Photoplethysmography and Continuous-Wave Doppler Ultrasound as a Complementary Test to Ankle–Brachial Index in Detection of Stenotic Peripheral Arterial Disease
Restricted accessResearch articleFirst published online May, 2013
Photoplethysmography and Continuous-Wave Doppler Ultrasound as a Complementary Test to Ankle–Brachial Index in Detection of Stenotic Peripheral Arterial Disease
Purpose: We evaluated the sensitivity and specificity of ankle–brachial index (ABI), photoplethysmography (PPG), and continuous-wave Doppler ultrasound (CWD) in the detection of anatomically stenotic peripheral arterial disease (PAD). Methods: Ninety-seven patients (194 legs) patients who had coincidentally undergone computed tomography angiography (CTA), ABI, PPG, and CWD for the evaluation of PAD were retrospectively reviewed. Sensitivity and specificity were measured. Results: Among 194 legs, 163 (84%) legs had stenotic PAD on CTA. Overall sensitivity of ABI, PPG, and CWD was 69.3%, 81.6%, and 90.8% and specificity was 96.8%, 77.4%, and 64.5%, respectively. Ankle–brachial index showed a statistically significantly decreased sensitivity (14.8%) for below trifurcation level stenosis compared with CWD (92%) and PPG (67%). The sensitivity of ABI was also significantly decreased in single level and moderate stenosis (45.1% and 42.1%, respectively). In contrast, the sensitivity of CWD and PPG was not significantly decreased. Conclusion: The ABI showed significantly decreased sensitivity especially in stenosis below the trifurcation level. Both PPG and CWD were complementary to ABI in these groups of patients.
HirschATHaskalZJHertzerNR. ACC/AHA 2005 guidelines for the management of patients with PAD (lower extremity, renal, mesenteric, and abdominal aortic): executive summary a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease) endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. J Am Coll Cardiol. 2006;47(6):1239–1312.
2.
NorgrenLHiattWRDormandyJANehlerMRHarrisKAFowkesFG. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(suppl S):S5–S67.
3.
CriquiMHFronekABarrett-ConnorEKlauberMRGabrielSGoodmanD. The prevalence of peripheral arterial disease in a defined population. Circulation. 1985;71(3):510–515.
4.
SelvinEErlingerTP. Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999-2000. Circulation. 2004;110(6):738–743.
5.
MeijerWTHoesAWRutgersDBotsMLHofmanAGrobbeeDE. Peripheral arterial disease in the elderly: the Rotterdam study. Arterioscler Thromb Vasc Biol. 1998;18(2):185–192.
6.
HooiJDStoffersHEKesterAD. Risk factors and cardiovascular diseases associated with asymptomatic peripheral arterial occlusive disease. The Limburg PAOD Study. Peripheral Arterial Occlusive Disease. Scand J Prim Health Care. 1998;16(3):177–182.
7.
LengGCLeeAJFowkesFG. Incidence, natural history and cardiovascular events in symptomatic and asymptomatic peripheral arterial disease in the general population. Int J Epidemiol. 1996;25(6):1172–1181.
8.
BelchJJTopolEJAgnelliG. Critical issues in peripheral arterial disease detection and management: a call to action. Arch Intern Med. 2003;163(8):884–892.
9.
CriquiMHDenenbergJO. The generalized nature of atherosclerosis: how peripheral arterial disease may predict adverse events from coronary artery disease. Vasc Med. 1998;3(3):241–245.
10.
SimonsPCAlgraAEikelboomBCGrobbeeDEvan der GraafY. Carotid artery stenosis in patients with peripheral arterial disease: the SMART study. SMART study group. J Vasc Surg. 1999;30(3):519–525.
11.
HouseAKBellRHouseJMastagliaFKumarAD'AntuonoM. Asymptomatic carotid artery stenosis associated with peripheral vascular disease: a prospective study. Cardiovasc Surg. 1999;7(1):44–49.
12.
HirschATCriquiMHTreat-JacobsonD. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001;286(11):1317–1324.
13.
ReichRS. The pulses of the foot: their value in the diagnosis of peripheral circulatory disease. Ann Surg. 1934;99(4):613–622.
14.
SteinRHriljacIHalperinJLGustavsonSMTeodorescuVOlinJW. Limitation of the resting ankle-brachial index in symptomatic patients with peripheral arterial disease. Vasc Med. 2006;11(1):29–33.
15.
GuoXLiJPangW. Sensitivity and specificity of ankle-brachial index for detecting angiographic stenosis of peripheral arteries. Circ J. 2008;72(4):605–610.
16.
SchroderFDiehmNKareemS. A modified calculation of ankle-brachial pressure index is far more sensitive in the detection of peripheral arterial disease. J Vasc Surg. 2006;44(3):531–536.
17.
LijmerJGHuninkMGvan den DungenJJLoonstraJSmitAJ. ROC analysis of noninvasive tests for peripheral arterial disease. Ultrasound Med Biol. 1996;22(4):391–398.
18.
NamSCHanSHLimSH. Factors affecting the validity of ankle-brachial index in the diagnosis of peripheral arterial obstructive disease. Angiology. 2010;61(4):392–396.
19.
RamseyDEMankeDASumnerDS. Toe blood pressure. A valuable adjunct to ankle pressure measurement for assessing peripheral arterial disease. J Cardiovasc Surg (Torino). 1983;24(1):43–48.
20.
LynchTGHobsonRW2ndWrightCB. Interpretation of Doppler segmental pressures in peripheral vascular occlusive disease. Arch Surg. 1984;119(4):465–467.
AllenJ. Photoplethysmography and its application in clinical physiological measurement. Physiol Meas. 2007;28(3):R1–R39.
23.
AlnaebMEBoutinACrabtreeVPMikhailidisDPSeifalianAMHamiltonG. Assessment of lower extremity peripheral arterial disease using a novel automated optical device. Vasc Endovascular Surg. 2007;41(6):522–527.
24.
NewcombeRG. Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med. 1998;17(8):857–872.
25.
EgorovaNNGuillermeSGelijnsA. An analysis of the outcomes of a decade of experience with lower extremity revascularization including limb salvage, lengths of stay, and safety. J Vasc Surg. 2010;51(4):878–885.
26.
ShareghiSGopalAGulK. Diagnostic accuracy of 64 multidetector computed tomographic angiography in peripheral vascular disease. Catheter Cardiovasc Interv. 2010;75(1):23–31.
27.
YaoSTHobbsJTIrvineWT. Ankle systolic pressure measurements in arterial disease affecting the lower extremities. Br J Surg. 1969;56(9):676–679.
28.
KhanTHFarooquiFANiaziK. Critical review of the ankle brachial index. Curr Cardiol Rev. 2008;4(2):101–106.
29.
BrooksBDeanRPatelSWuBMolyneauxLYueDK. TBI or not TBI: that is the question. Is it better to measure toe pressure than ankle pressure in diabetic patients?Diabet Med. 2001;18(7):528–532.
30.
AllenJOverbeckKNathAFMurrayAStansbyG. A prospective comparison of bilateral photoplethysmography versus the ankle-brachial pressure index for detecting and quantifying lower limb peripheral arterial disease. J Vasc Surg. 2008;47(4):794–802.
31.
YuJHHwangJYShinMS. The prevalence of peripheral arterial disease in korean patients with type 2 diabetes mellitus attending a university hospital. Diabetes Metab J. 2011;35(5):543–550.
32.
DurhamJRHorowitzJDWrightJGSmeadWL. Percutaneous transluminal angioplasty of tibial arteries for limb salvage in the high-risk diabetic patient. Ann Vasc Surg. 1994;8(1):48–53.
33.
FeiringAJWesolowskiAALadeS. Primary stent-supported angioplasty for treatment of below-knee critical limb ischemia and severe claudication: early and one-year outcomes. J Am Coll Cardiol. 2004;44(12):2307–2314.
34.
AllenJOatesCPLeesTAMurrayA. Photoplethysmography detection of lower limb peripheral arterial occlusive disease: a comparison of pulse timing, amplitude and shape characteristics. Physiol Meas. 2005;26(5):811–821.
