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The Ankle-Brachial Index and the Diabetic Foot: A Troublesome Marriage.

Discussion in 'Diabetic Foot & Wound Management' started by NewsBot, Apr 26, 2011.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    The Ankle-Brachial Index and the Diabetic Foot: A Troublesome Marriage.
    Aerden D, Massaad D, von Kemp K, van Tussenbroek F, Debing E, Keymeulen B, Van den Brande P.
    Ann Vasc Surg. 2011 Apr 20. [Epub ahead of print]
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Predictors of decrease in ankle–brachial index among patients with diabetes mellitus
    J. Hoe et al
    Diabetic Medicine, in press
     
  4. davidh

    davidh Podiatry Arena Veteran

    I have often thought that ABI measurement is carried out with a certain amount of complacency.

    I see clinical negligence cases (not just in diabetes patients) in which the claimant has lost a foot or partial lower limb.
    Usually the clinical signs and symptoms are there for all to see well before it is too late to do anything about it. A reliance on Doppler or ABI readings, even once a year, whilst pain, cold, and change in appearance between left and right foot is present, is, at the very least, careless.

    There are NHS pathways to Vascular Surgeons - sometimes they have to be pushed to open, but for the Podiatrist being confronted with an at-risk limb it is far safer to refer on urgently, not to cover anyone's back, but for the sake of the patient.
     
  5. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Hidden dangers revealed by misdiagnosed peripheral arterial disease using ABPI measurement.
    Formosa C, Cassar K, Gatt A, Mizzi A, Mizzi S, Camileri KP, Azzopardi C, Deraffaele C, Falzon O, Cristina S, Chockalingam N.
    Diabetes Res Clin Pract. 2013 Oct 9
     
  6. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Is the ankle-brachial index directly associated with current glycemic control in diabetic patients? Preliminary results of our study
    Banu Sarer Yurekli, Gokcen Unal Kocabas, Cem Mirili, Ismail Yurekli & Habib Cakir
    Endocrine Abstracts (2014) 35 P406
     
  7. Troy Harris

    Troy Harris Member

    I recently ordered a vascular consult on a 70 year old female inpatient who had smoked for >40 years who had multiple bullae on her feet, bilateral foot and ankle rubor, complained of bilateral below knee pain at rest, nonpalpable pedal pulses, and the following bedside doppler exam: inaudible dp pulse bilaterally, weakly monophasic pt and perforating peroneal bilaterally. The patient seemed overdramatic as she would not allow light touch below the knee without yelling. Her feet displayed rubor in dependency, but she complained of increased foot pain in dependency. Pedal X rays and MRI were essentially negative. The patient refused an ABI due to cuff pain. Her assessment was cellulitis (bilateral feet and legs) and contusions.

    So here's my query: I was thinking this could be critical limb ischemia. The feet didn't look ischemic as they weren't cold or gangrenous. The skin was thin, blistered, and almost wet. But the vascuar consultant, who often gets frustrated for getting consults that are unnecessary, said "palpable femoral pulses, palpable popliteal pulses, palpable PT pulses (really, with a monophasic weak doppler signal?), "excellent pulses, no vascular intervention necessary."

    I am a (podiatry) resident, but not for much longer. I was wondering if anyone could shed light on the apparent differences between my findings & the vascular findings from our well respected vascular surgeon. I'm looking for deficiencies in my assessment so I can learn from this. Did the vascular doctor just not want to deal with an overly dramatic patient, or were my findings so off that I didn't recognize "excellent pulses?" Thanks for any responses.
     
    Last edited: May 3, 2014
  8. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Ankle-brachial index, toe-brachial index, and cardiovascular mortality in persons with and without diabetes mellitus.
    Hyun S, Forbang NI, Allison MA, Denenberg JO, Criqui MH, Ix JH.
    J Vasc Surg. 2014 Aug;60(2):390-5.
     
  9. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Relative value of the Ankle-Brachial Index of intermittent claudication.
    Lozano FS, March JR, González-Porras JR, Carrasco E, Lobos JM, Ros E
    International Journal of Clinical Practice [2014]
     
  10. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    The combination of the ankle brachial index and brachial ankle pulse wave velocity exhibits a superior association with outcomes in diabetic patients.
    Chang LH, Lin HD, Kwok CF, Won JG, Chen HS, Chu CH, Hwu CM, Kuo CS, Jap TS, Shih KC, Lin LY.
    Intern Med. 2014;53(21):2425-31
     
  11. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Second Toe Systolic Pressure Measurements are Valid Substitutes for First Toe Systolic Pressure Measurements in Diabetic Patients: A Prospective Study.
    Bhamidipaty V, Dean A, Yap SL, Firth J, Barron M, Allard B, Chan ST.
    Eur J Vasc Endovasc Surg. 2014 Nov 3.
     
  12. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    ABNORMAL STRESS ANKLE BRACHIAL INDEX PREDICTS ALL-CAUSE MORTALITY
    Uday Kanakadandi; Aiden Abidov; Kapildeo Lotun; Deepak Bhatt
    Vascular Medicine | March 2015
     
  13. Beccapod

    Beccapod Member

    HI

    perhaps a simple question; while attempting ABI measurement, the patient complains of 9/10 pain in the limb at the site of blood pressure cuff compression. Why?

    Many thanks
    B
     
  14. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Correlation between Patient-Reported Symptoms and Ankle-Brachial Index after Revascularization for Peripheral Arterial Disease
    Hyung Gon Je, Bo Hyun Kim, Kyoung Im Cho, Jae Sik Jang, Yong Hyun Park and John Spertus
    Int. J. Mol. Sci. 2015, 16(5), 11355-11368; doi:10.3390/ijms160511355 18 May 2015
     
  15. Beccapod

    Beccapod Member

    Thank you :D
     
  16. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    What Is the Clinical Utility of the Ankle-Brachial Index in Patients With Diabetic Foot Ulcers and Radiographic Arterial Calcification?
    Francisco Javier Álvaro-Afonso et al
    International Journal of Lower Extremity Wounds July 27, 2015
     
  17. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Ankle-brachial index in diabetic patients - which upper cut-off value is to be used?
    Homza M, Machaczka O, Porzer M, Kozak M, Plasek J, Sipula D.
    Bratisl Lek Listy. 2018;119(12):793-797.
     
  18. Rob Kidd

    Rob Kidd Well-Known Member

    To me there are two issues here. One of accuracy of data, and then the time honoured problem of indices. One takes a systolic at the arm - it is eg 130mm hg. One takes the same at the ankle - it is eg 100 mm hg. How sure are you that your data is correct? You now invoke an index, which produces a number: how sure are you that it is valid? Any manipulation of indexed data immediately breaks the assumptions of the simple t test (and all other subsequent multivariate) tests. I am not saying that ABI is wrong, I am simply saying: slow down, think it through.
     
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