A Doppler-based evaluation of peripheral lower limb arterial insufficiency in diabetes mellitus.
OBJECTIVE
To determine the frequency, level and flow patterns of lower limb arterial insufficiency in diabetic patients on Doppler ultrasound study.


METHODS
Cross-sectional study.


METHODS
Radiology Department, Civil Hospital, Karachi, from February 2007 to September 2008.


METHODS
One hundred adult diabetic patients with suspected peripheral vascular insufficiency irrespective of gender were included. Demographic data, presenting complaints, treatment history, and level of HbA1c were recorded. Doppler evaluated arterial status and ankle brachial index (ABI) were recorded on proforma. Statical analysis were done on SPSS version 12.


RESULTS
The mean HbA1c was 8.4+/-1.4 gm/dl, a majority of 77% having a controlled level of <10mg/dl. Arterial insufficiency on Doppler ultrasound was documented in 62% (p=0.016) and the dorsalis paedis artery was the predominant site of stenosis (24%). Spectral broadening and biphasic flow were salient features. The mean value of resistive index in stenotic cases was 0.563+/-0.16 with a mean velocity difference of 0.37+/-0.29 m/s (p<0.001) at the site of stenosis.


CONCLUSIONS
Peripheral vascular insufficiency was a significant finding in patients having diabetes for an average of 9.8 years, even in the presence of controlled HbA1c. The dorsalis paedis was the commonest site of involvement. The insufficiency was moderate with a biphasic flow pattern in a majority of cases. Difference in resistive index and flow velocities at and above the site of stenosis provided an important clue to the diagnosis of level of stenosis that helps in planning limb salvage management.
Department of Radiology, Dow University of Health Sciences and Civil Hospital, Karachi. docriffat@yahoo.com
Riffat
R
Shaheen
Saba
S
Sohail
D000368:Aged; D001158:Arteries / Q000473:pathology; D003251:Constriction, Pathologic; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging*; D018608:Ultrasonography, Doppler