Validation of a Standardised Duplex Ultrasound Classification System for the Reporting and Grading of Peripheral Arterial Disease

Huthart, Samuel; Oates, Crispian; Allen, John; Fiaschi, Kathia; Sims, Andrew; Stansby, Gerard

doi:10.1016/j.ejvs.2022.04.013

Cited by 6 publications

(3 citation statements)

References 28 publications

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“…18 We used monophasic waveforms to diagnose probable proximal occlusive disease. 19,20 In the hands of trained operators, DUS is accurate, 21 particularly in the femoral/popliteal arteries, and less accurate below the knee. 22 Duplex ultrasound was our "gold standard" for evaluating physiologic modalities.…”

Section: Discussionmentioning

confidence: 99%

Utility of Toe-Brachial Index

Del Valle

2024

Journal for Vascular Ultrasound

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Introduction: The toe-brachial index is typically an adjunctive examination to the ankle-brachial index, which has long been the primary physiologic modality for diagnosing peripheral arterial disease. The goal of this project was to determine toe-brachial index reliability, particularly with patients with diabetes. Methods: We compared duplex ultrasound to the ankle-brachial index and toe-brachial index on 100 patients (200 legs) with suspected symptomatic peripheral arterial disease. Duplex ultrasound stenosis in the femoral/popliteal/infrapopliteal arteries was at least a doubling of velocity between adjacent segments. A blunted systolic Doppler waveform was consistent with proximal occlusive disease. Normal physiologic ranges were arbitrarily set as ankle-brachial index 1.2 to 0.9 and toe-brachial index 0.9 to 0.5. We calculated overall sensitivity/specificity values by averaging. Results: Both physiologic modalities had overall low sensitivity (ankle-brachial index 62%, toe-brachial index 56%). In diabetics, ankle-brachial index sensitivity was 61% and toe-brachial index sensitivity was 57%. Sensitivity improved in the presence of inflow disease (ankle-brachial index 78%, toe-brachial index 63%). Both modalities had good overall specificity (ankle-brachial index 96%, toe-brachial index 86%). In patients with diabetes, the ankle-brachial index specificity was 94% and toe-brachial index specificity was 79%. Both physiologic modalities had identical accuracy (0.43) in comparison to duplex ultrasound. Conclusion: Routine toe-brachial index in conjunction with the ankle-brachial index may not be clinically productive.

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Section: Discussionmentioning

confidence: 99%

Utility of Toe-Brachial Index

Del Valle

2024

Journal for Vascular Ultrasound

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“…Diabetic peripheral neuropathy diagnosis in cases showing the following criteria: typical subjective neuropathic manifestations that included symmetrical distal neuropathy, insensitivity to a 10 g monofilaments, altered pinprick sensations and vibration sense on doing the test with a 128-Hz tuning fork. Peripheral arterial disease [10] was diagnosed clinically by prescence of the following signs in the leg: coldness in leg or foot, leg weakness(muscle atrophy),skin color changes, smoot and shiny skin with hair loss, decreased or absent pulse in the feet and presence of sores or ulcers in the legs or feet that don't heal. Also Ankle brachial index was done for diagnosis of PAD: (ABI) measured as the SB at the ankle, divided by the SB at the arm.…”

Section: All Cases Were Subjected To: Complete History Takingmentioning

confidence: 99%

Serum level of fetuin-A as a biomarker for vascular complications and severity of insulin resistance in individuals with type 2 diabetes

Sherif,

Ahwal,

Elsawy

et al. 2024

Int. J. Adv. Res. Med.

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“…Reference test A duplex ultrasonography system (M-Turbo, Fujifilm Sonosite Inc., Bothell, WA, USA) was used on both lower limbs to detect the presence of disease in the arterial lumen from groin to ankle, from images and blood velocity waveforms. The Vascular Scientist used a 7-feature grading system 29 , derived from Thrush and Hartshorne, 26,30 to classify patients as PAD+ (significant disease detected in either leg) or PAD-(significant disease in neither).…”

Section: Pad Assessmentsmentioning

confidence: 99%

Prospective Assessment of the Diagnostic Accuracy of Multi-site Photoplethysmography Pulse Measurements for Diagnosis of Peripheral Artery Disease in Primary Care

et al. 2022

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Peripheral arterial disease (PAD) is associated with cerebral and coronary artery disease. Symptomatic PAD affects about 5% of people over 55 years; many more have asymptomatic PAD. Early detection enables modification of arterial disease risk factors. Diagnostically, assessment of symptoms or signs can be unreliable; ankle brachial pressure index (ABPI) testing is time-consuming and few healthcare professionals are properly trained. This study assessed the diagnostic accuracy of multi-site photoplethysmography (MPPG), an alternative non-invasive test for PAD, in primary care. PAD patients identified from general practice registers were age- and sex-matched with controls. Participants were assessed using MPPG, ABPI and duplex ultrasound (DUS). Outcome measures were sensitivity and specificity of MPPG and ABPI (relative to DUS) and concordance. MPPG test results were available in 249 of 298 eligible participants from 16 practices between May 2015 and November 2016. DUS detected PAD in 101/249 (40.6%). MPPG sensitivity was 79.8% (95% confidence interval [CI] 69.9–87.6%), with specificity 71.9% (95% CI 63.7–79.2%). ABPI sensitivity was 80.2% (95% CI 70.8–87.6%), with specificity 88.6% (95% CI 82–93.5%). With comparable sensitivity to ABPI, MPPG is quick, automated and simpler to do than ABPI; it offers the potential for rapid and accessible PAD assessments in primary care.

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Validation of a Standardised Duplex Ultrasound Classification System for the Reporting and Grading of Peripheral Arterial Disease

Cited by 6 publications

References 28 publications

Utility of Toe-Brachial Index

Utility of Toe-Brachial Index

Serum level of fetuin-A as a biomarker for vascular complications and severity of insulin resistance in individuals with type 2 diabetes

Prospective Assessment of the Diagnostic Accuracy of Multi-site Photoplethysmography Pulse Measurements for Diagnosis of Peripheral Artery Disease in Primary Care

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