Diagnosis of peripheral vascular disease for diabetic foot risk assessment

Abstract

BackgroundWithin Australia, peripheral arterial disease (PAD) affects 10–25% of people over the age of 55, which can lead to foot ulceration and gangrene. PAD is more common in people with type 2 diabetes, who if ulcers appear, have a lower recovery rate. Therefore it is important to find diagnostic tools, which are accurate and identify PAD early in disease development. The ankle-brachial-pressure index (ABPI) is most often used in primary health care. However these lack sensitivity. MethodsUsing convenience sampling 60 participants were recruited at Charles Sturt University and divided into two age groups of <30 and >30 years as well as into females and males. The ABPI and pulse wave analysis, using peak blood flow velocity (PBFV) were compared. Both parametric and nonparametric statistics were used depending on the data source. Significance was set at p<0.05. ResultsTwenty-nine participants were under 30 years of age and the remainder above 30 years of age with no known pathology. ABPI results ranged between 0.91 and 1.17 and PBFV between 7.6 and 51.8cm/s. No participants had abnormal ABPI. Only PBFV showed significant differences for age and gender (p<0.05). Post hoc analysis indicated that both ABPI and PBFV were significantly different between the younger males compared to the older females; older males to older females and younger females to older females. DiscussionNormative data in a healthy younger population is an important adjunct to clinical reviews and the method used to determine abnormal blood flow. Of interest is that the ABPI results fall between 0.91 and 1.17 suggesting that the currently used lower cut-off of 0.9 is appropriate but that that the higher cut-off could be moved down from 1.3 for clinical decision making.