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Management of diabetic foot
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Venu Kavarthapu, Raju Ahluwalia
Measurement of transcutaneous cutaneous oxygen tension (TcPO2, ≥25 mmHg) and toe blood pressure (≥30 mmHg increases pre-test probability of healing by 25%) may prognosticate the potential for healing. Some studies suggest that toe pressure is more sensitive than ankle pressure in the diagnosis of limb threatening ischaemia. Those with chronic limb-threatening ischaemia are likely to benefit from early revascularisation, either endovascular or, if suitable and medically fit, a surgical bypass, to help treat infection and ulceration.
Peripheral Arterial Thromboembolic Disorders
Published in Hau C. Kwaan, Meyer M. Samama, Clinical Thrombosis, 2019
From a clinical point of view, staging of collateral function and staging of resulting ischemia of the leg must be clearly distinguished. Pressure gradients (P1 and P2) between systemic blood pressure (P1) and postocclusive pressure (P2 = ankle pressure) signify the collateral to supply to the occlusion. As mentioned earlier, femoral occlusions produce, on the average, a pressure gradient of 60 mmHg. Higher gradients indicate a better and lower gradients a worse collateral supply. The ankle pressure (= P2), on the other hand, indicates the status of the leg itself. Ankle pressures around 70 mmHg allow for a walking distance of several hundred meters. Ankle pressures of or under 40 mmHg are dangerous to the leg and a further drop may lead to rest pain and necrosis.
Peripheral Vascular Disease
Published in Andrew Stevens, James Raftery, Jonathan Mant, Sue Simpson, Health Care Needs Assessment, 2018
In the diagnosis and assessment of critical limb ischaemia, the validity and variability of Doppler ultrasound measurement of ankle pressures, Duplex scanning and arteriography are comparable to the use of these procedures in severe claudication. A very low ankle pressure (< 40 mmHg) was considered indicative of severe ischaemia and increased risk of limb loss, but this has now been criticised because many patients with critical limb ischaemia have non-compliant vessels resulting in falsely elevated ankle pressures.39
Transcutaneous blood gas monitoring and tissue perfusion during common femoral thromboendarterectomy
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2022
Emilie Sigvardt, Søren Møller Rasmussen, Jonas Peter Eiberg, Helge Bjarup Dissing Sørensen, Christian Sylvest Meyhoff, Eske Kvanner Aasvang
This small study also demostrated the clinical variability among patients (Figure 1). One patient (ID2) had no response in tcpO2 and tcpCO2 to arterial clamping and declamping. We suggest this to be explained by a close-to-zero ankle pressure (Table 3) prior to intervention, most possibly a result of severe aterosklerosis or total occlusion. Several cases presented mid-clamp spikes, which may reflect artifacts from the surgical diathermy affecting the electrical circuitry. Surgeons also momentarily declamped the femoral artery during the revascularization in order to test graft flow and occurrence of anastomose leakage. This is presumably represented in ID6 as transitory bulges on the tcpO2 curve. ID8 reached no baseline during occlusion which could be explained by prolonged aterosklerosis leading to abundant collateral circulation around the clamp site as seen in previous studies [9]. Paradoxically, two patients (ID2 and ID9) had a low tcpO2 and high tcpCO2 after declamping which again may be related to severe aterosklerosis leading to more pronounced anaerobic metabolism combined with slower wash out after declamping.
Low back pain and calf pain in a recreational runner masking peripheral artery disease: A case report
Published in Physiotherapy Theory and Practice, 2021
Fabrizio Brindisino, Denis Pennella, Giuseppe Giovannico, Giacomo Rossettini, John D. Heick, Filippo Maselli
Gerhard-Herman et al. (2017) demonstrated that the ABI provides better discrimination than the absolute ankle pressure alone in distinguishing between normal limb arteries and those with lower extremity perfusion disease. An abnormal ABI can suggest PAD and together these parameters are predictive of other conditions such as systemic atherosclerotic disease. Moreover, the presence of a low ABI is predictive of cardiovascular mortality with a relative risk of cardiovascular mortality in the low ABI cohort reported as increased by approximately three to fourfold (Newman, Sutton-Tyrrell, Vogt, and Kuller, 1993). The formula that was used in this case report was “systolic ankle pressure/systolic arm pressure” as described by Fowkes et al. (2008) and reported in Table 1.
Carotid intima media thickness and ankle brachial index are inversely associated in subjects with and without diabetes
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2018
Karoline Winckler, Niels Wiinberg, Andreas Kryger Jensen, Birger Thorsteinsson, Louise Lundby-Christensen, Berit Lilienthal Heitmann, Gorm Boje Jensen, Lise Tarnow
This study also had some limitations. One is its cross-sectional design, which in contrast to longitudinal studies, eliminates the possibility for making conclusions regarding time-dependent relationships between carotid IMT and ABI. Toe-brachial index (TBI) could also have been considered a more suitable measure for subjects with DM especially with established PAD. If the study was based solely on subjects with DM, measurements of TBI could have been preferable. But as the current study is part of a population-based study, peripheral blood pressure was measured on the whole population with a simple automatic screening method. Media sclerosis in which TBI is an indicator for is not that common in the general population why ankle pressure was applied. Finally, DM was self-reported and the group of subjects with DM was relatively small, but the number of subjects with DM seems to be comparable to the prevalence in the general population. The self-reported status of DM was cross checked with information on use of insulin and other diabetic medicine in order to minimize recall and information bias. Future studies will require a larger number of subjects with DM to make more detailed analyses feasible.