title: What Is the Clinical Utility of the Ankle-Brachial Index in Patients With Diabetic Foot Ulcers and Radiographic Arterial Calcification?
abstract: The purpose of this study was to analyze the influence of radiographic arterial calcification (RAC) on the clinical interpretation of ankle-brachial index (ABI) values in patients with diabetic foot ulcers. We analyzed a retrospective clinical database of 60 patients with diabetic foot ulcers from the Diabetic Foot Unit (Complutense University, Madrid, Spain) between January 2012 and March 2014. For each patient, anteroposterior XR-plains were evaluated, and the ABI and toe-brachial index (TBI) were assessed by an experienced clinician. To analyze the correlation among quantitative variables, we applied the Pearson correlation coefficient. Fifty percent (n = 9/18) of our patients with a normal ABI and RAC had a TBI < 0.7 associated with peripheral arterial disease (PAD). In patients with RAC, the prevalence of a normal ABI (72%, 18/25) was higher than in patients without RAC (52%, 11/21). The Pearson correlation coefficient among the ABI and TBI in patients with an ABI < 1.4 (n = 46) was lesser (r = .484, P = .001) than in patients with an ABI < 1.4 but without RAC (n = 21; r = .686, P = .001). ABI values between 0.9 and 1.4 would be falsely considered as normal and could underestimate the prevalence of PAD, especially in patients with neuropathy, diabetic foot ulcers, or RAC.
authors.affiliation: Complutense University Clinic, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain fraalv@hotmail.com.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Álvaro-Afonso
authors.affiliation: Complutense University Clinic, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Lázaro-Martínez
authors.affiliation: La Paloma Hospital, Las Palmas de Gran Canaria, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Aragón-Sánchez
authors.affiliation: Complutense University Clinic, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: García-Morales
authors.affiliation: Complutense University Clinic, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: García-Álvarez
authors.affiliation: Complutense University Clinic, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Raúl Juan
authors.initials: RJ
authors.lastname: Molines-Barroso
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D017719:Diabetic Foot / Q000150:complications* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D058729:Peripheral Arterial Disease / Q000150:complications* / Q000000981:diagnostic imaging*; D011859:Radiography; D012189:Retrospective Studies; D061205:Vascular Calcification / Q000150:complications* / Q000000981:diagnostic imaging*
keywords: ankle-brachial index; diabetic foot; radiographic arterial calcification; radiography; toe-brachial index