Diagnostic value of ankle peak systolic velocity in diabetic patients with critical limb ischemia
https://doi.org/10.14341/DM9776
Abstract
AIM: To evaluate the diagnostic value of ankle peak systolic velocity (APSV) in diabetic patients diagnosed with critical limb ischaemia (CLI) and its resolution after percutaneous transluminal angioplasty (PTA).
MATERIALS AND METHODS: Forty-eight diabetic patients with CLI were included in this study. CLI was diagnosed according to the IWGDF 2015 criteria. Patients were examined before and 5–7 days after PTA with transcutaneous oxygen tension of the foot's soft tissues and APSV by duplex ultrasonography.
RESULTS: The median transcutaneous oxygen tensions before and after PTA were 14 [3; 20.5] and 30 [18.5, 39.0] mmHg, respectively (p <0.001). The median APSV in diabetic patients with CLI was 10 [7.4; 15.5] cm/s before PTA and −46 [33.5, 59] cm/s after PTA (p <0.001). The APSV cutoff point for diabetic patients with CLI is ≤25.5 cm/s with a sensitivity of 79.4% [95% CI 62.1–91.3] and a specificity of 96.4% [95% CI 81.7–99.9].
CONCLUSIONS: APSV may be considered as an additional method for CLI assessment. Lower limb artery calcification, soft tissue oedema or infection and foot ulcer and gangrene influence the results of routine ischaemia diagnostic methods such as the ankle–brachial index, toe–brachial index, transcutaneous oximetry but not APSV.
About the Authors
Zera N. DzhemilovaEndocrinology Research Centre
Russian Federation
MD
Olga N. Bondarenko
Endocrinology Research Centre
Russian Federation
MD, PhD
Gagik R. Galstyan
Endocrinology Research Centre
Russian Federation
MD, PhD, Professor
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1. Fig. 1. The level of measurement of the spectral characteristics of the blood flow in the dorsal artery of the foot and posterior tibial artery (angiogram of the right foot). | |
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2. Fig. 2. Measurement of the ankle peak systolic blood flow velocity in the spectral Doppler mode. The arrow indicates the Doppler wave, the peak of which forms the blood flow velocity (cm / s). | |
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3. Fig. 3. Transcutaneous oxygen tension of the soft tissues of the foot in patients with diabetes mellitus and critical lower limb ischemia before and after percutaneous transluminal balloon angioplasty: CTBA is percutaneous transluminal balloon angioplasty. The data are presented as Me [Q1; Q3]. | |
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4. Fig. 4. Results of ankle peak systolic blood flow velocity in patients with diabetes and critical lower limb ischemia before and after percutaneous transluminal balloon angioplasty: CTBA is percutaneous transluminal balloon angioplasty, ZBBA is the posterior tibial artery. TAS - dorsal artery of the foot. The data are presented as Me [Q1; Q3]. | |
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5. Fig. 5. ROC analysis for cutting points of the ankle peak systolic blood flow velocity during critical lower limb ischemia in patients with diabetes mellitus: AUC - area under the curve, area under the curve. | |
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6. Fig. 6. Morphological lesions of lower limb arteries in patients with diabetes and critical lower limb ischemia according to the L. Graziani classification: severe lesions of lower limb arteries with occlusions of the distal channel (lower leg arteries) and in some cases of the proximal bed are found in the majority of cases ( categories 4–7). | |
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7. Fig. 7. Distribution of patients with chronic arterial insufficiency according to R.B. Rutherford, n = 51, lower limb. | |
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8. Fig. 8. Angiogram of the arteries of the lower limb of a patient with diabetes mellitus and critical limb ischemia. The green arrow indicates the normal blood flow in the superficial femoral artery, the red arrows indicate the collateral vessels, the yellow arrow the blood flow in the distal segment of the artery. | |
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For citations:
Dzhemilova Z.N., Bondarenko O.N., Galstyan G.R. Diagnostic value of ankle peak systolic velocity in diabetic patients with critical limb ischemia. Diabetes mellitus. 2019;22(2):131-140. https://doi.org/10.14341/DM9776
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