Use of the toe brachial index to detect lower extremity arterial disease in diabetics

Czech version

Authors: O. Machaczka ^1,2,3; M. Homza ⁴; P. Macounová ²; M. Kovalová ²; J. Janoutová ^1,3; V. Janout ¹
Authors‘ workplace: Univerzita Palackého v Olomouci, Fakulta zdravotnických věd, Centrum vědy a výzkumu, Ředitel: prof. MUDr. Vladimír Janout, CSc. ¹; Ostravská univerzita v Ostravě, Lékařská fakulta, Ústav epidemiologie a ochrany veřejného zdraví, Vedoucí: doc. MUDr. Rastislav Maďar, PhD., MBA, FRCPS. ²; Univerzita Palackého v Olomouci, Fakulta zdravotnických věd, Ústav zdravotnického managementu, Přednostka: doc. MUDr. Jana Janoutová, Ph. D. ³; Ostravská univerzita v Ostravě, Lékařská fakulta, Katedra interních oborů, Vedoucí: MUDr. Ivo Valkovský, Ph. D. ⁴
Published in: Prakt. Lék. 2020; 100(6): 270-275
Category: Reviews

Overview

The toe brachial index (TBI) is used for the detection of lower extremity arterial disease in the case of reduced effectiveness of the ankle brachial index (ABI). This is most common in diabetics due to arterial calcification. It is assumed that the arteries on the toe are less stressed by calcification and thus TBI can give more accurate results.

The aim of this work is to provide a brief overview of current knowledge about TBI and its use to detect lower extremity arterial disease in diabetics in comparison with ABI.

For the purposes of this work, a search of information and current scientific knowledge focused on the use of TBI in the detection of lower extremity arterial disease in diabetics was performed.

In contrast to well-defined ABI limits, the diagnostic criteria for a normal TBI value remain ambiguous. According to international guidelines, a value of 0.7 is recommended. Studies show that the arteries on the toe are less stressed by calcification, allowing TBI to give more accurate results than ABI. According to some studies, this can only happen when the ABI is > 1.3, which indicates obvious arterial calcification. However, calcification is common among diabetics even with an ABI value < 1.3. In general, studies on the validity of TBI in diabetics differ in their results as well as in their validity. The difference in results can be due, to the use of different methods and procedures, an ambiguous criterion value and a greater susceptibility of the measurement to ambient temperature fluctuations. However, according to the latest international guidelines, the TBI method is recommended in diabetics on the basis of high evidence of identification. Thus, TBI appears to be an equivalent alternative to ABI, which can be used in diabetics not only to supplement the examination, but also on its own.

Keywords:

toe brachial index – diabetes mellitus – lower extremity arterial disease

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

3. Bonham PA. Determining the toe brachial pressure index: use this method to accurately assess perfusion in feet and toes. Nurs Manag 2003; 33(9): 54–55.

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. 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.

6. Cole S, Walker RA, Norris R. Vascular laboratory practice (Part III). London, UK: IPEM 2001.

7. Craike P, Chuter V, Bray A, et al. The sensitivity and specificity of the toe brachial index in detecting peripheral arterial disease. J Foot Ankle Res 2013; 6(S1): P3.

8. Faisal AA, Cooper TC Jr. Onemocnění periferních tepen. Diagnóza a léčba. Med. promoci 2008; 9(6): 14–19.

9. Homza M, Machaczka O, Porzer M, et al. Comparison of different methods of ABI acquisition for detection of peripheral artery disease in diabetic patients. Biomed Pap 2018; 163(3): 227–232.

10. Hoyer C, Sandermann J, Petersen LJ. The toe-brachial index in the diagnosis of peripheral arterial disease. J Vasc Surg 2013; 58(1): 231–238.

11. Hyun S, Forbang NI, Allison MA, et al. Ankle-brachial index, toe-brachial index, and cardiovascular mortality in persons with and without diabetes mellitus. J Vasc Surg 2014; 60(2): 390–395.

12. Kannel WB, McGee DL. Diabetes and cardiovascular disease. JAMA 1979; 241(19): 2035–2038.

13. Karen I, Svačina Š, Škrha J. Diabetes mellitus: doporučený postup péče o pacienty s diabetes mellitus: novelizace 2013. Praha: Společnost všeobecného lékařství ČLS JEP, c2013: 21 s. Doporučené postupy pro všeobecné praktické lékaře.

14. Karetová D. Onemocnění periferních tepen: diagnóza a léčba [komentář]. Med. promoci 2008; 9(6): 19–22.

15. Karetová D, Ingrischová M. Ischemická choroba dolních končetin u diabetiků odlišnosti vzniku, projevů a diagnostiky. Med. promoci 2009; 10(2): 56–63.

16. Karetová D, Vojtíšková J, Roztočil K. Ischemická choroba dolních končetin: novelizace 2016. Praha: Centrum doporučených postupů pro praktické lékaře, Společnost všeobecného lékařství 2016.

17. Malý R, Chovanec V. Ischemická choroba dolních končetin a diabetes. Vnitř. Lék. 2010; 56(4): 341–346.

18. Musil D. Ischemická choroba dolních končetin. Interní Med 2007; 9(4): 170–174.

19. 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.

20. Pahlsson HI, Laskar C, Stark K, et al. The optimal cuff width for measuring toe blood pressure. Angiology 2007; 58(4): 472–476.

21. Potier L, Abi Khalil C, Mohammedi K, Roussel R. Use and Utility of Ankle Brachial Index in Patients with Diabetes. Eur J Vasc Endovasc 2011; 41(1): 110–116.

22. Quong WL, Fung AT, Yu RY, Hsiang YN. Reassessing the normal toe-brachial index in young healthy adults. J Vasc Surg 2015; 63(3): 652–656.

23. Ramsey DE, Manke DA, Sumner DS. Toe blood pressure. A valuable adjunct to ankle pressure measurement for assessing peripheral arterial disease. J Cardiovasc Surg 1983; 24(1): 43–48.

24. Sacks D, Bakal CW, Beatty PT, et al. Position statement on the use of the ankle brachial index in the evaluation of patients with peripheral vascular disease: A consensus statement developed by the standards division of the society of cardiovascular & interventional radiology. J Vasc Interv Radiol 2002; 13(4): 353.

25. Sahli D, Eliasson B, Svensson M, et al. Assessment of toe blood pressure is an effective screening method to identify diabetes patients with lower extremity arterial disease. Angiology 2004; 55(6): 641–651.

26. Sawka AM, Carter SA. Effect of temperature on digital systolic pressures in lower limb in arterial disease. Circulation 1992; 85(3): 1097–1101.

27. 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.

28. 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 [online] 2015; 49(2): 192–198.

29. Škrha J, a kol. Diabetologie. Praha: Galén 2009.

30. Tehan P, Bray A, Chuter VH. Non-invasive vascular assessment in the foot with diabetes: sensitivity and specificity of the ankle brachial index, toe brachial index and continuous wave Doppler for detecting peripheral arterial disease. J Diabetes Complicat 2016; (30(1): 155–160.

31. Tehan P, Bray A, Keech R, et al. Sensitivity and specificity of the toe-brachial index for detecting peripheral arterial disease: initial findings. J Ultrasound Med 2015; 34(10): 1737–1743.

32. 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.