Peripheral Arterial Disease: Efficacy of the Oscillometric Method

Vega, Jorge; Romaní, Sebastián; Garcipérez, Francisco J.; Vicente, Lucía Sánchez-Tarazaga; Pacheco, Nazaret; Zamorano, José Luís; Gómez-Barrado, José J.; Muñoz-Torrero, Juan Francisco Sánchez

doi:10.1016/j.rec.2010.12.006

Cited by 19 publications

(33 citation statements)

References 8 publications

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“…In addition, the learning curve for the oscillometric ABI is much shorter than that for the Doppler ABI, as it is mainly an automated technique. In fact, the oscillometric ABI can be even more accurate than the Doppler ABI, when both techniques are performed by physicians with little experience . This may be the case in screening.…”

Section: Discussionsupporting

confidence: 68%

“…Third, the reliability of pooled estimates is contingent upon the quality of the studies in the meta‐analysis, the quality assessment of studies with QUADAS‐2 showed some deficiencies across the studies, especially the patient selection and reference test domains, see Figure and Table . Fourth, although Doppler ABI is considered the non‐invasive gold standard, it has some flaws, especially when measurements are performed by poorly skilled technicians . Four studies did not report the staff performing the Doppler technique, therefore accuracy of the Doppler technique cannot be warranted in all the studies.…”

Section: Discussionmentioning

confidence: 99%

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The accuracy of an oscillometric ankle-brachial index in the diagnosis of lower limb peripheral arterial disease: A systematic review and meta-analysis

et al. 2017

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Summary Introduction Peripheral arterial disease (PAD) remains underdiagnosed and undertreated, partly because of limitations in the Doppler ankle‐brachial index (ABI), the non‐invasive gold standard. Objective This systematic review and meta‐analysis aims to compare the diagnostic accuracy of the oscillometric ABI and the Doppler ABI, and to examine the influence of two approaches to analysis: legs vs subjects and inclusion of oscillometric errors as PAD equivalents vs exclusion. Methods Systematic searches in EMBASE, MEDLINE, Web of Science and the Cochrane Library databases were performed, from inception to February 2017. Random‐effects models were computed with the Moses‐Littenberg constant. Hierarchical summary receiver operating characteristic curves (HSROC) were used to summarise the overall test performance. Results Twenty studies (1263 subjects and 3695 legs) were included in the meta‐analysis. The pooled diagnostic odds ratio (dOR) for the oscillometric ABI was 32.49 (95% CI: 19.6‐53.8), with 65% sensitivity (95% CI: 57‐74) and 96% specificity (95%CI: 93‐99). In the subgroup analysis, the “per subjects” group showed a better performance than the “per legs” group (dOR 36.44 vs 29.03). Similarly, an analysis considering oscillometric errors as PAD equivalents improved diagnostic performance (dOR 31.48 vs 28.29). The time needed for the oscillometric ABI was significantly shorter than that required for the Doppler ABI (5.90 vs 10.06 minutes, respectively). Conclusions and relevance The oscillometric ABI showed an acceptable diagnostic accuracy and feasibility, potentially making it a useful tool for PAD diagnosis. We recommend considering oscillometric errors as PAD equivalents, and a “per subject” instead of a “per leg” approach, in order to improve sensitivity. Borderline oscillometric ABI values in diabetic population should raise concern of PAD.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

The accuracy of an oscillometric ankle-brachial index in the diagnosis of lower limb peripheral arterial disease: A systematic review and meta-analysis

et al. 2017

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“…The true gold standard would be an intravascular perfusion study. Both methods have been compared to the true gold standard in 85 patients with claudication undergoing angiography 23. The oscillometric method showed 97% sensitivity, 89% specificity, 98% positive predictive value and 86% negative predictive value.…”

Section: Discussionmentioning

confidence: 99%

Ankle-Brachial Index determination and peripheral arterial disease diagnosis by an oscillometric blood pressure device in primary care: validation and diagnostic accuracy study

et al. 2012

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ObjectivesTo determine the level of agreement between a ‘conventional’ Ankle-Brachial Index (ABI) measurement (using Doppler and mercury sphygmomanometer taken by a research nurse) and a ‘pragmatic’ ABI measure (using an oscillometric device taken by a practice nurse) in primary care. To ascertain the utility of a pragmatic ABI measure for the diagnosis of peripheral arterial disease (PAD) in primary care.DesignCross-sectional validation and diagnostic accuracy study. Descriptive analyses were used to investigate the agreement between the two procedures using the Bland and Altman method to determine whether the correlation between ABI readings varied systematically. Diagnostic accuracy was assessed via sensitivity, specificity, accuracy, likelihood ratios, positive and negative predictive values, with ABI readings dichotomised and Receiver Operating Curve analysis using both univariable and multivariable logistic regression.SettingPrimary care in metropolitan and rural Victoria, Australia between October 2009 and November 2010.Participants250 persons with cardiovascular disease (CVD) or at high risk (three or more risk factors) of CVD.ResultsDespite a strong association between the two method's measurements of ABI there was poor agreement with 95% of readings within ±0.4 of the 0.9 ABI cut point. The multivariable C statistic of diagnosis of PAD was 0.89. Other diagnostic measures were sensitivity 62%, specificity 92%, positive predictive value 67%, negative predictive value 90%, accuracy 85%, positive likelihood ratio 7.3 and the negative likelihood ratio 0.42.ConclusionsOscillometric ABI measures by primary care nurses on a population with a 22% prevalence of PAD lacked sufficient agreement with conventional measures to be recommended for routine diagnosis of PAD. This pragmatic method may however be used as a screening tool high-risk and overt CVD patients in primary care as it can reliably exclude the condition.

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“…Se optó por la peor situación posible para considerar la existencia de enfermedad 25 vascular periférica, es decir, que no se pudieran palpar los pulsos simultáneamente en al menos un miembro . 15,26,27 Arteriopatía periférica: todo índice tobillo/brazo derecho e izquierdo inferior a 0,9 . Úlcera/amputación previa: se considera úlcera previa a toda lesión estadiable como como lesión estadío I, II, III, IV y V de la Clasificación de Wagner para pie diabético en uno o ambos pies de origen traumático o no.…”

Section: Definiciones Operacionalesunclassified

Risk factors associated with diabetic foot

Rojas

2016

Rev. virtual Soc. Parag. Med. Int

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ResumenIntroducción: El pie diabético representa una de las causas de mayor morbilidad e incapacidad en las personas con Diabetes Mellitus. Esta población abarca hasta el 70% de las amputaciones, en su mayoría desencadenada por la infección. La vasculopatía periférica, la neuropatía periférica asociadas al control metabólico juegan un rol importante en su génesis. El conocimiento de los mismos en la atención primaria asociadas a las medidas de prevención colaborarán en la disminución de este flagelo que aqueja a millones en la actualidad.Objetivos: Determinar los factores de riesgo asociados a las lesiones del pie diabético. Describir las características demográficas y clínicas de los pacientes con lesiones del pie diabético.Material y métodos: estudio de casos y controles. No probabilístico, de casos consecutivos. Se incluyeron pacientes adultos internados en el Departamento de Medicina Interna durante el 2015, diabéticos, con y sin lesiones en pie, sin amputaciones previas e independientes del tratamiento farmacológico.Resultados: se incluyeron 86 sujetos, de los cuales 59% de los casos presentaron onicomicosis, el 57% neuropatía, el 67% vasculopatía, 45% algún tipo de deformidad y un 63% utilizaban calzados inadecuados.Conclusiones: La onicomicosis representó un factor de riesgo significativo para el desarrollo del pie diabético (p=0,02). En lo que respecta a la vasculopatía, la neuropatía y el control glicémico no se pudo establecer un riesgo significativo.Palabras claves: pie diabético, polineuropatía diabética, angiopatía diabética, onicomicosis. AbstractIntroduction: The diabetic foot is one of the main causes of higher morbidity and disability in people with Diabetes Mellitus. This population comprises up to 70% of amputations, mostly triggered by infections. The peripheral vascular disease and the peripheral neuropathy associated with metabolic control play an important role in its genesis. The knowledge about them associated with prevention measures in primary care contribute to reduce this scourge that currently afflicts millions.

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Peripheral Arterial Disease: Efficacy of the Oscillometric Method

Cited by 19 publications

References 8 publications

The accuracy of an oscillometric ankle-brachial index in the diagnosis of lower limb peripheral arterial disease: A systematic review and meta-analysis

The accuracy of an oscillometric ankle-brachial index in the diagnosis of lower limb peripheral arterial disease: A systematic review and meta-analysis

Ankle-Brachial Index determination and peripheral arterial disease diagnosis by an oscillometric blood pressure device in primary care: validation and diagnostic accuracy study

Risk factors associated with diabetic foot

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