Talib, Norain
(2017)
Association between ankle-brachial systolic index, pulse oximetry gradient index and CT angiogram of lower limb among type 2 diabetic for detecting peripheral arterial disease.
Masters thesis, Universiti Sains Malaysia .
Abstract
Background: Peripheral arterial disease (PAD) is a known macrovascular complication
of type 2 diabetes. Most primary care clinic has no establish algorithm on how to screen
patient with PAD. Hereby, we conducted a study among patient in tertiary hospital
diabetic unit, by using simple useful, handy test and correlate the tests with diagnostic
imaging to detect PAD in our local community in Kubang Kerian, Kelantan.
Objective: To determine association between ankle-brachial systolic index, pulse
oximetry and CTA lower limb for detecting peripheral arterial disease among Type 2
Diabetic patients.
Methodology: Patients who attended Diabetic Specialist Clinic HUSM were eligible for
the study. Adult patients with Type 2 DM has HbA1c more than 6.5% in 3 months were
recruited. Symptoms of claudication were assessed using ECQ. The lower limb perfusion
was evaluated by ABSI and PO gradient. Radiologically the perfusion was assessed using
CTA LL as a gold standard. The severity of stenosis was categorized into <50% (minimal
to mild stenosis) and ≥50%(moderate to severe stenosis). The site of stenosis (above and
below knee) were also analysed.
Results: A total of 22 limbs from 11 patients were analysed. A strong association between
abnormal ABSI and LPO gradient (r = 0.818, p = <0.001) in this study was obtained.
There is significant fair association between ABSI findings and history of lower limbclaudication (r = 0.378, p = 0.076) between patients. There was statistically significant
association between present of stenosis and abnormal ABSI or PO gradient (p = 0.016).
On further analysis, the odd of having abnormal ABSI or PO gradient value is 12 times
higher in patient with moderate to severe stenosis than those with minimal to mild arterial
PAD (ORc ,95% CI). In single logistic regression, the odd of having abnormal ABSI or
PO gradient value is 8 times higher in patient with moderate to severe below knee arterialstenosis (≥ 50% stenosis) than those with minimal to mild (<50%) above and below knee
PAD (p = 0.037). Conclusions: Patients who have severe below knee PAD has shown
strong association with abnormal ABSI and PO. PO gradient has significant association
with PAD as equal as ABSI and the result was confirmed by CTA LL study.
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