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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

1. Aboyans V, Criqui MH, Abraham P, et al. Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Circulation 2012; 126(24): 2890–2909.

2. Aboyans V, Lacroix P, Lebourdon A, et al. The intra-and interobserver variability of ankle-arm blood pressure index according to its mode of calculation. J Clin Epidemiol 2003; 56(3): 215–220.

3. Bartoš V, Pelikánová T, a kol. Praktická diabetologie. 5. vydání. Praha: Maxdorf 2011.

4. Brooks B, Dean R, Patel S, et al. TBI or not TBI: that is the question. Is it better to measure toe pressure than ankle pressure in diabetic patients? Diabetic Med 2001; 18(7): 528–532.

5. Clairotte C, Retout S, Potier L, et al. Automated ankle-brachial pressure index measurement by clinical staff for peripheral arterial disease diagnosis in nondiabetic and diabetic patients. Diabetes Care 2009; 32(7): 1231–1236.

6. Faisal AA, Cooper TC Jr. Onemocnění periferních tepen – diagnóza a léčba. Medicína po promoci 2008, 9(6): 14–19.

7. Franz RW, Jump MA, Spalding MC, Jenkins JJ. Accuracy of duplex ultrasonography in estimation of severity of peripheral vascular disease. Int J Angiol 2013; 22(3): 155–158.

8. Chung NS, Han SH, Lim SH, et al. Factors affecting the validity of ankle-brachial index in the diagnosis of peripheral arterial obstructive disease. Angiology 2010; 61(4): 392–396.

9. Karetová D, Roztočil K, Herber O. Ischemická choroba dolních končetin: doporučený diagnostický a léčebný postup pro všeobecné praktické lékaře 2011. Praha: Společnost všeobecného lékařství ČLS JEP, Centrum doporučených postupů pro praktické lékaře 2011. Doporučené postupy pro praktické lékaře. ISBN 978-80-86998-43-5.

10. Karetova D, Seifert B, Vojtiskova J, et al. The Czech ABI Project – prevalence of peripheral arterial disease in patients at risk using the ankle-brachial index in general practice (a cross-sectional study). Neuro Endocrinol Lett 2012; 33(Suppl 2): 32–37.

11. Niazi K, Khan TH, Easley KA. Diagnostic utility of the two methods of ankle brachial index in the detection of peripheral arterial disease of lower extremities. Catheter Cardiovasc Interv 2006; 68(5): 788–792.

12. Nukumizu Y, Matsushita M, Sakurai T, et al. Comparison of Doppler and oscillometric ankle blood pressure measurement in patients with angiographically documented lower extremity arterial occlusive disease. Angiology 2007; 58(3): 303–308.

13. Premalatha G, Ravikumar R, Sanjay R, et al. Comparison of colour duplex ultrasound and ankle-brachial pressure index measurements in peripheral vascular disease in type 2 diabetic patients with foot infections. J Assoc Physicians India 2002; 50: 1240–1244.

14. Schröder F, Diehm N, Kareem S, et al. A modified calculation of ankle-brachial pressure index is far more sensitive in the detection of peripheral arterial disease. J Vasc Surg 2006; 44(3): 531–536.

15. Stoekenbroek RM, Ubbink DT, Reekers JA, Koelemay MJW. Hide and seek: does the toe-brachial index allow for earlier recognition of peripheral arterial disease in diabetic patients? Eur J Vasc Endovasc 2015; 49(2): 192–198.

16. Vojtíšková J, Seifert B. Oscilometrické měření periferních tlaků na dolních končetinách. Nová kompetence všeobecných praktických lékařů. Kapitoly z kardiologie 2014; 6(2): 55–59.

17. Williams DT, Harding KG, Price P. An evaluation of the efficacy of methods used in screening for lower-limb arterial disease in diabetes. Diabetes Care 2005; 28(9): 2206–2210.

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