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Singhania P, Das TC, Bose C, Mondal A, Bhattacharjee R, Singh A, Mukhopadhyay S, Chowdhury S. Toe brachial index and not ankle brachial index is appropriate in initial evaluation of peripheral arterial disease in type 2 diabetes. Diabetol Metab Syndr 2024; 16:52. [PMID: 38414018 PMCID: PMC10898040 DOI: 10.1186/s13098-024-01291-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 02/12/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Non-invasive clinic-based tools for assessing PAD are not without limitations. Therefore, costly tests like Doppler study, CT angiography and MR angiography are often required to make a diagnosis. Ankle brachial index (ABI), commonly used for assessment of PAD, has high false positivity rates in sclerosed, calcified arteries which render them non-compressible. Toe brachial index (TBI) can be an alternative, as digital arteries are relatively unaffected by these changes. AIM To compare the reliability of ABI and TBI in diagnosing PAD in type 2 diabetes using CT angiography (CTA) as the reference. METHODS 175 adults with T2D were selected. ABI &TBI were measured with an automated vascular Doppler XT 6 ports bilaterally for all subjects. For any subject, the limb with lower ABI and TBI was included for analysis. ABI < 0.9 & TBI < 0.6 were taken as evidence of PAD. CTA showing > 50% narrowing was taken as evidence of PAD. RESULTS 24% of our study subjects had CTA confirmed PAD. ABI has low sensitivity of 35.29% (95% CI 0.21-0.52) compared to TBI being 82.35% (95% CI 0.66-0.92). The specificity however was similar. ABI < 0.9 was able to detect CTA confirmed PAD, but ABI > 0.9, including the so-called normal ABI (0.9-1.3) was unable to detect PAD. ROC showed ABI at 1.005 has sensitivity 64.71% (95% CI 0.48- 0.79) and specificity 61.7% (95% CI 0.53-0.69) and TBI at 0.6 has sensitivity 82.35% (95% CI 0.66-0.92) & specificity 92% (95% CI 0.87-0.96). Utilizing Cohen's Kappa, the reliability of ABI with respect to CTA showed fair agreement (K = 0.225, p = 0.001), whereas the reliability of TBI with respect to CTA showed substantial agreement (K = 0.759, p < 0.0001). CONCLUSION ABI < 0.9 detects PAD reliably, but presence of PAD in patients with ABI > 9.0 including the normal of ABI (0.9-1.3) can be confirmed with TBI, which correlated strongly with CTA. TBI is also non-inferior for PAD detection, when ABI < 0.9. TBI and not ABI can be utilized for initial assessment of PAD in subjects with T2D.
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Affiliation(s)
- Pankaj Singhania
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Tapas Chandra Das
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Chiranjit Bose
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Asif Mondal
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | | | - Archana Singh
- Department of Radiodiagnosis, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research, Kolkata, India.
| | - Subhankar Chowdhury
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research, Kolkata, India
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Sun H, Wu Y, Sung L, Lin X, Tsai F, Lin Y, Tam K, Wang F, Chang S. Use of consecutive transcutaneous oxygen measurement when assessing the need for revascularization and association with the outcomes of ischemic diabetic ulcers. Int Wound J 2024; 21:e14635. [PMID: 38272805 PMCID: PMC10789651 DOI: 10.1111/iwj.14635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/17/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024] Open
Abstract
This study compared the ankle-brachial index (ABI) with transcutaneous oxygen pressure (TcPO2 ) in assessing peripheral vascular disease (PVD) prevalence in 100 diabetic foot ulcer (DFU) patients. Patients were categorized into vascular or nonvascular reconstruction groups and underwent both ABI and TcPO2 measurements four times over 6 months. Predictive validity for PVD diagnosis was analysed using the area under the receiver-operating characteristic curve (AUC). The study found TcPO2 to be a superior predictor of PVD than ABI. Among the DFU patients, 51 with abnormal TcPO2 values underwent vascular reconstruction. Only TcPO2 values showed significant pretreatment differences between the groups and increased post-reconstruction. These values declined over a 6-month follow-up, whereas ABI values rose. For those with end-stage renal disease (ESRD), TcPO2 values saw a sharp decrease within 3 months. Pre-reconstruction TcPO2 was notably lower in amputation patients versus limb salvage surgery patients. In conclusion, TcPO2 is more effective than ABI for evaluating ischemic limb perfusion and revascularization necessity. It should be prioritized as the primary follow-up tool, especially for ESRD patients.
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Affiliation(s)
- Hao‐Yi Sun
- School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Yi‐Chun Wu
- Division of Plastic Surgery, Integrated Burn & Wound Care Center, Department of SurgeryShuang‐Ho HospitalNew Taipei CityTaiwan
- Department of Biomedical EngineeringNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Li‐Chin Sung
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
- Division of Cardiology, Department of Internal Medicine, Shuang‐Ho HospitalTaipei Medical UniversityNew Taipei CityTaiwan
- Taipei Heart InstituteTaipei Medical UniversityTaipeiTaiwan
- TMU Research Center of Urology and Kidney (TMU‐RCUK)Taipei Medical UniversityTaipeiTaiwan
| | - Xin‐Yi Lin
- Division of Plastic Surgery, Integrated Burn & Wound Care Center, Department of SurgeryShuang‐Ho HospitalNew Taipei CityTaiwan
| | - Feng‐Chou Tsai
- Division of Plastic Surgery, Integrated Burn & Wound Care Center, Department of SurgeryShuang‐Ho HospitalNew Taipei CityTaiwan
- Department of Surgery, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Yen‐Kuang Lin
- Graduate Institute of Athletics and Coaching ScienceNational Taiwan Sport UniversityTaoyuanTaiwan
| | - Ka‐Wai Tam
- Division of General Surgery, Department of Surgery, Shuang‐Ho HospitalTaipei Medical UniversityNew Taipei CityTaiwan
- Division of General Surgery, Department of Surgery, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
- Cochrane TaiwanTaipei Medical UniversityTaipeiTaiwan
| | - Fu‐Yu Wang
- Cabrini HospitalMelbourneVictoriaAustralia
| | - Shun‐Cheng Chang
- Division of Plastic Surgery, Integrated Burn & Wound Care Center, Department of SurgeryShuang‐Ho HospitalNew Taipei CityTaiwan
- Department of Surgery, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
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Sabeti S, Nayak R, McBane RD, Fatemi M, Alizad A. Contrast-free ultrasound imaging for blood flow assessment of the lower limb in patients with peripheral arterial disease: a feasibility study. Sci Rep 2023; 13:11321. [PMID: 37443250 PMCID: PMC10345143 DOI: 10.1038/s41598-023-38576-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/11/2023] [Indexed: 07/15/2023] Open
Abstract
While being a relatively prevalent condition particularly among aging patients, peripheral arterial disease (PAD) of lower extremities commonly goes undetected or misdiagnosed due to its symptoms being nonspecific. Additionally, progression of PAD in the absence of timely intervention can lead to dire consequences. Therefore, development of non-invasive and affordable diagnostic approaches can be highly beneficial in detection and treatment planning for PAD patients. In this study, we present a contrast-free ultrasound-based quantitative blood flow imaging technique for PAD diagnosis. The method involves monitoring the variations of blood flow in the calf muscle in response to thigh-pressure-cuff-induced occlusion. Four quantitative metrics are introduced for analysis of these variations. These metrics include post-occlusion to baseline flow intensity variation (PBFIV), total response region (TRR), Lag0 response region (L0RR), and Lag4 (and more) response region (L4 + RR). We examine the feasibility of this method through an in vivo study consisting of 14 PAD patients with abnormal ankle-brachial index (ABI) and 8 healthy volunteers. Ultrasound data acquired from 13 legs in the patient group and 13 legs in the healthy group are analyzed. Out of the four utilized metrics, three exhibited significantly different distributions between the two groups (p-value < 0.05). More specifically, p-values of 0.0015 for PBFIV, 0.0183 for TRR, and 0.0048 for L0RR were obtained. The results of this feasibility study indicate the diagnostic potential of the proposed method for the detection of PAD.
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Affiliation(s)
- Soroosh Sabeti
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Rohit Nayak
- Department of Radiology, Mayo Clinic College of Medicine and Science, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Robert D McBane
- Department of Cardiovascular, Division of Vascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Mostafa Fatemi
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Azra Alizad
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
- Department of Radiology, Mayo Clinic College of Medicine and Science, 200 1st Street SW, Rochester, MN, 55905, USA.
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Choi Y, Lee HS, Kim JW, Lee BS, Lee WJ, Jung HG. Analysis of repeated lesions after diabetic forefoot amputation. Diabetes Res Clin Pract 2022; 190:109992. [PMID: 35842029 DOI: 10.1016/j.diabres.2022.109992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/03/2022]
Abstract
AIM This study was performed to analyze the clinical characteristics, related factors, and prognosis of repeated lesions after diabetic forefoot amputation. METHODS The medical records of 998 patients who underwent forefoot amputation because of their diabetic feet from March 2002 to February 2021 were retrospectively analyzed. Of the 508 selected patients with a follow-up period of at least 6 months, 288 had repeated lesions in the forefoot, and 220 did not have repeated lesions. The related factors of repeated lesions were compared and analyzed. Of the patients with repeated lesions, 142 and 104 on the ipsilateral and contralateral sides, respectively were also compared and examined. RESULTS Repeated lesions were statistically significant in diabetic polyneuropathy, vascular calcification, and dialysis. However, the anatomical positions of diabetic foot lesions, causes of lesions, anatomical amputation levels, number of surgeries, and management duration had no significant differences. Contralateral lesions occurred 8 months later than ipsilateral lesions, but reamputation above the Lisfranc joint was more frequent and prognosis was poorer. CONCLUSIONS Repeated lesions were affected by general conditions, and the contralateral side must be carefully examined after diabetic forefoot amputation.
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Affiliation(s)
- Youngrak Choi
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Ho Seong Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea.
| | - Ji Wan Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Bum-Sik Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Woo Je Lee
- Asan Diabetes Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Hong-Geun Jung
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul 05030, Republic of Korea
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Patry J, Laurencelle L, Bélisle J, Beaumier M. Vascular Assessment in Patients With a Lower Limb Wound: A Correlational Study of Photoplethysmography and Laser Doppler Flowmetry Toe Pressure Techniques. J Diabetes Sci Technol 2022; 16:470-477. [PMID: 33345614 PMCID: PMC8861787 DOI: 10.1177/1932296820979973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Vascular assessment of the lower limbs is essential in patients with diabetes. In the presence of noncompressible arteries, the ankle brachial index (ABI) can either be inconclusive or provide false-positive results. Toe pressure measurement has been suggested as an alternative as a noninvasive method for detecting peripheral arterial disease (PAD). Toe pressure measurement can be performed either by photoplethysmography (PPG) or by Laser Doppler flowmetry (LDF). The aim of this study was to determine correlations between the two techniques in order to promote the use of PPG in clinical practice. METHODS This was a prospective correlational study of 108 consecutive recruited adult patients, with and without diabetes, with at least one lower limb wound from a University-affiliated hospital wound care clinic. Toe pressure measurements were both performed with PPG and LDF devices. RESULTS Mean toe pressure values for PPG and LDF were, respectively, 83.7 (SD 35.4) and 79.5 (SD 32.0) mmHg (with a paired t-test 3.969, P < 0.01). In patients with at least one lower limb wound, a strong linear relation was found between PPG and LDF toe pressure techniques with a Pearson's r correlation coefficient of 0.920 (P < 0.001). CONCLUSIONS PPG and LDF toe pressure techniques are equivalent in patients with at least one lower limb wound, irrespective of the presence of diabetes. Therefore, in the presence of an ABI with inconclusive results, such as in a patient with noncompressible vessels, both toe pressure techniques can be used for assessing the vascular supply of the lower limb with a wound.
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Affiliation(s)
- Jérôme Patry
- Centre de recherche du CISSS de
Chaudière-Appalaches, Lévis, Canada
- Emergency and Family Medicine
Department, Faculty of Medicine, Université Laval, Québec, Canada
- Physical Activity Sciences Department,
Université du Québec à Trois-Rivières, Trois-Rivières, Canada
- Jérôme Patry, DPM, MD, MSc, CISSS de
Chaudière-Appalaches/Clinique des plaies complexes, 143 rue Wolfe, Lévis,
Québec, G6V 3Z1, Canada.
| | - Louis Laurencelle
- Physical Activity Sciences Department,
Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Justine Bélisle
- Emergency and Family Medicine
Department, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Maryse Beaumier
- Centre de recherche du CISSS de
Chaudière-Appalaches, Lévis, Canada
- Health Sciences Department, Université
du Québec à Rimouski, Lévis Campus, Lévis, Canada
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Darban Hosseini Amirkhiz G, Babaei MR, Madani NH, Khamseh ME. Toe-brachial index is beyond a peripheral issue in patients with type 2 diabetes. PLoS One 2021; 16:e0253138. [PMID: 34129625 PMCID: PMC8205164 DOI: 10.1371/journal.pone.0253138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 05/28/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Atherosclerosis is the leading cause of death in patients with diabetes. We aimed to evaluate the association between ankle-brachial index (ABI) and toe-brachial index (TBI) with carotid intima-media thickness (CIMT) in patients with type 2 diabetes (T2DM). METHODS This cross sectional study included 296 patients with T2DM who met the American Diabetes Association criteria for the assessment of peripheral arterial atherosclerosis. The ABI ≤ 0.9 and TBI ≤ 0.7 were considered as abnormal values. Linear and logistic regression analyses were performed to evaluate the association between TBI/ABI and CIMT. RESULTS Right CIMT was significantly greater in the low TBI group (p = 0.03) while, left CIMT did not show a significant difference. Each 0.1-unit decrease in TBI value was independently associated with 0.017 mm increase in the right CIMT (β ± SE; -0.017 ± 0.005, p = 0.002) and with odds of the presence of increased CIMT [odds ratio and 95% confidence interval: 1.21 (1.02, 1.44)] after adjustment with all traditional risk factors. There was not any significant association between ABI and increased CIMT. CONCLUSIONS Beyond a suitable tool for the diagnosis of peripheral artery disease in patients with T2DM, TBI can be applied for prediction of subclinical carotid atherosclerosis.
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Affiliation(s)
- Gisoo Darban Hosseini Amirkhiz
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mohammad Reza Babaei
- Department of Interventional Radiology, Firouzgar Hospital, Iran University of Medical Science (IUMS), Tehran, Iran
| | - Nahid Hashemi Madani
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mohammad Ebrahim Khamseh
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
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Carmena-Pantoja M, Álvaro-Afonso FJ, García-Morales E, García-Álvarez Y, Tardáguila-García A, Lázaro-Martínez JL. The Influence of Arterial Calcification on Clinical Outcomes in Patients with Diabetic Foot Ulcer Complicated by Osteomyelitis Treated by Surgery. INT J LOW EXTR WOUND 2021:15347346211022587. [PMID: 34048273 DOI: 10.1177/15347346211022587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of our study was to analyze the influence of radiographic arterial calcification (RAC) on clinical outcomes and wound healing in patients with diabetic foot ulcers complicated by osteomyelitis treated by surgery. We analyzed retrospectively the clinical records of 102 patients with diabetic foot osteomyelitis who underwent surgery at a specialized diabetic foot unit between January 2014 and December 2016. The clinical data of evolution until its complete epithelialization and a follow-up 1 year were reviewed, and after reviewing the radiological images, patients were classified into 2 groups: those with RAC and those without RAC. We analyzed several clinical features in both groups. The presence of RAC was associated with a greater time of healing (10.68 ± 7.24 vs 8.11 ± 4.50 weeks; P = .029) and shorter time to recurrence and reulceration (13.30 ± 9.25 vs 18.81 ± 11.63 weeks; P = .036). However, this association was not found for patients with mild and moderate peripheral artery disease (PAD), whose time of healing was 8.97 ± 4.51 weeks compared to 9.16 ± 6.39 weeks for patients without PAD; P = .864. The time of healing of diabetic foot ulcers complicated by osteomyelitis treated by surgery can be negatively affected by the presence of RAC even more than by the presence of mild and moderate ischemia. The presence of RAC may offer clinical guidance at the level of primary care though this would need thorough validation in future studies.
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Affiliation(s)
| | - Francisco Javier Álvaro-Afonso
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 16734Universidad Complutense de Madrid, Madrid, Spain
| | - Esther García-Morales
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 16734Universidad Complutense de Madrid, Madrid, Spain
| | - Yolanda García-Álvarez
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 16734Universidad Complutense de Madrid, Madrid, Spain
| | - Aroa Tardáguila-García
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 16734Universidad Complutense de Madrid, Madrid, Spain
| | - José Luis Lázaro-Martínez
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 16734Universidad Complutense de Madrid, Madrid, Spain
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Papanas N, Mani R, Rerkasem K. Ultrasound: The Magic Wand for Wound Healers. INT J LOW EXTR WOUND 2020; 19:291-292. [DOI: 10.1177/1534734620977227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Nikolaos Papanas
- Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Raj Mani
- Founding Editor, International Journal of Lower Extremity Wounds
| | - Kittipan Rerkasem
- NCD Centre of Excellence, Research Institute of Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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González-de la Torre H, Verdú-Soriano J, Quintana-Lorenzo ML, Berenguer-Pérez M, Lavín RS, Soldevilla-Ágreda J. Specialised wound care clinics in Spain: distribution and characteristics. J Wound Care 2020; 29:764-775. [PMID: 33320747 DOI: 10.12968/jowc.2020.29.12.764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To determine the number of specialised wound care units/clinics (SWCUs) in Spain, at present, and to describe their most important characteristics. METHOD This was an observational study with a descriptive-analytical, cross-sectional, multicentre approach, where the studied population consisted of SWCUs in Spain. A specific data-collection questionnaire was designed using a modified Delphi method, consisting of four rounds, with the collaboration of 10 wound experts. The final questionnaire included 49 items distributed across four dimensions/areas with a content validity index (CVI-Total for pertinence=0.96 and CVI-Total for relevance=0.94. RESULTS A total of 42 SWCUs were included in the study. Most SWCUs were based in hospitals (n=15, 35.7%) or healthcare centres, covering a specific healthcare area (n=17, 40.5%). SWCU coordinators were primarily nurses (n=33, 78.6%). Staff members' professions in SWCUs included registered nurses (n=38 units, 92.7%), nursing assistants (n=8 units, 19.5%), podiatrists (n=8 units, 19.5%), vascular surgeons (n=7 units, 17%), osteopaths (n=2 units, 4.8%) and medical doctors from different specialties (n=3 units, 7.2%). For wound aetiology, the most prevalent wounds managed were diabetic foot ulcers (n=38 units, 90.5%), followed by venous leg ulcers (n=36 units, 85.7%) and arterial ischaemic ulcers (n=36 units, 85.7%). A statistically significant association was found between the number of staff members in a SWCU and the existence of resistance/opposition barriers when developing a SWCU (Chi-square test, p=0.049; Cramér's V=0.34; 34%), as well as between resistance/opposition barriers when developing a SWCU and a nurse as coordinator of a SWCU (MacNemar test, p=0.007, Cramér's V=0.35; 35%). CONCLUSION The typical SWCU implemented in Spain is located in a hospital or integrated in a healthcare structure that offers coverage to a whole health area and providing services for people with hard-to-heal wounds (wound management and prevention) and health professionals (advice, consultancy and training/education). Despite the growing number of SWCUs in Spain, the future of this new organisational model is uncertain, as there can be barriers to creating them and some deficiencies, such as low staff numbers, which need to be addressed.
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Affiliation(s)
- Héctor González-de la Torre
- Complejo Hospitalario Materno-Infantil Insular de Gran Canaria, Servicio Canario de Salud, Las Palmas de Gran Canaria, Spain
| | - José Verdú-Soriano
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, Spain
| | - María L Quintana-Lorenzo
- Gerencia de Atención Primaria de Gran Canaria, Servicio Canario de Salud, Las Palmas de Gran Canaria, Spain
| | - Miriam Berenguer-Pérez
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, Spain
| | - Raquel Sarabia Lavín
- Departamento de Enfermería, Facultad de Enfermería, Universidad de Cantabria, Santander, Spain
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Manu CA, Freedman B, Rashid H, Winkley K, Edmonds ME. Peripheral Arterial Disease Located in the Feet of Patients With Diabetes and Foot Ulceration Demands a New Approach to the Assessment of Ischemia. THE INTERNATIONAL JOURNAL OF LOWER EXTREMITY WOUNDS 2020; 21:397-404. [PMID: 32806976 DOI: 10.1177/1534734620947979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Peripheral arterial disease (PAD) is common below the knee in diabetes but arteries in the foot are controversially said to be spared of occlusive disease. This is relevant to the convenient site of vascular assessment that is recommended in guidelines. Should assessment be distal at toe/forefoot to detect foot disease or only proximal to detect disease at ankle level? The objective was to determine frequency of PAD at foot and ankle level. This was a cross-sectional observational study, evaluating arterial disease proximally by palpation of pedal pulses and Ankle Brachial Index (ABI), and distally by Toe Brachial Index (TBI), and forefoot transcutaneous oxygen tension (tcpO2), in consecutive patients presenting with foot ulceration. We assessed 301 limbs in 154 patients: 59% of limbs were ulcerated. PAD in the foot was detected in 70% and 74% of limbs by TBI and forefoot tcpO2, respectively, but PAD at ankle level only in 51% and 34% by pulse palpation and ABI, respectively. In limbs with "normal" ABI, PAD was present in the foot in 70% as indicated by low TBI, and in 73% by low tcpO2, with 70% to 64% having associated ulceration, respectively. When compared with arterial waveforms, as a measure of PAD, TBI gave an excellent AUC (area under the curve of the receiver operating characteristic curve) of 0.81 (95% confidence interval: 0.73-0.89), but ABI gave a poor AUC of 0.65 (95% confidence interval: 0.55-0.76). In conclusion, arterial disease is important in the foot and can be detected by TBI, which should be performed even when ABI is normal. Guidelines that recommend TBI only if ABI is artificially raised need updating.
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Eleftheriadou I, Tsilingiris D, Tentolouris A, Mourouzis I, Grigoropoulou P, Kapelios C, Pantos C, Makrilakis K, Tentolouris N. Association of Circulating Osteopontin Levels With Lower Extremity Arterial Disease in Subjects With Type 2 Diabetes Mellitus: A Cross-Sectional Observational Study. INT J LOW EXTR WOUND 2020; 19:180-189. [DOI: 10.1177/1534734619898097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Osteopontin (OPN) is involved in the atherosclerotic and inflammatory process. In this article, we examined the relationship between circulating OPN levels with lower extremity arterial disease (LEAD) in individuals with type 2 diabetes mellitus (T2DM). Seventy individuals with T2DM and 66 individuals without T2DM were recruited. Diagnosis of LEAD was based on the absence of triphasic waveform on the pedal arteries. Plasma OPN levels were determined by Luminex Multiplex immunoassay. LEAD was present in 34 (48.6%) patients with T2DM. In the diabetes cohort, individuals with LEAD had higher plasma OPN concentrations than those without LEAD (geometric mean [95% confidence intervals]; 43.4 [37.5-50.4] vs 26.1 [22.9-29.8] ng/mL, respectively, P < .001). Multivariable analysis showed that presence of LEAD independently associated with higher OPN levels in subjects with T2DM, with marginal statistical significance ( P = .049). In both cohorts, plasma OPN concentrations were negatively associated with ankle-brachial index values ( P < .05). In the total sample, there was a gradual increase of OPN levels across subgroups with triphasic, biphasic, and monophasic/blunted waveforms ( P < .001). In conclusion, plasma OPN levels are associated with the presence and severity of LEAD in subjects with T2DM. Further studies are needed to investigate the role of OPN in the pathogenesis and progression of LEAD.
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Affiliation(s)
- Ioanna Eleftheriadou
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Dimitrios Tsilingiris
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Anastasios Tentolouris
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Iordanis Mourouzis
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Pinelopi Grigoropoulou
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Christos Kapelios
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Constantinos Pantos
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Makrilakis
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Nikolaos Tentolouris
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
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12
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Kiesz RS, Góra B, Kolarczyk-Haczyk A, Kachel M, Trendel W, Paz J, Nowakowski P, Proczka R, Milewski K. Clinical significance of mirror lesions in lower extremity arterial disease. Catheter Cardiovasc Interv 2019; 95:300-306. [PMID: 31639273 DOI: 10.1002/ccd.28559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/16/2019] [Accepted: 10/09/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the clinical relevance of bilateral peripheral arterial disease (PAD) patterns. BACKGROUND No prior study has evaluated the clinical significance of symmetrical lesion patterns, particularly the coexistence of same-level significant plaques in both lower extremities ("mirror lesions"). METHODS We conducted a single-facility, primary data analysis involving 225 patients with symptomatic PAD. RESULTS Eighty-two percent of the patients had bilateral lesions: 14.2% had femoropopliteal, 38.7% had infrapopliteal, and 27.1% had both femoropopliteal and infrapopliteal lesions. The lesions were found in the exact same arteries bilaterally in 24.9% of the patients, while 26.7% had a local mirror pattern limited to the femoropopliteal (13.7%) or infrapopliteal (12.9%) arteries. Having a lesion in an artery was a risk factor for occlusive disease of the corresponding artery on the other side. Patients presenting with critical limb ischemia (CLI) had a history of resting pain (17%), ulceration/gangrene (13%), or prior amputation (26%) of the contralateral limb. Patients with significant bilateral disease had unilateral false-negative ABI results in 11.6% of the cases. The arterial Doppler study results were unilaterally false-negative in 19.6% and bilaterally false-negative in 2.8% of the patients. CONCLUSIONS Patients with known peripheral arterial disease need to have both limbs fully evaluated and monitored, even in cases with negative screening results. Mirror angiographic imaging is common and often accompanied by symptoms of claudication. Unilateral ischemia is a strong risk factor for contralateral disease. Patients with CLI are at high risk for occlusive lesions of the nonindex limb.
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Affiliation(s)
- R Stefan Kiesz
- University of Texas Health Science Center, San Antonio, San Antonio, Texas
| | - Bartłomiej Góra
- San Antonio Endovascular and Heart Institute, San Antonio, Texas
| | | | - Mateusz Kachel
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | - Wojciech Trendel
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | - Jesica Paz
- San Antonio Endovascular and Heart Institute, San Antonio, Texas
| | | | - Robert Proczka
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | - Krzysztof Milewski
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
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13
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Abouhamda A, Alturkstani M, Jan Y. Lower sensitivity of ankle-brachial index measurements among people suffering with diabetes-associated vascular disorders: A systematic review. SAGE Open Med 2019; 7:2050312119835038. [PMID: 30854203 PMCID: PMC6399753 DOI: 10.1177/2050312119835038] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 02/11/2019] [Indexed: 02/06/2023] Open
Abstract
Diabetes mellitus is a systemic disease affecting microvascular and macrovascular systems and is considered as the strongest risk factor for peripheral arterial disease. Although the prevalence of the peripheral arterial disease is high among people living with diabetes, its severity is not accurately detected with the prevalent diagnostic methodologies. The ankle-brachial index measurement is a simple, objective, and reliable tool for diagnosis of peripheral arterial disease. However, it is of limited value in the diagnosis of peripheral arterial disease among diabetic patients due to its low sensitivity among diabetic individuals. Diabetes mellitus results in atherosclerosis and calcification of peripheral arterial walls leading to false normal ankle-brachial index values. Therefore, healthcare practitioners should be careful not to misinterpret ankle-brachial index results among diabetic patients. A literature search was conducted using the keywords “ankle-brachial index,” “interpretation,” “limitations,” “diabetic foot,” and “peripheral arterial disease” on different medical search engines. The results were manually scanned and then further reviewed to select the articles related to our topic of discussion. This article will review the use of ankle-brachial index measurement among diabetic patients, its limitations and its prognostic value. In Conclusion, Ankle-brachial index can be used for diagnosis of peripheral arterial disease with some precautions (e.g. raising the threshold of diagnosis or using the lowest systolic pressure value measured at the ankle) and can also be a prognostic indicator for cardiovascular morbidity and mortality.
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Affiliation(s)
- Ayman Abouhamda
- King Fahad Hospital, Jeddah, Saudi Arabia
- Ayman Abouhamda, King Fahad Hospital, 8142 Ibn Abi Al Izz, Jeddah 23434 - 4714, Saudi Arabia.
| | | | - Yousef Jan
- Ministry of Health, Jeddah, Saudi Arabia
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14
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Zubair M, Al Amri M, Ahmad J. A retrospective study of ABI and TBI during the healing of ulcer among diabetic patients. Diabetes Metab Syndr 2019; 13:78-83. [PMID: 30641806 DOI: 10.1016/j.dsx.2018.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 08/21/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the role of ABI and TBI in the detection of ulcer wounds among diabetic patients. METHODS A retrospective approach is used to enroll 192 diabetic patients to detect their ulcer wounds using ABI and TBI index. HbA1c and lipid profile were other important variables in determining the efficacy of screening test. Frequency analysis and Pearson Correlation were used to analyze the data through SPSS. FINDINGS The results have shown that 57.1% male and 42.9% female were treated in <0.60 ABI group; 67.4% male and 32.6% female were treated in 0.60-0.90 ABI group; 65.9% male and 34.1% female were treated in 0.90-1.30 ABI group; and 63.8% male and 36.2% female were treated in >1.30 ABI group. The correlation showed insignificant association between ABI and ulcer outcomes, but significant association between TBI and ulcer outcomes at 5% level of significance. CONCLUSION The study concluded that ABI should be based on standardized normal values to be used as an effective biomarker in screening diabetic foot ulcer patients.
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Affiliation(s)
- Mohammad Zubair
- Department of Medical Microbiology, Faculty of Medicine, University of Tabuk, Tabuk, 71491, Saudi Arabia; Rajiv Gandhi Centre for Diabetes and Endocrinology, Faculty of Medicine, J.N. Medical College, Aligarh Muslim University, Aligarh, 202002, India.
| | - Marai Al Amri
- Department of Surgery, Faculty of Medicine, University of Tabuk, Tabuk, 71491, Saudi Arabia
| | - Jamal Ahmad
- Rajiv Gandhi Centre for Diabetes and Endocrinology, Faculty of Medicine, J.N. Medical College, Aligarh Muslim University, Aligarh, 202002, India.
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15
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Kikuchi S, Miyake K, Tada Y, Uchida D, Koya A, Saito Y, Ohura T, Azuma N. Laser speckle flowgraphy can also be used to show dynamic changes in the blood flow of the skin of the foot after surgical revascularization. Vascular 2018; 27:242-251. [PMID: 30419804 PMCID: PMC6542015 DOI: 10.1177/1708538118810664] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Laser speckle flowgraphy is a new method that enables the rapid evaluation of foot blood flow without contact with the skin. We used laser speckle flowgraphy to evaluate foot blood flow in peripheral arterial disease patients before and after surgical revascularization. Materials and methods A prospective single-center study. Thirty-one patients with 33 limbs that underwent surgical revascularization for peripheral arterial disease were included. Pre- and postoperative foot blood flows were measured on the plantar surface via laser speckle flowgraphy and skin perfusion pressure. The laser speckle flowgraphy device was used to visualize the blood flow distribution of the target skin and processed the pulse wave velocity of synchronized heart beats. The mean blood flow, which was expressed as the area of the pulse wave as the beat strength of skin perfusion on laser speckle flowgraphy converted into a numerical value, was assessed as dynamic changes following surgery. Beat strength of skin perfusion was also investigated in non-peripheral arterial disease controls (23 patients/46 limbs). Results The suitability of beat strength of skin perfusion in non-peripheral arterial disease controls was achieved; the beat strength of skin perfusion value was significantly higher in every area of interest in non-peripheral arterial disease controls compared to that in peripheral arterial disease limbs at the preoperative stage (105.8 ± 8.2 vs. 26.3 ± 8.2; P < 0.01). Although the pulse wave before surgery was visually flat in peripheral arterial disease patients, the pulse wave was remarkably and immediately improved through surgical revascularization. Beat strength of skin perfusion showed a dynamic change in foot blood flow (26.3 ± 8.2 at preoperation, 98.5 ± 6.7 immediately after surgery, 107.6 ± 5.7 at seven days after surgery, P < 0.01 for each compared to preoperation) that correlated with an improvement in skin perfusion pressure. Conclusions Laser speckle flowgraphy is a noninvasive, contact-free modality that is easy to implement, and beat strength of skin perfusion is a useful indicator of foot circulation during the perioperative period. Further analysis with a larger number of cases is necessary to establish appropriate clinical use.
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Affiliation(s)
- Shinsuke Kikuchi
- 1 Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Keisuke Miyake
- 1 Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Yuki Tada
- 1 Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Daiki Uchida
- 1 Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Atsuhiro Koya
- 1 Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Yukihiro Saito
- 1 Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Takehiko Ohura
- 2 Pressure Ulcers and Wound Healing Research Center, Sapporo, Japan
| | - Nobuyoshi Azuma
- 1 Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan
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