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 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.

scholarly journals Ankle Brachial Index Screening for Peripheral Arterial Disease in Asymptomatic Diabetic Patients

2021 ◽  
Vol 83 (1) ◽  
pp. 1575-1581
Author(s):  
Heba A . El-Malky ◽  
Alaa El Deen Dawood ◽  
Mahmoud S. El-Desoky ◽  
Mai A. Kamel
Keyword(s):  
Peripheral Arterial Disease ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Diabetic Patients ◽  
Peripheral Arterial

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 Lower sensitivity of ankle-brachial index measurements among people suffering with diabetes-associated vascular disorders: A systematic review

2019 ◽  
Vol 7 ◽  
pp. 205031211983503 ◽  
Author(s):  
Ayman Abouhamda ◽  
Majid Alturkstani ◽  
Yousef Jan
Keyword(s):  
Diabetes Mellitus ◽  
Peripheral Arterial Disease ◽  
Systemic Disease ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Diabetic Patients ◽  
Lower Sensitivity ◽  
Index Measurement ◽  
Cardiovascular Morbidity And Mortality ◽  
Peripheral Arterial

Diabetes mellitus is a systemic disease affecting microvascular and macrovascular systems and is considered as the strongest risk factor for peripheral arterial disease. Although the prevalence of the peripheral arterial disease is high among people living with diabetes, its severity is not accurately detected with the prevalent diagnostic methodologies. The ankle-brachial index measurement is a simple, objective, and reliable tool for diagnosis of peripheral arterial disease. However, it is of limited value in the diagnosis of peripheral arterial disease among diabetic patients due to its low sensitivity among diabetic individuals. Diabetes mellitus results in atherosclerosis and calcification of peripheral arterial walls leading to false normal ankle-brachial index values. Therefore, healthcare practitioners should be careful not to misinterpret ankle-brachial index results among diabetic patients. A literature search was conducted using the keywords “ankle-brachial index,” “interpretation,” “limitations,” “diabetic foot,” and “peripheral arterial disease” on different medical search engines. The results were manually scanned and then further reviewed to select the articles related to our topic of discussion. This article will review the use of ankle-brachial index measurement among diabetic patients, its limitations and its prognostic value. In Conclusion, Ankle-brachial index can be used for diagnosis of peripheral arterial disease with some precautions (e.g. raising the threshold of diagnosis or using the lowest systolic pressure value measured at the ankle) and can also be a prognostic indicator for cardiovascular morbidity and mortality.

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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