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Sensitivity and Specificity of Ankle Brachial Index (ABI) and Pulse Wave Handheld Doppler (PWHD) Compared with Angiography as Diagnostic Test for Patients with Peripheral Artery Disease (PAD)

Valdy Thomas, Djony Tjandra, Richard Sumangkut, Billy Karundeng, Grace Korompis

Background: Peripheral artery disease (PAD) is a clinical condition that occurs due to atherosclerosis and narrowing of the arteries involving the aorta, branches of the visceral arteries such as the iliac arteries, and the arteries of the distal extremities. The femoropopliteal artery is the most commonly involved site in patients with atherosclerotic PAD. Ankle Brachial Index (ABI) determination may have limited value in some patients with diabetes, because calcification of the tibial artery can render it uncompressible, resulting in a very high ABI value (>1.40). Handheld vascular Doppler with pulse volume waveform interpretation (PVW) is an easily available and non-invasive modality for evaluation of the inferior extremity arteries and can detect the severity of blood flow disturbances or ongoing PAD. The best diagnostic method for PAD is angiography using digital substraction angiography (DSA) to assess existing atherosclerotic lesions. The advantages of ABI and PWHD examinations are in terms of simplicity, ease of use, and non-invasiveness instead of angiography in PAD diagnosis led the investigators to compare the sensitivity and specificity values between ABI and PWHD with angiography as a diagnostic test for PAD patients.

Methods: This study used a cross-sectional diagnostic test design with the subjects were patients diagnosed with PAD, both outpatients and inpatients at Prof. DR. R.D Kandou Manado. ABI, PWHD and angiography examination were performed on all study subjects.

Results: The data show that ABI has a sensitivity of 95.2% and a specificity of 80% in diagnosing PAD patients when compared to angiography as the standard of diagnosis of PAD. PWHD compared to angiography has a sensitivity of 100% and a specificity of 100%. When ABI and PWHD are combined, it has a sensitivity of 100% with a specificity of 80%. The sensitivity and specificity of PWHD compared to angiography based on angiographic location in popliteal artery has a sensitivity of 91.7% and a specificity of 92.6%. PWHD compared with angiography on posterior tibial artery (PTA) has a sensitivity of 81% and a specificity of 88.9%. ABI compared with angiography on dorsalis pedis artery has a sensitivity of 100% and a specificity of 71.4%, with p <0.0001.

Conclusion: The high sensitivity and specificity of ABI and PWHD can be used as a diagnostic test tool for PAD patients by general practitioners in first level health facilities.

Keywords: diabetic foot, peripheral artery disease, angiography, Doppler, ankle brachial index

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