Determination of the Ankle-brachial Index in Type 2 Diabetic Patients with an Automatic Oscillometric Device

Aurelio Sessa

doi:10.11648/j.ejcbs.20190501.12

Abstract

An altered ankle-brachial index (ABI) is an indicator of peripheral arterial disease (PAD). Usually the measurement of the systolic pressure in both brachial arteries and pedal pulses is performed with a continuous-wave Doppler ultrasound. Recently an oscillometric automated device is available to measure ABI. This instrument is a simple to use, fast and accurate method suitable for common use in clinical practice. 701 patients with type 2 diabetes who attended consecutively in office were studied by 24 General Practitioners (GPs). 74 patients had an abnormal ABI (≤ 0.90), 240 a borderline ABI (0-90-0.99) and 7 patients ABI ≥ 1.40. All these patients received a Doppler ultrasound examination and 117 had an asymptomatic PAD. GPs reported that the device was easy to use and that it can be an useful instrument of early diagnosis of PAD in daily practice.

Highlights

Peripheral arterial disease (PAD) is an atherosclerotic process leading to the reduction of the diameter of the major distal arteries in the aortic arch
The pulse waves of the 706 patients with type 2 diabetes were examined (386 males and 320 females), 5 of which did not have clinical or complete instrumental data and were excluded from the analysis. 28 of 706 patients had already been diagnosed with PAD in their medical records, confirmed by an arterial Doppler ultrasound
Three quarters of patients (75.5%) with an ankle-brachial index (ABI) ≤ 0.90, that did not know to have PAD, had an arterial Doppler ultrasound in the lower limbs that proved pathological while the percentage of those who had a borderline value of ABI was approximately 22.9% and 85.7% for those with an ABI of ≥ 1.40

Summary

Introduction

Peripheral arterial disease (PAD) is an atherosclerotic process leading to the reduction of the diameter of the major distal arteries in the aortic arch. The American Diabetes Association recommends the measurement of ABI in all diabetic patients who are over 50 years old and/or who have been diagnosed with diabetes more than 10 years ago or who were smokers [4]. The ABI is the ratio between arterial blood pressure at the ankle and the arm. It is an efficient and low cost method for establishing a diagnosis of PAD. The same process is repeated for the arm by detecting the pulse wave and measuring the systolic blood pressure of the brachial artery. It possesses a high specificity (98%) and sensitivity (90%) [5].

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