Detection Of Peripheral Arterial Disease Research Articles

Comparative study of ankle brachial pressure index and blood sugar profile among offspring of diabetic and non-diabetic parents in early detection of peripheral arterial disease

Background: Type 2 diabetes mellitus (T2DM) is a complex disorder which is caused by a composite combination of genetic, epigenetic, and environmental factors. One of the most contributing quantitative risk factors is family history. The prevalence of peripheral arterial disease (PAD) in T2DM ranges from 20% to 30% and the lifetime risk of developing diabetes is up to 40% if either of parents is type 2 diabetic. Aim and Objectives: The aim of the study was to know whether non-diabetic offsprings of diabetic parents having chances of becoming diabetic and to have PAD in future part of life. Material and Methods: Taking all inclusion and exclusion criteria into consideration, 50 offsprings of diagnosed diabetic parents (>5 years) were taken as cases, and 50 healthy age-matched offsprings were taken from non-diabetic parents as controls. A thorough physical and systemic examination were done. After getting informed written consent, anthropometric measurements, FBS, PPBS, HbA1c, were measured. By taking ankle systolic blood pressure (SBP) and brachial SBP, ankle-brachial pressure index (ABPI) was calculated using a hand held vascular Doppler. Statistical analysis was done by Student’s t-test in SPSS software. Results: The mean HbA1c (%) level for controls was 5.68 ± 0.35 and for cases was 5.85 ± 0.44 with a P-value of 0.035 (significant). Similarly mean values for ankle SBP (mm Hg) were 148.4 ± 17.33 in controls and 159.8 ± 23.66 in cases with a P-value 0.0071 (significant). About 32% of controls and 50% of cases showed a non-compressible ABPI (ncABPI) arteries of >1.3, whereas only 2% of cases showed a typical ABPI of PAD, that is,

Deteksi Dini Penyakit Arteri Perifer pada Pasien Diabetes Melitus di Kota Mataram

Diabetes mellitus is currently becoming a major public health problem in the world. The prevalence of diabetes mellitus globally in 2019 is estimated at 9.3% and will increase to 10.9% in 2040. Peripheral artery disease is one of the important complications of diabetes mellitus. Patients with diabetes mellitus accompanied by peripheral artery disease have high morbidity and. Therefore, early detection of peripheral artery disease in diabetic patients is important. This event is carried out with the aim of early detection of peripheral artery disease in diabetes mellitus sufferers in Mataram. A total of 183 diabetes mellitus patients at the Siti Hajar Hospital, Mataram, were participated in this event, with an average age of 57 years and 67.8% of them were women. Most of the patients (75.4%) had poor blood glucose control. Of these, 26.8% of patients had peripheral artery disease. Patients and/or caregivers showed high enthusiasm during the education regarding the detection results of the peripheral artery disease. This event was very useful in increasing the knowledge of diabetic patients, especially in terms of blood sugar control, prevention, and management of peripheral artery disease.

Toward Automated Detection of Peripheral Artery Disease Using Electronic Health Records

Peripheral artery disease (PAD) often goes undiagnosed because of high rates of atypical or absent symptoms and poor provider and patient awareness about the disease. We aimed to develop a model to automate identification of PAD patients using machine learning algorithms and data from electronic health records (EHRs).

Clinical Utility of the Ankle-Brachial Index and Toe Brachial Index in Patients with Diabetic Foot Ulcers.

This cross sectional study investigated the clinical use of the ankle-brachial index (ABI) and toe brachial index (TBI) in 91 type 2 diabetic foot ulcer patients who visited the diabetic foot clinic, Prince Sultan Military Medical City, Saudi Arabia during July 2017 and January 2018. The ABI and TBI facilitated the detection of peripheral arterial disease (PAD) and the patients' medical records were used to collect the clinical and demographic variables. The variables of duration (p = 0.047) and treatment (p = 0.046) of the ABI showed significant differences. Age (p = 0.034) and duration (p = 0.001) were the factors related to the diagnosis of TBI by the "χ2" test. From the TBI, 26.4% of the patients were found to have PAD, while the ABI showed that 21.8% of patients had the condition. However, no statistical significance was noted. From the regression analysis, the variable duration of diabetes (≥ 20 years of age) was recognized as an independent risk factor for TBI. In conclusion, it is recommended both the ABI and TBI to be used as screening tests for PAD in diabetic foot ulcer patients.

Non-invasive vascular assessment in people with type 2 diabetes: Diagnostic performance of Plethysmographic-and-Doppler derived ankle brachial index, toe brachial index, and pulse volume wave analysis for detection of peripheral arterial disease

ObjectiveThere is evidence that standard assessment techniques for detecting PAD might be of less diagnostic accuracy in people with type 2 diabetes. The aim of this study was to examine diagnostic performance of Plethysmographic-and-Doppler derived ankle brachial index, toe brachial index, and Pulse volume waveform analysis for detecting PAD in people with T2DM. MethodsIn this cross-sectional study 303 patients with T2DM were included in the study. The participants underwent ABI measurement, applying both Plethysmographic and Doppler derived devices, as well as TBI, PVW was also recorded for each patient. Diagnostic performance of each test for detecting PAD, applying ultrasound Doppler scan as the reference standard, was measured. Moreover, the best cut-off point for each method to detect PAD was determined. ResultsPVW showed the highest sensitivity (81.8%) for detecting PAD, followed by ABIDOP (72.7%), and ABIPLE (20%). However, all devices showed an excellent specificity for detecting PAD. The optimal cut-off point for diagnosis of PAD was 0.9 for ABIDOP, 1.2 for ABIPLE, and 0.38 for TBI. ConclusionWithin this population of patients with T2DM, TBI less than 0.38 provided the best sensitivity for detection of PAD followed by PVW, ABIDOP≤0.9, and ABIPLE<1.2.

Simple photoplethysmography pulse encoding technique for communicating the detection of peripheral arterial disease—a proof of concept study

Objective: To assess the feasibility of novel photoplethysmography (PPG) Pulse Sounder/Pulse Visualizer communication techniques for alerting the presence (or absence) of peripheral arterial disease (PAD). Approach: Proof of concept evaluation using our previously published multi-site PPG pulse data set (110 participants included; age > 40 years; 44% PAD by ankle brachial pressure index (ABPI)). Two main pulse encoding rules using the risetime as an example feature to mark each heartbeat in a 6 s analysis study window: if risetime at both great toes ⩽time threshold (‘no PAD’ state) then heartbeat marked with a single 5 kHz audio tone; if risetime from either great toe > threshold (‘PAD’) then heartbeat marked with a distinct train of 5 kHz audio tones. A simple spectrogram visual plot was also produced for each participant’s audio signals. ROC curve analysis first determined an appropriate risetime threshold using the simple-to-evaluate PAD Visualizer and then re-tested at this level with PAD Sounder and classification performance summarized. Main results: The pulse encoding rules used were easy to learn. Visualizer best communication performance at risetime 0.27 s gave specificity 80.6%, sensitivity 95.8%, accuracy 87.3%, negative predictive value 96.2%, and Kappa statistic of 0.75. Classification performance for blinded assessment with audio PAD Sounder was identical. Significance: Substantial agreements demonstrated between Sounder/Visualizer disease techniques and the ABPI PAD reference. These simple-to-use PAD communications methods when embedded into an appropriate device platform could offer significant benefits in PAD diagnosis for a range of clinical settings, including primary care where low-cost, portable and easy-to-use diagnostics can be desirable.

Detection of peripheral arterial disease using Doppler spectrogram based expert system for Point-of-Care applications

Peripheral arterial disease (PAD) is a common manifestation of cardiovascular diseases and more prevalent in underdeveloped countries. Ultrasound (US) is one of the preferred non-invasive diagnostic techniques for the evaluation of PAD. This work aims at achieving a low-cost PAD detection technique for mass screening. A computer aided diagnosis (CAD) method has been proposed based on the Doppler blood flow spectrograms of lower limb arteries. The proposed scheme initially removes noise from the spectrogram (350 × 175 pixels) and extracts the hemodynamic features which are generally independent of the Doppler angle. From these, best feature subsets are selected using the wrapper algorithm and supervised classifiers are developed in a machine learning framework to perform using 10-fold cross-validation technique. Overall, 334 arterial segments of 60 subjects are investigated where reference measurement is taken from the triplex mode US scanning. The quantitative assessment using random forest based classifier provides an accuracy of 84.37% and 87.93% for detecting the blood flow irregularities in above-knee and below-knee arterial segments, respectively. To classify the arterial diseases into normal, stenosis and occlusion categories, support vector machine (SVM) classifier is found to provide 97.91% accuracy on the unknown testing dataset. Moreover, variations of diagnostic parameters around the proximal and distal arterial segments define the zone of significant stenosis. The degree of stenosis is determined to quantify the severity of obstruction and the accuracy for stenosis greater than 50% is found to be 96.83%. Finally, smartphone application is implemented to provide a cost-effective, portable, user-friendly solution for Point-of-Care US system.

DEGREE OF SUSPICION OF PERIPHERAL ARTERY DISEASE AMONG GERIATRICS AND POLICEMEN IN ILIGAN CITY, PHILIPPINES

Background: Peripheral artery disease is a type of cardiovascular disease which belongs to vascular system disease and ranked the second most common non transmissible disease that cause death in the Philippines. The ankle brachial index (ABI) constitutes simple, non-invasive, cost-effective method for the early detection of peripheral artery disease (PAD) which complements assessment of cardiovascular risk.&#x0D; Objective: The study aims to determine who are at risk of peripheral artery disease among the Geriatrics and Policemen in Iligan City.&#x0D; Methods: It utilized descriptive-correlational-comparative research design and purposive sampling method. The data were gathered among 40 respondents: 20 Geriatrics and 20 policemen from Camp Tomas Cabili in Iligan City with the use of modified standardize questionnaire from Southern California Health Specialist Peripheral Artery Disease Patient Questionnaire.&#x0D; Results: Results showed majority (50%) of respondents were 50 years old and above; most (65%) were male. Pearson Correlational Coefficient shows that, among the demographic profile of the respondents, only age and lifestyle (diet and exercise) had a significant relationship with their degree of suspicion of having PAD. On the other hand, there was no significant relationship between gender, history of heredo-familial diseases, smoking, alcohol drinking habits, and the respondent’s degree of suspicion of having PAD. The result contradicts the nursing maxim that smoking is the most important risk factor for PAD; as in this case, even if most of the respondents were non-smokers and non-alcoholics, their poor diet and exercise alone increased their risk or degree of suspicion of having PAD.&#x0D; Conclusion: While age is beyond the control of the respondents, there is much that they could do to improve their lifestyle (diet and exercise) to lessen their risks for PAD. An institutional cafeteria serving nutritious food and exercise gyms could greatly benefit both the geriatrics and the policemen.

Abstract P306: Proportion of Community-dwelling Older Adults Potentially Benefiting From the Detection of Peripheral Arterial Disease (PAD) With Ankle-Brachial Index: the Atherosclerosis Risk in Communities (ARIC) Study

Background: The value of detecting PAD using the ankle-brachial index (ABI) among asymptomatic adults is controversial. However, the detection of PAD can help informing cardiovascular preventive therapy (e.g., statin and aspirin) and identifying PAD as a potential cause of reduced leg function which may be improved by exercise therapy. No previous studies have quantified the proportion of community-dwelling older adults who may benefit from PAD detection from these perspectives. Methods: In 4375 ARIC participants aged 66-90 between 2011-2013 without previously diagnosed PAD, we assessed the proportion of participants with newly detected PAD based on ABI who were not taking statin or aspirin and had reduced leg function (defined as the Short Physical Performance Battery score ≤9). Subsequently, we explored factors associated with higher odds of potentially benefitting from the detection of PAD (i.e., not taking statin/aspirin or having reduced leg function despite the presence of PAD) using logistic regression models. ABI ≤0.9 was the primary definition of PAD, but according to recent guidelines we secondarily explored ABI ≤1.0 or &gt;1.4. Results: There were 236 (5.4%) participants with an ABI ≤0.9, among which 119 were not taking statin or aspirin and 151 had reduced leg function (77 having both conditions), leading to 193 (4.4%) participants potentially benefitting from PAD detection with ABI. The corresponding proportion was 12.4% (544) when abnormal ABI was defined as ≤1.0 or &gt;1.4. Older age (per 10 years), black race, and current smoking were strongly associated with higher odds of potentially benefitting from detection of PAD (adjusted odds ratio &gt;2.5). The proportion of benefitting from PAD detection was especially high in current smokers followed by blacks (proportions shown in Figure1). Conclusions: Up to 12.4% of community-dwelling older adults may benefit from PAD detection with ABI. The proportion are especially high among current smokers and black race, with implications on targeted ABI assessment for detecting PAD.

Detection of peripheral arterial disease in patients with type 2 diabetes mellitus in family medicine clinic

&amp;lt;p&amp;gt;Introduction. Peripheral arterial disease (PAD) is a progressive, occlusive and atherosclerotic vascular disease and patients with type 2 diabetes mellitus (DM) are at increased risk of developing this disease. The aim of the study was to determine the frequency of PAD in patients with type 2 DM by measuring the ankle-brachial index (ABI) in the family medicine clinic. Methods. The cross-sectional study included the patients with type 2 DM, registered at the Family Medicine Department of Primary Healthcare Center Lakta&amp;amp;scaron;i. ABI measurement was carried out by means of the &amp;quot;Boso ABI Mess 100 Oscillometer&amp;quot; apparatus while patients were diagnosed with PAD if the ABI value was &amp;amp;lt;0.9 or &amp;amp;gt;1.3. Results. The study included 178 respondents with type 2 DM, aged &amp;amp;ge;50 years, whereby 90 of them (50.6%) were men. PAD was found in 26 (14.6%) respondents. There was a statistically significant difference in ABI (left/ right leg) between the patients with PAD and the ones without it (0.82/0.84 vs. 1.04/1.05; p&amp;amp;lt;0.01). The average duration of DM was longer in patients with PAD compared to those without PAD (12 vs. 8 years; p = 0.097) and the mean values of HbA1c were the same in both groups (7.7% vs. 7.9%; p = 0.634). There was no statistically significant difference in the frequency of hypertension, dyslipidaemia and obesity between the patients with and without PAD, respectively. Furthermore, the number of smokers among the patients with PAD was significantly higher (p &amp;amp;lt;0.01). Conclusion. In patients with type 2 DM, PAD prevalence was 14.6%. Diabetes lasted a bit longer in patients with PAD, and among them there were significantly more smokers compared to the group without PAD. The Edinburgh Claudication Questionnaire showed positive results in only a third of patients with PAD. Early PAD diagnosis could be established in considerably larger number of patients with type 2 DM by ABI measurement than by the use of the above-mentioned questionnaire.&amp;lt;/p&amp;gt;

Agreement of clinical tests for the diagnosis of peripheral arterial disease

AimThe aim of this study was to compare different screening modalities in the detection of PAD in a primary care setting. MethodsFifty participants living with Type 2 diabetes were recruited. Pulse palpation, waveform analysis, ankle brachial pressure index, absolute toe pressure, toe brachial pressure index and transcutaneous oxygen pressure were compared in the detection of peripheral arterial disease. One hundred limbs were included for analysis. ResultsThis study showed different results in peripheral arterial disease screening tests in the same group of participants. The highest percentage of participants who had PAD was for the Doppler Waveform (93.0%). This was followed by TBPI (72.0%), ABPI (57.0%), ATP (35.0%), TCPO (30.0%) and pulse palpation (23.0%). The difference between these percentages is significant (p<0.0005). The magnitude of the effect size is medium/moderate (Cramer’s V=0.498). ConclusionThis study demonstrates that inconsistencies exist between the agreement of the 6 different modalities used to detect PAD. These findings should create an awareness amongst clinicians when interpreting results of these tests. The authors advocate for urgent, more robust studies utilizing a gold standard modality for the diagnosis of PAD in order to provide evidence regarding which screening modalities would yield the most valid results.

Ankle-Brachial Index Screening and Improving Peripheral Artery Disease Detection and Outcomes

Ankle-Brachial Index Screening and Improving Peripheral Artery Disease Detection and Outcomes

Effective Pre-Screening Questions for Early Detection of Peripheral Artery Disease

Effective Pre-Screening Questions for Early Detection of Peripheral Artery Disease

Clinical examination and non-invasive screening tests in the diagnosis of peripheral artery disease in people with diabetes-related foot ulceration.

Peripheral artery disease is common in people with diabetes-related foot ulceration and is a risk factor for amputation. The best method for the detection or exclusion of peripheral artery disease is unknown. This study investigated the utility of clinical examination and non-invasive bedside tests in screening for peripheral artery disease in diabetes-related foot ulceration. Some 60 people presenting with new-onset ulceration participated. Accuracy of pulses, ankle pressure, toe pressure, toe-brachial index (TBI), ankle-brachial pressure index (ABPI), pole test at ankle, transcutaneous oxygen pressure and distal tibial waveform on ultrasound were examined. The gold standard diagnostic test used was > 50% stenosis in any artery or monophasic flow distal to calcification in any ipsilateral vessel on duplex ultrasound. The negative and positive likelihood ratios of pedal pulse assessment (0.75, 1.38) and the other clinical assessment tools were poor. The negative and positive likelihood ratios of ABPI (0.53, 1.69), transcutaneous oxygen pressure (1.10, 0.81) and ankle pressure (0.67, 2.25) were unsatisfactory. The lowest negative likelihood ratios were for tibial waveform assessment (0.15) and TBI (0.24). The highest positive likelihood ratios were for toe pressure (17.55) and pole test at the ankle (10.29) but the negative likelihood ratios were poor at 0.56 and 0.74. Pulse assessment and ABPI have limited utility in the detection of peripheral artery disease in people with diabetes foot ulceration. TBI and distal tibial waveforms are useful for selecting those needing diagnostic testing.

Effectiveness of a multicenter training programme to teach point-of-care vascular ultrasound for the detection of peripheral arterial disease in people with diabetes

BackgroundThe primary aim of this study was to evaluate the effectiveness of a training programme to teach a focused bedside ultrasound scan (PAD-scan; Podiatry Ankle Duplex Scan) for the detection of arterial disease in people with diabetes.MethodsFive podiatrists and one diabetologist across two hospitals were enrolled in a structured training programme consisting of a training course (1-day), supervised scanning (5-weeks), independent scanning (3-weeks) and a final evaluation of performance (1-day).Time, technical skills (Duplex Ultrasound Objective Structured Assessment of Technical Skills tool (DUOSATS); minimum score = 6, maximum score = 26) and accuracy (level of agreement with vascular scientist PAD-scan assessment) were assessed for every supervised scan and again for the final evaluation of performance.ResultsA total of 90 PAD-scans in 65 patients were performed during the supervised phase. Participants demonstrated significant improvements in median time (19 min(IQR 13.9–25.5) vs 9.3 min (IQR 7.3–10.5);p = 0.028) and DUOSATS scores (17.5 (IQR 16.8–21) vs 25 (IQR 24–25.3); p = 0.027). At the final evaluation, participants completed scans in 5.4 min (IQR 5.3–5.9), achieved full DUOSAT scores and perfect agreement with the vascular scientist.ConclusionA structured training programme, integrated into diabetic foot clinics, was effective in teaching the PAD-scan

A study on diabetic foot and its association with peripheral artery disease

Background: Diabetes mellitus is characterized by high blood sugar levels over a prolonged period due to alteration in either the insulin secretion, insulin action, or both. Worldwide, as of the recent 2016 data collected from the World Health Organization (WHO) around 422 million adults have diabetes mellitus which is estimated to almost double by 2030 which is composed of mainly type 2 diabetes (85-90% of all cases). The early detection of peripheral artery disease in asymptomatic patients goes a long way in reduction of major lower limb amputations and mortality. Hence, there is a need for evaluation of peripheral vascular disease in all diabetics, especially those with diabetic foot by formulating effective management protocols, thereby limiting the morbidity, mortality and social costs associated with the disease.Methods: Patients admitted and seen in out-patient department for diabetic foot ulcers between January 2013 and October 2013 in Department of general surgery, vascular surgery and diabetology, Kilpauk Medical College Hospital, Chennai, India were taken for study.Results: 150 cases satisfying the inclusion criteria were taken up for the study from January 2013 to October 2013. Out of 150 patients, 76 patients presented with ulcer in foot, 34 presented with gangrene of toe or foot. After clinical examination it was found that 52 patients had associated neuropathy, 17 patients had ABI less than 0.3 and 39 patients had ABI in between 0.4 and 0.9. Patients with ulcer and gangrene in foot and with ABI less than 0.9 were admitted and evaluated with doppler study of lower limbs. After getting consent, appropriate procedure was done for each patient. Wound debridement was done in 21 cases, toe disarticulation in 12, fore foot amputations in 4, Below knee amputation in 9, above knee amputation in 3. 11 patients were referred to vascular surgery and underwent revascularization procedures (BYPASS).Conclusions: The prevalence of peripheral artery disease in patients with diabetic foot is significantly high i.e. 38 % as per this study. Males have a higher predilection for developing peripheral vascular disease than females. The average age of presentation of PAD in diabetics is 40 -60 years. The most common level of arterial occlusion in PAD associated diabetic foot is femoro-popliteal segment followed by tibial segment.

Automated oscillometric blood pressure and pulse-wave acquisition for evaluation of vascular stiffness in atherosclerosis

ObjectiveEvaluation of diagnostic accuracy of an oscillometry-based device (VascAssist) combining fully automated ankle-brachial index (ABI) and pulse-wave velocity (PWV) assessment for detection of peripheral arterial disease (PAD).Subjects and methods110 consecutive subjects including symptomatic PAD patients (n = 41) and healthy PAD-free participants (n = 69) were recruited. All subjects underwent standard manual Doppler-based ABI (sABI) and oscillometry-based automated ABI (aABI) measurements (VascAssist). Oscillometry by the VascAssist included central and peripheral PWV assessment. Additionally, arterial stiffness (AS) was evaluated by flow-mediated vasodilation (FMD) of the brachial artery in all patients. All symptomatic PAD patients underwent catheter angiography for endovascular intervention and post-interventional acquisition of sABI, aABI, PWV and FMD.ResultsSensitivity, specificity, PPV and NPV of aABI for detecting PAD was 73%, 100%, 100%, and 86% as compared to 80%, 96%, 92%, and 89% for sABI. Pearson-correlation for diabetics was r = 0.81; (P < .001) and for non-diabetics r = 0.77; (P < .001). Bland–Altman-analysis revealed a difference (95% CI) for diabetics of 0.09 (−0.22–0.4] and non-diabetics 0.022 [−0.25–0.295]. Weak correlation exists for FMD/AS analysis (pre-interventional R = 0.386, P = .043; post-interventional R = −0.06; P = .76) and significant increase of pre-/post-interventional PWV analysis (P < .001).ConclusionCombined automatic ABI and PWV acquisition with the VascAssist device showed excellent diagnostic accuracy for detection of PAD. Compared to FMD, AS analysis may serve as an investigator-independent (screening) tool for determination of functional vascular damage in atherosclerosis.

The Prevalence of Peripheral Arterial Disease and Associated Factors among Adults in Jimma Town, South-West Ethiopia: A Community Based Survey

Background: Peripheral arterial disease (PAD) is defined as an ankle-brachial index (ABI) ≤ 0.90 in individuals aged 40 years or over. So far, the prevalence of PAD in Ethiopia is not known. We assessed the prevalence of PAD among Ethiopians using ABI and thus evaluated its applicability as a screening tool at the community level. Methods: A cross-sectional community based survey was conducted on 178 sampled individuals aged 40 years and above in Jimma town, Southwest Ethiopia from June 15 to July 15, 2011. Conventional cardiovascular risk factors and intermittent claudication (with Edinburgh Claudication assessment tool) were assessed using a structured questionnaire. Blood pressure was measured using a mercury sphygmomanometer and a hand held Doppler flow detector at arm and ankle respectively. The ABI was calculated from the ratio of higher ankle systolic blood pressure and the higher of the two brachial systolic pressure measurements. Descriptive statistics and chi-square or Fischer’s exact test, were used for data analysis and interpretation. Predictors of PAD were estimated using univariate and multivariate regression models. Results: The overall prevalence of peripheral arterial disease was 10.8%. But, none of the participants with peripheral arterial disease fulfilled the criteria for claudication. The traditional risk factors identified were; hypertension, diabetes mellitus, and current cigarette smoking accounting for 29.5%, 6.8% and 12.5% of participants respectively. Female sex, current smoking and diabetes mellitus were significantly associated with increased risk of PAD. Conclusion: Peripheral arterial disease is common among Ethiopians aged 40 years and above. Intermittent claudication was found to be insensitive in the detection of peripheral arterial disease. Female sex, current smoking and diabetes mellitus were predictors of PAD.

ABPI against Colour Duplex Scan: A Screening Tool for Detection of Peripheral Arterial Disease in Low Resource Setting Approach to Validation.

Background. In Sri Lanka the ABPI has not been used as a screening tool to detect peripheral arterial disease (PAD) in epidemiological studies. This study was conducted to determine the best cutoff value of ABPI to detect PAD in Sri Lankan population. Methods. The ABPI measured by arterial Doppler to detect PAD was validated against colour duplex scan as the criterion using 165 individuals referred to vascular laboratory, National Hospital Sri Lanka. In all selected individuals ABPI was measured and lower limb colour duplex scan was performed. Narrowing of luminal diameter of lower limb arteries 50% or more was considered as haemodynamically significant and having PAD. The discriminative performance of the ABPI was assessed using Receiver Operator Characteristic (ROC) curve and calculating the area under the curve (AUC). The sensitivity and specificity of different threshold levels of ABPI and the best cutoff value of ABPI to detect PAD were determined. Results. ABPI 0.89 was determined as the best cutoff value to identify individuals with PAD. At this level of ABPI high sensitivity (87%), specificity (99.1%), positive predictive value (98.9%), and negative predictive value (88.4%) were observed. Conclusion. ABPI ≤ 0.89 could be used as the best cut off value to detect PAD.

Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: a systematic review.

Non-invasive tests for the detection of peripheral artery disease (PAD) among individuals with diabetes mellitus are important to estimate the risk of amputation, ulceration, wound healing and the presence of cardiovascular disease, yet there are no consensus recommendations to support a particular diagnostic modality over another and to evaluate the performance of index non-invasive diagnostic tests against reference standard imaging techniques (magnetic resonance angiography, computed tomography angiography, digital subtraction angiography and colour duplex ultrasound) for the detection of PAD among patients with diabetes. Two reviewers independently screened potential studies for inclusion and extracted study data. Eligible studies evaluated an index test for PAD against a reference test. An assessment of methodological quality was performed using the quality assessment for diagnostic accuracy studies instrument. Of the 6629 studies identified, ten met the criteria for inclusion. In these studies, the patients had a median age of 60-74 years and a median duration of diabetes of 9-24 years. Two studies reported exclusively on patients with symptomatic (ulcerated/infected) feet, two on patients with asymptomatic (intact) feet only, and the remaining six on patients both with and without foot ulceration. Ankle brachial index (ABI) was the most widely assessed index test. Overall, the positive likelihood ratio and negative likelihood ratio (NLR) of an ABI threshold <0.9 ranged from 2 to 25 (median 8) and <0.1 to 0.7 (median 0.3), respectively. In patients with neuropathy, the NLR of the ABI was generally higher (two out of three studies), indicating poorer performance, and ranged between 0.3 and 0.5. A toe brachial index <0.75 was associated with a median positive likelihood ratio and NLRs of 3 and ≤ 0.1, respectively, and was less affected by neuropathy in one study. Also, in two separate studies, pulse oximetry used to measure the oxygen saturation of peripheral blood and Doppler wave form analyses had NLRs of 0.2 and <0.1. The reported performance of ABI for the diagnosis of PAD in patients with diabetes mellitus is variable and is adversely affected by the presence of neuropathy. Limited evidence suggests that toe brachial index, pulse oximetry and wave form analysis may be superior to ABI for diagnosing PAD in patients with neuropathy with and without foot ulcers. There were insufficient data to support the adoption of one particular diagnostic modality over another and no comparisons existed with clinical examination. The quality of studies evaluating diagnostic techniques for the detection of PAD in individuals with diabetes is poor. Improved compliance with guidelines for methodological quality is needed in future studies.