BMJ  2006;333:602 (16 September), doi:10.1136/bmj.333.7568.602

Letter

Preventing and detecting early vascular effects of diabetes

Word of caution on peripheral arterial assessment

The first 150 words of the full text of this article appear below.

EDITOR—Marshall and Flyvbjerg's clinical review gives contradictory information about measuring the ankle-brachial pressure ratio in diabetic patients, as well as portraying an unrealistic picture of the assessment of peripheral arterial disease in them.1

Firstly, 10-15% of diabetic patients may have a falsely raised ankle-brachial pressure ratio because early calcification of the tunica media renders the arteries incompressible.2 This should not be solely relied on as an objective assessment criterion. The pole test is more accurate.3 The arteries of the foot and toes are comparatively spared in diabetes. Therefore other tests—such as the toe pressure index, analysis of Doppler wave form, pulse volume analysis, and transcutaneous oxygen measurements—are far better but can rarely be done outside specialist clinics.

Secondly, for practical reasons the ankle-brachial pressure ratio should be measured at the peroneal (fibular) artery rather than the posterior tibial artery or dorsalis pedis, as mentioned in the clinical review. . . . [Full text of this article]

Saurabh Rai, vascular research fellow

University of Birmingham NHS Trust, Selly Oak, Birmingham B29 6JD saurabh_rai@hotmail.com


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Relevant Article

Prevention and early detection of vascular complications of diabetes
Sally M Marshall and Allan Flyvbjerg
BMJ 2006 333: 475-480. [Extract] [Full Text] [PDF]

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