Screening of peripheral arterial disease in primary health care
Received 11 March 2019
Accepted for publication 1 July 2019
Published 20 August 2019 Volume 2019:15 Pages 355—363
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Daniel A. Duprez
Zsombor Tóth-Vajna,1 Gergely Tóth-Vajna,2 Zsuzsanna Gombos,1 Brigitta Szilágyi,3 Zoltán Járai,4,5 Márton Berczeli,1 Péter Sótonyi1
1Heart and Vascular Center, Department of Vascular Surgery, Semmelweis University, Budapest, Hungary; 21st Department of Pediatrics, Semmelweis University, Budapest, Hungary; 3Department of Geometry, Institute of Mathematics, Budapest University of Technology and Economics, Budapest, Hungary; 4Department of Cardiology, St. Emeric University Teaching Hospital, Budapest, Hungary; 5Heart and Vascular Center, Department of Vascular Surgery, Department of Angiology, Semmelweis University, Budapest, Hungary
Correspondence: Márton Berczeli
Heart and Vascular Center, Department of Vascular Surgery, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
Tel +36 20 666 3354
Background and purpose: The screening tool for diagnosing lower extremity arterial disease is the assessment of the ankle-brachial index (ABI), which is widely used in general practice. However, resting ABI can easily produce a false negative result. In light of this, our goal was to determine the proportion of definitive diagnoses (peripheral arterial disease [PAD] confirmed or refuted) among patients screened in general practice, and the rate of cases in which the need for further specialized examination is necessary, with special attention to groups having non-compressible arteries and ABI negative symptomatic status. The aim of our work is to improve the efficiency of primary health care screening in PAD and reduce the extremely high domestic amputation ratio.
Patients and methods: Eight hundred and sixteen patients were screened. We used the Edinburgh Questionnaire and recorded medical histories, major risk factors, current complaints, and medication. Physical examinations were performed, including ABI testing.
Results: Thirty-three percent complained about lower extremity claudication; 23% had abnormal ABI values; 13% of the patients within the normal ABI range had complaints of dysbasia; and 12% were in the non-compressible artery group. The ABI-negative symptomatic group’s risk factor profile showed a close similarity to the clear PAD-positive and non-compressible artery groups.
Conclusion: The percentage of PAD could be higher than the number of patients diagnosed by ABI screening. Nearly a quarter of the population fell into the non-compressible artery and ABI-negative symptomatic groups, together defined as the “murky zone”. When screening purposely for PAD, these patients deserve special attention due to the insufficient selectivity and sensitivity of measurements. If there is high clinical suspicion of PAD in spite of normal ABI values, further assessment may be considered.
Keywords: peripheral arterial disease, ankle-brachial index, diabetes, screening method, ABI-negative symptomatic, non-compressible artery
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