scholarly journals Toe pressure and toe brachial index are predictive of cardiovascular mortality regardless of the most diseased arterial segment in symptomatic lower-extremity artery disease—A retrospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259122
Author(s):  
V. Koivunen ◽  
M. Juonala ◽  
M. Venermo ◽  
M. Laivuori ◽  
J. M. Jalkanen ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Cardiovascular Mortality ◽  
Cox Regression ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Pressure Measurements ◽  
Arterial Segment ◽  
Toe Brachial Index ◽  
Disease Location ◽  
Toe Pressure

Objective Although lower extremity arterial disease (LEAD) is most often multisegmental, the predominant disease location and risk factors differ between patients. Ankle-brachial index (ABI), toe-brachial index (TBI), and toe pressure (TP) are predictive of outcome in LEAD patients. Previously, we reported a classification method defining the most diseased arterial segment (MDAS); crural (CR), femoropopliteal (FP), or aortoiliac (AOI). Current study aimed to analyze the associations between MDAS, peripheral pressure measurements and cardiovascular mortality. Materials and methods We reviewed retrospectively 729 consecutive LEAD patients (Rutherford 2–6) who underwent digital subtraction angiography between January, 2009 to August, 2011 and had standardized peripheral pressure measurements. Results In Cox Regression analyses, cardiovascular mortality was associated with MDAS and non-invasive pressure indices as follows; MDAS AOI, TP <30 mmHg (HR 3.00, 95% CI 1.13–7.99); MDAS FP, TP <30 mmHg (HR 2.31, 95% CI 1.36–3.94), TBI <0.25 (HR 3.20, 95% CI 1.34–7.63), ABI <0.25 (HR 5.45, 95% CI 1.56–19.0) and ≥1.30 (HR 6.71, 95% CI 1.89–23.8), and MDAS CR, TP <30 mmHg (HR 4.26, 95% CI 2.19–8.27), TBI <0.25 (HR 7.71, 95% CI 1.86–32.9), and ABI <0.25 (HR 2.59, 95% CI 1.15–5.85). Conclusions Symptomatic LEAD appears to be multisegmental with severe infrapopliteal involvement. Because of this, TP and TBI are strongly predictive of cardiovascular mortality and they should be routinely measured despite the predominant disease location or clinical presentation.

scholarly journals The Increase of The Relative Amount of Nodular Calcification In Femoral Plaques is Associated With Milder Lower Extremity Arterial Disease

2022 ◽  
Author(s):  
Mae Azeez ◽  
Mirjami Laivuori ◽  
Johanna Tolva ◽  
Nina Linder ◽  
Johan Lundin ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Clinical Presentation ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Lower Extremity Arterial Disease ◽  
Learning Platform ◽  
Section Area ◽  
Urgent Operation ◽  
Hematoxylin And Eosin ◽  
Toe Pressure

Abstract Vascular calcification exists in different forms that reflect variable clinical and histological implications. Categories of calcification have not been quantified in relation to the clinical presentation of lower extremity arterial disease. The study analyzed 51 femoral plaques collected during femoral endarterectomy, characterized by > 90% stenosis. The plaques were longitudinally sectioned, stained with Hematoxylin and Eosin and digitized for a deep learning platform for quantification of the relative area of nodular calcification to the plaque section area. Vessel measurements and quantity of each calcification category was compared to the clinical risk factors and outcomes. nodular calcification area proportion is associated with reduced risk of severely lowered toe pressure (< 30mmHg) (OR=0.910, 95%CI =0.835-0992, p<0.05), severely lowered ankle brachial index (<0.4), (OR=0.912, 95%CI=0.84-0.986, p<0.05), and semi-urgent operation (OR=0.882, 95%CI=0.797-0.976, p<0.05). The analysis was adjusted by age, gender, hypertension, diabetes and dyslipidaemia. Increase of the relative amount of nodular calcification in femoral plaques with over 90% stenosis is associated with protection against severe LEAD, identified by severely lowered toe pressure and ankle brachial index and semi-urgent operations. Nodular calcification may contribute to a slower obstruction, hence milder obstructive ischaemic presentation.

Clinical Utility of the Ankle-Brachial Index and Toe Brachial Index in Patients with Diabetic Foot Ulcers

2020 ◽  
Vol 16 (3) ◽  
pp. 270-277 ◽  
Author(s):  
Mutasem Ababneh ◽  
Mousab Y. Al Ayed ◽  
Asirvatham A. Robert ◽  
Mohamed A. Al Dawish
Keyword(s):  
Diabetic Foot ◽  
Statistical Significance ◽  
Ankle Brachial Index ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Arterial Disease ◽  
Cross Sectional Study ◽  
Screening Tests ◽  
Cross Sectional ◽  
Toe Brachial Index

Background: This cross sectional study investigated the clinical use of the ankle-brachial index (ABI) and toe brachial index (TBI) in 91 type 2 diabetic foot ulcer patients who visited the diabetic foot clinic, Prince Sultan Military Medical City, Saudi Arabia during July 2017 and January 2018. Materials and Methods: The ABI and TBI facilitated the detection of peripheral arterial disease (PAD) and the patients’ medical records were used to collect the clinical and demographic variables. The variables of duration (p = 0.047) and treatment (p = 0.046) of the ABI showed significant differences. Age (p = 0.034) and duration (p = 0.001) were the factors related to the diagnosis of TBI by the “χ2” test. Results: From the TBI, 26.4% of the patients were found to have PAD, while the ABI showed that 21.8% of patients had the condition. However, no statistical significance was noted. From the regression analysis, the variable duration of diabetes (≥ 20 years of age) was recognized as an independent risk factor for TBI. Conclusion: In conclusion, it is recommended both the ABI and TBI to be used as screening tests for PAD in diabetic foot ulcer patients.

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 ◽  
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.

scholarly journals The accuracy of toe brachial index and ankle brachial index in the diagnosis of lower limb peripheral arterial disease: A systematic review and meta-analysis

2020 ◽  
Vol 315 ◽  
pp. 81-92
Author(s):  
Ángel Herraiz-Adillo ◽  
Iván Cavero-Redondo ◽  
Celia Álvarez-Bueno ◽  
Diana P. Pozuelo-Carrascosa ◽  
Montserrat Solera-Martínez
Keyword(s):  
Systematic Review ◽  
Peripheral Arterial Disease ◽  
Lower Limb ◽  
Meta Analysis ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Toe Brachial Index ◽  
Peripheral Arterial

scholarly journals The Influence of Heating on Toe pressure in Patients with Peripheral Arterial Disease

2017 ◽  
Vol 107 (1) ◽  
pp. 62-67 ◽  
Author(s):  
N. Settembre ◽  
T. Kagayama ◽  
P. Kauhanen ◽  
P. Vikatmaa ◽  
Y. Inoue ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Skin Temperature ◽  
Arterial Disease ◽  
Pressure Measurements ◽  
Baseline Measurement ◽  
The Third ◽  
The Mean ◽  
Peripheral Arterial ◽  
Different Response ◽  
Toe Pressure

Background and Aim: The toe skin temperature in vascular patients can be low, making reliable toe pressure measurements difficult to obtain. The aim of this study was to evaluate the effect of heating on the toe pressure measurements. Materials and Methods: A total of 86 legs were examined. Brachial pressure and toe pressure were measured at rest in a supine position using a laser Doppler device that also measured skin temperature. After heating the toes for 5 min with a heating pad, we re-measured the toe pressure. Furthermore, after heating the skin to 40° with the probe, toe pressures were measured a third time. Results: The mean toe skin temperature at the baseline measurement was 24.0 °C (standard deviation: 2.8). After heating the toes for 5 min with a warm heating pad, the skin temperature rose to a mean 27.8 °C (standard deviation: 2.8; p = 0.000). The mean toe pressure rose from 58.5 (standard deviation: 32) to 62 (standard deviation: 32) mmHg (p = 0.029). Furthermore, after the skin was heated up to 40 °C with the probe, the mean toe pressure in the third measurement was 71 (standard deviation: 34) mmHg (p = 0.000). The response to the heating varied greatly between the patients after the first heating—from −34 mmHg (toe pressure decreased from 74 to 40 mmHg) to +91 mmHg. When the toes were heated to 40 °C, the change in to toe pressure from the baseline varied between −28 and +103 mmHg. Conclusion: Our data indicate that there is a different response to the heating in different clinical situations and in patients with a different comorbidity.

Intratester and Intertester Reliability of Toe Pressure Measurements in People with and Without Diabetes Performed by Podiatric Physicians

2015 ◽  
Vol 105 (3) ◽  
pp. 201-208 ◽  
Author(s):  
Jennifer A. Sonter ◽  
Vivienne Chuter ◽  
Sarah Casey
Keyword(s):  
Pressure Measurement ◽  
Intraclass Correlation ◽  
Systolic Pressure ◽  
Correlation Coefficients ◽  
Arterial Disease ◽  
Screening Tools ◽  
Pressure Measurements ◽  
Limits Of Agreement ◽  
Doppler Probe ◽  
Toe Pressure

Background Toe pressures and the toe brachial index (TBI) represent possible screening tools for peripheral arterial disease; however, limited evidence is available regarding their reliability. The aim of this study was to determine intratester and intertester reliability of toe systolic pressure and the TBI in participants with and without diabetes performed by podiatric physicians. Methods Two podiatric physicians performed toe and brachial pressure measurements on 80 participants, 40 with and 40 without diabetes, during two testing sessions using photoplethysmography and Doppler probe. Intraclass correlation coefficients (ICCs) and 95% limits of agreement were determined. Results In people with diabetes, intratester reliability of toe pressure measurement was excellent for both testers (ICCs, 0.84 and 0.82). Reliability of the TBI was good (ICCs, 0.72 and 0.75) and brachial pressure fair (ICCs, 0.43 and 0.55). The intertester reliability of toe pressure (ICC, 0.82) and the TBI (ICC, 0.80) was excellent. Intertester reliability of brachial pressure was reduced in people with diabetes (ICC, 0.49). In age-matched participants, intratester reliability of toe pressure measurement was excellent for both testers (ICCs, 0.83 and 0.87), and reliability of the TBI (ICCs, 0.74 and 0.80) and brachial pressure (ICCs, 0.73 and 0.78) was good to excellent. Intertester reliability of toe pressure (ICC, 0.84), the TBI (ICC, 0.81), and brachial pressure (ICC, 0.77) was excellent. Conclusions Toe pressures and the TBI demonstrated excellent reliability in people with and without diabetes and can be an effective component of lower-extremity vascular screening. However, wide limits of agreement relative to blood pressure values for both cohorts indicate that results should be interpreted with caution.

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