Efficacy Of Toe Brachial Index Compared To Ankle Brachial Pulse Index As A Diagnostic Modality In Peripheral Vascular Disease In Diabetics

Abstract

Introduction: Peripheral vascular disease (PVD) is a major cause of morbidity and mortality especially affecting the elderly population. The prevalence of PVD is multifold higher in patients with diabetes compared with age- and sex matched non-diabetic subjects, and this may be because of hyperglycemia, hypertension, hyperlipidemia, platelet factors, and other factors that are increased in diabetic subjects. Ankle Brachial Pulse Index (ABPI) has continued to be a well trusted diagnostic and prognostic modality in people suffering from PVD but its efficacy is reduced in diabetics with PVD due to the concomitant calcification in the crural vessels which gives a false high ankle systolic pressure. Toe Brachial Index (TBI) is another diagnostic modality that utilizes the great toe artery pressure instead of the anterior tibial and posterior tibial arteries. It is hypothesized that the great toe artery is not affected by medial sclerosis in diabetics and therefore could be utilized to get the correct value of the index between peripheral pressure and central pressure, thereby improving their prognosis by shortening the delay between diagnosis and treatment. Objective of the Study: To evaluate the efficacy of Toe Brachial index in comparison to Ankle brachial pulse index as a diagnostic modality in patients of diabetes for the diagnosis of Peripheral Vascular Disease. Materials and Methods: Data is collected from Diabetic disease cases admitted in B.L.D.E.U’s Shri B. M. Patil Medical College, Hospital & Research Centre/attending surgical OPD from October 2014. Details of cases will be recorded including history, clinical xi examination, measuring ABPI & TBI, Colour Doppler imaging & other routine investigations. Procedure: Patients diagnosed with diabetes based on their Fasting Blood Sugar (FBS) and Post Prandial Blood Sugar OR those who are already on drugs for the treatment of diabetes i.e. insulin or oral hypoglycemic agents are included in the study. The Ankle brachial pulse index (ABPI) and Toe brachial index (TBI) are then calculated using Hand held xioppler and the findings extrapolated using Arterial Colour Doppler as a confirmatory study. Results: Maximum numbers of cases were in the age group of 56 to 65 years with a mean of 53 years with a male: female ratio of 3:1. Majority of the patients (70%) were newly diagnosed diabetics. Poor control of diabetes was present in 85% of cases but none of the patients had any evidence of ESRD. TBI was able to diagnose PVD in 85% (68 patients) of patients of diabetes in the study group when compared to ABPI which could diagnose only 11.3% (9 patients) of patients in the study group. Conclusion: Toe Brachial Index is a more Sensitive & Accurate diagnostic modality than Ankle Brachial Pulse Index for the diagnosis of Peripheral Vascular Disease in diabetics.