title: An arterial pulse examination is not sufficient for diagnosis of peripheral arterial disease in lumbar spinal canal stenosis: a prospective multicenter study.
abstract: METHODS
  Prospective, multicenter study.
  
  
  OBJECTIVE
  To conduct peripheral arterial disease (PAD) screening on intermittent claudication (IC) in patients with lumbar spinal canal stenosis (LSCS) to examine the relationships among combined LSCS and PAD, symptoms, and physical findings.
  
  
  BACKGROUND
  IC occurs due to two underlying diseases, LSCS and PAD, and has an increasing prevalence with the aging of society. Reliable diagnosis of PAD is critical for appropriate conservative management of IC patients with LSCS in an Orthopedic Surgery Outpatient Department (OSOPD).
  
  
  METHODS
  PAD tests were prospectively conducted in 201 patients with IC and LSCS who initially visited an OSOPD at a hospital affiliated with the Nogoya Spine Group. Occurrence of PAD as a complication was assessed using ankle brachial pressure index (ABI) and toe brachial pressure index (TBI) tests. PAD was diagnosed in patients with ABI ≤ 0.9 or TBI ≤ 0.6, and the relationship of the occurrence of PAD with symptoms and physical findings such as abnormal arterial pulses was investigated.
  
  
  RESULTS
  Combined LSCS and PAD was found in 52 patients (26%), with 45 cases (22%) diagnosed on the basis of TBI test in patients with a normal ABI. Of the patients with PAD, many suffered from risk factors for PAD, with a significantly higher frequency of PAD in patients with hyperlipidemia (P < 0.05). PAD also occurred significantly more frequently in patients with abnormal pulses in the popliteal (P < 0.05), posterior tibial (P < 0.0001), and dorsal pedis (P < 0.0001) arteries; however, the sensitivity of these tests for PAD diagnosis was relatively low, at 34%, 60% and 68%, respectively.
  
  
  CONCLUSIONS
  The results of the prospective study define the rate of occurrence of combined LSCS and PAD using ABI and TBI tests for the first time, and the findings suggest that screening for PAD should be conducted in LSCS patients. ABI and TBI tests are necessary for PAD screening in outpatients, whereas observation of the arterial pulse in the lower extremities is necessary but not sufficient for PAD diagnosis.
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan. Imagama@med.nagoya-u.ac.jp
authors.forename: Shiro
authors.initials: S
authors.lastname: Imagama
authors.forename: Yukihiro
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authors.lastname: Matsuyama
authors.forename: Yoshihito
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authors.lastname: Sakai
authors.forename: Zenya
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authors.forename: Norimitsu
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authors.lastname: Wakao
authors.forename: Masao
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authors.lastname: Deguchi
authors.forename: Yudo
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authors.lastname: Hachiya
authors.forename: Yoshimitsu
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authors.lastname: Osawa
authors.forename: Hisatake
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authors.lastname: Yoshihara
authors.forename: Mitsuhiro
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authors.lastname: Kamiya
authors.forename: Tokumi
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authors.lastname: Kanemura
authors.forename: Fumihiko
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authors.lastname: Kato
authors.forename: Yasutsugu
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authors.lastname: Yukawa
authors.forename: Toru
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authors.lastname: Yoshida
authors.forename: Atsushi
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authors.lastname: Harada
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authors.forename: Kazuhiro
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authors.lastname: Matsubara
authors.forename: Manabu
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authors.lastname: Goto
authors.forename: Koji
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authors.lastname: Sato
authors.forename: Shigehiko
authors.initials: S
authors.lastname: Ito
authors.forename: Koji
authors.initials: K
authors.lastname: Maruyama
authors.forename: Makoto
authors.initials: M
authors.lastname: Yanase
authors.forename: Yoshihiro
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authors.lastname: Ishida
authors.forename: Naoto
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authors.forename: Takao
authors.initials: T
authors.lastname: Hasegawa
authors.forename: Naoki
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authors.lastname: Ishiguro
mesh_terms: D055109:Ankle Brachial Index; D001916:Brachial Artery / Q000503:physiopathology; D004358:Drug Therapy / Q000379:methods; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D008159:Lumbar Vertebrae; D019637:Orthopedic Procedures / Q000379:methods; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D011446:Prospective Studies; D011674:Pulse; D012307:Risk Factors; D013115:Spinal Canal / Q000473:pathology*; D013130:Spinal Stenosis / Q000503:physiopathology* / Q000628:therapy