Banyai ◽

Sebastian Mafeld ◽

Johannes Heverhagen ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Ct Perfusion ◽

Arterial Disease ◽

Lower Leg ◽

Therapy Control ◽

Non Invasive ◽

Before And After ◽

Invasive Method ◽

The Mean ◽

Peripheral Arterial

Abstract Objectives The purpose of this study was the assessment of volumetric CT perfusion (CTP) of the lower leg musculature in patients with symptomatic peripheral arterial disease (PAD) before and after interventional revascularisation. Methods Twenty-nine consecutive patients with symptomatic PAD of the lower extremities requiring interventional revascularisation were assessed prospectively. All patients underwent a CTP scan of the lower leg, and hemodynamic and angiographic assessment, before and after intervention. Ankle-brachial pressure index (ABI) was determined. CTP parameters were calculated with a perfusion software, acting on a no outflow assumption. A sequential two-compartment model was used. Differences in CTP parameters were assessed with non-parametric tests. Results The cohort consisted of 24 subjects with an occlusion, and five with a high-grade stenosis. The mean blood flow before/after (BFpre and BFpost, respectively) was 7.42 ± 2.66 and 10.95 ± 6.64 ml/100 ml*min−1. The mean blood volume before/after (BVpre and BVpost, respectively) was 0.71 ± 0.35 and 1.25 ± 1.07 ml/100 ml. BFpost and BVpost were significantly higher than BFpre and BVpre in the treated limb (p = 0.003 and 0.02, respectively), but not in the untreated limb (p = 0.641 and 0.719, respectively). Conclusions CTP seems feasible for assessing hemodynamic differences in calf muscles before and after revascularisation in patients with symptomatic PAD. We could show that CTP parameters BF and BV are significantly increased after revascularisation of the symptomatic limb. In the future, this quantitative method might serve as a non-invasive method for surveillance and therapy control of patients with peripheral arterial disease. Key Points • CTP imaging of the lower limb in patients with symptomatic PAD seems feasible for assessing hemodynamic differences before and after revascularisation in PAD patients. • This quantitative method might serve as a non-invasive method, for surveillance and therapy control of patients with PAD.

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The relation of anatomical distribution of symptomatic peripheral arterial disease (PAD) with HbA1c level in patients with type 2 diabetes mellitus

Therapeutic Advances in Endocrinology and Metabolism ◽

10.1177/20420188211000504 ◽

2021 ◽

Vol 12 ◽

pp. 204201882110005

Author(s):

Nawaf J. Shatnawi ◽

Nabil A. Al-Zoubi ◽

Hassan M. Hawamdeh ◽

Yousef S. Khader ◽

Mowafeq Heis ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Peripheral Arterial Disease ◽

Hba1c Level ◽

Arterial Disease ◽

Anatomical Distribution ◽

The Mean ◽

Peripheral Arterial

Aims: Increased level of glycated hemoglobin (HbA1c) is associated with an increased prevalence of peripheral arterial disease (PAD). This study aimed to assess the relationship between the anatomical distribution of symptomatic PAD lesions in patients with type 2 diabetes and HbA1c levels at the time of PAD diagnosis. Patients and methods: A retrospective study was conducted at King Abdullah University Hospital during the period August 2011 to December 2015. Consecutive patients with type 2 diabetes presented with symptomatic PAD confirmed by computed tomography-angiography (CTA) were included in this study. CTA images were reviewed. Relevant information including demographic data, PAD symptoms, comorbidities, HbA1c level, lipid profile, C-reactive protein and the mean platelets volume were retrieved from medical records. Results: A total of 332 patients with type 2 diabetes (255 males and 77 females) were included in this study. The mean HbA1c at the time of PAD diagnosis was 8.68% (±2.06%). The prevalence of hemodynamic relevant atherosclerotic lesions of the superficial femoral artery, popliteal artery, leg vessels, femoro-popliteal, and crural segments was significantly higher in patients with HbA1c >7.5% compared with patients with HbA1c ⩽7.5%. Conclusion: The anatomical distribution of symptomatic PAD in patients with type 2 diabetes mellitus differed significantly according to HbA1c level at the time of PAD diagnosis.

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