No abstract available.
Diagnosis ; Peripheral Arterial Disease

PURPOSE: This study investigates the amputation rate within 1 year after the diagnosis of diabetic foot ulcer and its associated risk factors. MATERIALS AND METHODS: This study enrolled 60 patients with diabetic foot ulcer. The mean and standard deviation age was 64.4±12.8 years (range, 32~89 years); the mean and standard deviation prevalence period for diabetes mellitus was 21.0±7.5 years (range, 0.5~36 years). The amputation rate was evaluated by dividing the subjects into two groups—the major and minor amputation groups—within 1 year following the initial diagnosis of diabetic foot ulcer. Multivariate Cox proportional hazards regression analysis was used to identify the risk factors for amputation. RESULTS: The total amputation rate of 38.3% (n=23) was comprised of the amputation rate for the major amputation group (10.0%) and rate for the minor amputation group (23.8%). There was a high correlation between peripheral artery disease (toe brachial pressure index <0.7) and amputation (hazard ratio [HR] 5.81, confidence interval [CI] 2.09~16.1, p<0.01). Nephropathy was significantly correlated with the amputation rate (HR 3.53, CI 1.29~9.64, p=0.01). CONCLUSION: Clinicians who treat patients with diabetic foot complications must understand the fact that the amputation rate within 1 year is significant, and that the amputation rate of patients with peripheral artery disease or nephropathy is especially high.
Amputation* ; Diabetes Mellitus ; Diabetic Foot* ; Diagnosis* ; Humans ; Peripheral Arterial Disease ; Prevalence ; Risk Factors* ; Ulcer*

BACKGROUND: The purpose of this study was to examine illness perception, knowledge about the disease and health promoting behaviors, and to identify factors influencing health promoting behaviors among Peripheral Arterial Disease (PAD) patients. METHODS: The participants were 128 PAD patients who had been treated as an outpatient or an inpatient at the department of cardiology in a tertiary hospital in Seoul, Korea. Data were collected from October to December 2014, regarding general characteristics, disease related characteristics, illness perception and knowledge on PAD, health promoting behaviors by using a structured questionnaire. RESULTS: The number of subjects who had an awareness of PAD diagnosis was 70 (54.7%) among 128. In this study, knowledge on PAD was significantly correlated with health promoting behaviors (r=0.205, P=0.020). Especially, knowledge on PAD had a significant correlation with health responsibility (r=0.353, P<0.001) and exercise (r=0.230, P=0.009). In the regression analysis, knowledge on PAD was a factor that influences the health promoting behavior in this study subjects (R2=0.212, P=0.032). CONCLUSIONS: We could determine the degree of perception, knowledge, and health promoting behaviors among participants and the influence of PAD-related knowledge on health promoting behaviors. Conclusively, the results of this study support the development of education intervention to ameliorate disease perception and PAD related knowledge in order to improve health promoting behaviors among PAD patients.
Cardiology ; Diagnosis ; Education ; Health Behavior ; Humans ; Inpatients ; Korea ; Outpatients ; Peripheral Arterial Disease* ; Seoul ; Tertiary Care Centers

After diagnosis of peripheral artery disease in diabetic patients, revascularization can be considered in those who are not improved after guideline-directed medical therapy. Recently, more aggressive approaches with interventional treatment have been recommended. Before revascularization therapy, it is important to differentiate patients with claudication or critical limb ischemia, and the final goal and treatment modality of interventional treatments should be based on clinical diagnosis. For patients with claudication, the goal of revascularization is improvement of functional capacity or quality of life; however, in more severe forms of critical limb ischemia, the purpose of revascularization is limb salvage and ultimately saving patient's life. With improvement of vascular interventions, interventional treatment for peripheral artery disease is preferred, although surgical treatment might show better results than intervention in some cases.
Diabetes Mellitus ; Diagnosis ; Extremities ; Humans ; Ischemia ; Limb Salvage ; Peripheral Arterial Disease ; Quality of Life

Angiography has been playing important roles in diagnosis and treatment in the field of orthopaedic surgery. Conventional angiography is the most reliable and widely used method in diagnosis of peripheral arterial disease. But the clinical use of the conventional angiography has been limited by the risk of possible complications and time-consuming procedures. Radionuclide sngiography is rapidly performed, rapidly interpretable and time-saving procedure for the visualization of arterial tree prior to vascular intervention in the critically ill patient. We have analyzed and compared the 22 cases who had taken radionuclide angiography and conventional angiography simultaneously from November, 1986 to August, 1987 in Department of Orthopaedic Surgery, Hanysng University Hospital. The results were as follow 1. Radionuclide angiography is simple, non-invasive, accurste, reproducible method. It eliminstes the discomfort and morbidity of conventional angiography and can be done on an outpatient basis at a much lower cost. It is useful in the patients who may be allergic to the contrast medium. 2. In cases of arterial occlusion, radionuclide angiogrpahy is also useful in the evsluation of obstruction of major artery and can be substituted for conventionsl angiography. 3. For the purpose of evaluation of success in the cases of vascular reconstruction, radionuclide angiogrphy also demonstrate the vasculsr blood flow without any risk. 4. Although rsdionuclide angiography has limitstion in snatomic detsil, it could be psrtially substituted for conventionsl angiography in the diagnosis of vascular anomalies or tumors.
Angiography ; Arteries ; Critical Illness ; Diagnosis ; Humans ; Methods ; Outpatients ; Peripheral Arterial Disease ; Radionuclide Angiography ; Trees

PURPOSE: The aim of this study was to validate the diagnostic feasibility of a novel scoring system of peripheral arterial disease (PAD) in smokers and patients with diabetes depending on duplex Doppler sonographic features. METHODS: Patients presenting with the symptomatology of PAD were divided into three groups: diabetes only, smoking only, and smokers with diabetes. The patients were clinically examined, a clinical severity score was obtained, and the subjects were categorized into the three extrapolated categories of mild, moderate, and severe. All 106 subjects also underwent a thorough duplex Doppler examination, and various aspects of PAD were assessed and tabulated. These components were used to create a novel duplex Doppler scoring system. Depending on the scores obtained, each individual was categorized as having mild, moderate, or severe illness. The Cohen kappa value was used to assess interobserver agreement between the two scoring systems. RESULTS: Interobserver agreement between the traditional Rutherford clinical scoring system and the newly invented duplex Doppler scoring system showed a kappa value of 0.83, indicating significant agreement between the two scoring systems (P<0.001). CONCLUSION: Duplex Doppler imaging is an effective screening investigation for lower extremity arterial disease, as it not only helps in its diagnosis, but also in the staging and grading of the disease, providing information that can be utilized for future management and treatment planning.
Diagnosis ; Humans ; Lower Extremity* ; Mass Screening ; Peripheral Arterial Disease ; Smoke ; Smoking ; Ultrasonography ; Ultrasonography, Doppler, Duplex

BACKGROUND: The ankle brachial index (ABI) is a simple, inexpensive diagnostic test for peripheral arterial disease (PAD). However the diagnostic criterion of 0.9 has shown variable accuracy for identification of stenosis. We investigated more specific and sensitive diagnostic criterion of ABI for the diagnosis of PAD. METHODS: Among 5,379 patients who performed ABI test, 398 patients with abnormal ABI results or PAD symptoms underwent computed tomography angiography to confirm PAD. Each ABI results were compared with its sensitivity, specificity, positive and negative predictive values. ROC analysis and cross-tabulation analysis were performed to yield proper ABI criterion. RESULTS: ABI of 0.9 showed very high level of sensitivity (92.2%) and very low specificity(59.3%). ABI of 0.84 showed high level of specificity (81.4%), sensitivity (82.2%) and diagnostic correspondent rate (0.607). CONCLUSION: The ABI of 0.84 could be more accurate and useful diagnostic Criterion for identifying PAD.
Angiography ; Ankle Brachial Index* ; Ankle* ; Constriction, Pathologic ; Diagnosis ; Diagnostic Tests, Routine ; Humans ; Peripheral Arterial Disease* ; ROC Curve ; Sensitivity and Specificity

Diabetic foot is one of the most significant and serious complications of diabetes, and is defined as the foot of diabetic patients with ulceration, infection and/or destruction of the deep tissues, associated with neurological abnormalities and various degrees of peripheral vascular disease in the lower limb. The most significant risk factors for foot ulceration are diabetic neuropathy, peripheral arterial disease, and consequent traumas of the foot. Most diabetic ulcers can be prevented with good foot care and screening for risk factors for a foot at risk of complications. Active foot examination and foot care education are methods to prevent diabetic foot at a minimum cost. I will focus on the recommendations for diagnosis and treatment of diabetic foot.
Diabetic Foot* ; Diabetic Neuropathies ; Diagnosis* ; Education ; Foot ; Foot Ulcer ; Humans ; Lower Extremity ; Mass Screening ; Peripheral Arterial Disease ; Peripheral Vascular Diseases ; Risk Factors ; Ulcer

PURPOSE: Pseudoaneurysms after percutaneous vascular access are common and potentially fatal if left untreated. The aim of this study was to determine the incidence and risk factors associated with access site pseudoaneurysms after endovascular intervention for peripheral arterial disease (PAD) under a routine postintervention ultrasound (US) surveillance protocol. METHODS: A total of 254 PAD interventions were performed in a single center between January 2015 and November 2016, and puncture site duplex US surveillance was routinely performed within 48 hours of the procedure. Clinical, procedural and follow-up US data were analyzed. RESULTS: The overall incidence of pseudoaneurysm was 2.75% (6 cases in the femoral artery and 1 in the brachial artery). There was no difference between retrograde and antegrade approach, but there was a higher rate of pseudoaneurysm formation after manual compression compared to arterial closure device (ACD) use (4.3% vs. 0.87%). Manual compression was more commonly used for antegrade punctures (79.0%) and ACD for retrograde punctures (67.7%). Calcification was more frequently found in antegrade approach cases (46.8% vs. 16.9% for retrograde cases) and manual compression was preferred in its presence. All pseudoaneurysms were treated successfully at the time of diagnosis by US-guided compression repair and there were no cases of rupture. CONCLUSION: Pseudoaneurysm rates after therapeutic endovascular intervention for PAD were comparable to other cardiologic or interventional radiologic procedures despite the higher possibility of having a diseased access vessel. Routine US surveillance of access sites allowed for early diagnosis and noninvasive treatment of pseudoaneurysms, preventing potentially fatal complications.
Aneurysm, False ; Diagnosis ; Early Diagnosis ; Endovascular Procedures ; Femoral Artery ; Follow-Up Studies ; Incidence ; Peripheral Arterial Disease ; Punctures ; Risk Factors ; Rupture ; Ultrasonography ; Vascular Closure Devices

INTRODUCTION: Identifying peripheral arterial disease (PAD) during diabetic foot screening (DFS) is crucial in reducing the risk of diabetic foot ulcerations and lower limb amputations. Screening assessments commonly used include absolute systolic toe pressure (ASTP) and toe-brachial index (TBI). There is a lack of research defining the threshold values of both assessment methods. We aimed to compare the accuracy of ASTP and TBI and establish optimal threshold values of ASTP and TBI with reference to the internationally accepted ankle-brachial pressure index (ABPI) screening test, for a multiethnic diabetic population in Singapore. METHODS: A retrospective, observational study of DFS results from January 2017 to December 2017 was conducted. Receiver operating characteristic analysis was conducted for ASTP and TBI using the internationally accepted ABPI cut-off value of ≤0.9 to indicate PAD. RESULTS: A total of 1,454 patients with mean (standard deviation) age of 63.1 (12.4) years old were included. There were 50.8% men and 49.2% women, comprising 69.7% Chinese, 13.5% Indian, 10.1% Malay and 6.7% other ethnicities. Areas under the curve for ASTP and TBI were 0.89 (95% confidence interval [Cl] 0.85-0.94) and 0.94 (95% Cl 0.90-0.98), respectively, and the difference was statistically significant (P<0.001). Derived optimal threshold values to indicate ABPI≤0.9 for ASTP and TBI were <95.5mmHg (specificity 0.86, sensitivity 0.84) and <0.7 (specificity 0.89, sensitivity 0.95), respectively. CONCLUSION ASTP or TBI may be used to detect ABPI-determined PAD in DFS. The optimal threshold values derived from a multiethnic Asian diabetic population were <95.5mmHg for ASTP and <0.7 for TBI.
Ankle Brachial Index/methods* ; Diabetes Mellitus/epidemiology* ; Diabetic Foot/diagnosis* ; Female ; Humans ; Male ; Middle Aged ; Peripheral Arterial Disease/diagnosis* ; Retrospective Studies ; Toes