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.

scholarly journals The prevalence of peripheral arterial disease in diabetic subjects in south-west Nigeria

2012 ◽  
Vol 4 (1) ◽  
Author(s):  
Bolaji O. Oyelade ◽  
Akintayo D. OlaOlorun ◽  
Louis O. Odeigah ◽  
Isaac O. Amole ◽  
Olufemi S. Adediran
Keyword(s):  
Peripheral Arterial Disease ◽  
Intermittent Claudication ◽  
Objective Assessment ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Cross Sectional ◽  
Index Measurement ◽  
Clinical Methods ◽  
History Of ◽  
Peripheral Arterial

Background: Peripheral arterial disease (PAD) is rarely sought for and generally underdiagnosed even in diabetics in developing countries like Nigeria. PAD is easily detected and diagnosed by the ankle-brachial index, a simple and reliable test. Objectives: To determine the prevalence of PAD in diabetic subjects aged 50–89 years and the value of ankle-brachial index measurement in the detection of PAD.Method: A cross-sectional descriptive study of 219 diabetic subjects aged 50–89 years was carried out. The participants were administered a pre-tested questionnaire and measurement of ankle-brachial index (ABI) was done. The ankle-brachial index < 0.90 was considered equivalent to peripheral arterial disease.Results: The overall prevalence of PAD was 52.5%. The prevalence of symptomatic PAD was 28.7% whilst that of asymptomatic PAD was 71.3%. There were a number of associations with PAD which included, age (p < 0.05), sex (p < 0.05), and marital status (p < 0.05). The use of the ankle-brachial index in the detection of PAD was clearly more reliable than the clinical methods like history of intermittent claudication and absence or presence of pedal pulses.Conclusion: The prevalence of PAD is relatively high in diabetic subjects in the southwestern region of Nigeria. Notable is the fact that a higher proportion was asymptomatic. Also the use of ABI is of great value in the detection of PAD as evidenced by a clearly more objective assessment of PAD compared to both intermittent claudication and absent pedal pulses.

The Limitations of Ankle Brachial Index when used Alone for the Detection/Screening of Peripheral Arterial Disease in a Population with an Increased Prevalence of Diabetes

2007 ◽  
Vol 31 (3) ◽  
pp. 149-151 ◽  
Author(s):  
Brian P. Hembling ◽  
Kelley C. Hubler ◽  
Peter M. Richard ◽  
William A. O'Keefe ◽  
Chelsey Husfloen ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Waveform Analysis ◽  
Arterial Calcification ◽  
Normal Limits ◽  
High Prevalence ◽  
High Incidence ◽  
Doppler Waveform ◽  
Peripheral Arterial

A retrospective analysis was performed comparing the effectiveness of ankle brachial index (ABI) to Doppler waveform analysis for the detection of peripheral arterial disease (PAD) in a group of patients with an estimated 31% prevalence of diabetes. A total of 21,199 ankle pressures and corresponding Doppler waveforms were correlated; 8,628, or 41%, of the ankle pressures were within normal limits; 8,335, or 40%, of the ankle pressures were below normal limits; and 4,042, or 19%, of the ankle pressures were noncompressible. Using ABI alone for screening in a population with a high incidence of diabetes is significantly limited because of noncompressible ankle pressures caused by arterial calcification. A total of 19% of the segments evaluated in this population yielded noncompressible vessels. The prevalence of PAD, detected by Doppler waveform analysis in the segments with non-compressible ankle pressures, was 69%. Additional modalities such as Doppler waveform analysis would further increase the accuracy of screening for PAD in this population. Alternately, using the ABI alone for the detection of PAD can be improved by interpreting ABIs greater than 1.2 as positive results because of the high prevalence of PAD in this group.

scholarly journals A study to assess frequency of peripheral arterial disease in patients presenting with acute coronary syndrome

2017 ◽  
Vol 4 (5) ◽  
pp. 1276
Author(s):  
Somnath Mukherjee ◽  
Prashant Kumar ◽  
D. P. Sinha
Keyword(s):  
Acute Coronary Syndrome ◽  
Peripheral Arterial Disease ◽  
Past History ◽  
Systolic Dysfunction ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Observation Study ◽  
Cross Sectional ◽  
Coronary Syndrome ◽  
Peripheral Arterial

Background: To determine the frequency of peripheral arterial disease (PAD) in patients presenting with acute coronary syndrome (ACS) and association of PAD with different risk factors of coronary artery disease (CAD) and to look for in hospital outcome of ACS patients with or without PAD.Methods: This cross-sectional observation study was undertaken in the department of cardiology, IPGME&R Hospital, Kolkata from June 2015 to August 2016 to recruit 199 consecutive patients admitted with ACS and were evaluated with detailed clinical history, physical examination, ABI (Ankle Brachial Index) measurement, echocardiography and appropriate blood investigations.Results: Among 199 total ACS patients, STEMI was the predominant mode of presentation (71.86%) and majorities were male. PAD was seen in 26 patients and mean age was 56.68±8.84 years. Factors independently related with PAD in acute coronary syndromes are hypertension (OR- 1.49; 95% CI: 0.615-3.232), diabetes (OR- 2.55;95% CI : 0.9762-6.6665), smoking (OR-2.55; 95% CI: 1.055-6.19), past history of CVA (OR-11.15;95% CI: 1.77-70.32), LV systolic dysfunction (OR-1.388; 95% CI:0.607-3.1742). 2 and 13 patients died within 7 days of admission among 26 ACS-PAD group (7.69%) and 173 ACS-non-PAD group (7.5%) respectively and most of them had STEMI.Conclusions: Significant numbers of ACS patients are having PAD and older age, male sex, diabetes, hypertension, smoking and LV systolic dysfunction were found to be independent predictors for PAD in ACS patients. Early in hospital mortality was seem to be dependent on clinical presentation, not on presence or absence of PAD.

Short stature in men is associated with subclinical peripheral arterial disease

VASA ◽  
2016 ◽  
Vol 45 (6) ◽  
pp. 486-490
Author(s):  
Arto Heikkilä ◽  
Maarit Venermo ◽  
Hannu Kautiainen ◽  
Pertti Aarnio ◽  
Päivi Korhonen
Keyword(s):  
Cardiovascular Risk ◽  
Peripheral Arterial Disease ◽  
Short Stature ◽  
Smoking Status ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Inverse Association ◽  
Cross Sectional ◽  
Peripheral Arterial ◽  
The Relationship

Abstract. Background: Peripheral arterial disease (PAD) affects approximately 202 million individuals around the world and is associated with a high risk of myocardial infarction, stroke and death. Although there is a clear inverse association between adult height and the risk of cardiovascular disease, little is known about the relationship between height and PAD. The aim of our study was to assess the relationship between subclinical PAD and height. Patients and methods: In a cross-sectional cardiovascular risk factor study in southwestern Finland, ankle brachial index (ABI) and other risk factors were measured from a total of 972 cardiovascular risk subjects derived from the general population. None of them had previously diagnosed diabetes, cardiovascular or renal disease or intermittent claudication. Subjects with an ABI ≤ 0.90 were categorized as having subclinical PAD. Results: The average age of the study subjects was 58.1 ± 6.7 years for men and 58.8 ± 6.9 years for women. The prevalence of subclinical PAD was 5 % (95 % CI 3 % − 7 %) (23/455) among men and 5 % (95 % CI 3 %−7 %) (26/517) among women. The mean ABI among men and women was 1.09 ± 0.12 and 1.08 ± 0.12, respectively. In men, there was an inverse association between height and the prevalence of subclinical PAD (p < 0.001) along with a positive association between height and ABI values (p < 0.001). In a multivariate model, height, age and current smoking status remained independent factors that were associated with subclinical PAD in men, whereas in women, only pulse pressure was associated with subclinical PAD. Conclusions: Short stature in men is associated with subclinical PAD and lower ABI values.

scholarly journals Primary care screening for peripheral arterial disease: a cross-sectional observational study

2017 ◽  
Vol 67 (655) ◽  
pp. e103-e110 ◽  
Author(s):  
Jane H Davies ◽  
Jonathan Richards ◽  
Kevin Conway ◽  
Joyce E Kenkre ◽  
Jane EA Lewis ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Peripheral Arterial Disease ◽  
Public Awareness ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Smoking History ◽  
Cross Sectional ◽  
Number Needed To Screen ◽  
Peripheral Arterial

BackgroundEarly identification of peripheral arterial disease (PAD) and subsequent instigation of risk modification strategies could minimise disease progression and reduce overall risk of cardiovascular (CV) mortality. However, the feasibility and value of primary care PAD screening is uncertain.AimThis study (the PIPETTE study — Peripheral arterial disease In Primary carE: Targeted screening and subsequenT managEment) aimed to determine the value of a proposed primary care PAD screening strategy. Outcomes assessed were: prevalence of PAD and agreement of ankle– brachial index (ABI)-defined PAD (ABI ≤0.9) with QRISK®2-defined high CV risk (≥20).Design and settingA cross-sectional observational study was undertaken in a large general practice in Merthyr Tydfil, Wales.MethodIn total, 1101 individuals with ≥2 pre-identified CV risk factors but no known CV disease or diabetes were invited to participate. Participants underwent ABI measurement and QRISK2 assessment, and completed Edinburgh Claudication Questionnaires.ResultsA total of 368 people participated in the study (participation rate: 33%). Prevalence of PAD was 3% (n = 12). The number needed to screen (NNS) to detect one new case of PAD was 31. Refining the study population to those aged ≥50 years with a smoking history reduced the NNS to 14, while still identifying 100% of PAD cases. Of participants with PAD, 33% reported severe lifestyle-limiting symptoms of intermittent claudication that warranted subsequent endovascular intervention, yet had not previously presented to their GP. The QRISK2 score predicted high CV risk in 92% of participants with PAD.ConclusionThe low PAD yield and the fact that QRISK2 was largely comparable to the ABI in predicting high CV risk suggests that routine PAD screening may be unwarranted. Instead, strategies to improve public awareness of PAD are needed.

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.

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