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Abstract
Background
Peripheral vascular disease (PVD) is a primary risk factor of foot amputation. In patients with diabetes mellitus (DM), the frequency of PVD is twice that of the general population. The ankle-brachial index (ABI) is a valuable diagnostic test for PVD. In this study, we investigated the relationship between the ABI and PVD, as well as the cutoff value of ABI in the diagnosis of PVD, and analyzed whether the ABI can be used as a predictor for amputation.
Methods
Fifty-two type 2 DM patients (31 males, 21 females) underwent peripheral angiography. PVD was defined as the complete obstruction of arteries and/or significant luminal narrowing, with collateral vessels formation, using peripheral angiography. The ABI was calculated by measurement of the segmental pressure using the Doppler method.
Results
Significant differences were observed between PVD and non-PVD patients in terms of age, systolic pressure and total cholesterol (each P < 0.05). The ABI was significantly lower in legs with PVD (P < 0.01) and an ABI less than 0.90 was adequate for diagnosing PVD. The risk of amputation was significantly increased in relation to the ABI level, and the risk of amputation was 21.5 times greater in a leg with an ABI less than 0.40 compared to 0.90 (P = 0.021).
Figures and Tables
Fig. 1
Receiver-operating characteristic (ROC) curves for ankle-brachial index (ABI) for diagnosing peripheral vascular disease. The cutoff value of ABI is 0.91. The area under the ROC curve (95% CI) for the parameter is 0.758 (0.661~0.856).
Table 1
Clinical and biochemical characteristics of study groups
Alpha-GI, alpha-glucosidase inhibitor; BMI, body mass index; CAOD, coronary artery occlusive disease; CVA, cerebrovascular disease; DBP, diastolic blood pressure; DM, diabetes mellitus; FBS, fasting blood sugar; HDL-C, high density lipoprotein-cholesterol; LDL-C, low density lipoprotein-cholesterol; PAG, peripheral angiography; PVD, peripheral vascular disease; SBP, systolic blood pressure; TC, total cholesterol; TG, triglyceride; PAOD, peripheral artery obstructive disease.
*P < 0.001 between two groups with and without PVD in peripheral angiography.
†P < 0.05 between two groups with and without PVD in peripheral angiography.
‡P = 0.095 between two groups with and without PVD in peripheral angiography.
§P = 0.088 between two groups with and without PVD in peripheral angiography.
References
1. Gregg EW, Sorlie P, Paulose-Ram R, Gu Q, Eberhardt MS, Wolz M, Burt V, Curtin L, Engelgau M, Geiss L. 1999-2000 national health and nutrition examination survey: Prevalence of lower-extremity disease in the US adult population ≥ 40 years of age with and without diabetes. Diabetes Care. 2004. 27:1591–1597.
2. Cui R, Iso H, Yamagishi K, Tanigawa T, Imano H, Ohira T, Kitamura A, Sato S, Naito Y, Shimamoto T. Ankle-arm blood pressure index and cardiovascular risk factors in elderly Japanese men. Hypertens Res. 2003. 26:377–382.
3. Kallio M, Forsblom C, Groop PH, Groop L, Lepantalo M. Development of new peripheral arterial occlusive disease in patients with type 2 diabetes during a mean follow-up of 11years. Diabetes Care. 2003. 26:1241–1245.
4. American Diabetes Association. Peripheral arterial disease in people with diabetes. Diabetes Care. 2003. 26:3333–3341.
5. Boulton AJM. Pickup JC, Williams G, editors. Foot problems in patients with diabetes mellitus. Textbook of Diabetes. 1997. 2nd ed. Oxford: Blackwell Science;58.1–58.20.
6. Reimer P, Landwehr P. Non-invasive vascular imaging of peripheral vessels. Eur Radiol. 1998. 8:858–872.
7. Piecuch T, Jaworski R. Resting ankle-arm pressure index in vascular diseases of lower extremities. Angiology. 1989. 40:181–185.
8. Stoffers HE, Kester AD, Kaiser V, Rinkens PE, Kitslaar PJ, Knottnerus JA. The diagnostic value of the measurement of the ankle-brachial systolic pressure index in primary health care. J Clin Epidemiol. 1996. 49:1401–1405.
9. Hiatt WR, Marshall JA, Baxter J, Sandoval R, Hildebrandt W, Kahn LR, Hamman RF. Diagnostic methods for peripheral arterial disease in the San Luis Valley Diabetes Study. J Clin Epidemiol. 1990. 43:597–606.
10. Feigelson HS, Criqui MH, Fronek A, Langer RD, Molgaard CA. Screening for peripheral arterial disease: the sensitivity, specificity, and predictive value of noninvasive tests in defined population. Am J Epidemiol. 1994. 140:526–534.
11. Criqui MH, Denenberg JO, Bird CE, Fronek A, Klauber MR, Langer RD. The correlation between symptoms and non-invasive test results in patients referred for peripheral arterial disease testing. Vasc Med. 1996. 1:65–71.
12. Kim DJ, Choi BJ, Ko YG, Chang HJ, Ahn CW, Ryu DR, Yun YS, Han SH, Nam JH, Park SW, Song YD, Lim SK, Kim KR, Shim WH, Lee HC, Huh KB. Risk factors for peripheral arterial disease as screened by plethysmography in patients with NIDDM. J Kor Diabetes Assoc. 1999. 23:172–181.
13. Chung YS, Yoo HJ, Seo SO, Kim HK, Kim DM, Yoo JM, Ihm SH, Choi MG, Park SW. Risk factors of peripheral vascular disease (PVD) and nutritional factors in diabetic patients over 60 years old complicated with PVD diagnosed by ankle-brachial index (ABI). J Kor Diabetes Assoc. 1999. 23:814–821.
14. Resnick HE, Lindsay RS, McDermott MM, Devereux RB, Jones KL, Fabsitz RR, Howard BV. Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the Strong Heart Study. Circulation. 2004. 109:733–739.
15. Hooi JD, Stoffers HE, Kester AD, van Ree JW, Knottnerus JA. Peripheral arterial occlusive disease: prognostic value of signs, symptoms, and the ankle-brachial pressure index. Med Decis Making. 2002. 22:99–107.
16. Nam SH, Lee SO, Lee HW, Ryu BY, Kim HK, Choi CS. A study on clinical significance of ankle systolic pressure and ankle-brachial pressure index in chronic occlusive arterial disease. J Korean Soc Vasc Surg. 1995. 11:214–223.
17. Paumbo PJ, Melton LJ III. Harris MI, Hamman RF, editors. Peripheral vascular disease and diabetes. Diabetes in America. 1985. Bethesda, Md: NIH pub;No. 85-1468.
18. Tapp RJ, Shaw TE, de Courten MP, Dunstan DW, Welborn TA, Zimmet PZ. AusDiab Study Group: Foot complications in Type 2 diabetes: an Australian population-based study. Diabet Med. 2003. 20:105–113.
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