[Ease of use, feasibility and performance of ankle arm index measurement in patients with chronic leg ulcers. Study of 100 consecutive patients].
International guidelines on leg ulcers recommend measuring the ankle arm index (AAI) to diagnose and assess peripheral arterial occlusive disease (PAOD) of the lower limbs. These guidelines do not, however, describe the method which should be used to make the measurement: which artery should be measured -in the event of an open leg ulcer, what are the practical difficulties for positioning the cuff- how well do patients tolerate the procedure? We conducted a prospective study focusing on ease of use, tolerance and performance of AAI measurements in patients with leg ulcers. In compliance with recent French guidelines, we measured the AAI for both distal leg arteries and retained the lowest value for analysis. Within a six-month study period, 100 consecutive inpatients with leg ulcers of various etiologies were studied. Mean age was 75, female predominance 60%, body mass index 27. Etiologies of leg ulcers were pure venous (29%), mixed venous predominant (17%), pure arterial (9%), mixed arterial predominant (8%), mixed (6%), hypertensive ulcers (11%), rare cause (8%), multifactorial (12%). Pain was present in 92%, with a VAS above 3 for 73%. Measurement of AAI was possible in 98% of patients. It was too painful and thus considered unethical for two patients with hypertensive ulcers. For the 98 patients measured, the ulcer had to be protected during the measurement in 76%. The measurement procedure only took five minutes for one leg, and was judged easy to perform by 93% of the operators. For the majority (76%) of patients, the measurement was not painful. We determined the diagnostic performance of AAI by comparing the results with those of arterial ultrasound in 90 patients who had a complete arterial ultrasound exploration of the legs. Compared with arterial ultrasound, the sensitivity of AAI<0.9 for detecting the presence of PAOD was 84.7%, with 97% specificity. PAOD was not diagnosed in any patient who had two palpable distal pulses and a normal AAI. Measurement of AAI in patients with leg ulcers is an easy to use, well-tolerated, high-performance tool for the assessment of PAOD.
Lazareth
I
I
Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France. ic.lazareth@wanadoo.fr
Taieb
J C
JC
Michon-Pasturel
U
U
Priollet
P
P
D000842:Ankle / Q000033:anatomy & histology*; D055109:Ankle Brachial Index; D001132:Arm / Q000033:anatomy & histology*; D015992:Body Mass Index; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D007871:Leg Ulcer / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D017410:Practice Guidelines as Topic; D012680:Sensitivity and Specificity; D014463:Ultrasonography