Calcification of digital arteries and impact on current PAD guidelines
Research type
Research Study
Full title
Limitations of the TBI in the identification of PAD due to the occurrence of digital arterial calcification.
IRAS ID
117521
Contact name
Jane Lewis
Contact email
Research summary
Current NICE guidelines for the diagnosis and treatment pathways of Peripheral Arterial Disease (PAD), together with the Inter-Society Consensus for the Management of PAD, suggest that when a patient presents with an Ankle Brachial Pressure Index of above 1.3 a Toe Brachial Index (TBI) should be performed.
The rationale behind performing a TBI is that where the larger more proximal arteries can become calcified, the arteries in the low digits are unlikely to be affected, and will therefore give a better indication of the arterial status of the lower limb and foot and potential of Peripheral Arterial Disease.Supplementary observations made of plain film x-rays of Podiatry patients suspected of having digital or forefoot osteomyelitis, highlighted a proportion presenting with calcification of low digit arteries. The presence of low digital calcification would decrease the sensitivity of TBI as these arteries would be incompressible and skew the results potentially reporting a patient as not having PAD when the opposite could be true.
This retrospective study would formalize these observations; report on the diagnostic evaluations for PAD undertaken within the Podiatric department of Cardiff and Vale University Health Board and highlight limitations of current practices in primary care. The plain film x rays and Podiatric records of 194 patients will be reviewed within the Podiatry Department. No direct patient participation will be required. The study is expected to be completed by July 2014.
REC name
South Central - Oxford A Research Ethics Committee
REC reference
13/SC/0607
Date of REC Opinion
19 Nov 2013
REC opinion
Favourable Opinion