title: ﻿﻿﻿﻿﻿﻿﻿Measuring toe pressures using a portable photoplethysmograph to detect arterial disease in high-risk patients: an overview of the literature.
abstract: Lower extremity arterial disease (LEAD) is estimated to affect one third of individuals older than 65 years of age, occurs in younger individuals who use tobacco or have diabetes mellitus (DM), and often remains undiagnosed until a patient pres- ents with ischemia-related symptoms or complications. Valid and reliable noninvasive tests such as the ankle-brachial index (ABI) are recommended to detect LEAD. However, ABI results can be inconclusive or the index can be elevated (i.e., >1.3) in persons with calcified ankle arteries due to DM, renal failure, or arthritis. In these instances, obtaining toe pressure (TP) measurements, which correlate well with angiographic findings, is advised, providing the patient does not have vasoconstriction with cold toes or vasospastic disease. In such cases, TP can be obtained using a portable pho- toplethysmograph (PPG), which offers a simple and inexpensive method for healthcare providers in a variety of clinical settings to assess for the presence of LEAD. Portable PPG TP measurements have been found to have a high level of agreement with vascular laboratory PPG tests to detect LEAD, as well as good sensitivity and a high specificity. Adopting a TP measurement protocol of care to assess high-risk individuals such as patients with DM and elevated ABIs potentially can have a major impact on early identification of LEAD and reduce the risk of ischemia-related complications, including lower extremity wounds and amputations.
authors: Medical University of South Carolina, College of Nursing, Charleston, SC, USA. bonhamp@musc.edu
authors: Phyllis
authors: P
authors: Bonham
mesh_terms: D006801:Humans; D010991:Plethysmography / Q000295:instrumentation*; D011312:Pressure; D012307:Risk Factors; D014034:Toes; D014652:Vascular Diseases / Q000175:diagnosis*