Comparison of Ultrasound Blood Flow Characteristics of the Lower Limb in Diabetics with Early-Stage Peripheral Artery Disease and Non-Diabetic Controls — Oak Academic Publishing
Research ArticleOpen AccessGoogle Scholar indexed
Comparison of Ultrasound Blood Flow Characteristics of the Lower Limb in Diabetics with Early-Stage Peripheral Artery Disease and Non-Diabetic Controls
Radiography Department, National University of Science and Technology, Bulawayo, Zimbabwe
,
School of Health and Society, University of Salford, Greater Manchester, UK
,
Radiography Department, National University of Science and Technology, Bulawayo, Zimbabwe
,
School of Health and Society, University of Salford, Greater Manchester, UK
1 Radiography Department, National University of Science and Technology, Bulawayo, Zimbabwe
2 School of Health and Society, University of Salford, Greater Manchester, UK
3 Radiography Department, National University of Science and Technology, Bulawayo, Zimbabwe
4 School of Health and Society, University of Salford, Greater Manchester, UK
The aim of this study was to compare lower limb blood flow in asymptomatic diabetic patients with early-stage peripheral artery disease (PAD) and non-diabetic controls using duplex ultrasound parameters. This was a comparative cohort study of lower limb blood flow in 35 Black-African diabetic patients ( 25 females and 10 males with early-stage PAD median age 54 [IQR, 47 - 61] years ; median HbA 1c 6.3 [IQR, 5.7 - 8.0]% ; BMI 29.2 ± 6.7; ABI 1.1 ± 0.1 ) and 36 non-diabetic controls (28 females and 8 males; median age 54 [IQR, 47 - 61] years; median HbA 1c 6.3 [IQR, 5.7 - 8.0] %, BMI 29.2 ± 6.7; ABI 1.1 ± 0.1). Peak systolic velocity (PSV), pulsatility index (PI) and resistive index (RI), were utilised to compare blood flow in the popliteal arteries (PA), anterior tibial arteries (ATA) and posterior tibial arteries (PTA) in addition to ankle brachial index. All the ultrasound parameters showed good ( ICC ≥ 0.7 ; 0.50 - 0.85 , 95% CI ) to excellent ( ICC = 1.0 ; 1.0 - 1.0 , 95% CI ) reliability within groups as well as acceptable variability ( <10% CV ) other than pulsatility index of the anterior tibial artery within diabetic patients ( 11.1% CV ). PSV, RI and PI were significantly and meaningfully higher ( P < 0.001 ; d ≥ 0.33 ), in diabetic patients compared to non-diabetic controls except for PI - PTA ( P = 0.72 ; d = 0.11 ). Differences in PSV and RI highlighted the effects of early-stage PAD on lower limb blood flow of diabetic patients. In contrast, the effects of early-stage PAD on blood flow were not demonstrated in the PTA and ATA of diabetic patients by PI.
KeywordsAtherosclerosisPeak Systolic VelocityPulsatility IndexResistive Index
Fowkes, F.G., Housley, E., Cawood, C.H., Macintyre, C.C., Ruckley, C.V. and Prescott, R.J. (1991) Edinburgh Artery Study: Prevalence of Asymptomatic and Symptomatic PAD in the General Population. International Journal of Epidemiology, 20, 384-392. https://doi.org/10.1093/ije/20.2.384
Fowkes, G.R., Rudan, I., Rudan, D., Aboyans, V., Deneberg, J.O., McDermott, M.M., Norman, P.E., Sampson, U.K.A., Williams, L.J., Mensah, G.A. and Criqui, M.H. (2013) Comparison of Global Estimates of Prevalence and Risk Factors for Peripheral Artery Disease in 2000 and 2010: A Systematic Review Analysis. The Lancet, 382, 1329-1340. https://doi.org/10.1016/S0140-6736(13)61249-0
Criqui, M.H., Froneka, A., Barret-Conner, E., Klauber, M.R., Gabriel, S. and Goodman, D. (1985) The Prevalence of PAD in a Defined Population. Circulation, 71, 510-515. https://doi.org/10.1161/01.CIR.71.3.510
Rooke, T.W., Hirsch, A.T., Misra, S., Sidawy, A.N., Beckman, J.A., Findeiss, L.K., Golzarian, J., Gornik, H.L., Halperin, J.L., Jaff, M.R., Moneta, G.L., Olin, J.W., Stanley, J.C., White, C.J., White, J.V. and Zierler, R.E. (2011) 2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients with Peripheral Artery Disease (Updating the 2005 Guideline): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of American College of Cardiology, 58, 2020-2045. https://doi.org/10.1016/j.jacc.2011.08.023
Hirsch, A.T., Haskal, Z.J., Hertzer, N.R., Bakal, C.W., Creager, M.A., Halperin, J.L., Hiratzka, L.F., Murphy, W.R.C., Olin, J.W., Puschett, J.B., Rosenfield, K.A., Sacks, D., Stanley, J.C., Taylor, L.M.J., White, C.J., White, J. and White, R.A. (2006) ACC/AHA 2005 Practice Guidelines for the Management of Patients with Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): 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). Circulation, 113, e463-e654. https://doi.org/10.1161/CIRCULATIONAHA.106.174526
Gerhard-Herman, M.D., Gornik, H.L., Barret, C., Barshes, N.R., Corriere, M.A., Drachman, D.E., Fleisher, L.A., Fowkes, F.G.R., Humburg, N.M., Kinlay. S., Lookstein, R., Misra, S., Mureebe, L., Olin, J.W., Patel, R.A.G., Regensteiner, J.G., Schanzer, A., Shishehbor, M.H., Stewart, K.J., Treat-Jacobson, K.J. and Walsh, W.E. (2016) Clinical Practice Guideline, AHA/ACC Guideline on the Management of Patients with Lower Extremity Peripheral Artery Disease. Journal of the American College of Cardiology, 69, e71-e126. https://doi.org/10.1016/j.jacc.2016.11.007
Collins, R., Cranny, G., Burch, J., Aguiar-Ibanez, R., Craig, D., Wright, K., Berry, E., Gough, M., Kleijnen, J. and Westwood, M. (2007) A Systematic Review of Duplex Ultrasound, Magnetic Resonance Angiography and Computed Tomography Angiography for the Diagnosis and Assessment of Symptomatic Lower Limb Peripheral Arterial Disease. Health Technology Assessment, 11, 1-184. https://doi.org/10.3310/hta11200
Di Minno, G., Spadarella, G., Cafaro, G., Petitto, M., Lupoli, R., Di Minno, A., de Gaetano, G. and Tremoli E. (2014) Systematic Reviews and Meta-Analyses for More Profitable Strategies in Peripheral Artery Disease. Annals of Medicine, 46, 475-489. https://doi.org/10.3109/07853890.2014.932618
Carthy, E.R. (2013) Lower Limb Peripheral Arterial Disease (Clinical Guideline 147) A Guideline Summary. Annals of Medicine and Surgery, 2, 26-30. https://doi.org/10.1016/S2049-0801(13)70024-4
Cacoub, P.P., Bhatt, D.L., Steg, P.G., Topol, E.J., Creager, M.A. and The CHARISMA Investigators (2009) Patients with Peripheral Arterial Disease in the CHARISMA Trial. European Heart Journal, 30, 192-201. https://doi.org/10.1093/eurheartj/ehn534
Pannucci, C.J. and Wilkins, E.G. (2010) Identifying and Avoiding Bias in Research. Plastic Reconstruction Surgery, 26, 619-625. https://doi.org/10.1097/PRS.0b013e3181de24bc
Parirenyatwa, D. and Gwinji, G. (2016) The National Health Strategy for Zimbabwe, 2016-2020. https://www.fao.org
Kaku, K. (2010) Pathophysiology of Type Diabetes and Its Treatment Policy. Japan Medical Association Journal, 53, 41-46.
Bhatia, V., Arya, V., Dabadghao, P., Balasubramanian, K., Sharma, K. and Verghese, N. (2004) Aetiology and Outcome of Childhood and Adolescent Diabetes Mellitus in North India. Journal of Paediatric Endocrinology and Metabolism, 17, 993-999. https://doi.org/10.1515/JPEM.2004.17.7.993
(2018) Type 2 Diabetes in Adults: Management, (NG 28) NICE. www.nice.org.uk/guidance/ng28
Hernando, F.J. and Conejero, A.M. (2007) Peripheral Artery Disease: Pathophysiology, Diagnosis and Treatment. Revista Espanola Cardiologia, 60, 969-982. https://doi.org/10.1157/13109651
Sanghavi, M. and Rutherford, J.D. (2014) Cardiovascular Physiology of Pregnancy. Circulation, 130, 1003-1008. https://doi.org/10.1161/CIRCULATIONAHA.114.009029
Rutherford, R.B., Baker, J.D. and Ernst, C. (1997) Recommended Standards for Reports Dealing Lower Extremity Ischaemia: Revised Version. Journal of Vascular Surgeons, 26, 517-538. https://doi.org/10.1016/S0741-5214(97)70045-4
Hardman, R.L., Jazaeri, O., Yi, O., Smith, M. and Gupta, R. (2014) Overview of Classification Systems in Peripheral Artery Disease. Seminars in Interventional Radiology, 31, 378-388. https://doi.org/10.1055/s-0034-1393976
Higashi, Y., Sasakis, S., Nakagawa, K., Matsuura, H., Kajiyama, G. and Oshima, T. (2001) A Non-Invasive Measurement of Reactive Hyperaemia That Can Be Used to Assess Resistance Artery Endothelial Function in Humans. American Journal of Cardiology, 87, 121-125. https://doi.org/10.1016/S0002-9149(00)01288-1
Huang, Z., Shiva, S., Kim-Shapiro, D.B., Patel, R.P., Ringwood, L.A., Irby, C.E., Huang, K.T., Ho, C., Hogg, N., Schechter, A.N. and Gladwin, M.T. (2005) Ezymatic Function of Haemoglobin as a Nitrite Reductase That Produces NO under Allosteric Control. Journal of Clinical Investigations, 115, 2099-2107. https://doi.org/10.1172/JCI24650
Hamments, D. (2014) Vascular Technology, the Burwin Institute of Diagnostic Medical Ultrasound V14A. https://www.burwin.com/
Hwang, J.Y. (2017) Doppler Ultrasonography of the Lower Extremities: Anatomy and Scanning Guidelines. Ultrasonography, 36, 111-119. https://doi.org/10.14366/usg.16054
Leoniuk, J., Lukasiewicz, A., Szorc, M.Z., Sackiewicz, I., Janica, J. and Lebkowska, U. (2014) Doppler Ultrasound Detection of Preclinical Changes in Foot Arteries in Early Stage Type 2 Diabetes. Polish Journal of Radiology, 79, 283-289. https://doi.org/10.12659/PJR.890486
Eiberg, J.P., Gronvall-Rasmussen, J.B., Hansen, M.A. and Schroeder, T.V. (2010) Duplex Ultrasound Scanning of Peripheral Arterial Disease of the Lower Limb. European Society of Vascular Surgery, 40, 507-512. https://doi.org/10.1016/j.ejvs.2010.06.002
Harrington, C. (2012) Sonography Principles and Instrumentation, the Burwin Institute. https://www.burwin.com/
Chavhan, G.B., Parra, D.A., Mann, A. and Navarro, O.M. (2008) Normal Doppler Spectral Waveforms of Major Paediatric Vessels: Specific Patterns. RadioGraphics, 28, 691-706. https://doi.org/10.1148/rg.283075095
Koo, T.K. and Li, M.Y. (2016) A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. Journal of Chiropractic Medicine, 15, 155-163 https://doi.org/10.1016/j.jcm.2016.02.012
Cormack, S.J., Newton, R.U., McGuigan, M.R. and Doyle, T.L. (2008) Reliability of Measures Obtained during Single and Repeated Countermovement Jumps. International Journal of Sports Physiology and Performance, 3, 131-144. https://doi.org/10.1123/ijspp.3.2.131
Kimberlin, C.L. and Winterstein, A.G. (2008) Validity and Reliability of Measurement Instruments Used in Research. American Journal of Health Systems Pharmacists, 65, 2276-2284. https://doi.org/10.2146/ajhp070364
Lakens, D. (2013) Calculating and Reporting Effect Sizes to Facilitate Cumulative Science: Practical Primer t-Tests and ANOVAs. Frontiers in Psychology, 4, Article 863. https://doi.org/10.3389/fpsyg.2013.00863
Sawilowsky, S.S. (2009) New Effect Size Rules of Thumb. Journal of Modern Applied Statistical Methods, 8, 597-599. http://digitalcommons.wayne.edu/jmasm/vol8/issue2/26 https://doi.org/10.22237/jmasm/1257035100
Zhang, T., Xia, L.H., Bian, Y.Y., Feng, B., Wang, C., Meng, F., Zhang, Y. and Chen, M. (2013) Blood Flow of the Acral Finger Arterioles in Patients with Type 2 Diabetes by Quality Doppler Profiles. Cell Biochemistry and Biophysics, 67, 717-25. https://doi.org/10.1007/s12013-013-9561-4
Janssen (2013) Pulsatility Index Is Better than Ankle Brachial Doppler Index for Non-Invasive Detection of Critical Limb Ischaemia in Diabetes. VASA: European Journal of Vascular Medicine, 34, 235-241. https://doi.org/10.1024/0301-1526.34.4.235
Hodgkiss-Harlow, K.D. and Bandyk, D.F. (2014) Interpretation of Arterial Duplex Testing of Lower Extremity Arteries and Interventions. Seminars in Vascular Surgery, 26, 95-104. https://www.sciencedirect.com/journal/seminars-in-vascular-surgery https://doi.org/10.1053/j.semvascsurg.2013.11.002
Sanna, G., Alesso, D., Mediati, M., Cimminiello, C., Borghi, C., Fazzari, A.L., Mangrella, M. and The PANDORA Study Investigators (2011) Prevalence of Peripheral Arterial Disease in Subjects with Moderate Cardiovascular Risk: Italian Results from the PANDORA Study DATA from PANDORA (Prevalence of Peripheral Arterial Disease in Subjects with Moderate CVD Risk, with No Overt Vascular Diseases Nor Diabetes Mellitus). Biomedical Central Cardiovascular Disorders, 11, Article No. 59. http://www.biomedcentral.com/1471-2261/11/59 https://doi.org/10.1186/1471-2261-11-59
Gerhard-Herman, M., Gardin, J.M., Jaf, M., Mohler, E., Roman, M. and Tasneem, Z.N. (2006) Guidelines for Non-Invasive Vascular Laboratory Testing: A Report from the American Society of Vascular Medicine and Biology. American Society of Echocardiography, 19, 955-972. https://doi.org/10.1016/j.echo.2006.04.019
Norgren, L., Hiatt, W., Dormandy, J., Nehler, M., Harris, K. and Fowkes, F. (2007) Intersociety Consensus for the Management of Peripheral Arterial Disease (TASC II). European Journal of Vascular and Endovascular Surgery, 33, S1-S75. https://doi.org/10.1016/j.ejvs.2006.09.024