Transcutaneous oxygen tension and ankle brachial pressure index as predictors of outcome in diabetic foot

Background: Diabetic foot ulcer poses a serious threat to patients with Diabetes as the presence of an ulcer further significantly increases the risk of an amputation. Aim and Objectives: The present study was undertaken to assess: Correlation of transcutaneous oxygen tension (TcpO2) and ankle brachial pressure index (ABI) in outcome of diabetic foot and severity of neuropathy by grades. Materials and Methods: About 30 patients of Type 2 Diabetes Mellitus with foot lesions and 30 healthy controls were selected after obtaining informed consent and ethical committee clearance. Subjects were recruited taking into consideration various inclusion and exclusion criteria. The subjects were assessed for the following parameters: Vibration perception, hot, and cold perception along with TcpO2 and ankle brachial pressure index (ABI). The test results were compared within the two groups of cases, that is, Group I: Healed ulcer and Group II-Non-healed ulcer. The results of the two groups were compared with 30 healthy controls also. Results: Males were predominant (66.67%) compared to females (33.33%) in the diabetic foot patients. Severe derangements in the sensory modalities were found as observed by the bilaterally reduced values of vibration perception, hot perception and cold perception tests when diabetic foot patients were compared to controls. The values, however, were not significantly different between the two groups of patients of diabetic foot. The values of TcPO2 and ABI were bilaterally reduced in the cases as compared to controls and amongst the Group I and Group II comparison these values showed a significant difference. A highly significant positive correlation was observed between the TcPO2 and ABI test results in the diabetic foot patients that indicates both are complimentary tests for diabetic foot outcome prediction. Conclusion: Increased duration of diabetes, high value of Hba1c and presence of neuropathy were found to be important risk predictors for diabetic foot. Early and severe derangement of vibration perception indicated early involvement of large nerve fibers. Heat and cold perception is affected late and less severely, indicating late involvement of small nerve fibers in diabetic polyneuropathy. The positive correlation between TcPO2 and ABI indicates both are complementary tests for predicting the outcome of diabetic foot. However, TcPO2 being a better predictor maybe incorporated as a routine screening test for diabetic foot risk and outcome predictor in the diabetic foot clinic.

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, <0.9. Conclusion: HbA1c being slightly higher in cases as compared to controls, points toward some ongoing dysregulation of blood glucose levels. With a ncABPI ratio being more in cases than in controls, our study showed that offsprings of diabetic parents are at more risk to develop atherosclerotic related complications such as PAD and CVD in future.

Prospective observational study evaluating the predictive value of ankle branchial pressure index on the outcomes of diabetic foot ulcers

Background: The study was conducted to determine the diagnostic accuracy of ankle branchial pressure index (ABPI) in predicting major amputation and duration of wound healing in diabetic foot ulcers.Methods: 105 participants (30-85 years) admitted in general surgery inpatient with diabetic foot ulcers during 18 months were enrolled in the present prospective observational study. Institutional ethics committee approved the study and written informed consent was obtained from all study participants. Data was analyzed using R and the tests of significance were chi square test and ANOVA. Area under curve (AUC) of receiver operator characteristic (ROC) was used to describe the diagnostic accuracy of ABPI. P<0.05 was considered statistically significant.Results: The mean ABPI of study participants was 0.7 with 23.8% participants having normal ABPI. Lower ABPI was associated with longer duration of ulcer healing (p=0.003). All participants with ABPI <0.3 required more than 120 days for wound healing (p<0.001) and required above knee amputation (p<0.001). AUC ROC of ABPI and major amputation is 0.987 with 92.9% sensitivity and 98.9% specificity. Significantly higher proportion of participants with ABPI ≤0.48 underwent major amputation. The AUC of ROC of ABPI on duration of wound healing was 0.953 with 84.9% sensitivity and 98.1% specificity.    Conclusions: ABPI can be used as a routine tool in all patients with diabetic foot ulcers for screening peripheral arterial disease so that the decision for amputation can be made early during diabetic foot ulcers.

A study on clinical grading and bacteriological profile of diabetic foot ulcers in tertiary care centre

Background: Diabetes is one of the commonest diseases worldwide and diabetic foot ulcer and its complications are associated with significant morbidity and even amputation. Early detection of colonizing agent of these ulcers help in reduced morbidity and hospital stay. We targeted this subgroup of patients to study Wagner’s grade, identify the bacterial agent and its antibiotic sensitivity and ankle-brachial pressure index (ABPI) assessment to detect PAD, for the best treatment outcome of diabetic foot ulcers.Methods: The present study was conducted in the Department of Surgery of SGMCRF, Venjaramoodu on 210 patients with diabetic foot ulcers between November 2017 and May 2019. Wagner’s grading of ulcer, culture and antibiotic sensitivity of microbe were done as well as ABPI was measured. Outcome of ulcers was compared to ABPI and ABPI was compared to time of healing.Results: Out of 210 patients 122 were males and 88 females, 62.9% had neuropathy and 66.7% had vasculopathy. Most patients presented with Wagner’s grade-II ulcers.  Most common microbe isolated was pseudomonas aeruginosa which was most sensitive to piperacillin and tazobactam combination. Majority of lesions 62.9% had ABPI in range of 0.5-0.89.Conclusions: Wagner’s grading and presence of neuropathy are predictors of major amputation. Piperacillin and tazobactam should be empirical choice of antibiotic. ABPI was inversely related to time of healing and has got significant association with treatment outcome.

Risk Factors and Incidence for Peripheral Arterial Disease in Patients with Typical Lumbar Spinal Stenosis

OBJECTIVE: Intermittent claudication (IC) is a typical symptom of peripheral arterial disease (PAD) and lumbar spinal stenosis (LSS). In order to prevent misdiagnosis of vascular disease, it is important to know the incidence of and risk factors for PAD in patients with LSS. Therefore, the aim of our study was to evaluate the incidence of and risk factors for PAD in patients with typical and severe LSS who underwent spinal surgical treatment. METHODS: The occurrence of PAD was examined retrospectively in 171 consecutive patients with LSS and severe IC who underwent surgical treatment at our hospital from June 2012 to June 2013. Data were collected on background characteristics (sex, age) and known risk factors for PAD, such as hypertension, diabetes mellitus, smoking, hyperlipidemia, stroke, and ischemic heart disease. RESULTS: Of the 171 patients enrolled, 7 had an abnormal ankle-brachial index (ABI). Computed tomography angiography (CTA) was performed in these patients, and a final diagnosis of PAD was established for all 7 patients. The incidence of PAD in all patients with LSS was 4.1%(7 of 171). Stroke and ischemic heart disease were significantly more common in the LSSPAD group compared with the LSS group. Multiple logistic regression analyses with a forced-entry method revealed that age and stroke (p<0.05) were independent risk factors for PAD. CONCLUSION: To prevent misdiagnosis of fatal PAD, we recommend ABI be assessed in patients with LSS and history of stroke.

Ankle Brachial Pressure Index: As a predictor of peripheral arterial disease in diabetic & non diabetic subjects.

Background: Peripheral arterial disease is known to be associated with the diabetes and ankle-brachial pressure index (ABPI) can be used to screen such patients having PAD. Aims & Objective: To highlight the application of ankle brachial pressure index as a routine procedure and to assess the feasibility of using ABPI in detecting PAD in the patients of diabetes mellitus. Material and Methods: 30 Diabetic and 30 Non diabetic patients were recruited. Details regarding anthropometric measurements, blood sugar levels, lipid profile, Edinburgh questionnaire, peripheral pulse examinations etc. were filled in preformed questionnaire. Ankle-brachial pressure index (ABPI) was measured with the help of Handheld Doppler machine. Descriptive statistics in the form of frequency and percentage is used for description of data. Chi-square test was used for comparison of events in two groups. Results: PAD was more common in old age but found not to be associated with gender. Body mass index, surface area and wait hip ration was significant more in PAD group as compared to non-PAD. All blood sugar parameters [Fasting blood sugar (FBS), postprandial blood sugar after 2 hours (PP2BS) and Glycosylated haemoglobin (HB1AC)] were significantly more in PAD group as compared to non-PAD. High density lipoprotein was significantly less in PAD group as compared to non-PAD. Triglyceride, Total Cholesterol and Low density lipoprotein was significantly more in PAD group as compared to non-PAD. ABPI was significantly less in diabetics as compared to non-diabetics. More diabetics were in having PAD as compared to non-diabetics. Conclusion: PAD is found to be associated with more weight, adverse lipid profile and diabetes. ABPI can be used to screen the PAD in diabetic patients.

Effects of electroacupuncture on the arterial stiffness in stroke patients / 全日本鍼灸学会雑誌

[Objective]It seems that in Japan’s aging society, investigating the position of acupuncture and moxibustion for the treatment of arteriosclerotic diseases is important. In this report we evaluated the effects of electroacupuncture (EA) on stroke patients by measuring changes in pulse wave velocity (PWV), brachial-ankle PWV (baPWV), ankle brachial pressure index (ABI), blood pressure (BP) and heart rate (HR). <BR>[Method]The subjects were 210 initial stroke patients. Stroke patients were randomly allocated to three groups, those only taking drug therapy (drug group), those taking drug therapy combined with rehabilitation (rehab group), and those taking drug therapy and rehabilitation combined with EA (EA group). 81 cerebral thrombosis patients (drug group n = 25, rehab group n = 28, EA group n = 28), 68 cerebral embolus patients (drug group n = 24, rehab group n = 20, EA group n = 24) and 61 cerebral hemorrhage patients (drug group n = 20, rehab group n = 21, EA group n = 20) were examined. For the evaluation method blood pressure pulse wave measuring equipment was used to measure PWV, baPWV, ABI, BP, and HR after two months, four months, and six months from the onset of treatment. <BR>[Results]After two months and four months there was no significant difference in blood vessel elasticity of the three cerebral thrombosis groups. Whereas after six months, compared to the drug group, the baPWV in cerebral thrombosis patients significantly decreased for the rehab group (p < 0.05) and EA group (p < 0.01). There were no significant differences in ABI, BP, or HR. Cerebral hemorrhage and cerebral embolism patients showed no significant difference in baPWV, ABI, BP, and HR.<BR>[Conclusion]We examined the effects of adding EA to the treatment of patients who suffered cerebral thrombosis, cerebral embolism, or cerebral hemorrhage. These results show that adding EA to drug treatment and rehabilitation significantly improves blood vessel elasticity and suggests that using EA would reduce the risk of cerebral thrombosis and its reoccurrence.

The Relationship among Pulse Wave Velocity, Ankle-Brachial Pressure Index and Heart Rate Variability in Adult Males / 가정의학회지

BACKGROUND: Pulse wave velocity (PWV) and ankle-brachial pressure index (ABI) are non-invasive tools to measure atherosclerosis and arterial stiffness. Heart rate variability (HRV) has proven to be a non-invasive powerful tool in the investigation of the autonomic cardiovascular control. Therefore, the purpose of this study was to determine the relationship among PWV, ABI, and HRV parameters in adult males. METHODS: The study was carried out with 117 males who visited a health care center from April, 2009 to May, 2010. We conducted blood sampling (total cholesterol, triglyceride, high density lipoprotein, cholesterol, fasting glucose) and physical examination. We studied brachial-ankle PWV (baPWV) and ABI. We examined HRV parameters including standard deviation of NN interval (SDNN), low frequency (LF), high frequency (HF), LF/HF ratio. We analyzed the relationship among baPWV, ABI, and HRV parameters. RESULTS: SDNN had a significant negative correlation with age, systolic blood pressure and heart rate. LF and HF had a significant negative correlation with age, and age and heart rate, respectively. baPWV was significantly and positively associated with age, systolic and diastolic blood pressures, total cholesterol, fasting glucose and heart rate. ABI was negative correlated significantly with systolic and diastolic blood pressures and heart rate. After adjusting for all associated variables, baPWV was not correlated with HRV parameters, but there was a significant positive association between SDNN and ABI (r = 0.195, P = 0.014). CONCLUSION: SDNN of HRV parameters had a significant positive correlation with ABI.

Effects of acupuncture stimulation on the arterial compliance-A comparison between LI10, ST36, CV12 and non-stimulation- / 全日本鍼灸学会雑誌

[Objective]We researched the effect on three acupuncture stimulation groups and a non-stimulation group used for arterial compliance. <BR>[Methods]This study was conducted on 70 healthy volunteers divided randomly into four groups. We observed the effects of arterial compliance by measuring the brachial-ankle pulse wave velocity score (baPWVs), ankle brachial pressure index (ABI), Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) using form PWV/ABI®. Acupuncture stimulation groups were divided into LI10 (Shousanli, Te no Sanri n = 23) group, ST36 (Zusanli, Ashi no Sanri n = 18) group, and CV12 (Zhongwan, Chukan n = 19) groups.<BR>[Results]We found that baPWVs significantly decreased in both the LI10 (before 1222 ± 203cm/s vs after 986 ± 143cm/s) and ST36 (before 1245 ± 126 cm/s vs after 1014 ± 120 cm/s) groups (p < 0.05), but not significantly in the CV12 group (before 1264 ± 222 cm/s vs 1287 ± 226 cm/s) and non-stimulation groups (before 1228 ± 144 cm/s vs after 1222 ± 150 cm/s). ABI, SBP, DBP and HR were not significant in the all groups. <BR>[Conclusion]These results suggest that upper and lower extremities or the abdomen in acupuncture stimulation may influence the activity of arterial compliance.

Determinants of 1-Year Changes of Brachial Ankle Pulse Wave Velocity (baPWV) in Patients with Type 2 Diabetes Mellitus / 당뇨병

BACKGROUND: Cardiovascular disease is the leading cause of mortality in type 2 diabetes. PWV correlates well with arterial distensibility and stiffness and a useful approach for evaluating the severity of systemic atherosclerosis in adults, and, in particular, the measurement of brachial-ankle PWV (baPWV) has been commonly reported as a simple, noninvasive and practicable method. baPWV was mainly affected by age, SBP and sex. And also, baPWV was affected by many different factors such as body weight, BMI, waist to hip ratio, HbA1c, microalbuminuria, triglyceride, gammaGTP, duration of DM. We evaluated determinants of 1-year changes of baPWV in patients with type 2 DM. METHODS: The study group comprised 189 diabetic patients who measured ankle brachial pressure index (ABI), baPWV at base line and 1-year later. The anthropometric parameters, blood pressure, pulse pressure, fasting plasma glucose (FBS), fasting insulin, A1c, lipid profile, hsCRP, microalbuminuria, AST/ALT, gammaGTP were also checked concurrently. We also analyzed correlation between change of baPWV and subject's medications. We retrospectively analyzed the relationship between the 1-year changes of baPWV and the other factors. All analyses were performed with the SPSS Version 14.0 and P values < 0.05 were considered significant. RESULTS: baPWV change was affected by systolic blood pressure change, diastolic blood pressure change, pulse pressure change, body weight, BMI, triglyceride change, insulin treatment and total cholesterol. Multiple regression analysis of the relationship between change of baPWV and other associated variables shows that the 1-year change of baPWV was significantly associated with the changes of blood pressure and insulin treatment in patients with type 2 DM. CONCLUSION: 1-year change of baPWV was significantly associated with the changes of blood pressure in patients with type 2 DM.

Usefulness of ankle brachial pressure index measured using photoplethysmography and automated blood pressure measurement device / 대한내과학회지

BACKGROUND: Resting ankle brachial pressure index is a non-invasive method to assess the patency of lower extremity arterial system and it can be measured using traditional Doppler method or photoplethysmography. Automated blood pressure measurement is a easy and quick method for measurement of ankle brachial pressure index, but usefulness of this method have not been investigated. So we evaluated the accuracy of Automated blood pressure measurement device as flow detector in determining the ankle brachial pressure index in comparison to photoplethysmography. METHODS: A total 136 subjects containing 117 diabetic patients and 19 volunteers were included in the study. With each subject in the supine position, dorsalis pedis arterial pulses were palpated by examiner. And the brachial and ankle systolic blood pressure were recorded using photoplethysmography (Rheoscreen, Medis, Germany) and automated blood pressure measurement device (MD-800, Meditec, Korea). Ankle brachial pressure index for each leg was separately calculated by dividing the ankle systolic pressure by the higher brachial systolic pressure. Statistical analyses were performed by SPSS for Windows (version 10.0 SPSS Inc.) RESULTS: Brachial and ankle systolic pressure measured using automated blood pressure measurement device were higher than photoplethysmography and correlations between both method were significant (r=0.886, r=0.844). Ankle brachial pressure index derived using automated blood pressure measurement have a better correlation with photoplethysmography method (r=0.622) than pulse palpation (r=0.255). The subject was considered to have peripheral arterial disease if either leg ABI was 0.9 or less. Peripheral arterial disease was more frequent when it was defined using photoplethysmography (13.8%) vs automated blood pressure measurement device (6.3%). The sensitivity of the automated blood pressure measurement is 32.4%, the specificity is 97.8% and the accuracy is 88.8% for peripheral arterial disease defined using photoplethysmography. CONCLUSION: Automated blood pressure measurement was easier and quicker and less expensive as compared with photoplethysmography. Automated blood pressure measurement was not sensitive but more accurate as compared with pulse palpation. So we recommend that it be used on a routine screening basis of peripheral arterial disease in primary care.