The toe-brachial index in the diagnosis of peripheral arterial disease

Abstract

In contrast to the well-defined and evidence-based limits of the ABI, the diagnostic criteria for a pathologic TBI remain ambiguous. Although several guidelines and reviews of PAD diagnostics recommend a TBI <0.70 as cutoff, it is not strictly evidence-based. The current literature is not sufficient to conclude a specific cutoff as diagnostic for PAD. The current studies in normal populations and the correlation with angiography are sparse, and additional trials are needed to further validate the limits. Large-scale trials are needed to establish the risk of morbidity and mortality for the various diagnostic limits of the TBI.

Toe Pressure and Toe Brachial Index are Predictive of Cardiovascular Mortality, Overall Mortality, and Amputation Free Survival in Patients with Peripheral Artery Disease

“…6,9 However, among diabetics the diagnostic value of TBI has been questioned. 10,11 The correlation of low TP with increased mortality and decreased amputation free survival (AFS) has been demonstrated in patients with incompressible leg arteries. 12,13 In addition to AP and ABI, TP is used in the widely accepted TransAtlantic Inter-Society Consensus II (TASC II) classification of limb ischaemia.…”

Ankle-Brachial Index, Toe-Brachial Index, and Pulse Volume Recording in Healthy Young Adults

“…Furthermore, the effects of age and sex on TBI are almost unknown. 4,23) In this study, we clarified the characteristics of ABI, TBI, and PVR of healthy people in their early 20s together with baPWV using data measured from our medical students. We also discussed their ankle %MAP and UT, and the implications of these measurements.…”

“…Although the cut-off value of TBI for detecting PAD is set at 0.6 or 0.7, there has been no global consensus. 1,[3][4][5] Although the normal standard ranges of ABI and TBI are based on data obtained mostly from middle and senior adults, [3][4][5][6] young patients with lower limb complaints such as coldness, pain, or claudication are also primarily examined by ABI and TBI measurements because PAD including Buerger disease, Raynaud disease, Takayasu arteritis, and even arteriosclerotic diseases can occur in young patients, as the prevalence of PAD is estimated to be 1.2% to 4% of people in their late 20s. 7) However, they occasionally show ABI <1.0 or TBI <0.7 despite their normal physical findings, making the diagnosis confusing.…”

Toe-Brachial Index in the Second Toe: Substitutability to Toe-Brachial Index in the Great Toe and Ankle-Brachial Index

“…Moreover, the TBI cutoff value for detecting PAD has been estimated without consensus. 12,18) The various and cumbersome techniques for TP measurement not only hindered research to a few and small studies lacking evidence, 8,18) but also made it difficult to determine the association between TBI and ABI values. Brooks et al 10) measured ABI by the Doppler method and TBI by either the Doppler method or the photoplethysmography procedure in 174 feet from patients with diabetes; the difference between ABI and TBI was 0.4.…”

“…The TBI value is based on relations to the presence of clinical symptoms or angiographic PAD findings, not on the measurement results to assess the equivalent for an ABI of 0.9. 12,18) used for the automatic TBI and ABI calculation. Measurements were performed in the order of TBI-2, TBI-1, and ABI.…”