Current Insights On ABI And Diagnosing PAD

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Michael DeBrule, DPM

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Dr. Praveen Nayaksays: September 3, 2013 at 1:50 am

I would like to congratulate the author on the good work and update on ABI.
It was enlightening.

What happens in a low flow (where ABI should be low) and associated with calcified vessel (where ABI would be falsely high)? In such a combination, the ABI may show in normal range. Since most of diabetics have calcified vessels, this combination is likely.
What do we do?

Dr. Praveen Nayak
MBBS, MS (Gen Surg), PGDC in Diabetic foot care
Consultant Diabetic foot care specialist
Department of Podiatric Surgery
KMC Mangalore

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Desmond Bell, DPMsays: June 26, 2014 at 8:06 am

Hello Dr. Nayak,
The point you raise is the very reason why I do not rely on ABI as a diagnostic tool versus a cursory screening tool.
I have seen too many instances in my practice where patients revealing "normal" ABIs had, in reality, significant to severe PAD when referred for further testing.

In my opinion, if significant PAD is a concern (as a contributing factor for non-healing of a wound or in a clinically worrisome patient at risk for amputation), I would refer to a vascular specialist (interventionist or surgical) and/or order more diagnostic non-invasive studies, such as pulse volume recordings with segmental waveforms for starters. Skin perfusion pressures would also be clinically superior to an ABI in such a case.

Kind regards,
Desmond Bell, DPM
First Coast Cardiovascular Institute, PA
Jacksonville, FL 32216

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Edward M, M.D.says: September 15, 2013 at 4:56 pm

Very well done article.

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