“DO ABI AND PULSE VOLUME COMPARE WITH

THE DUPLEX SCAN FOR IDENTIFYING PAD?”

Dr Jane Lewis

Cardiff and Vale University Health Board, UK

Aim

To compare the sensitivity and specificity of an *automated Ankle-Brachial Index (ABI) and Pulse Volume waveform (PVR) with the Ultrasound Duplex Scan (UDS) for identifying Peripheral Arterial Disease (PAD)

EP452

Methods Patients that were referred for

lower limb arterial scans at

two Vascular Laboratory

departments in the UK

underwent an automated ABI

and PVR measurement using

a device utilising Volume

Plethysmography followed by

a UD Scan.

PAD was recorded for

automated ABI if ABI <0.9

(and noted if >1.30), PVR’s if

graded mild/moderate/severe

and with a haemodynamically

significant stenosis or

occlusive disease with the

UDS. A result of PAD or NO

PAD was recorded for each

patient and each method.

The outcome measures for

this study were the sensitivity,

specificity and accuracy

between the automated ABI

and UDS results and the PVR

and UDS results.

Results

38% were found to have PAD using the gold standard UDS

Smoker and PAD = 16.4% yes, 11.7% non, 11.7% ex

CHD had PAD = 15%

Diabetes and PAD = 7%

Overall results were:

ABI and UDS

sensitivity 85%

specificity 89%

overall accuracy 88%

PVR and UDS

sensitivity 97%

specificity 89%

overall accuracy 95%

200 patients recruited

195 completed study

5 sets of results were rejected due to equipment failure (n=3) and patients discomfort at laying supine (n=2)

65% male, 35% female

Mean age was 67 years (SD 12.38)

Diabetes = 26.7% with, 73.3% without

CHD = 36.7% with, 63.3% without

Smoking = 28.9% yes, 41.1% non, 30% ex

Results Examples of normal & mild disease

Examples of moderate and severe disease

A) Both ABI and PVR waveforms indicate normal lower limb arterial supply

C) Both ABI and PVR waveforms indicate moderate PAD

B) Left ABI and PVR waveform indicate normal lower limb arterial supply and right ABI and PVR waveform indicate mild PAD

D) Left ABI and PVR waveform indicate normal lower limb arterial supply and right ABI and PVR waveform indicate severe PAD

Conclusions

With the potential of raised

ABI’s in those with diabetes

mellitus and chronic kidney

disease (often raised into the

normal range), the combined

use of the ABI and PVR within

one device can only enhance

vascular assessment for

treatment planning of leg

ulcers and foot wounds.

With the results being

clinically acceptable and its

rapid assessment time, the

automated device could also

be introduced into a primary

care screening environment

as a reliable tool for

confirming symptomatic PAD

and early identification of

asymptomatic PAD for those

at risk.

*Dopplex Ability – Huntleigh Healthcare, Cardiff, UK Acknowledgements: Professor Joyce Kenkre – University of South Wales, UK Dr Jon Evans – Huntleigh Healthcare, UK