The ankle brachial index in people with and without diabetes: intra‐tester reliability

Casey, Sarah; Chuter, Vivienne

doi:10.1186/s13047-020-00389-w

Cited by 14 publications

(24 citation statements)

References 40 publications

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“…The main drawback is that ABI cannot accurately locate the vascular lesion and is unable to determine the morphological changes in vessels. Its sensitivity will also be significantly reduced when patients suffer from diseases involving small vessels, such as diabetes because such diseases are more likely to co-exist with medial arterial calcification which can prevent compression and pressure measurement [ 28 , 29 ]. Therefore, a normal ABI does not exclude the presence of PAD [ 27 ].…”

Section: Early Screening Methods For Pad In Icvd Patientsmentioning

confidence: 99%

Early identification and treatment for peripheral arterial disease in patients with ischemic cerebrovascular disease

2023

Eur J Med Res

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Ischemic cerebrovascular disease (ICVD) is a major cause of mortality and disability worldwide and is often caused by atherosclerosis. As a systemic disease, atherosclerosis usually affects multiple vascular beds, mainly including cerebral, coronary, and peripheral arteries. Therefore, ICVD is easily complicated by lower-extremity peripheral arterial disease (PAD). ICVD patients with PAD have more serious symptoms and a worse prognosis, however, neurologists might neglect the evaluation and management of the coexistent PAD, and there is still a lack of consensuses about the diagnosis and treatment for such patients. By summarizing relevant research progresses, this review showed that duplex ultrasound had more advantages in the early screening and evaluation of PAD in ICVD patients among multiple methods to diagnose PAD. Furthermore, the current evidence seems to support that single-drug antiplatelet can be used as the basic treatment, and new antithrombotic strategies, such as ticagrelor only or aspirin combined with low-dose rivaroxaban are expected to further reduce the incidence of stroke for ICVD patients with PAD. More effective treatments would be explored by large-scale trials to guide the clinical management to prevent secondary stroke for such patients.

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Section: Early Screening Methods For Pad In Icvd Patientsmentioning

confidence: 99%

Early identification and treatment for peripheral arterial disease in patients with ischemic cerebrovascular disease

2023

Eur J Med Res

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“…For ankle systolic pressure, the higher pressures of the dorsal pedis artery and posterior tibial artery were used. The Doppler method measuring ABI has gained reliability in previous studies [ 11 , 12 ].…”

Section: Methodsmentioning

confidence: 99%

Clinical Characteristics of Lower-Limb Ischemia in Japanese Patients with Type 2 Diabetes and Usefulness of the Great Toe Blood Flow as a Predictive Indicator of Leg Arterial Obstruction

Sakamoto

Ikeda

2022

Healthcare

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Nurses are required to make quantitative, evidence-based observations when implementing diabetic foot care. This study aimed to clarify the characteristics of lower-limb ischemia in patients with type 2 diabetes using subjective and objective symptoms and physiological indicators and whether the physiological characteristics are established as predictive indicators of arterial obstruction. Fifty Japanese patients with type 2 diabetes (100 limbs) were classified into three groups using the ankle–brachial index (ABI). Patients with an ABI of ≤0.69 had subjective and objective symptoms of blood flow disturbance, such as pain at rest, cold sensation, pale skin, and imperceptibility to the dorsalis pedis artery. Blood flow in the first toe was the lowest. Binary logistic regression analysis established hallux perfusion as a predictive model for lower-limb arterial occlusion (odds ratio = 0.979, 95% confidence interval 0.900–0.999). Thus, when nurses perform diabetic foot care, it is necessary to evaluate not only subjective and objective symptoms, but also blood flow at the microcirculatory level of the great toe.

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“…79 No studies included people with DFU. Two studies reported participants having diabetes-related complications including neuropathy, nephropathy, retinopathy 74,75 and one study reported previous history of vascular surgery (36.7%), intermittent claudication symptoms (36.7%), rest pain symptoms (3.3%). 77 CHUTER ET AL.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…There was little consistency in the training and qualifications of the raters. The tests were performed using students, 77 inexperienced and experienced podiatrists, 75,78 diabetes educator, vascular sonographer, 76 and vascular technologists. 79 The majority of studies used manual methods for performing the measurements with 1 study reporting the use of automated devices.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: A systematic review

Chuter

Schaper

Mills

et al. 2023

Diabetes Metabolism Res

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As a progressive disease process, early diagnosis and ongoing monitoring and treatment of lower limb peripheral artery disease (PAD) is critical to reduce the risk of diabetes‐related foot ulcer (DFU) development, non‐healing of wounds, infection and amputation, in addition to cardiovascular complications. There are a variety of non‐invasive tests available to diagnose PAD at the bedside, but there is no consensus as to the most diagnostically accurate of these bedside investigations or their reliability for use as a method of ongoing monitoring. Therefore, the aim of this systematic review was to first determine the diagnostic accuracy of non‐invasive bedside tests for identifying PAD compared to an imaging reference test and second to determine the intra‐ and inter‐rater reliability of non‐invasive bedside tests in adults with diabetes. A database search of Medline and Embase was conducted from 1980 to 30 November 2022. Prospective and retrospective investigations of the diagnostic accuracy of bedside testing in people with diabetes using an imaging reference standard and reliability studies of bedside testing techniques conducted in people with diabetes were eligible. Included studies of diagnostic accuracy were required to report adequate data to calculate the positive likelihood ratio (PLR) and negative likelihood ratio (NLR) which were the primary endpoints. The quality appraisal was conducted using the Quality Assessment of Diagnostic Accuracy Studies and Quality Appraisal of Reliability quality appraisal tools. From a total of 8517 abstracts retrieved, 40 studies met the inclusion criteria for the diagnostic accuracy component of the review and seven studies met the inclusion criteria for the reliability component of the review. Most studies investigated the diagnostic accuracy of ankle ‐brachial index (ABI) (N = 38). In people with and without DFU, PLRs ranged from 1.69 to 19.9 and NLRs from 0.29 to 0.84 indicating an ABI <0.9 increases the likelihood of disease (but the extent of the increase ranges from a small to large amount) and an ABI within the normal range (≥0.90 and <1.3) does not exclude PAD. For toe‐brachial index (TBI), a threshold of <0.70 has a moderate ability to rule PAD in and out; however, this is based on limited evidence. Similarly, a small number of studies indicate that one or more monophasic Doppler waveforms in the pedal arteries is associated with the presence of PAD, whereas tri‐ or biphasic waveform suggests that PAD is less likely. Several forms of bedside testing may also be useful as adjunct tests and 7 studies were identified that investigated the reliability of bedside tests including ABI, toe pressure, TBI, transcutaneous oxygen pressure (TcPO2) and pulse palpation. Inter‐rater reliability was poor for pulse palpation and moderate for TcPO2. The ABI, toe pressure and TBI may have good inter‐ and intra‐rater reliability, but margins of error are wide, requiring a large change in the measurement for it to be considered a true change rather than error. There is currently no single bedside test or a combination of bedside tests that has been shown to have superior diagnostic accuracy for PAD in people with diabetes with or without DFU. However, an ABI <0.9 or >1.3, TBI of <0.70, and absent or monophasic pedal Doppler waveforms are useful to identify the presence of disease. The ability of the tests to exclude disease is variable and although reliability may be acceptable, evidence of error in the measurements means test results that are within normal limits should be considered with caution and in the context of other vascular assessment findings (e.g., pedal pulse palpation and clinical signs) and progress of DFU healing.

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The ankle brachial index in people with and without diabetes: intra‐tester reliability

Cited by 14 publications

References 40 publications

Early identification and treatment for peripheral arterial disease in patients with ischemic cerebrovascular disease

Early identification and treatment for peripheral arterial disease in patients with ischemic cerebrovascular disease

Clinical Characteristics of Lower-Limb Ischemia in Japanese Patients with Type 2 Diabetes and Usefulness of the Great Toe Blood Flow as a Predictive Indicator of Leg Arterial Obstruction

Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: A systematic review

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