Comparison of ankle brachial index with ultrasonographic examination of lower limb arteries in diabetics
Authors:
O. Machaczka 1,2; M. Homza 3,4; J. Janoutová 5; A. Zatloukalová 1,2; V. Janout 5
Authors‘ workplace:
Ostravská univerzita
Lékařská fakulta
; Centrum epidemiologického výzkumu
Ředitel: RNDr. Vítězslav Jiřík, Ph. D.
1; Ústav epidemiologie a ochrany veřejného zdraví
Vedoucí: doc. MUDr. Rastislav Maďar, Ph. D., MBA, FRCPS.
2; Fakultní nemocnice Ostrava
Kardiovaskulární oddělení
Primář: MUDr. Miroslav Homza, MBA
3; Masarykova univerzita, Brno
Interní kardiologická klinika
Přednosta: prof. MUDr. Jindřich Špinar, CSc., FESC
4; Univerzita Palackého, Olomouc
Fakulta zdravotnických věd
Centrum vědy a výzkumu
Ředitel: prof. MUDr. David Školoudík, Ph. D.
5
Published in:
Prakt. Lék. 2018; 98(2): 88-95
Category:
Of different specialties
Overview
Ankle brachial index (ABI) is a non-invasive method that is used primarily for the determination of lower extremity arterial disease (LEAD). In diabetic patients, however, may decrease the sensitivity of ABI due to complications of diabetes. In the Czech Republic this method is included in the recommended procedure even for dispensarization of type 2 diabetics.
Objective:
The objective was to evaluate the validity of the ABI method in diabetics compared to the duplex sonography method (DUS) as an investigative standard. The partial objectives were to compare the two most commonly used methods for ABI - oscillometric (ABI OSCI) and doppler (ABI DPP) methods and then compare these methods with DUS.
Methods:
ABI was measured in 21 type 2 diabetics using the ABI DPP and ABI OSCI. For ABI DPP, different methods were used to calculate the final value, which differed at the site of measurement of systolic pressure on the ankle (dorsalis pedis or tibialis posterior artery) and at the value of the systolic pressure of the lower limb given to the numerator of the formula (higher value from two ankle measurements – HAP method, lower value – LAP method). The data thus obtained were first compared with each other and subsequently with the DUS method, namely with the established value of arterial stenosis. The sensitivity and specificity of the individual ABI methods was calculated as compared to DUS using the cut-off values – ABI 0.9; stenosis 50%.
Results:
The statistically significant difference between the ABI OSCI and the various computational methods of ABI DPP was found. When comparing with the DUS, it was found that the highest agreement was achieved with the ABI DPP LAP. However, this agreement was interpreted as average (54.29%, k = 0.415). This method also has the highest sensitivity of 95% but with a low sensitivity of 31%. In contrast, the ABI OSCI showed a high specificity of 92%, but with a low sensitivity of 46%.
Conclusions:
The ABI DPP LAP method can be more appropriate tool for screening LEAD in diabetics. The question, however, remains whether the ABI method in diabetics is generally valid enough to definitively diagnose and assess the severity of LEAD.
Keywords:
ankle brachial index – duplex sonography – lower extremity arterial disease – diabetes mellitus
Sources
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General practitioner for children and adolescents General practitioner for adultsArticle was published in
General Practitioner
2018 Issue 2
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