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Abstract
Resumo Contexto A calcificação da camada média arterial pode tornar o Índice Tornozelo-Braquial (ITB) falsamente elevado em diabéticos, dificultando a avaliação da doença arterial. Objetivo Comparar os valores do ITB de diabéticos e não diabéticos com isquemia crítica. Métodos Foram incluídos 140 pacientes (60% de diabéticos) acompanhados no Serviço de Cirurgia Vascular do Complexo Hospitalar Universitário Professor Edgard Santos com isquemia crítica por DAOP infra-inguinal. Comparou-se a média dos valores do ITB dos dois grupos de pacientes, correlacionando o ITB com a gravidade da isquemia, segundo a Classificação de Rutherford. A análise estatística foi realizada pelo EPI-INFO. Resultados A maioria dos 140 pacientes (77%) se encontrava na Categoria 5 da Classificação de Rutherford, 6% na 4 e 17% na 6. Nove diabéticos (11%) e um não diabético (2%) apresentaram ITB > 1,15 (p = 0,02), sendo excluídos da análise das médias do ITB. Considerando os 130 pacientes, os 75 doentes diabéticos apresentaram média do ITB na artéria tibial posterior de 0,26 versus 0,28 dos 55 doentes não diabéticos (p = 0,6); e no ITB da artéria pediosa aqueles apresentaram média de 0,32 versus 0,23 desses (p = 0,06). Estratificando os doentes nas categorias da Classificação de Rutherford, não houve diferença nas médias do ITB nas categorias 4 e 5. Apenas em relação à artéria pediosa e em pacientes na Categoria 6, a média do ITB foi significativamente maior em diabéticos (0,44 versus 0,16; p = 0,03). Conclusão Os diabéticos apresentaram maior prevalência de ITB falsamente elevado. Porém, excluindo-se esses casos, a média dos valores de ITB são semelhantes aos não diabéticos, exceto na artéria pediosa, nos pacientes com isquemia na categoria 6.
Highlights
The Ankle-Brachial Index is a noninvasive method that is simple to evaluate and can provide important information for diagnosis, prognosis and follow-up of patients with peripheral arterial occlusive disease (PAOD).[1,2] In addition to the index’s role in assessment of ischemic limbs, both ABI values below the limits of normality (≤ 0.9) and elevated values have been linked with mortality from cardiovascular disease.[1,3] Patients with critical limb ischemia (CLI), characterized by pain at rest and ulcers or gangrene secondary to PAOD, are at high risk of cardiovascular events such as myocardial infarction and stroke, in addition to the risk of limb loss.[1]
We considered an ABI > 1.15 for a person with critical ischemia to be falsely elevated
Our study has the limitations inherent to a retrospective study. Notwithstanding, it offers a detailed analysis of the behavior of ABI values in diabetic and non‐diabetic patients with severe critical limb ischemia (CLI), reporting the parameters observed in these patients
Summary
The Ankle-Brachial Index is a noninvasive method that is simple to evaluate and can provide important information for diagnosis, prognosis and follow-up of patients with peripheral arterial occlusive disease (PAOD).[1,2] In addition to the index’s role in assessment of ischemic limbs, both ABI values below the limits of normality (≤ 0.9) and elevated values (over de 1.4) have been linked with mortality from cardiovascular disease.[1,3] Patients with critical limb ischemia (CLI), characterized by pain at rest and ulcers or gangrene secondary to PAOD, are at high risk of cardiovascular events such as myocardial infarction and stroke, in addition to the risk of limb loss.[1]. Calcification of the arterial tunica media can falsely elevate the Ankle-Brachial Index (ABI) in diabetics, making it difficult to assess arterial disease. Mean ABI values for the two groups of patients were compared and correlated with severity of ischemia, according to the Rutherford Classification. Mean ABI for the dorsalis pedis artery in Category 6 patients was significantly higher among diabetics (0.44 vs 0.16; p = 0.03). Conclusions: The diabetic patients had a higher prevalence of falsely elevated ABI, but when these cases were excluded, mean ABI values were similar to those of non‐diabetic patients, with the exception of ABI measured at the dorsalis pedis artery in patients with category 6 ischemia.
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