Jornal Vascular Brasileiro
https://app.periodikos.com.br/journal/jvb/article/doi/10.1590/1677-5449.03115
Jornal Vascular Brasileiro
Original Article

Estudo comparativo do Índice Tornozelo-Braquial em diabéticos e não diabéticos com isquemia crítica

Comparative study of the Ankle-Brachial Index in diabetic and non-diabetic patients with critical limb ischemia

Vanessa Prado dos Santos; Carlos Alberto Silveira Alves; Ronald José Ribeiro Fidelis; Cícero Fidelis; José Siqueira de Araújo Filho

http://dx.doi.org/10.1590/1677-5449.03115 J Vasc Bras, vol.14, n4, p.305-310, 2015
PDF Português
PDF English
SciELO
Downloads: 3
Views: 1369

Resumo

Resumo Contexto A calcificação da camada média arterial pode tornar o Índice Tornozelo-Braquial (ITB) falsamente elevado em diabéticos, dificultando a avaliação da doença arterial. Objetivo Comparar os valores do ITB de diabéticos e não diabéticos com isquemia crítica. Métodos Foram incluídos 140 pacientes (60% de diabéticos) acompanhados no Serviço de Cirurgia Vascular do Complexo Hospitalar Universitário Professor Edgard Santos com isquemia crítica por DAOP infra-inguinal. Comparou-se a média dos valores do ITB dos dois grupos de pacientes, correlacionando o ITB com a gravidade da isquemia, segundo a Classificação de Rutherford. A análise estatística foi realizada pelo EPI-INFO. Resultados A maioria dos 140 pacientes (77%) se encontrava na Categoria 5 da Classificação de Rutherford, 6% na 4 e 17% na 6. Nove diabéticos (11%) e um não diabético (2%) apresentaram ITB > 1,15 (p = 0,02), sendo excluídos da análise das médias do ITB. Considerando os 130 pacientes, os 75 doentes diabéticos apresentaram média do ITB na artéria tibial posterior de 0,26 versus 0,28 dos 55 doentes não diabéticos (p = 0,6); e no ITB da artéria pediosa aqueles apresentaram média de 0,32 versus 0,23 desses (p = 0,06). Estratificando os doentes nas categorias da Classificação de Rutherford, não houve diferença nas médias do ITB nas categorias 4 e 5. Apenas em relação à artéria pediosa e em pacientes na Categoria 6, a média do ITB foi significativamente maior em diabéticos (0,44 versus 0,16; p = 0,03). Conclusão Os diabéticos apresentaram maior prevalência de ITB falsamente elevado. Porém, excluindo-se esses casos, a média dos valores de ITB são semelhantes aos não diabéticos, exceto na artéria pediosa, nos pacientes com isquemia na categoria 6.

Palavras-chave

diabetes mellitus, aterosclerose, isquemia, Índice Tornozelo-Braquial, complicações do diabetes

Abstract

Abstract Background Calcification of the arterial tunica media can falsely elevate the Ankle-Brachial Index (ABI) in diabetics, making it difficult to assess arterial disease. Objective To compare ABI values in diabetics and non-diabetics with critical ischemia. Methods A total of 140 patients (60% diabetics) with critical ischemia due to infrainguinal peripheral arterial obstructive disease were recruited from the vascular surgery service at the Complexo Hospitalar Universitário Professor Edgard Santos. Mean ABI values for the two groups of patients were compared and correlated with severity of ischemia, according to the Rutherford Classification. Statistical analysis was conducted using EPI-INFO. Results A majority of the 140 patients (77%) were classified as Rutherford Category 5, 6% as Category 4 and 17% as Category 6. Nine diabetics (11%) and one non-diabetic (2%) exhibited ABI > 1.15 (p = 0.02) and were excluded from the comparative analysis of mean ABIs. For the 130-patient sample, the 75 diabetic patients had a mean ABI for the posterior tibial artery of 0.26, vs. 0.28 for the 55 non-diabetic patients (p = 0.6); while mean ABIs for the dorsalis pedis artery were 0.32 vs. 0.23 respectively (p = 0.06). When the patients were stratified by Rutherford categories, there were no differences in mean ABIs in categories 4 or 5. Only mean ABI for the dorsalis pedis artery in Category 6 patients was significantly higher among diabetics (0.44 vs. 0.16; p = 0.03). Conclusions The diabetic patients had a higher prevalence of falsely elevated ABI, but when these cases were excluded, mean ABI values were similar to those of non-diabetic patients, with the exception of ABI measured at the dorsalis pedis artery in patients with category 6 ischemia.

Keywords

diabetes mellitus, atherosclerosis, ischemia, Ankle-Brachial Index, complications of diabetes

References

Norgren L, Hiatt WR, Dormandy JÁ, Nehler MR, Harris KA, Fowkes FG. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007;45(1^sSuppl S):S5-67.

Williams DT, Harding KG, Price P. An evaluation of the efficacy of methods used in screening for lower-limb arterial disease in diabetes. Diabetes Care. 2005;28(9):2206-10.

Resnick HE, Lindsay RS, McDermott MMG. Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the strong heart study. Circulation. 2004;109(6):733-9.

Santos VP, Caffaro RA, Pozzan G, Saieg MA, Castelli Jr V. Comparative histological study of atherosclerotic lesions and microvascular changes in amputated lower limbs of diabetic and non-diabetic patients. Arq Bras Endocrinol Metabol. 2008;52(7):1115-23.

Everhart JE, Pettitt DJ, Knowler WC, Rose FA, Bennett PH. Medial arterial calcification and its association with mortality and complications of diabetes. Diabetologia. 1988;31(1):16-23.

Ramsey DE, Manke DA, Sumner DS. Toe blood pressure: a valuable adjunct to ankle pressure measurement for assessing peripheral arterial disease. J Cardiovasc Surg (Torino). 1983;24(1):43-8.

Takolander R, Rauwerda JA. The use of non-invasive vascular assessment in diabetic patients with foot lesions. Diabet Med. 1996;13(^sSuppl 1):S39-42.

Smith FB, Lee AJ, Price JF, van Wijk MC, Fowkes FG. Changes in ankle brachial index in symptomatic and asymptomatic subjects in the general population. J Vasc Surg. 2003;38(6):1323-30.

Reich LM, Heiss G, Boland LL, Hirsch AT, Wu K, Folsom AR. Ankle–brachial index and hemostatic markers in the Atherosclerosis Risk in Communities (ARIC) study cohort. Vasc Med. 2007;12(4):267-73.

Gregg EW, Sorlie P, Paulose-Ram R. Prevalence of lower-extremity disease in the US adult population > 40 years of age with and without diabetes. Diabetes Care. 2004;27(7):1591-7.

Tavintharam S, Cheung N, Lim SC. Prevalence and risk factors for peripheral artery disease in an Asian population with diabetes mellitus. Diab Vasc Dis Res. 2009;6(2):80-6.

Jirkovská A, Boucek P, Wosková V, Bartos V, Skibová J. Identification of patients at risk for diabetic foot: a comparison of standardized noninvasive testing with routine practice at community diabetes clinics. J Diabetes Complications. 2001;15(2):63-8.

Makdisse M, Ramos LR, Moreira F. Escore para rastrear idosos (≥75 anos) de alto risco para doença arterial periférica. Arq Bras Cardiol. 2007;88(6):630-6.

Aragão JA, Reis FP, Borges Neto RR, Aragão MECS, Nunes MAP, Feitosa VLC. Prevalência de doença arterial obstrutiva periférica em doentes com insuficiência renal crônica. J Vasc Bras. 2009;8(4):301-6.

Panico MDB, Spichler ES, Neves MF, Pinto LW, Spichler D. Prevalência e fatores de risco da doença arterial periférica sintomática e assintomática em hospital terciário, Rio de Janeiro, Brasil. J Vasc Bras. 2009;8(2):125-32.

Jude EB, Oyibo SO, Chalmers N, Boulton AJ. Peripheral arterial disease in diabetic and nondiabetic patients. Diabetes Care. 2001;24(8):1433-7.

Rueda CA, Nehler MR, Perry DJ. Patterns or artery disease in 450 patients undergoing revascularization for critical limb ischemia: implications for clinical Trial design. J Vasc Surg. 2008;47(5):995-1000, discussion 999-1000.

Colwell JA, Lopes-Virella M, Halushka PV. Pathogenesis of atherosclerosis in diabetes mellitus. Diabetes Care. 1981;4(1):121-33.

Strandness Jr DE, Priest RE, Gibbons GE. Combined clinical and pathologic study of diabetic and nondiabetic peripheral arterial disease. Diabetes. 1964;13(4):366-72.

Goldenberg S, Alex M, Joshi RA, Blumenthal HT. Nonatheromatous periferal vascular disease of the lower extremity in diabetes mellitus. Diabetes. 1959;8(4):261-73.

Conard MC. Large and small artery occlusion in diabetics and nondiabetics with severe vascular disease. Circulation. 1967;36(1):83-91.

Ferrier TM. Comparative study of arterial disease in amputated lower limbs from diabetics and non-diabetics (with special reference to feet arteries). Med J Aust. 1967;1(1):5-11.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5ddec6560e8825ab267279a1 jvb Articles
1677-7301 (Electronic)
J Vasc Bras ©2024 All rights reserved.

J Vasc Bras

Share this page
Page Sections