Current imaging strategies in cardio-oncology
Susan F. Dent in Practical Cardio-Oncology, 2019
Ankle-brachial index (ABI) is a simple test, which provides an accurate and rapid way for detecting the presence and severity of lower extremity arterial disease. The ABI is defined as the ratio of the systolic blood pressure in the upper arm compared to the ankle. Brachial and dorsalis pedis arterial systolic pressures are measured by applying an appropriately sized blood pressure cuff and using a continuous wave Doppler probe to record the arterial signal. Values below 0.9 are indicative of peripheral arterial disease (30). ABI can be performed at baseline and annually in asymptomatic patients at risk for peripheral artery disease such as patients receiving abdominal and/or pelvic radiation. In symptomatic patients, especially treated with high-risk agents such as nilotinib or ponatinib, direct visualization with arterial ultrasonography or CT/MR angiography may be indicated (2).
How to perform revision lumbar decompression
Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro in Revision Spine Surgery, 2019
Prior to obtaining advanced imaging or laboratory testing, a history should be taken and a detailed physical exam performed at the initial evaluation. The patient should be questioned regarding the exact nature of the symptoms to identify radiculopathy or neurogenic claudication. A detailed review of the patient's past spinal surgery should be obtained. Inspection of the previous surgical incision may reveal subcutaneous fullness and fluctuance, indicating a postoperative pseudomeningocele. The presence of a draining wound at the previous surgical site indicates an infection that must be addressed with surgical debridement. Sagittal balance may be assessed with the patient standing. Significant stenosis may result in positive sagittal balance or leaning forward to decompress the neural elements. Peripheral pulses should be palpated to rule out vascular claudication. In office, ankle-brachial index may be utilized to evaluate for peripheral vascular disease. Hip joints are ranged to rule out pain from hip arthropathy, primarily with internal/external rotation. The neurologic status of the patient is evaluated and graded with sensory testing, motor strength testing, deep tendon reflexes, and assessment of gait.
Lower extremity fractures
David E. Wesson, Bindi Naik-Mathuria in Pediatric Trauma, 2017
Proximal tibial physeal fractures are rare injuries that usually occur with a high-energy mechanism, often during sports [72, 73]. Because the popliteal artery is tethered posteriorly and the spike of the metaphyseal fragment in these fractures displaces posteriorly, arterial injury should be evaluated whenever this fracture is encountered [72, 74, 75]. X-rays should be obtained. The diagnosis is easily made if the fracture is displaced, but it is possible for the fracture to have spontaneously reduced or to have been reduced by coaches, parents, or medical personnel prior to presentation to the emergency department (Figure 20.3.38) [72, 74, 75]. Due to the risk of arterial injury at the time of injury, promp diagnosis of this fracture is important. Ankle-brachial index measurement and frequent monitoring for arterial insufficiency is important. Angiography should be considered if there are any concerns for arterial injury. Compartment syndrome and peroneal nerve injury are also potential complications of these injuries [72]. Reduction in the emergency department may be considered if there is no neurovascular compromise. If there is concern for a vascular injury, reduction should be performed in the operating room under anesthesia. If the fracture is unstable after reduction, crossed pins may be placed to stabilize the fracture. A long leg cast is applied and can be bivalved if there are concerns for swelling or compartment syndrome.
Accuracy and repeatability of the Dopplex Ability
Published in Expert Review of Medical Devices, 2018
Rebecca N. Millen, Kate N. Thomas, Arunesh Majumder, Brigid G. Hill, Andre M. Van Rij, Jo Krysa
Peripheral arterial disease (PAD) is a common circulatory disease involving atherosclerosis of the lower limb arteries. There is little epidemiological data on the prevalence of PAD in New Zealand; however, literature of developed countries estimates a prevalence of around 10% in those aged over 65 years, and the prevalence is significantly increasing over time [1]. The consequences of late-stage PAD include arterial ulcers and lower limb ischemia. Ulcer care has been estimated at approximately $1000 USD/month, and revascularization and amputations have been estimated at a cost of approximately $35,000 USD each, with ongoing assisted living costs also significant [2]. Therefore, efficient ways of early diagnosis of PAD would be beneficial in the community clinical setting, to reduce the late-stage complications of the disease. The ankle-brachial index (ABI) is one of the most common tests used to identify PAD, which measures the ratio of the systolic ankle to brachial pressure. It is low cost, non-invasive, and reliable and has a high sensitivity and specificity [2]. Pulse volume recording (PVR) is another useful non-invasive arterial test, based on the volume changes with each pulse in the lower limb using air plethysmography technology [3]. PVR are especially beneficial for assessing lower limb perfusion in patients with non-compressible vessels in whom the ABI cannot be relied upon due to spuriously high values. Despite these advantages, both the ABI and PVR can be time consuming in the primary care setting, and also require specialized equipment and training.
Subclinical atherosclerosis in the carotid artery: can the ankle-brachial index predict it in type 2 diabetes patients?
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2021
Kati Kärberg, Margus Lember
The ankle-brachial index (ABI) is a non-invasive, easy-to-perform, inexpensive test to detect occlusive vascular disease. It is the ratio between highest blood pressure posterior tibial artery or dorsalis pedis artery and brachial artery. There is general agreement that ABI <0.9 describes patients with ≥50% stenosis in the peripheral distal artery and has 75% sensitivity and 86% specificity to diagnose PAD [17]. A clear and strong association between low ABI (<0.9) as a marker of systemic atherosclerosis and cardiovascular events has been demonstrated in several studies [18–20]. Although ABI 1.1–1.3 is considered normal, there is plenty of grey area between the values 0.9 and 1.1. ABI <1.0 is assumed to be indicative of an increased probability of atherosclerosis, primarily because some critical risk factors may affect the value of ABI [18,21,22]. Foot ulcers, neuropathy, and arterial calcification may lead to wrong ABI values in diabetic patients. It may be falsely considered normal and therefore dismiss atherosclerotic disease. The ROC curve analysis showed that a cut-off set at 1.0–1.1 could identify >80% of the patients with PAD regardless of presence or absence of DM [21]. A study on Japanese patients with T2DM recommended using an ABI level of 0.9–1.0 as a potential marker of systemic atherosclerosis in asymptomatic patients in clinical practice [22]. In light of the above, there is no specific ABI value for early atherosclerosis.
Association of a low ankle brachial index with progression to end-stage kidney disease in patients with advanced-stage diabetic kidney disease
Published in Renal Failure, 2023
Ruiying Tang, Yun Liu, Jiexin Chen, Jihong Deng, Yan Liu, Qingdong Xu
The ankle-brachial index (ABI) has recently become a routine screening parameter for vascular complications in patients with DM [5]. A correlation between the ABI and microvascular complications in diabetes has been widely reported [6]. The ABI is calculated as the ankle-to-arm systolic blood pressure (SBP) ratio. It is a simple, noninvasive screening tool used to detect peripheral arterial disease (PAD) [7,8] as it reflects the aging and pathological state of blood vessels. An ABI threshold of 0.90 has been reported to have 90% sensitivity and specificity to detect PAD when compared to angiography methods [9]. A low ABI (<0.9) is a predictor of cardiovascular disease, stroke, and mortality in the general population and in patients with DM and chronic kidney disease (CKD) [10–13]. Atherosclerosis also contributes to the deterioration of kidney function, as a low ABI is predictive of future diminished kidney function and is associated with an increased risk of CKD and decreased eGFR [14–16]. Additionally, a close relationship between low ABI and early-stage CKD was found in patients with diabetes with normal albuminuria [15], suggesting that a low ABI level contributed to diminished kidney function independent of albuminuria. However, U-shape relationships between the ABI and eGFR, CKD, cardiovascular disease, and all-cause mortality have also been reported [9,17].
Related Knowledge Centers
- Ankle
- Arm
- Blood Pressure
- Dorsalis Pedis Artery
- Sensitivity & Specificity
- Sphygmomanometer
- Systole
- Posterior Tibial Artery
- Brachial Artery
- Peripheral Artery Disease
- Sensitivity & Specificity