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. 2016 Jul 12:4:2050312116659088.
doi: 10.1177/2050312116659088. eCollection 2016.

Non-invasive assessment of peripheral arterial disease: Automated ankle brachial index measurement and pulse volume analysis compared to duplex scan

Jane Ea Lewis  1 , Paul Williams  2 , Jane H Davies  3
Affiliations

Non-invasive assessment of peripheral arterial disease: Automated ankle brachial index measurement and pulse volume analysis compared to duplex scan

Jane Ea Lewis et al. SAGE Open Med. .

Abstract

Objectives: This cross-sectional study aimed to individually and cumulatively compare sensitivity and specificity of the (1) ankle brachial index and (2) pulse volume waveform analysis recorded by the same automated device, with the presence or absence of peripheral arterial disease being verified by ultrasound duplex scan.

Methods: Patients (n=205) referred for lower limb arterial assessment underwent ankle brachial index measurement and pulse volume waveform recording using volume plethysmography, followed by ultrasound duplex scan. The presence of peripheral arterial disease was recorded if ankle brachial index <0.9; pulse volume waveform was graded as 2, 3 or 4; or if haemodynamically significant stenosis >50% was evident with ultrasound duplex scan. Outcome measure was agreement between the measured ankle brachial index and interpretation of pulse volume waveform for peripheral arterial disease diagnosis, using ultrasound duplex scan as the reference standard.

Results: Sensitivity of ankle brachial index was 79%, specificity 91% and overall accuracy 88%. Pulse volume waveform sensitivity was 97%, specificity 81% and overall accuracy 85%. The combined sensitivity of ankle brachial index and pulse volume waveform was 100%, specificity 76% and overall accuracy 85%.

Conclusion: Combining these two diagnostic modalities within one device provided a highly accurate method of ruling out peripheral arterial disease, which could be utilised in primary care to safely reduce unnecessary secondary care referrals.

Keywords: Automated ankle brachial index; lower limb; peripheral arterial disease; pulse volume; pulse volume waveform; ultrasound duplex scan.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: J.H.D. previously undertook a PhD which was part sponsored by Huntleigh Diagnostics. J.E.A.L. and P.W. declare no conflict of interest.

Figures

Figure 1.
Figure 1.
Pulse volume waveform interpretation (according to four-level grading system).
Figure 2.
Figure 2.
Example of a results printout from the automated device.
Figure 3.
Figure 3.
Example of an ultrasound Duplex scan image.
Figure 4.
Figure 4.
(a) Flow diagram illustrating diagnostic accuracy of ABI as per Standards for Reporting Diagnostic Accuracy (STARD) and (b) flow diagram illustrating diagnostic accuracy of PVW as per Standards for Reporting Diagnostic Accuracy (STARD).
Figure 5.
Figure 5.
Distribution of ABIs.
Figure 6.
Figure 6.
Receiver operating characteristic (ROC) curve for automated ABI device in diagnosing PAD as defined by ultrasound duplex scan. Area under curve=0.88 (95% CI: 0.83–0.93, p<0.001). ABI: ankle brachial index; CI: confidence interval; PAD: peripheral arterial disease.
See this image and copyright information in PMC

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References

    1. Fowkes FGR, Rudan D, Rudan I, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet 2013; 382: 1329–1340. - PubMed
    1. Tendera M, Aboyans V, Bartelink ML, et al. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: The Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J 2011; 32(22): 2851–2906. - PubMed
    1. Fowkes FGR, Murray GD, Butcher I, et al. Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. JAMA 2008; 300(2): 197–208. - PMC - PubMed
    1. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease) endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation 2006; 47(6): 1239–1312. - PubMed
    1. Jaipersad AS, Silverman SH, Lip GYH. Peripheral artery disease: appreciating the asymptomatic yet lethal epidemic. Int J Clin Pract 2010; 64(7): 832–835. - PubMed

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