Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2019, 163(3):227-232

Comparison of different methods of ABI acquisition for detection of peripheral artery disease in diabetic patients

Miroslav Homzaa,b, Ondrej Machaczkac, Martin Porzera,b, Milan Kozakd, Jiri Plaseka,b, David Sipulaa,b
a Department of Cardiovascular Diseases, University Hospital Ostrava, Czech Republic
b Department of Internal Medicine, Faculty of Medicine, University of Ostrava, Czech Republic
c Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Czech Republic
d Department of Internal Cardiology Medicine, Faculty of Medicine, Masaryk University Brno, Czech Republic

Background: Ankle brachial index (ABI) is the principal screening method for peripheral arterial disease (PAD). In this study, we compare various types of Doppler-derived and oscillometric ABIs with results obtained through duplex ultrasonography.

Methods: 62 patients were enrolled in the study. For each limb, blood pressures for both ankle arteries and the arm were measured using Doppler and an automated oscillometric device. Duplex ultrasound was performed for all limbs and occlusions >50% were considered PAD-positive. ABI was calculated using both higher (HABP) and lower (LABP) arterial blood pressure on the individual limbs and the ability to predict duplex-detected stenoses was evaluated.

Results: LABP calculation provided results superior to the guideline-recommended HABP. Considering patients with ABI >1.4 or measurement failure as PAD-positive further enhanced the test parameters. The higher ABI cut-off of 1.0 resulted in somewhat better sensitivities (max 92%) and negative predictive values (max 87%) at the expense of a substantial increase in the number of false positives. Oscillometric method yielded poor sensitivities but very good specificities (max 94%) and positive predictive values (max 90%).

Conclusions: Doppler-based LABP provides better results than the guideline-recommended HABP in diabetic patients, nevertheless even this method is not perfect. Increasing the cut-off value to 1.0 in these patients does not bring a substantial improvement of the test performance. Patients with high ABI should be automatically considered PAD-positive and referred for further investigation using imaging techniques.

Keywords: ankle brachial index, diabetes, oscillometric measurement, dopplerometric measurement, duplex ultrasonography

Received: May 7, 2018; Revised: July 9, 2019; Accepted: August 10, 2018; Prepublished online: September 14, 2018; Published: September 23, 2019  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Homza, M., Machaczka, O., Porzer, M., Kozak, M., Plasek, J., & Sipula, D. (2019). Comparison of different methods of ABI acquisition for detection of peripheral artery disease in diabetic patients. Biomedical papers, 163(3), 227-232
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. GBD2016, Global, Regional, and National Incidence, Prevalence, and Years Lived with Disability for 328 Diseases and Injuries for 195 Countries, 1990-2016: A Systematic Analysis for the Global Burden of Disease Study 2016. Lancet 2017;390(10100):1211-59. Go to original source... Go to PubMed...
    2. ADA ADA, Peripheral Arterial Disease in People with Diabetes. Diabetes Care 2003;26(12):3333-41. Go to original source... Go to PubMed...
    3. Hennion DR, Siano KA. Diagnosis and Treatment of Peripheral Arterial Disease. Am Fam Physician 2013;88(5):306-10. Go to PubMed...
    4. Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, Fleisher LA, Fowkes FG, Hamburg NM, Kinlay S, Lookstein R, Misra S, Mureebe L, Olin JW, Patel RA, Regensteiner JG, Schanzer A, Shishehbor MH, Stewart KJ, Treat-Jacobson D, Walsh ME. 2016 Aha/Acc Guideline on the Management of Patients with Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017;69(11):1465-508. Go to original source... Go to PubMed...
    5. Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss LK, Golzarian J, Gornik HL, Halperin JL, Jaff MR, Monet GL, Olin JW, Stanley JC, White CJ, White JV, Zierler R, Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM Jr, White CJ, White JV, White RA, Jacobs AK, Anderson JL, Albert N, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Kushner FG, Magnus Ohman E, Stevenson W. 2011 Accf/Aha Focused Update of the Guideline for the Management of Patients with Peripheral Artery Disease (Updating the 2005 Guideline): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011;124(18):2020-45. Go to original source... Go to PubMed...
    6. Aboyans V, Ricco J-B, Bartelink M-L, Björck M, Brodmann M, Cohnert T, Collet J-P, Czerny M, De Carlo M, Debus S, Espinola-Klein C, Kahan T, Kownator S, Mazzolai L, Naylor RA, Roffi M, Röther J, Sprynger M, Tendera M, Tepe G, Venermo M, Vlachopoulos C, Desormais I. 2017 Esc Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in Collaboration with the European Society for Vascular Surgery (Esvs). European Heart Journal 2017;00:1-60. Go to original source...
    7. Aboyans V, Ho E, Denenberg JO, Ho LA, Natarajan L, Criqui MH. The Association between Elevated Ankle Systolic Pressures and Peripheral Occlusive Arterial Disease in Diabetic and Nondiabetic Subjects. J Vasc Surg 2008;48(5):1197-203. Go to original source... Go to PubMed...
    8. Zhang H, Li XY, Si YJ, Lu XL, Luo XS, Liu ZY. Manifestation of Lower Extremity Atherosclerosis in Diabetic Patients with High Ankle-Brachial Index. Chin Med J (Engl) 2010;123(7):890-4. Go to PubMed...
    9. Singh GD, Armstrong EJ, Waldo SW, Alvandi B, Brinza E, Hildebrand J, Amsterdam EA, Humphries MD, Laird JR. Non-Compressible Abis Are Associated with an Increased Risk of Major Amputation and Major Adverse Cardiovascular Events in Patients with Critical Limb Ischemia. Vasc Med 2017; 22(3):210-217. Go to original source... Go to PubMed...
    10. Aerden D, Massaad D, von Kemp K, van Tussenbroek F, Debing E, Keymeulen B, Van den Brande P. The Ankle--Brachial Index and the Diabetic Foot: A Troublesome Marriage. Ann Vasc Surg 2011;25(6):770-7. Go to original source... Go to PubMed...
    11. Espinola-Klein C, Rupprecht HJ, Bickel C, Lackner K, Savvidis S, Messow CM, Munzel T, Blankenberg S. Different Calculations of Ankle-Brachial Index and Their Impact on Cardiovascular Risk Prediction. Circulation 2008;118(9):961-7. Go to original source... Go to PubMed...
    12. Schroder F, Diehm N, Kareem S, Ames M, Pira A, Zwettler U, Lawall H, Diehm C. A Modified Calculation of Ankle-Brachial Pressure Index Is Far More Sensitive in the Detection of Peripheral Arterial Disease. J Vasc Surg 2006;44(3):531-6. Go to original source... Go to PubMed...
    13. Takahashi I, Furukawa K, Ohishi W, Takahashi T, Matsumoto M, Fujiwara S. Comparison between Oscillometric- and Doppler-Abi in Elderly Individuals. Vasc Health Risk Manag 2013;9:89-94. Go to original source... Go to PubMed...
    14. Span M, Gersak G, Millasseau SC, Meza M, Kosir A. Detection of Peripheral Arterial Disease with an Improved Automated Device: Comparison of a New Oscillometric Device and the Standard Doppler Method. Vasc Health Risk Manag 2016;12:305-11. Go to original source... Go to PubMed...
    15. Massmann A, Stemler J, Fries P, Kubale R, Kraushaar LE, Buecker A. Automated Oscillometric Blood Pressure and Pulse-Wave Acquisition for Evaluation of Vascular Stiffness in Atherosclerosis. Clin Res Cardiol 2017;106(7):514-524. Go to original source... Go to PubMed...
    16. Benchimol A, Bernard V, Pillois X, Hong NT, Benchimol D, Bonnet J. Validation of a New Method of Detecting Peripheral Artery Disease by Determination of Ankle-Brachial Index Using an Automatic Blood Pressure Device. Angiology 2004;55(2):127-34. Go to original source... Go to PubMed...
    17. Beckman JA, Higgins CO, Gerhard-Herman M. Automated Oscillometric Determination of the Ankle-Brachial Index Provides Accuracy Necessary for Office Practice. Hypertension 2006;47(1):35-8. Go to original source... Go to PubMed...
    18. Nukumizu Y, Matsushita M, Sakurai T, Kobayashi M, Nishikimi N, Komori K. Comparison of Doppler and Oscillometric Ankle Blood Pressure Measurement in Patients with Angiographically Documented Lower Extremity Arterial Occlusive Disease. Angiology 2007;58(3):303-8. Go to original source... Go to PubMed...
    19. Aboyans V, Lacroix P, Doucet S, Preux PM, Criqui MH, Laskar M. Diagnosis of Peripheral Arterial Disease in General Practice: Can the Ankle-Brachial Index Be Measured Either by Pulse Palpation or an Automatic Blood Pressure Device? Int J Clin Pract 2008;62(7):1001-7. Go to original source... Go to PubMed...
    20. Wohlfahrt P, Ingrischova M, Krajcoviechova A, Palous D, Dolejsova M, Seidlerova J, Galovcova M, Bruthans J, Jozifova M, Adamkova V, Filipovsky J, Cifkova R. A Novel Oscillometric Device for Peripheral Arterial Disease Screening in Everyday Practice. The Czech-Post Monica Study. Int Angiol 2011; 30(3): 256-61. Go to PubMed...
    21. Hingorani A, LaMuraglia GM, Henke P, Meissner MH, Loretz L, Zinszer KM, Driver VR, Frykberg R, Carman TL, Marston W, Mills JL, Sr., Murad MH. The Management of Diabetic Foot: A Clinical Practice Guideline by the Society for Vascular Surgery in Collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine. J Vasc Surg 2016;63(2 Suppl):3s-21s. Go to original source... Go to PubMed...
    22. Frykberg RG, Zgonis T, Armstrong DG, Driver VR, Giurini JM, Kravitz SR, Landsman AS, Lavery LA, Moore JC, Schuberth JM, Wukich DK, Andersen C, Vanore JV. Diabetic Foot Disorders. A Clinical Practice Guideline (2006 Revision). J Foot Ankle Surg 2006;45(5 Suppl):S1-66. Go to original source... Go to PubMed...
    23. KDIGO, Kdigo 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone disorder (Ckd-Mbd). Kidney International Supplements 2017;7(1):1-59. Go to original source... Go to PubMed...
    24. Aboyans V, Criqui MH, Abraham P, Allison MA, Creager MA, Diehm C, Fowkes FG, Hiatt WR, Jonsson B, Lacroix P, Marin B, McDermott MM, Norgren L, Pande RL, Preux PM, Stoffers HE, Treat-Jacobson D. Measurement and Interpretation of the Ankle-Brachial Index: A Scientific Statement from the American Heart Association. Circulation 2012;126(24):2890-909. Go to original source... Go to PubMed...
    25. Criqui MH. Peripheral Arterial Disease--Epidemiological Aspects. Vasc Med 2001;6(3 Suppl):3-7. Go to original source... Go to PubMed...
    26. Janssen A. Pulsatility Index Is Better Than Ankle-Brachial Doppler Index for Non-Invasive Detection of Critical Limb Ischaemia in Diabetes. Vasa 2005;34(4):235-41. Go to original source... Go to PubMed...
    27. Premalatha G, Ravikumar R, Sanjay R, Deepa R, Mohan V. Comparison of Colour Duplex Ultrasound and Ankle-Brachial Pressure Index Measurements in Peripheral Vascular Disease in Type 2 Diabetic Patients with Foot Infections. J Assoc Physicians India 2002;50:1240-4. Go to PubMed...
    28. Williams DT, Harding KG, Price P. An Evaluation of the Efficacy of Methods Used in Screening for Lower-Limb Arterial Disease in Diabetes. Diabetes Care 2005;28(9):2206-10. Go to original source... Go to PubMed...
    29. Parameswaran GI, Brand K, Dolan J. Pulse Oximetry as a Potential Screening Tool for Lower Extremity Arterial Disease in Asymptomatic Patients with Diabetes Mellitus. Arch Intern Med 2005;165(4):442-6. Go to original source... Go to PubMed...
    30. Hur KY, Jun JE, Choi YJ, Lee YH, Kim DJ, Park SW, Huh BW, Lee EJ, Jee SH, Huh KB, Choi SH. Color Doppler Ultrasonography Is a Useful Tool for Diagnosis of Peripheral Artery Disease in Type 2 Diabetes Mellitus Patients with Ankle-Brachial Index 0.91 to 1.40. 2018;42(1):63-73. Go to original source... Go to PubMed...
    31. Clairotte C, Retout S, Potier L, Roussel R, Escoubet B. Automated Ankle-Brachial Pressure Index Measurement by Clinical Staff for Peripheral Arterial Disease Diagnosis in Nondiabetic and Diabetic Patients. Diabetes Care 2009;32(7):1231-6. Go to original source... Go to PubMed...
    32. Vogelberg KH, Stork W. Measurement of Pulse Reappearance Time in Diagnosis of Peripheral Vascular Disease in Diabetes. Diabetes Care 1988;11(4):345-50. Go to original source... Go to PubMed...

    This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.


    Return to the content