The Ankle–Brachial Index and the Diabetic Foot: A Troublesome Marriage

Aerden, Dimitri; Massaad, Dany; Kemp, K. Von; Tussenbroek, Franciscus van; Debing, Erik; Keymeulen, Bart; Brande, P. Van den

doi:10.1016/j.avsg.2010.12.025

Cited by 93 publications

(94 citation statements)

References 25 publications

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“…However, a consistent relationship may not be observed between severely reduced ABI results that are congruent with the degree of arterial obstruction. 2 To our knowledge, there are currently no published studies in the literature addressing the angiographic validation of non-invasive indices such as the ABI and TBI (toe-brachial index) among patients with CLI. This study highlights the shortcomings of these modalities in the evaluation of patients with CLI, who should undergo angiography to adequately characterize the burden of disease, and to determine the best revascularization strategy.…”

Section: Introductionmentioning

confidence: 99%

Validation of the relationship between ankle–brachial and toe–brachial indices and infragenicular arterial patency in critical limb ischemia

et al. 2015

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The relationship between ankle-brachial index (ABI) remains uncertain relative to clinical and angiographic features of critical limb ischemia (CLI). From July 2011 to February 2013, 89 consecutive patients with CLI had non-invasive testing for indications of rest pain (n=23, 26%), as well as minor (n=29, 33%) and major (n=37, 42%) ischemic tissue loss. All patients subsequently underwent ABI testing and lower extremity angiography with visualization of the infragenicular arteries. Toe-brachial index (TBI) testing was available among 31 of these patients. Among patients with any ischemic tissue loss, 29% had an ABI between 0.7 and 1.4. Patients with rest pain alone had reduced odds of abnormal arterial runoff in univariate (OR 0.75, 95% CI 0.63-0.90; p=0.002) but not multivariate (p=0.50) analysis. Advanced age, increased ABI, reduced creatinine clearance, hyperlipidemia, and prior coronary artery disease were predictive of abnormal infragenicular runoff. Despite limitations in statistical power, median TBI, compared to ABI, tended to increase when infragenicular arterial runoff was preserved. Overall, the association of TBI with abnormal runoff was not significant (p=0.38). In conclusion, in the evaluation of CLI, nearly one-third of patients with any ischemic tissue loss had a normal or mildly reduced ABI. Assessment of TBI may augment the diagnostic accuracy of ABI in the evaluation of CLI.

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Section: Introductionmentioning

confidence: 99%

Validation of the relationship between ankle–brachial and toe–brachial indices and infragenicular arterial patency in critical limb ischemia

et al. 2015

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“…12 In a study comparing arteriography and ABIs in diabetic patients, ABI correlated poorly with severity of below-knee atherosclerosis. 6 The use of transcutaneous oximetry to assess tissue perfusion of BKA has been extensively studied, although is not widely used. 13 However, in amputation for gangrene, a previous series found diabetic patients had greater tissue perfusion pressure than nondiabetic patients.…”

Section: Discussionmentioning

confidence: 99%

“…Ankle-brachial indices (ABIs) were not routinely measured as most patients had uncontrolled diabetes, and in our experience, such patients often have noncompressible ABIs, a notoriously inaccurate marker for severity of underlying PAD. 6 Pathology was examined from the first procedure and assigned to either gangrene or gangrene with evidence of arteriosclerosis. Patients were then followed to their second formalization procedure.…”

Section: Methodsmentioning

confidence: 99%

Unrecognized Arteriosclerosis Is Associated with Wound Complications after Below-Knee Amputation

Gifford

Anthony

Kaji

et al. 2015

Annals of Vascular Surgery

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“…A klinikai tünetek, a fizikális vizsgálat korlátai mellett, a perifériás érbetegség diagnózisának felállításakor hagyományosan javasolt Doppler-(boka/kar index) vizsgálatnak az értékelhetősége is csökkent a cukorbeteg populációban [16].…”

Section: A Perifériás éRbetegség Felismerésének Sajátosságai Cukorbetunclassified

A diabeteses láb ischaemiás eredete. Epidemiológia, a diagnózis nehézségei, prevenciós és revascularisatiós lehetőségek

et al. 2017

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A "diabeteses láb" mint multifaktoriális megbetegedés hátterében a neuropathia, infekció, csont-és lágyrész-eltérések mellett a legutóbbi évek epidemiológiai adatai alapján az alsó végtagi ischaemia szerepe egyre inkább hangsúlyossá válik. Cukorbetegségben az alsó végtagi ütőérszűkület rendkívüli mértékben fokozza az alsó végtagi fekélyképződés, valamint a minor és major amputáció kockázatát. A diabetesre jellemző klinikai megjelenés miatt az alsó végtagi ütő-érszűkület felismerésére a hagyományos diagnosztikus eljárások korlátozottan alkalmazhatók. A hatékony diagnosztika alapfeltétele olyan vascularis központok elérhetősége, amelyek a szakmai ismeretek és rendelkezésre álló diagnosztikus eszközök segítségével alkalmasak a cukorbetegcsoportban az érbetegség időben történő detektálására. Az ischaemiás kórokra visszavezethető diabeteses láb kezelése során a hatékony gyógyszeres kezelés mellett az érát-járhatóság helyreállításának kiemelt fontosságot tulajdonítanak. Az érsebészeti és intervenciós radiológiai beavatkozá-sok sikeresen előzhetik meg a végtagvesztést. Népegészségügyi érdek, hogy kiemelt vascularis centrumok alakuljanak, ahol az angiológusok, érsebészek, intervenciós radiológusok csoportjai a társszakmákkal együttműködve lehetnek képesek multidiszciplináris módon az érbetegségek magas szintű szakmai ellátására. Orv. Hetil., 2017, 158(6), 203-211. Kulcsszavak: diabeteses láb, perifériás érbetegség, alsó végtagi amputációIschemic origin of diabetic foot disease. Epidemiology, difficulties of diagnosis, options for prevention and revascularization "Diabetic foot" as definition covers a multifactorial clinical condition. According to the recent epidemiological data, the role of lower limb ischemia is getting more influential over other pathological causes, like neuropathy, infections and bone or soft tissue deformity. In diabetes, vascular disease leads to increased risk for leg ulcers and minor or major amputations. The traditional diagnostic tools for recognition of peripheral arterial disease have limited value because of diabetes specific clinical manifestations. Available vascular centers with special expertise and diagnostic tools are the prerequisite for efficient diagnosis supporting timely recognition of peripheral arterial disease. In course of treatment of diabetic foot with ischemic origin, beyond effective medical treatment revascularization (open vascular surgery or endovascular procedures) has paramount importance for prevention of limb loss. Vascular teams of vascular specialists, vascular surgeons and interventional radiologist in dedicated centers in multidisciplinary cooperation with other professions represent public health issue in effective prevention.

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The Ankle–Brachial Index and the Diabetic Foot: A Troublesome Marriage

Cited by 93 publications

References 25 publications

Validation of the relationship between ankle–brachial and toe–brachial indices and infragenicular arterial patency in critical limb ischemia

Validation of the relationship between ankle–brachial and toe–brachial indices and infragenicular arterial patency in critical limb ischemia

Unrecognized Arteriosclerosis Is Associated with Wound Complications after Below-Knee Amputation

A diabeteses láb ischaemiás eredete. Epidemiológia, a diagnózis nehézségei, prevenciós és revascularisatiós lehetőségek

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