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Is oscillometric ankle pressure reliable in leg vascular disease?
Linköping University, Department of Medicine and Care, Vascular surgery. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Biomedical Engineering. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Care, Vascular surgery. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
2001 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 21, no 2, 155-163 p.Article in journal (Refereed) Published
Abstract [en]

The objective of the study was to evaluate the validity of oscillometric systolic ankle pressure in symptomatic leg arterial occlusive disease. Ankle pressure measurements using oscillometric curves obtained using a standard 12-cm cuff with a specially designed device for signal processing were validated against the continuous wave (CW) Doppler technique. Thirty-four subjects without signs or symptoms of peripheral vascular disease (68 legs) and 47 patients with leg ischaemia (85 legs) varying from moderate claudication to critical ischaemia were examined. The oscillometric curves were analysed using several algorithms reported in the literature, based on the assumption that maximum oscillations are recorded near mean arterial pressure. In normals, reasonable agreement between CW Doppler and oscillometric methods was seen. When an algorithm that determined the lowest cuff pressure at which maximum oscillations occurred, and a characteristic ratio for systolic pressure of 0·52 was used, the mean difference between CW Doppler and oscillometry was 1·7 mmHg [range −19 to +27, limits of agreement (2 SD) 21·1 mmHg]. In ischaemic legs, oscillometry overestimated systolic ankle pressure by a mean of 28·8 mmHg [range –126 to +65, limits of agreement 82·8 mmHg]. The difference was more pronounced among patients with critical ischaemia compared with claudicants, and also more evident among diabetics. The error of oscillometric pressure determination in subjects with leg arterial disease inversely increased with CW Doppler ankle pressure. In 39% of the recordings in legs with a CW Doppler systolic pressure below 100 mmHg, the oscillometric mean arterial pressure was higher than the recorded CW Doppler systolic pressure. In conclusion, the oscillometric method to determine systolic ankle pressure, based on the concept of maximum cuff oscillations occurring near mean arterial pressure, is not reliable in leg arterial disease, usually overestimating ankle pressure.

Place, publisher, year, edition, pages
2001. Vol. 21, no 2, 155-163 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-26714DOI: 10.1046/j.1365-2281.2001.00314.xLocal ID: 11308OAI: oai:DiVA.org:liu-26714DiVA: diva2:247264
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
In thesis
1. On leg ischaemia: aspects of epidemiology and diagnostics
Open this publication in new window or tab >>On leg ischaemia: aspects of epidemiology and diagnostics
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The first part of this thesis consists of a population-based epidemiological study on symptomatic leg arterial disease in a Swedish community, based on a postal questionnaire and systolic ankle pressure measurements, with calculation of the ankle-brachial pressure index (ABPI; usually ≥ 1.0 in healthy subjects). The second part investigates alternative methods for ankle systolic pressure measurements, with the potential of automation.

(Papers I-III) A postal questionnaire on leg symptoms and concomitant diseases was distributed to all the inhabitants of Vadstena 50-89 years old (n=7,524). The response rate was 92% and of those reporting any leg pain, 80% (353/441) attended an examination with ABPI determination. Symptomatic leg ischaemia (SLI) was defined as leg pain on walking + ABPI ≤ 0.8. The prevalence was 4.1 %, increasing with age, with no major difference between men and women. Other manifestations of arteriosclerotic disease (previous angina pectoris, myocardial infarction or cerebrovascular incident), hypertension and diabetes mellitus were more prevalent among SLI cases than in healthy subjects. At a four-year follow-up, the age and sex adjusted mortality ratio was almost doubled in SLI subjects. Their relative risk of a myocardial infarction, cardiac death and death due to any cardiovascular event was 2.7, 2.0 and 1.9, respectively, compared to an age and sex matched control group. In SLI subjects without a previous history of ischaemic heart disease, the relative risk of a myocardial infarction was 3.1. Cardiovascular disease alone was mainly responsible for the increased risk of death. At a ten-year follow-up, a baseline ABPI up to 0.8 was inversely correlated with mortality. In a Cox regression model, a low ABPI was significantly and independently associated with an increased risk of death. An ABPI of 0.81-0.99 was not associated with an increased mortality risk. Over ten years, 1/7 of the SLI cases had a leg vascular reconstructive procedure, the majority within the first two years, and 1/14 underwent a major amputation. In conclusion, in spite of the good prognosis of the local disease, SLI can be looked upon as a marker for generalised arteriosclerotic disease and as a risk predictor for severe arteriosclerotic events and premature death.

(Papers IV-VI) Oscillometric technique, commonly used for automatic arm blood pressure measurements, was validated against the CW Doppler in systolic ankle pressure determination in healthy subjects and in patients with leg arterial disease. While performing adequately in healthy subjects, it was found to be invalid in leg arterial disease. The oscillometric technique was deemed as not suitable for use as an automatic ankle pressure recorder in the diagnosis ofleg arteriosclerotic disease.

A new technique, based on a two-channel photoplethysmographic (PPG) probe (880nm) placed underneath the pneumatic cuff, together with electronics, was developed and compared with both CW Doppler and intra-arterial recordings in subjects without vascular disease, and with the CW Doppler in leg arterial disease. On visual analysis of the PPG curves, the agreement was good. An automatic algorithm for analysis of PPG-data gave comparable results. The PPG method is a promising technique for future automation of systolic ankle pressure measurements, and for inclusion in a complete ABPI recorder.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2005. 81 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 884
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-30837 (URN)16490 (Local ID)91-7373-862-X (ISBN)16490 (Archive number)16490 (OAI)
Public defence
2005-03-04, Berzeliussalen, Universitetssjukhuset, Campus US, Linköpings Universitet, Linköping, 13:00 (Swedish)
Opponent
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2012-10-03Bibliographically approved

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Jönsson, BjörnLindberg, Lars-GöranSkau, TommyThulesius, Olav

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