Raised Ankle/Brachial Pressure Index in Insulin‐treated Diabetic Patients

Goss, David; Trafford, June de; Roberts, V. C.; Flynn, M. D.; Edmonds, M E; Watkins, P. E.

doi:10.1111/j.1464-5491.1989.tb01231.x

Cited by 64 publications

(35 citation statements)

References 8 publications

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“…The negative palpation findings of the diabetic arteries support the observation that diabetes causes incompressible arteries and falsely elevated ABIs [4,10,13]. An artery of a diabetic patient could thus be even more diseased than the ABI implies, meaning that some other measure of his or her pedal circulation must be used (e.g., toe pressure) [14].…”

Section: Discussionmentioning

confidence: 71%

Distal Pulse Palpation: Is It Reliable?

et al. 1999

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The aim of this study was to evaluate the reliability of distal pulse palpation. The dorsalis pedis and the tibialis posterior arteries of 25 patients with suspected lower limb arterial disease were independently palpated by three vascular surgeons and three medical students in the outpatient clinic and by two vascular nurses and one physician in the vascular laboratory. The palpation findings were compared to the ankle/brachial index (ABI). Palpable and unpalpable pulses were best separated with ABI 0.76 as the cutoff point. The degree of misdiagnosis was unacceptably high, with an underdiagnosis of more than 30%. The agreement was highest (kappa 0. 68, good) among the vascular laboratory personnel in the peaceful vascular laboratory and lowest (kappa 0.38, fair) among the vascular surgeons in the busy outpatient clinic. The poor agreement and the high proportion of misdiagnosis obtained in the outpatient clinic argue against the use of pulse palpation as a single diagnostic method. Palpable pulses with low ABIs clearly state the need for more objective measurements whenever ischemia is suspected. Yet, by carefully palpating both pedal arteries under good, nonhurried conditions the reproducibility and accuracy of pulse palpation can be tolerable.

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Section: Discussionmentioning

confidence: 71%

Distal Pulse Palpation: Is It Reliable?

et al. 1999

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“…If peri-wound TcPO 2 measurements were over 30 mmHg, then further treatment including reconstructive procedures was planned; otherwise, amputations at according levels were performed. The anklebrachial index (ABI) is not used as it is not reliable in diabetic patients due to the high incidence of calcifi ed vessels causing falsely elevated values [ 13 ]. In diabetic patients, the most signifi cant atherosclerosis occurs in the crural arteries often sparing the arteries of the foot [ 31 ].…”

Section: Vascular Interventionmentioning

confidence: 99%

Skin Necrosis of Diabetic Foot and Its Management

Hong

2014

Skin Necrosis

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The chapter describes the statistics related to diabetic foot ulceration, pathology of necrosis formation, types of necrosis, and the current surgical management of diabetic foot skin necrosis.According to the statistics given in the USA, approximately 3-4 % of individuals with diabetes currently have foot ulcers or deep infections and 25 % will develop foot ulcers sometime during their life [ 24 , 30 ]. Their risk of lower leg amputation increases by a factor of 8 once an ulcer develops. It is estimated that the ageadjusted rate of lower extremity amputation in diabetic patients is 15-fold that of nondiabetics [ 20 ]. Intractable diabetic foot ulcers can bring not only decreased physical, emotional, and social functions but huge economic impact to the patient [ 1 , 25 , 27 ]. Furthermore, the 5-year mortality after major amputations may range from 39 % to as high as 80 % [ 24 , 21 ]. The necrosis is often seen in the late stages of the diabetic foot. The presence of skin necrosis is a serious implication leading to the loss of limb. Their respective indications vary depending essentially on criteria like the hardness of the black cover and the extent of necrosis in depth, the extent of necrotic tissue over the skin.In neuropathic foot, infection is usually the cause, whereas it can be solely due to ischemia alone with slow onset of mummifi cation like dry necrosis.

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“…• Variation in the interpretation of results of investigations related to blood vessels is due to discrepancies related to arterial size, variation, amount of subcutaneous fat, edema or neurovascular diabetic changes [8] . …”

Section: IImentioning

confidence: 99%