Ankle-brachial Index Values Research Articles

Feasibility of Implementing Ankle–Brachial Index Screening at a Rural Farm Show

Purpose: Peripheral artery disease (PAD) is a common condition associated with significant morbidity and mortality. Early detection in at-risk populations through ankle-brachial index (ABI) screening is underutilized in community settings. This study assessed the feasibility of ABI screening at a rural community event for early PAD detection. Methods: A cross-sectional study was conducted at a rural farm show, where participants completed a demographic and health behavior survey and underwent ABI screening using an automatic blood pressure device. Ankle–brachial index values were categorized as normal (1.00–1.40), borderline (0.91–0.99), or abnormal (≤0.9 or >1.4). Descriptive statistics were calculated, and Chi-square analysis with odds ratio assessed associations between ABI values and survey responses. Results: Among 91 participants, 18.7% (n = 17) had abnormal ABI values, and 46.2% (n = 42) had borderline or abnormal readings. A significant association was found between diabetes and abnormal ABI values (P = .034). Participants reporting diabetes were about 3.29 times more likely to have an abnormal ABI reading compared with nondiabetic participants (odds ratio 3.29, 95% CI 1.05, 10.23). Conclusions: This study shows that ABI screening can be successfully implemented at community events using cost-effective equipment, enabling early detection of PAD, especially in rural areas with limited access to health care. Physical therapists are ideally suited to lead these screenings and provide subsequent supervised exercise therapy. Expanding ABI screening in community outreach programs has the potential to enhance early intervention and reduce PAD-related health disparities among at-risk populations.

APPLICATION OF BUERGER ALLEN EXERCISE IN PATIENTS WITH INEFFECTIVE PERIPHERAL PERFUSION WITH TYPE II DIABETES MELLITUS AT PASAR REBO JAKARTA HOSPITAL

Introduction : Diabetes is a metabolic disease characterized by hyperglycemia due to inability of the pancreas to secrete insulin. Theprevalence of diabetes in the world reaches 422 million people. In Indonesia alone the highest prevalence in DKI Jakarta. Diabetes Mellitus patients are at risk of developing complications, such as nerve damage (neuropathy) and blood vessel disorders (angiopathy). Buerger Allen Exercise is a non-pharmacological therapy aimed at improving blood circulationin in the lower extremities of patients with diabetes mellitus. Method: descriptive qualitative with case study approach and intervention. Result: The results showed that based on the implementation of Buerger Allen Exercise which is carried out for 3 x 24 hours for the second patient, the result on the nursing diagnosis of ineffective peripheral perfusion and the risk of electrolyte imbalance were solved with an initial ABI value of 0,82 increasing to 0,95. However, the problem of unstable blood glucose levels was only partially resolved because the second patient’s blood glucose levels were still very unstable. Conclusion: Both patients experienced an increase in Ankle Brachial Index (ABI) values after performing Buerger Allen exercises,indicating the success of this exercise in addressing nursing problems related to ineffective peripheral perfusion.

APPLICATION OF RANGE OF MOTION EXERCISE THERAPY IN PATIENTS EXPERIENCING INEFFECTIVE PERIPHERAL PERFUSION WITH TYPE 2 DIABETES MELLITUS AT PASAR REBO HOSPITAL, JAKARTA

Introduction: Health problems can affect the systems in the human body, one of which is the endocrine system, which is often disrupted. Endocrine health problems are diseases that attack the endocrine system. There are many types of diseases that attack the endocrine system, one of which is diabetes mellitus. Objective: To provide an overview of nursing care for patients who has ineffective peripheral perfusion with diabetes mellitus type 2 using the application of range of motion exercise therapy at RSUD Pasar Rebo. Method: Qualitative descriptive research type with a case study research method, namely, by collecting data. Sources of assessment data were obtained from observation, interviews, family, nursing notes and literature study. Results: The results of the research in this scientific paper proposal, based on the results of case studies in several research journals, state that it was found that there was a good influence on the AnkleBrachial Index (ABI) as an indicator of the resolution of the problem of ineffective peripheral perfusion, after carrying out range of motion exercise therapy in patients with diabetes. experiencing ineffective peripheral perfusion problems with diabetes mellitus type 2 with an implementation duration of 2 days. Conclusion: In nonpharmacological therapy by carrying out range of motion exercise therapy, peripheral perfusion problems were not effectively resolved. by the improving of Ankle-Brachial Index value.

Identifying Risk Factors for Lower Extremity Artery Disease (LEAD) in Cardiology Patients: The Role of Ankle-Brachial Index Measurement.

Background and aims: Lower Extremity Artery Disease (LEAD) is a predictor of atherosclerotic plaques in other locations and significantly increases the risk of death from cardiovascular events. This study aimed to identify cardiology patient subpopulations that should undergo Ankle-Brachial Index (ABI) measurement. Methods: A total of 800 patients hospitalized in the Department of Cardiology were included. Inclusion criteria were age over 40 years for men and over 45 years for women, with the ability to measure ABI. Results: The study group was divided into two subgroups based on ABI values, with LEAD (ABI ≤ 0.9) detected in 61 patients (7.6%). Among these, 45% exhibited symptoms of intermittent claudication. LEAD was significantly more common in patients with a lower ejection fraction, a history of myocardial infarction, coronary artery disease, coronary atherosclerosis, heart failure, hypercholesterolemia, diabetes, and in those with a past diagnosis of atherosclerosis. There was no statistical association with the incidence of ischemic stroke, renal failure, hypertension or a family history of cardiovascular disease. Average living conditions and financial status increased LEAD likelihood (p = 0.029; p = 0.018), while physical activity reduced it (p < 0.001). LEAD occurred more often in both current and former smokers. Patients with LEAD were more likely to be on statin therapy (p = 0.002). Higher hemoglobin A1c levels significantly increased the risk of LEAD. Conclusions: Identifying patients with risk factors for LEAD suggests that ABI measurement should be performed to detect LEAD early and implement appropriate diagnostic and therapeutic strategies.

Ankle-Brachial Index as a Predictor of Acute Ischemic Cerebrovascular Event After Central Retinal Artery Occlusion.

BACKGROUND Identifying patients at higher risk of acute ischemic cerebrovascular events (AICE) following central retinal artery occlusion (CRAO) is crucial for secondary prevention of stroke. This study aimed to investigate whether a low ankle-brachial index value is associated with an increased risk of AICE after CRAO. MATERIAL AND METHODS We prospectively analyzed patients who were admitted to our hospital because of CRAO between February 2019 and March 2023 and whose ankle-brachial index was no greater than 1.40. We explored the potential association between the index and risk of AICE (defined as ischemic stroke or transient ischemic attack) within 1 year after occlusion. Patients were classified into 2 groups according to whether their index was low (≤0.90) or normal (0.91-1.40). RESULTS Of the 335 patients in the final analysis, 110 (32.8%) had an ankle-brachial index of ≤0.90 and 89 (26.6%) experienced AICE during 1-year follow-up. In univariable analysis, patients with a low index had a significantly higher AICE incidence than those with a normal index (36.4% vs 21.8%, P<0.01). Multivariable logistic regression analysis, adjusting for variables associated with low index, identified low index as an independent predictor of AICE after CRAO (OR 1.864, 95% CI 1.095-3.174, P=0.022). CONCLUSIONS Low values of the ankle-brachial index may independently predict higher risk of AICE after CRAO. This index may serve as a non-invasive screening tool for patients with CRAO who require intensified secondary stroke prevention.

Differences in The Effectiveness of Buerger Allen Exercise and Foot Exercises on Peripheral Perfusion in Type 2 Diabetes Mellitus

Diabetes mellitus results in both microvascular and macrovascular complications due to inadequately managed glucose levels over an extended period. A notable complication is peripheral neuropathy, which arises from compromised peripheral circulation. Implementing Buerger Allen Exercises and Foot Exercises can enhance circulation and mitigate these complications, with effectiveness assessed using the ankle-brachial index. This study aims to evaluate the differential efficacy of Buerger Allen Exercises compared to Foot Exercises in improving peripheral perfusion among patients diagnosed with type 2 diabetes mellitus affiliated with the Patrang Community Health Center. The research employs a quasi-experimental design featuring a pretest-posttest two-group format. The study sample consists of 30 respondents diagnosed with type 2 diabetes mellitus. The intervention, which included both Buerger Allen Exercises and Foot Exercises, was conducted once and lasted 20 minutes. The results indicate that the Buerger Allen Exercise group exhibited an average ankle-brachial index value of 0.992, while the Foot Exercise group yielded an average value of 0.900. The obtained p-value (0.004) was less than or equal to the alpha level of 0.005. Therefore, a statistically significant difference exists between the Buerger Allen Exercise intervention group and the Foot Exercise group. In conclusion, the Buerger Allen Exercise intervention is more effective than the Foot Exercise regimen in enhancing peripheral perfusion, as evidenced by the measured ankle-brachial index values.

Autologous cell therapy for ischemic diabetic foot: a meta-analysis of randomized controlled trials for the development of the Italian guidelines for the treatment of diabetic foot syndrome.

To assess the efficacy and safety of autologous cell therapy (ACT) in patients with ischemic diabetic foot ulcers (DFU). The present meta-analysis was designed to support the development of the Italian Guidelines for the Treatment of Diabetic Foot Syndrome (DFS). A Medline and Embase search were performed up to Feb 1st, 2024 collecting all RCTs including diabetic patients or reporting subgroup analyses on diabetic patients with ischemic foot ulcers comparing ACT with placebo/no therapy/standard of care (SoC), with a duration of at least 26 weeks. Prespecified endpoints were: major amputation (principal) and minor amputation, ulcer healing, time-to-healing, transcutaneous oxygen pressure (TcPO2), ankle-brachial index (ABI), pain, and all-cause mortality (secondary). Any ACT was allowed, irrespective of cell product type and route of administration (intra-arterial and intramuscular). Seven studies fulfilled all inclusion criteria, all using intramuscular transplantation as route of administration, but only 2 had a follow-up greater than 26 weeks. Participants treated with ACT had a significantly lower risk of major amputations in comparison with SoC/placebo (MH-OR 0.47 [0.24, 0.92], p = 0.03). ACT was also associated with a significantly higher rate of ulcer healing (MH-OR: 10.1 [3.5, 29.6], p < 0.001), greater increase of TcPO2 and ABI values (WMD: 17.57 [13.02, 22.12], p < 0.001), and reduction of pain (WMD: -1.83 [-2.32, -1.34], p = 0.003). ACT must be considered as a potential therapy for patients with ischemic diabetic foot ulcers. Further studies are needed to better clarify their role in the treatment and management of DFS.

Impact of BMI on Recovery and Quality of Life Post-Revascularization in Peripheral Arterial Disease Patients.

This study included 107 patients with peripheral arterial disease (PAD) undergoing revascularization and aimed to evaluate the effects of body mass index (BMI) on outcomes of quality of life (intermittent claudication questionnaire - ICQ), pain-free walking distance (PFWD), and maximum claudication distance (MCD). The study included 107 patients aged 18-80 years with PAD undergoing revascularization (average age 66±6.7 years; 82% men and 18% women, average BMI 28.02±4.35). The diagnosis of PAD was made based on medical opinion and an ankle-brachial index (ABI) value of <0.9. Methods used were BMI assessment, PFWD and MCD distances assessment (treadmill test using the Gardner-Skinner protocol), and quality of life assessment (ICQ). The examination was performed twice - at 1-5 days before the planned revascularization (classical surgery, angioplasty, or hybrid) and 3 months after the procedure. A statistically significant correlation was demonstrated between the improvement of PFWD, MCD, ICQ, and patients' BMI (P<0.01). The worst results were achieved by patients with II-degree obesity (PFWD improvement by an average 10.33±0.87, MCD of 21.67±3.25, ICQ of 14.01±0.60), while the best results were obtained by those with normal body weight (PFWD improvement by an average of 52.57±2.42, MCD of 137.20±22.30, ICQ of 21.18±0.54). Patients with a higher BMI have worse PFWD and MCD distances and quality of life 3 months after revascularization, which indicates the need to consider obesity when planning therapy. Further studies are needed to better understand the impact of BMI on the effectiveness of treatment and rehabilitation of patients with PAD.

Developing a multi-center registry of peripheral artery disease using natural language processing: unlocking the power of the electronic health record

Abstract Background Although peripheral artery disease (PAD) is common and associated with a high risk of mortality, contemporary PAD research remains limited due to poor accuracy of diagnosis codes in the electronic health record (EHR). We previously developed and validated a novel natural language processing (NLP) algorithm that can extract ankle brachial index (ABI) and toe-brachial index (TBI) values from clinical documents and identify patients with PAD with high accuracy (positive predictive value 92.4%). Purpose Scale the NLP system for developing a nationwide registry of PAD in the Veterans Health Administration (VHA), the largest integrated health system in the U.S. that provides care to ~9 million Veterans across 130 sites. Describe the baseline characteristics and mortality outcomes among participants and identify predictors of long-term mortality. Methods A total of 1,182,025 documents from vascular and radiology procedures during 2013-2020 were processed by the NLP system. After excluding non-ABI vascular studies, patients with a known diagnosis of PAD prior to 2015, patients younger than 40 years of age, and those who do not regularly follow-up in the VHA, we identified 107,711 patients with newly diagnosed PAD during 2015-2020. Patients were followed longitudinally using the VA’s electronic health record data. The primary outcome was all-cause mortality. We used Cox proportional hazards regression to examine predictors of long-term mortality. Results The mean age was 70.5 years; 97.3% were males, and 18.5% were of Black race. The mean ABI value was 0.78 (SD: 0.26) and the mean TBI value was 0.51 (SD: 0.19). There was a high prevalence of hypertension (83.6%), heart failure (20.8%), diabetes (53.6%), renal failure (22.1%) and chronic obstructive pulmonary disease (32.4%, Table 1). At 1-year, 9.6% of patients had died and this proportion increased to 25.4% at 3 years. Although nearly all patient variables were significantly associated with mortality, older age, severe PAD at diagnosis, diabetes, heart failure, renal failure and COPD were the strongest predictors of long-term mortality. Black race was associated with lower hazard of long-term mortality. Conclusions Using a previously validated novel NLP algorithm that extracts ABI and TBI values from clinical documents, we have successfully developed a registry of newly diagnosed PAD in the VHA. Ongoing studies from our cohort will yield important insights into the association between clinical management of PAD and clinical outcomes, with the goal of identifying opportunities for improving care.

Ankle brachial index,a non invasive tool predicts cardiovascular events after acute myocardial infarction:a 3 year follow -up study

Abstract Background / Introduction The ankle-brachial index (ABI) is a non-invasive tool that was initially used for the diagnosis of lower-extremity peripheral artery disease (PAD). It has been proven that ABI is a marker of atherosclerosis in other vascular sites and can therefore be used to predict cardiovascular events regardless the presence or not of PAD symptoms. Purpose This study aims to examine the prognostic value of ABI in the setting of acute myocardial infarction (MI), as up till now there is not enough relevant evidence. Method We followed up 441 patients [79% male;mean age 62 years;67% hypertnesive; 30% with diabetes mellitus (DM); 52% current smokers] who were hospitalized because of MI for a period of three years. All patients underwent baseline estimation of clinical and laboratory parameters during theri hospitalization.The ABI was measured according to established methodology using a certified automated device and abnormal ABI defined as a value ≤ 0.9. The primary endpoint was a composite of all-cause and cardiovascular death, as well as major cardiovascular events including decompensated heart failure, new acute coronary syndrome, cerebrovascular event, malignant arrhythmia, PAD event and new onset renal dysfunction. All events were assessed both in-hospital and within 3 years of follow-up. Results Our study population had a mean ABI of 1.1 (IQR: 1.00 to 1.18). With the use of reduced multivariate regression models ABI was proven to be a prognostic indicator for the in-hospital composite endpoint. Patients with an abnormal ABI had a threefold risk of in-hospital events [HR 2.93, 95% CI: 1.48-5.81, p=0.002]. After conducting multivariate analysis ABI maintained its predictive power of all-cause mortality [HR 2.88, 95% CI: 1.53 – 5.42, p=0.001], regardless of hypertension DM, LDL levels and smoking status of the study population in 3 years follow-up. Conclusion An impaired ABI is associated with greater risk of in-hospital events in patients with acute MI. Moreover, ABI emerges as an independent predictor of long-term all-cause mortality in those patients.The findings of this study suggest that subclinical and clinical PAD are associated with poor outcomes among patients with acute MI; thus, routine ABI tests enhance risk stratification and might carry important prognostic significance in these patients regardless of PAD symptoms.

Foot Sole Temperature Correlates with Ankle-Brachial Index, Pulse Wave Velocity, and Arterial Age in Diabetic Patients Without Diagnosis of Peripheral Arterial Disease.

Background/Objectives: Some vascular alterations such as peripheral arterial disease (PAD) or arterial stiffness can alter perfusion of the limbs, so we wondered if this is reflected in the temperature of the soles of the feet of diabetic patients who did not have a diagnosis of peripheral arterial disease. Foot sole temperature was correlated with the ankle-brachial index (ABI), carotid-femoral pulse wave velocity (cfPWV), brachial-ankle pulse wave velocity (baPWV), and arterial age. Methods: A total of 175 patients with type 2 diabetes mellitus, without a previous diagnosis of PAD, were recruited. Comorbidities, anthropometry, biochemical analysis results, temperature, ABI, cfPWV, baPWV, and arterial age were recorded. Forty-two temperature records were obtained from the sole of the foot with an FLIR T865 thermal imaging camera. ABI, cfPWV, baPWV, and arterial age were obtained using plethysmographic and oscillometric methods. Statistical analysis was performed with SPSS v.29.0 (correlations and multiple linear regression models). Results: All temperature points analyzed correlated negatively with ABI (p < 0.001) and rho values ranged from -0.168 to -0.210. Likewise, cfPWV, baPWV, and arterial age had similar results, since most temperature records showed low rho values and a negative correlation with these parameters. Four models were developed to explain the variables of interest. Temperature was involved in all of them. The temperature of the first toe was included in the prediction of cfPWV, baPWV, and arterial age. Conclusions: There is an inversely proportional relationship between temperature and ABI, cfPWV, baPWV, and arterial age in diabetic patients without a previous diagnosis of arterial disease. Temperature can be a predictor of these hemodynamic variables.

Screening for Peripheral Vascular Disease: The Role of Ankle-Brachial Index (ABI) and Estimated Glomerular Filtration Rate (eGFR) Changes in Chronic Kidney Disease.

Background Chronic kidney disease (CKD) is a significant public health issue worldwide, closely linked with cardiovascular events such as atherosclerosis, peripheral arterial disease (PAD), stroke, coronary artery disease (CAD), and heart failure. The ankle-brachial index (ABI) is a simple tool that compares blood pressure in the ankle and arm, helping to detect PAD and assess the risk of cardiovascular events. An increased ABI signifies an increased risk of cardiovascular disease (CVD), whereas a diminished ABI correlates with angiographically verified atherosclerosis along with heightened death rates. Recent research indicates a U-shaped relationship between ABI and mortality, underscoring the necessity for early detection and action to mitigate potential consequences. Aim This study aimed to correlate ABI changes with estimated glomerular filtration rate (eGFR) changes in CKD patients to screen for the development of peripheral vascular disease. Materials and methods This prospective cross-sectional study was conducted in the outpatient department of a tertiary care hospital in India, focusing on patients diagnosed with CKD admitted to the general medicine department. The inclusion criteria were CKD patients with an eGFR less than 60 ml/min/1.73 m², accompanied by indicators of renal damage such as albuminuria, reduced kidney size on ultrasound, abnormal urinary sediment, or biopsy-proven kidney disease. Patients with peripheral vascular disease, with end-stage renal disease (on dialysis), with limb amputations, with hemodynamic instability, or who declined participation were excluded. eGFR was calculated using the Modification of Diet in Renal Disease (MDRD) equation, and the ABI was measured at baseline, three months, and six months. ABI values below 0.9 indicated peripheral vascular disease, and the study aimed to correlate changes in ABI with eGFR to assess vascular disease development in non-dialyzed CKD patients. Results By the end of the third month, a positive correlation was observed between ABI and eGFR (r=0.259), which persisted at the end of the sixth month (r=0.245). Conclusion The study concludes that a direct relationship exists between decreasing eGFR and ABI, which increases susceptibility to PAD and CVD. A low ABI is linked to an accelerated decline in eGFR, indicating that systemic atherosclerosis predicts kidney function deterioration.

Prevalence of peripheral artery disease in young coronary artery disease patients

Background and objectives. Peripheral artery disease (PAD) and coronary artery disease (CAD) are progressive inflammatory conditions caused by arteriosclerosis, typically presenting after the age of 50. However, assessing peripheral vascular disease (PVD) in younger populations may offer early indications of coronary heart disease (CHD) risk. This study investigates the prevalence of abnormal ankle brachial index (ABI) values among young myocardial infarction (MI) patients and examines the correlation of ABI with other cardiovascular risk factors. Material and methods. This cross-sectional study was conducted at Saveetha Medical College and Hospital, involving 147 patients aged 40 years or younger who were admitted with MI symptoms. The study focused on the incidence and severity of MI in relation to age, sex, and the presence of risk factors such as smoking, alcohol use, dyslipidemia, hypertension (HTN), and diabetes mellitus (DM). Results. The study analyzed the incidence of myocardial infarction (MI) in a population under 40 years old. It was found that the incidence rate increased with age within this group. Specifically, males were more frequently affected than females, with 70% of cases occurring in males. Among female participants, all were over 30 years old. In terms of ankle-brachial index (ABI) values, 40% of females exhibited abnormal ABI, compared to 25% of males. Significant risk factors identified included smoking, with 60% of participants reporting tobacco use, alcohol consumption at 50%, and dyslipidemia present in 45% of cases. Hypertension (HTN) and diabetes mellitus (DM) were less prevalent, affecting 20% and 15% of participants, respectively. There was a significant correlation between low ABI values and the use of tobacco (p&lt;0.01) and alcohol (p&lt;0.05). However, the analysis showed no significant relationship between the number of vascular involvements indicated by ABI and the length of hospital stay. The length of hospital stay did increase with patient age, with an average increase of 2 days for every decade of age, but this was not significantly associated with ABI values. Conclusion. ABI is a valuable diagnostic tool in young populations for detecting early signs of CHD, offering advantages over routine blood pressure measurements. This study supports the broader use of ABI in both young and older populations to improve early detection and management of cardiovascular risks. Further research is needed to explore the implications of ABI in routine clinical practice and its correlation with other cardiovascular risk factors.

Relationship of Thyroid Volume and Function with Ankle-Brachial Index, Toe-Brachial Index, and Toe Pressure in Euthyroid People Aged 18-65.

Background and Objectives: The interrelationship between thyroid function and the state of the cardiovascular system has been investigated both in preclinical and human studies. However, it remains unclear whether there is any association between thyroid hormones and features of subclinical cardiovascular dysfunction in euthyroid patients. Material and Methods: This study involved 45 people (females: 57.8%) with no thyroid disease who, during planned hospitalization, underwent thyroid ultrasound, determination of biochemical parameters of thyroid function, and measurement of ankle-brachial index (ABI) and toe-brachial index (TBI). People with signs of acute illness or a deterioration of their health were excluded. Results: Significant correlations were found between free triiodothyronine (FT3) and several parameters of both ABI (R = 0.347; p = 0.019 for the mean ABI taken from right side and left side values) and TBI (R = 0.396; p = 0.007 for the mean TBI taken from right side and left side values), as well as the maximal toe pressure (TP) taken from right side and left side values (R = 0.304; p = 0.045). Thyrotropin (TSH) was shown to be significantly correlated only with the maximal TBI value (taken from right side and left side values) (R = 0.318; p = 0.033), whereas free thyroxin (FT4) was shown to be significantly correlated only with the minimal TBI value (taken from right side and left side values) (R = 0.381; p = 0.01). Thyroid volume (TV) was shown to be correlated with TP (R = 0.4; p = 0.008 for the mean TP taken from right side and left side values) and some parameters of TBI value (R = 0.332; p = 0.028 for the mean TBI taken from right side and left side values), but no significant correlations were found between TVand ABI parameters. Patients with a mean ABI value ≤ 1.0 or a mean TBI value ≤ 0.75 have lower TSH, FT3, FT4, and TV than the rest of the study population, but the difference was statistically significant only for FT3. Conclusions: Even in a population of euthyroid patients with no diagnosed thyroid disease, there are some significant correlations between the volume and function of the thyroid gland and the selected features of subclinical cardiovascular dysfunction such as ABI and TBI.

Epidemiology and Burden of Peripheral Artery Disease in People With Type 2 Diabetes: A Systematic Literature Review.

Type 2 diabetes (T2D) and lower-extremity peripheral artery disease (PAD) are growing global health problems associated with considerable cardiovascular (CV) and limb-related morbidity and mortality, poor quality of life and high healthcare resource use and costs. Diabetes is a well-known risk factor for PAD, and the occurrence of PAD in people with T2D further increases the risk of long-term complications. As the available evidence is primarily focused on the overall PAD population, we undertook a systematic review to describe the burden of comorbid PAD in people with T2D. The MEDLINE, Embase and Cochrane Library databases were searched for studies including people with T2D and comorbid PAD published from 2012 to November 2021, with no restriction on PAD definition, study design or country. Hand searching of conference proceedings, reference lists of included publications and relevant identified reviews and global burden of disease reports complemented the searches. We identified 86 eligible studies, mostly observational and conducted in Asia and Europe, presenting data on the epidemiology (n = 62) and on the clinical (n = 29), humanistic (n = 12) and economic burden (n = 12) of PAD in people with T2D. The most common definition of PAD relied on ankle-brachial index values ≤ 0.9 (alone or with other parameters). Incidence and prevalence varied substantially across studies; nonetheless, four large multinational randomised controlled trials found that 12.5%-22% of people with T2D had comorbid PAD. The presence of PAD in people with T2D was a major cause of lower-limb and CV complications and of all-cause and CV mortality. Overall, PAD was associated with poor quality of life, and with substantial healthcare resource use and costs. To our knowledge, this systematic review provides the most comprehensive overview of the evidence on the burden of PAD in people with T2D to date. In this population, there is an urgent unmet need for disease-modifying agents to improve outcomes.

Exploring the Changes in IL-6 and Related Cytokines in Angiogenesis after Tibial Transverse Transplantation in Diabetic Foot Ulcers.

The transverse tibial transfer technique is employed primarily to treat diabetic foot ulcers (DFUs), aiming to enhance leg circulation and promote new blood vessel growth. This technique is also beneficial for various conditions associated with poor blood flow in the lower extremities. However, there is no clear molecular mechanism to explain the relationship between the transverse tibial transfer technique and angiogenesis in patients with diabetic foot. This study aims to preliminarily explore the change of IL-6 and related cytokines in promoting angiogenesis during transverse tibial transplantation, providing a direction for future research. We retrospectively assessed a study from April 2022 to November 2023 on 76 patients with severe DFUs at Wagner stages 3-4. Flow cytometry was used to detect the levels of 12 cytokines in serum before the operation and 3, 7, 14, 21, and 35 days after the operation. Ankle-brachial index (ABI), transcutaneous oxygen tension (TcPO2), and glycosylated hemoglobin (Hba1c) were recorded at admission and discharge. We examined the variations in cytokine levels, wound healing duration, amputation rates, infection incidence, and other key outcomes. In our investigation, a total of 76 individuals participated, comprising 49 males and 27 females. These subjects had an average age of 64.7 years, with a standard deviation of 13 years. The mean ulcer healing time was 74 ± 31 days, amputation occurred in 3 patients, pin tract infection occurred in one patient (1.3%), and incision infection occurred in one patient (1.3%). By day 35 following the surgery, both the ABI and TcPO2 values showed a significant increase from their preoperative levels. HbA1c significantly improved compared with presurgery (p < 0.001), IL-6 levels were significantly increased compared with presurgery (p < 0.05), and then decreased. The transverse tibial transfer (TTT) technique is safe and efficient for managing DFUs. The wound healing time in patients who smoke or consume alcohol is statistically significant compared with that of nonsmoking and nondrinking patients. IL-6 exhibited substantial changes at various postoperative time points. Future research could investigate the role of IL-6 in tibial transverse translation.

Long-term Outcomes of Peripheral Artery Disease In Veterans: Analysis of the PEripheral ARtery Disease Long-term Survival Study (PEARLS).

Contemporary research in peripheral artery disease (PAD) remains limited due to lack of a national registry and low accuracy of diagnosis codes to identify PAD patients in electronic health records. Leveraging a novel natural language processing (NLP) system that identifies PAD with high accuracy using ankle brachial index (ABI) and toe-brachial index (TBI) values, we created a registry of 103,748 patients with new onset PAD patients in the Veterans Health Administration (VHA). Study endpoints include mortality, cardiovascular (hospitalization for acute myocardial infarction or stroke) and limb events (hospitalization for critical limb ischemia or major amputation) and were identified using VA and non-VA encounters. The mean age was 70.6 years; 97.3% were males, and 18.5% self-identified as Black race. The mean ABI value was 0.78 (SD: 0.26) and the mean TBI value was 0.51 (SD: 0.19). Nearly one-third (32.4%) patients were currently smoking and 35.4% formerly smoked. Prevalence of hypertension (86.6%), heart failure (22.7%), diabetes (54.8%), renal failure (23.6%), and chronic obstructive pulmonary disease (35.4%) was high. At 1-year, 9.4% of patients had died. The 1-year incidence of cardiovascular events was 5.6 per 100 patient-years and limb events was 4.5 per 100 patient-years. We have successfully launched a registry of >100,000 patients with a new diagnosis of PAD in the VHA, the largest integrated health system in the U.S. The ncidence of death and clinical events in our cohort is high. Ongoing studies will yield important insights regarding improving care and outcomes in this high-risk group.

The Effect of Revascularization on Lower Limb Circulation Parameters in Symptomatic Peripheral Arterial Disease.

Background: The prevalence of peripheral arterial disease and the number of revascularization procedures performed in symptomatic patients are steadily increasing. However, uncertainties remain regarding hemodynamic monitoring after revascularization and the prediction of clinical outcomes. This study aimed to investigate hemodynamic parameters with a focus on the microvasculature. Methods: This prospective, single-center study included 29 patients (15 with intermittent claudication [IC] and 14 with chronic limb-threatening ischemia [CLTI]). Before and after the revascularization procedure, in addition to the ankle-brachial index (ABI), microperfusion parameters, including microvascular blood flow, capillary oxygen saturation (SO2), and relative hemoglobin content (rHb), were assessed with lightguide spectrophotometry combined with laser Doppler flowmetry using an oxygen-to-see (O2C) device in the horizontal and elevated leg positions. Results: At baseline, SO2 in the elevated leg position was significantly lower in patients with CLTI than in those with IC (p = 0.0189), whereas the other microcirculatory parameters and ABI values were not significantly different. Patients with diabetes mellitus had a higher flow rate than those without in the horizontal leg position (p = 0.0162) but not in the elevated leg position. After successful revascularization, the flow increased immediately and significantly in both positions, whereas SO2, rHb, and the ABI did not. Conclusions: Elevated leg SO2 was significantly lower in CLTI than in clinically compensated peripheral arterial disease, whereas microvascular flow was a suitable surrogate parameter indicating successful revascularization. In studies using surgical or interventional revascularization procedures, noninvasive hemodynamic monitoring of the microcirculation at the foot level might be beneficial.

EFFECTIVENESS OF AUTOLOGOUS PLATELET-RICH PLASMA FOR HEALING DIABETIC FOOT ULCERS

Autologous platelet-rich plasma (APRP) is widely used to accelerate the healing of chronic wounds. However, the advisability of its use in patients with diabetic foot ulcers (DFU), which develop in various forms of the disease and are associated with complex metabolic conditions, is still being discussed. This study consisted in a comparative analysis of the effectiveness of local use of autologous platelet-rich plasma in the treatment of DFU in patients with neuropathic and neuroischemic forms of the disease. A total of 106 patients with type 2 diabetes mellitus undergoing hospital treatment were divided into a study group (n=48) and a traditional wound therapy group (n=58), similar in ankle-brachial index values ​​and ulcer size. Systemic therapy in both groups of patients included measures to regulate metabolism and nutrition, and infection control. Treatment results were assessed by the area of foot wounds and duration of healing. The duration of therapy and the mean platelet concentration in autologous plasma did not differ between groups. The wound healing time in patients with the neuropathic form (60.4±23.77 days) and the neuroischemic form of the disease (64.8±29.6 days) during treatment with APRP was significantly shorter than in the subgroups of the comparison group with traditional treatment of DFU (85.11±40.7 and 90.40±47.12 days respectively) (p&lt;0.01), but there was no significant difference between the subgroups receiving treatment with APRP. Although there was no significant difference in the average daily healing area among all subgroups (p&gt;0.05), the rate of wound healing in the subgroups with APRP was higher (14.85±10.66 and 15.33±14.91 mm2/day, respectively) than in the subgroups of the comparison group (8.39±6.02 and 8.79±7.13 mm2/day, respectively), which confirms the effectiveness of local treatment with APRP in combination with traditional systemic therapy.

Examining Psychological Factors in Peripheral Artery Disease: Affective Temperament, Anxiety, and Depression in Patients Undergoing Revascularization Procedures.

This study aimed to assess the prevalence of depressive and anxiety symptoms in peripheral artery disease (PAD) patients, correlating these symptoms with clinical parameters and examining affective temperaments within the study group. A total of 159 PAD patients, predominantly male, admitted for vascular surgery due to lower limb atherosclerosis, participated in this cross-sectional study. Various assessments were conducted, including the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A) for affective temperaments, the Hospital Anxiety and Depression Scale (HADS) for anxiety and depression symptoms, and the Numerical Rating Scale (NRS) for pain intensity. Additionally, the Ankle-Brachial Index (ABI) was measured to assess circulation in the legs. The findings revealed a higher prevalence of depressive and anxiety symptoms in the PAD patient group compared to the control group. Notably, depressive and anxiety symptoms correlated with the severity of PAD, as indicated by lower ABI values in the operated leg. Patients undergoing surgical revascularizations exhibited higher depressive symptoms than those undergoing endovascular procedures. Furthermore, correlations were observed between depressive symptoms and the number of previous vascular procedures and amputations, alongside increased pain levels at admission. Clinical factors such as diabetes, hypertension, heart failure, ischemic heart disease, previous revascularization procedures, amputations, and the intensity of affective temperaments did not correlate with HADS scores. The study highlighted the intricate relationship between mood disorders and PAD severity, emphasizing the potential prognostic implications of untreated depression and anxiety in PAD patients. These findings suggest the importance of closely monitoring and addressing psychological well-being in PAD management. However, the study encountered limitations such as varying assessment timing and sample size discrepancies among comorbidities, impacting the observation of associations between mood disorders and certain conditions. In conclusion, depressive and anxiety symptoms are often in PAD. Further research is needed to explore therapeutic interventions targeting mental health and pain management to improve the course and outcomes of PAD.