ANKLE BRACHIAL PRESSURE INDEX, VALUE AND LIMITATIONS CONSIDERATIONS ABOUT ITS APPLICABILITY FOR DIABETIC INDIVIDUALS

Abstract

Non-invasive ultrasound investigations are frequently used as a screening maneuver for peripheral vascular disease. The ankle to brachial pressure index (ABPI) it is a noninvasive hand-held Doppler test that is able to perform a peripheral vascular interrogation. It is thaught to be reasonable accurate for the diagnosis of hemodynamical significant arterial disease, meaning that the advanced wall injuries are already set. When performing the ABPI investigation the lack of methodological standardization is challanging even in the nondiabetic population. In this review we highlight the ankle to brachial pressure index (ABPI) effectiveness and limitations comparing non-diabetic versus diabetic patients with peripheral arterial disease, trying a (re)consideration of its diagnostic accuracy. Almost 60% of peripheral arterial diseased patients are free of symptoms, probably because of collaterals network. The vascular disease is particularly high among diabetic individuals and suggests that multiple arterial beds are simultaneously affected. As we know, there is a general consensus about regular vascular assessment in diabetic population. The ABPI as a screening tool for lower limb arterial disease is less sensitive in diabetic individuals, mainly when neuropathy and vascular calcification exist. ABPI interrogation should therefore always be cautiously considered. Hand held Doppler assessment and ABPI results should be integrated in the clinical context of the patients. Either clinically symptomatic or silent (because of collaterals efficiency and neuropathy), lower limb arterial disease needs to be further and detailed interrogated. Color duplex investigation (CDI) seems to be a highly sensitive and accurate method of assessing arterial vasculopathy mainly in diabetics.