scholarly journals Assessment of Diabetic Foot through the Developmental Stages of Lower Limb Abnormalities Using Ultrasound

2020 ◽  
Author(s):  
Suresh K.S. ◽  
Sukesh Kumar A.
Keyword(s):  
Blood Pressure ◽  
Lower Limb ◽  
Diabetic Foot ◽  
Developmental Stages ◽  
Systolic Pressure ◽  
Arterial Calcification ◽  
Velocity Spectrum ◽  
Transcutaneous Oxygen ◽  
Peripheral Arterial ◽  
Medial Arterial Calcification

A diabetic foot is one of the most serious complications of diabetes mellitus. This causes large number of lower leg amputations worldwide. Usually this disease is getting diagnosed in a very later stage. Ankle-arm index, diastolic blood pressure, fasting plasma glucose, hemoglobin A1C, high blood pressure, medial arterial calcification, nerve conduction velocity, peripheral vascular disease, systolic blood pressure, transcutaneous oxygen tension, etc. are some of the major indicators of a diabetic foot. Among these peripheral arterial abnormalities and neuropathy are the most dominant visible factors. Detection and monitoring of diabetic foot help to demonstrate the feet at risk of ulceration positively. This study reveals the various assessment methodologies of lower limb abnormalities leading to diabetic foot using ultrasound. Ultrasound is being used in various cases related to diabetic foot, from the identification of systolic pressure for the ankle brachial pressure index to the velocity analysis of hemodynamic studies. The study analyses the lower limb abnormalities and extracts the features of diabetic foot from the velocity spectrum of ultrasound Doppler scan.

scholarly journals CONTRIBUTION OF TRANSCUTANEOUS OXYMETRY IN DIABETIC FOOT SYNDROME

2013 ◽  
Vol 1 ◽  
pp. 307-313
Author(s):  
Ludovit Gaspar ◽  
Matej Bendzala ◽  
Andrea Komornikova ◽  
Ivan Ocadlik ◽  
Michal Makovnik ◽  
...  
Keyword(s):  
Doppler Ultrasound ◽  
Diabetic Foot ◽  
Ultrasound Examination ◽  
Clinical Manifestations ◽  
Lower Limbs ◽  
Diabetic Foot Syndrome ◽  
Arterial Calcification ◽  
Primary Position ◽  
Transcutaneous Oxygen ◽  
Peripheral Arterial

Four major complications are participating in tissue damage in diabetic foot syndrome – diabetic angiopathy, neuropathy, osteoarthropathy and inflammation. Low ankle-brachial pressure index (ABI) is a well-known indicator for ischemia of lower limbs, but in patients with diabetes mellitus is common also a high ABI (over 1.3) as reliable predictor of the presence of arterial calcification – medial calcinosis. Aim of the study is to determine the degree of ischemia using transcutaneous oximetry in patients with diabetic foot syndrome - with clinical manifestations of peripheral arterial occlusive disease (PAOD) and medial calcinosis. We investigated three groups: first consisted of 46 members in IInd stage of PAOD according to Fontaine classification, in second group were 30 members in IIIrd stage of PAOD and third had 29 members in IVth stage of PAOD. The ABI was determined with Doppler ultrasound examination. Transcutaneous oxygen tension (TcPO2) was measured with Oxykapnomonitor Hellige SMK Germany equipment with sensing probe – transoxode. Resting values of TcPO2 were obtained in lying patient on the foot in first metatarsal space. Subsequently leg was passively elevated into 30 degree angle for 3 minutes and then reimposed into primary position. One minute exercise – plantar and dorsal feet flexion was performed and after the TcPO2 values stabilization the patient hung his shin from the edge of the bed touching the floor. TcPO2 values were continuously recorded by analog waveform. In more severe stages of PAOD according to Fontaine stage III and IV we detected lower levels of TcPO2 under basal resting conditions: 20 respectively 5 mmHg. Patients with IInd stage of PAOD had basal TcPO2 values of 40 mmHg. Conclusions of the study are: TcPO2 values are not affected by the presence of medial calcinosis and sothis method is particularly beneficial in patients where Doppler ultrasound examination shows artificial high pressure values on lower limbs. In the third and fourth stage of PAOD passive leg elevation is as effective in determination of ischemia as working test.

scholarly journals A METHOD TO DETERMINE THE PERIPHERAL ARTERIAL BLOOD PRESSURE IN THE MOUSE

1941 ◽  
Vol 74 (1) ◽  
pp. 29-40 ◽  
Author(s):  
Philip D. McMaster
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Arterial Blood Pressure ◽  
Close Agreement ◽  
Carotid Arteries ◽  
Systolic Pressure ◽  
Arterial Blood ◽  
Relative Transparency ◽  
Direct Measurements ◽  
Peripheral Arterial

Advantage has been taken of the relative transparency of the claw of the mouse to devise a method, here described, to measure the blood pressure in the animal's leg. Direct measurements of the systolic blood pressure from the carotid arteries of anesthetized mice have also been made. Simultaneous blood pressure readings by both these methods applied to the same animal showed close agreement. The systolic pressure ranged from 60 to 126 mm. Hg, according to the conditions.

Association of infrapopliteal medial arterial calcification with lower-limb amputations in high-risk patients: A systematic review and meta-analysis

2020 ◽  
pp. 1358863X2097973
Author(s):  
Fabrizio Losurdo ◽  
Roberto Ferraresi ◽  
Alessandro Ucci ◽  
Anna Zanetti ◽  
Giacomo Clerici ◽  
...  
Keyword(s):  
Risk Factor ◽  
High Risk ◽  
Lower Limb ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Arterial Calcification ◽  
High Risk Patients ◽  
Patients With Diabetes ◽  
Risk Patients ◽  
Medial Arterial Calcification

Medial arterial calcification (MAC) is a known risk factor for cardiovascular morbidity. The association between vascular calcifications and poor outcome in several vascular districts suggest that infrapopliteal MAC could be a risk factor for lower-limb amputation (LLA). This study’s objective is to review the available literature focusing on the association between infrapopliteal MAC and LLA in high-risk patients. The PubMed and Embase databases were systematically searched. We selected original studies reporting the association between infrapopliteal MAC and LLAs in patients with diabetes and/or peripheral artery disease (PAD). Estimates were pooled using either a fixed-effects or a random-effects model meta-analysis. Heterogeneity was evaluated using the Q and I2 statistics. Publication bias was investigated with a funnel plot and Egger test. The trim-and-fill method was designed to estimate the possibly missing studies. Influence analysis was conducted to search studies influencing the final result. Test of moderators was used to compare estimates in good versus non-good-quality studies. Fifteen articles satisfied the selection criteria ( n = 6489; median follow-up: 36 months). MAC was significantly associated with LLAs (pooled adjusted risk ratio (RR): 2.27; 95% CI: 1.89–2.74; I2 = 25.3%, Q-test: p = 0.17). This association was kept in the subgroup of patients with diabetes (RR: 2.37; 95% CI: 1.76–3.20) and patients with PAD (RR: 2.48; 95% CI: 1.72–3.58). The association was maintained if considering as outcome only major amputations (RR: 2.11; 95% CI: 1.46–3.06). Our results show that infrapopliteal MAC is associated with LLAs, thus suggesting MAC as a possible new marker of the at-risk limb.

scholarly journals Lower-limb hot-water immersion acutely induces beneficial hemodynamic and cardiovascular responses in peripheral arterial disease and healthy, elderly controls

2017 ◽  
Vol 312 (3) ◽  
pp. R281-R291 ◽  
Author(s):  
Kate N. Thomas ◽  
André M. van Rij ◽  
Samuel J. E. Lucas ◽  
James D. Cotter
Keyword(s):  
Blood Pressure ◽  
Lower Limb ◽  
Water Immersion ◽  
Duplex Ultrasound ◽  
Arterial Disease ◽  
Hot Water ◽  
Healthy Elderly ◽  
Limb Perfusion ◽  
Peripheral Arterial ◽  
Hot Water Immersion

Passive heat induces beneficial perfusion profiles, provides substantive cardiovascular strain, and reduces blood pressure, thereby holding potential for healthy and cardiovascular disease populations. The aim of this study was to assess acute responses to passive heat via lower-limb, hot-water immersion in patients with peripheral arterial disease (PAD) and healthy, elderly controls. Eleven patients with PAD (age 71 ± 6 yr, 7 male, 4 female) and 10 controls (age 72 ± 7 yr, 8 male, 2 female) underwent hot-water immersion (30-min waist-level immersion in 42.1 ± 0.6°C water). Before, during, and following immersion, brachial and popliteal artery diameter, blood flow, and shear stress were assessed using duplex ultrasound. Lower-limb perfusion was measured also using venous occlusion plethysmography and near-infrared spectroscopy. During immersion, shear rate increased ( P < 0.0001) comparably between groups in the popliteal artery (controls: +183 ± 26%; PAD: +258 ± 54%) and brachial artery (controls: +117 ± 24%; PAD: +107 ± 32%). Lower-limb blood flow increased significantly in both groups, as measured from duplex ultrasound (>200%), plethysmography (>100%), and spectroscopy, while central and peripheral pulse-wave velocity decreased in both groups. Mean arterial blood pressure was reduced by 22 ± 9 mmHg (main effect P < 0.0001, interaction P = 0.60) during immersion, and remained 7 ± 7 mmHg lower 3 h afterward. In PAD, popliteal shear profiles and claudication both compared favorably with those measured immediately following symptom-limited walking. A 30-min hot-water immersion is a practical means of delivering heat therapy to PAD patients and healthy, elderly individuals to induce appreciable systemic (chronotropic and blood pressure lowering) and hemodynamic (upper and lower-limb perfusion and shear rate increases) responses.

scholarly journals Why Is ABI Effective in Detecting Vascular Stenosis? Investigation Based on Multibranch Hemodynamic Model

2013 ◽  
Vol 2013 ◽  
pp. 1-10
Author(s):  
Xiaoyun Li ◽  
Ling Wang ◽  
Chi Zhang ◽  
Shuyu Li ◽  
Fang Pu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Brachial Artery ◽  
Lower Limb ◽  
Ankle Brachial Index ◽  
Systolic Pressure ◽  
Arterial Stenosis ◽  
Hemodynamic Model ◽  
Stenosis Severity ◽  
Arterial Stenoses ◽  
Flow Propagation

The ankle-brachial index (ABI), defined as the ratio of systolic pressure in the ankle arteries and that in the brachial artery, was a useful noninvasive method to detect arterial stenoses. There had been a lot of researches about clinical regularities of ABI; however, mechanism studies were less addressed. For the purpose of a better understanding of the correlation between vascular stenoses and ABI, a computational model for simulating blood pressure and flow propagation in various arterial stenosis circumstances was developed with a detailed compartmental description of the heart and main arteries. Particular attention was paid to the analysis of effects of vascular stenoses in different large-sized arteries on ABI in theory. Moreover, the variation of ABI during the increase of the stenosis severity was also studied. Results showed that stenoses in lower limb arteries, as well as, brachial artery, caused different variations of blood pressure in ankle and brachial arteries, resulting in a significant change of ABI. Furthermore, the variation of ABI became faster when the severity of the stenosis increased, validating that ABI was more sensitive to severe stenoses than to mild/moderate ones. All these in findings revealed the reason why ABI was an effective index for detecting stenoses, especially in lower limb arteries.

scholarly journals The ankle-brachial index value in patients with purulent-necrotic complications of diabetic foot syndrome

2019 ◽  
Vol 41 part 2 (2) ◽  
pp. 59-61
Author(s):  
B. O. Matviychuk ◽  
V. S. Zaremba ◽  
N. R. Fedchyshyn ◽  
O. P. Tsymbala
Keyword(s):  
Lower Limb ◽  
Diabetic Foot ◽  
Ankle Brachial Index ◽  
Arterial Occlusion ◽  
Predictive Marker ◽  
Arterial Disease ◽  
Actual Problem ◽  
Definition Of ◽  
Peripheral Arterial ◽  
Index Value

Diabetes and predetermined him heavy purulent-necrotic complications is actual problem medicine today’s. It is proved that patients with diabetes have big risk to development of heart-vessel disease due to the development of atherosclerosis. Standard of diagnosis peripheral arterial disease of lower limb is finding ankle-brachia index (ABI). This method is good at definition of degree of arterial occlusion. Purpose of the study. Purpose of the work: to analyse the diagnostic capability of ABI in patients who have purulent-necrotic complications of diabetic foot. Material and methods. The prospective studies covered 218 patients. The average patients age 54,2 ± 10,3years, 45,5% of them – men. The mild form of disease was in 33,2%, moderate severity – in 45,2%, severe – in 21,6%. The duration of purulent-necrotic complications was 11,5 ± 1,2 days. Results. We have seen that 128 patients have different degrees of macroangiopathy. in patients who performed amputation at the level of the thigh of ABI was 0,41 ± 0,13; at the level of the leg – 0,59 ± 0,12. Conclusion. 1. Timely diagnosis is the basis of effective treatment of purulent necrotic complications of diabetic foot. 2. In treatment, it is necessary to take into account the indicators of ABI as the main diagnostic marker of peripheral artery disease of lower limb. 3. Definition of ABI is an objective and valuable predictive marker. Keywords: diabetic food, purulent-necrotic complications, diabetes, ankle-brachia index.

Toe brachial index measured by automated device compared to duplex ultrasonography for detecting peripheral arterial disease in older people

Vascular ◽  
2017 ◽  
Vol 25 (6) ◽  
pp. 612-617 ◽  
Author(s):  
Jennifer Sonter ◽  
Peta Tehan ◽  
Vivienne Chuter
Keyword(s):  
Blood Pressure ◽  
Peripheral Arterial Disease ◽  
Older People ◽  
Diagnostic Accuracy ◽  
Lower Limb ◽  
Arterial Disease ◽  
Duplex Ultrasonography ◽  
Toe Brachial Index ◽  
Peripheral Arterial ◽  
Toe Blood Pressure

Introduction To investigate the diagnostic accuracy of an automated toe blood pressure device for detecting peripheral arterial disease in older people. Methods Ninety participants underwent toe and brachial blood pressure measurements and colour duplex ultrasonography of the right lower limb. Peripheral arterial disease was diagnosed if > 50% arterial obstruction was identified in any lower limb vessel using colour duplex ultrasonography. A receiver operating characteristic curve was analysed and the sensitivity and specificity of commonly used toe brachial index and toe blood pressure values were determined. Results The optimum toe brachial index threshold value for diagnosing peripheral arterial disease was 0.72 (sensitivity 76.2%, specificity 75%). The area under the curve was 0.829 (95% CI 0.743 to 0.915, p < 0.0001) suggesting fair diagnostic accuracy. A toe blood pressure of 70 mmHg was found to have excellent specificity (97.92%) for detecting PAD but poor sensitivity (42.86%). Conclusions The accuracy of automated toe blood pressure and TBI measurements was determined to be good when using colour duplex ultrasound as the reference standard for the non-invasive diagnosis of peripheral arterial disease. Results should be interpreted in the context of all clinical signs and symptoms.

The fate of the ischaemic limb in diabetes: it is neuropathy that makes the difference

VASA ◽  
2001 ◽  
Vol 30 (Supplement 58) ◽  
pp. 15-20 ◽  
Author(s):  
Chantelau
Keyword(s):  
Pain Perception ◽  
Sensory Neuropathy ◽  
Arterial Calcification ◽  
Limb Ischaemia ◽  
Surgical Interventions ◽  
Risk Patients ◽  
Arterial Haemodynamics ◽  
The Difference ◽  
Peripheral Arterial ◽  
Medial Arterial Calcification

Evidence is presented of the deleterious effects of sensory and autonomic polyneuropathy on coexisting peripheral arterial occlusive disease (PAOD) in diabetes mellitus. Autonomic neuropathy triggers medial arterial calcification in the lower leg, which affects arterial haemodynamics, and aggravates preexisting PAOD. Calcificated arteries are incompressible and give false blood pressure readings by sphygmomanometry, with subsequent underestimation of PAOD. Sensory neuropathy leads to loss of protective pain sensation, and precludes the timely diagnosis and treatment of limb ischaemia (no claudication, no rest pain). Absent pain perception is also critical for the outcome of surgical interventions, as wound infections and other complications will occur unnoticed. These features have consequences for the detection of high-risk patients, and for the safety of surgery as well.

Sign in / Sign up

Export Citation Format

Share Document