Diagnostic Accuracy of Ankle-Brachial Pressure Index Compared with Doppler Arterial Waveforms for Detecting Peripheral Arterial Disease: A Systematic Review

Kashetsky, Nadia; Sachdeva, Muskaan; Lu, Justin D.; Mufti, Asfandyar; Kim, Patrick; Bagit, Ahmed; Sibbald, R. Gary

doi:10.1097/01.asw.0000822628.82131.1d

Cited by 5 publications

(2 citation statements)

References 29 publications

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“…As of January 2022, according to The National Diabetes Report, over 30 million people have diabetes, and over 90 million have prediabetes in the United States [50]. T2DM and the vascular complications of this disease continue to increase in prevalence incidence and are a leading cause of human suffering and death [51]. The etiology of DM is multifactorial and involves a complex combination of genetics and environmental factors.…”

Section: Diabetes Mellitusmentioning

confidence: 99%

The Role of Physiotherapy in Peripheral Artery Disease in Patients With Diabetes Mellitus: A Narrative Review

Herrera,

Rueda Capistrani,

Obando Vera

et al. 2024

Cureus

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Diabetes mellitus (DM) comprises a spectrum of metabolic disorders distinguished by the persistent elevation of glucose levels in the bloodstream. It stands as a primary risk factor for peripheral arterial disease (PAD), denoted by atherosclerosis affecting the lower extremities. One clinical manifestation of symptomatic PAD is intermittent claudication alleviated by rest but also capable of presenting as atypical leg pain. Confirmatory diagnostic measures, including the ankle-brachial index (ABI), toe-brachial index (TBI), or Doppler waveform analysis, are imperative in the verification of PAD. For management, the recommendation is to incorporate physiotherapy alongside concurrent medical interventions, such as anticoagulants, antiplatelet agents, statins, or, in certain cases, surgical procedures. This narrative review seeks to elucidate the advantages of physiotherapy in diabetic patients with PAD, contributing to the deceleration of disease progression and improving symptoms. Although supervised exercise therapy is strongly supported by empirical evidence as more beneficial, the absence of supervised environments is a common issue. Consequently, the preference lies in the combination of supervised exercise with homebased regimens. The objective is that each patient exercises for more than three days per week, progressively extending their duration weekly. This approach has demonstrated a noteworthy enhancement in walking functionality, exercise tolerance, pain alleviation, and an overall improvement in the quality of life for patients.

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Section: Diabetes Mellitusmentioning

confidence: 99%

The Role of Physiotherapy in Peripheral Artery Disease in Patients With Diabetes Mellitus: A Narrative Review

Herrera,

Rueda Capistrani,

Obando Vera

et al. 2024

Cureus

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“…The Ankle Brachial Pressure Index (ABPI) has been the established standard for vascular assessment in individuals with lower limb ulceration. 1 While alternative methods, such as duplex ultrasound 2 and artificial intelligence‐powered analysis of arterial doppler waveforms, 3 have been explored, recent epidemiological data show limited adoption of these advanced diagnostic tools in the United Kingdom. 4 Guest et al 4 found that around 25% of wounds in the United Kingdom lack a proper diagnosis, and only about 15% of patients with lower limb ulcers have documented ABPI assessments.…”

Section: Introductionmentioning

confidence: 99%

Clinimetrics of the Lanarkshire Oximetry Index for patients with leg ulcers: A systematic review and meta‐analysis

Wynn,

Stephens,

Pradeep

et al. 2023

International Wound Journal

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Ankle Brachial Pressure Index (ABPI) measurement has long been considered the gold standard of vascular assessment for people with lower limb ulceration. Despite this, only around 15% of patients in the United Kingdom who require an ABPI measurement undergo the assessment. The Lanarkshire Oximetry Index (LOI) is a cheaper and arguably more accessible approach to vascular assessment and was initially proposed as an alternative to the ABPI in 2000. No synthesis of evidence related to the LOI has been performed since its introduction into the literature. Primary studies were sought to determine the clinimetric properties of the LOI and its level of agreement with ABPI assessments. Systematic searches of MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, BNI, ProQuest Health and Medicine, Science Direct, Google Scholar and the British Library (online search) were conducted. Reference lists of identified studies were also reviewed to identify additional studies. Three primary studies met the inclusion criteria, reporting data from 307 patients and 584 limbs assessed using both the LOI and ABPI. All three studies reported fair to moderate kappa values for interrater reliability (κ = 0.290–0.747) and statistically significant positive correlation coefficients (r = 0.37, p < 0.001 in two studies) between the LOI and ABPI. The combined data from the three studies indicated a sensitivity of 52% (41.78–62.1, 95% confidence interval [CI]) and specificity of 96.08% (93.4–97.9, 95% CI) for the LOI using the ABPI as a reference. Additional data are required to indicate the safety of the LOI in practice. Data are also required to determine if the LOI is more acceptable to clinicians compared to the ABPI and whether there are any barriers/enablers to its implementation in practice. Given the relatively low specificity of the LOI, it may be beneficial to combine measurement of the LOI with a subjective clinical risk assessment tool to improve the sensitivity of this alternative approach to vascular assessment.

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Automated devices for identifying peripheral arterial disease in people with leg ulceration: an evidence synthesis and cost-effectiveness analysis

Boyers,

Cruickshank,

Aucott

et al. 2024

Health Technol Assess

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Background Peripheral artery disease is a common condition caused by narrowing/blockage of the arteries, resulting in reduced blood supply. Peripheral artery disease is associated with an increased risk of vascular complications, but early treatment reduces mortality and morbidity. Leg ulcers are long-lasting wounds, usually treated by compression therapy. Compression therapy is not suitable for people with peripheral artery disease, as it can affect the arterial blood supply. In clinical practice, people with peripheral artery disease are identified by measurement of the ankle–brachial pressure index using a sphygmomanometer and manual Doppler device. However, this method can be uncomfortable for people with leg ulcers and automated devices have been proposed as a more acceptable alternative. The objective of this appraisal was to summarise the clinical and cost-effectiveness evidence on the use of automated devices to detect peripheral artery disease in people with leg ulcers. Methods Clinical effectiveness To identify reports of relevant studies, we searched major electronic databases and scrutinised the information supplied by the manufacturers of the automated devices under investigation. Due to the lack of evidence on people with leg ulcers, we considered evidence from studies of any design assessing automated devices versus an acceptable reference device in any population receiving ankle–brachial pressure index assessment. We summarised information on diagnostic accuracy of the automated devices and level of agreement with the reference device. For each device, when data permit, we pooled data across studies by conducting random-effects meta-analyses using a Hierarchical Summary Receiving Operating Characteristics model. Cost-effectiveness An economic model comprising a decision tree (24 weeks) and Markov models to capture lifetime costs and quality-adjusted life-years associated with venous, arterial and mixed aetiology disease in leg ulcer patients. Analyses were conducted from a United Kingdom National Health Service and Personal Social Services perspective. Costs and quality-adjusted life-years were discounted at 3.5% per year. Deterministic and several probabilistic analyses were used to capture uncertainty surrounding a range of optimistic and pessimistic assumptions about the impact of automated tests on health outcomes (ulcer healing and requirement for invasive management of arterial disease). Results Clinical effectiveness From the 116 records retrieved by the electronic searches, we included 24 studies evaluating five devices (BlueDop Vascular Expert, BOSO ABI-System 100, Dopplex Ability, MESI ankle–brachial pressure index MD and WatchBP Office ABI). Two studies assessing people with leg ulcers found that automated devices often gave higher ankle–brachial pressure index readings than manual Doppler (underestimation of arterial disease). In the 22 studies involving people without leg ulcers, automated devices generally demonstrated good specificity and moderate specificity. Meta-analysis of 12 studies showed a pooled sensitivity of 64% (95% confidence interval 57% to 71%) and a pooled specificity of 96% (95% confidence interval 92% to 98%) for detection of peripheral artery disease. Cost-effectiveness Automated devices cost less than manual Doppler to deliver. However, increased risks of invasive treatment requirements for inappropriately compressed arterial/mixed ulcers due to false-negative results, and increased healing times due to delayed compression of false-positive test results mean that in most scenarios manual Doppler was less costly and had slightly higher quality-adjusted life-years than automated devices. Results are highly uncertain, dependent on many assumptions and should be interpreted cautiously. Limitations and conclusions The limited evidence identified for each automated device, especially in people with leg ulcers, and its clinical heterogeneity precludes any firm conclusions on the diagnostic performance and cost-effectiveness of these devices in clinical practice. Study registration This study is registered as PROSPERO CRD42022327588. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Evidence Synthesis programme (NIHR award ref: NIHR135478) and is published in full in Health Technology Assessment; Vol. 28, No. 37. See the NIHR Funding and Awards website for further award information.

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Diagnostic Accuracy of Ankle-Brachial Pressure Index Compared with Doppler Arterial Waveforms for Detecting Peripheral Arterial Disease: A Systematic Review

Cited by 5 publications

References 29 publications

The Role of Physiotherapy in Peripheral Artery Disease in Patients With Diabetes Mellitus: A Narrative Review

The Role of Physiotherapy in Peripheral Artery Disease in Patients With Diabetes Mellitus: A Narrative Review

Clinimetrics of the Lanarkshire Oximetry Index for patients with leg ulcers: A systematic review and meta‐analysis

Automated devices for identifying peripheral arterial disease in people with leg ulceration: an evidence synthesis and cost-effectiveness analysis

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