Accuracy of the pedal acceleration time to diagnose limb ischemia in patients with and without diabetes using the WIfI classification

Author:

de Castro-Santos Guilherme1ORCID,Gonçalves Patric Emerson Oliveira2,Procópio Ricardo Jayme1,Dardik Alan3,Navarro Túlio Pinho1

Affiliation:

1. Department of Surgery, Vascular Surgery Unit, Federal University of Minas Gerais, Belo Horizonte, Brazil

2. School of Kinesiology, University of British Columbia, Vancouver, BC, Canada

3. Department of Surgery, Yale School of Medicine, New Haven, CT, USA

Abstract

Introduction: Evaluation of limb hemodynamics using the ankle–brachial index (ABI) may be difficult due to skin lesions, extensive necrosis, and obesity, such as commonly present in patients with diabetes with chronic limb-threatening ischemia (CLTI). We hypothesized that the pedal acceleration time (PAT) correlates with ABI and Wound, Ischemia, and foot Infection (WIfI) scores in patients with diabetes to serve as a new modality to accurately stage CLTI. Methods: A single-center, cross-sectional study included patients with and without diabetes > 18 years with CLTI. Limbs were categorized in three grades of ischemia based on the ABI (ABI < 0.8, < 0.6, and < 0.4) and in two classes based on WIfI stages of amputation risk. Receiver operator characteristic (ROC) curves were used to determine PAT sensitivity, specificity, and accuracy to predict lower-limb ischemia. Results: A total of 141 patients (67 nondiabetic and 74 diabetic) and 198 lower limbs (94 nondiabetic and 104 diabetic) met the inclusion criteria. In patients without diabetes, the accuracy of PAT for detecting an ABI < 0.8 was 85%; for detecting an ABI < 0.6 was 85%; and for detecting an ABI < 0.4 was 87%. In patients with diabetes, the accuracy of PAT in detecting an ABI < 0.8 was 91%; for detecting an ABI < 0.6 was 79%; and for detecting an ABI < 0.4 was 88%. In patients without diabetes, the accuracy for detecting WIfI stages of moderate and high amputation risk was 77% and for patients with diabetes was also 77%. Conclusions: PAT shows high correlation with the ABI as well as with the WIfI stages of amputation risk and the grades of ischemia, with high accuracy.

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine

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