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Evaluation of simple non-invasive techniques for assessment of lower extremity arterial disease
Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin.
Vise andre og tillknytning
2005 (svensk)Inngår i: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 25, nr 3, s. 129-134Artikkel i tidsskrift (Fagfellevurdert) Published
sted, utgiver, år, opplag, sider
2005. Vol. 25, nr 3, s. 129-134
Identifikatorer
URN: urn:nbn:se:umu:diva-16059DOI: 10.1111/j.1475-097X.2005.00597.xOAI: oai:DiVA.org:umu-16059DiVA, id: diva2:155732
Tilgjengelig fra: 2007-08-16 Laget: 2007-08-16 Sist oppdatert: 2018-06-09bibliografisk kontrollert
Inngår i avhandling
1. Early arterial disease of the lower extremities in diabetes: diagnostic evaluation and risk markers
Åpne denne publikasjonen i ny fane eller vindu >>Early arterial disease of the lower extremities in diabetes: diagnostic evaluation and risk markers
2009 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

The aim of the present thesis was to assess the occurrence of early lower extremity arterial disease (LEAD) in patients with diabetes and to assess novel potential risk markers for development or worsening of LEAD in the same patients. In parallel different measures of impaired peripheral circulation were evaluated.

The measurement of ankle-to- brachial blood pressure index (ABI) to screen for asymptomatic LEAD in diabetic subjects is unreliable since a large proportion of patients have stiff ankle arteries (mediasclerosis) and thus may display a too high ABI. We studied type 1-, type 2 diabetic and non-diabetic subjects without a previous history of LEAD and a composite variable of ankle – plus toe blood pressures and indices was compared to ABI alone in detecting LEAD. Significantly more subjects with reduced peripheral circulation were detected using the composite variable compared to ABI alone. This was particularly true in diabetic subjects, about 30% of whom had signs of impaired peripheral circulation. Thus, it was found that toe blood pressure measurements, alone or in combination with ankle blood pressure measurements, increase the sensitivity for finding early asymptomatic LEAD in diabetic subjects. No significant difference in reproducibility between measurements of absolute ankle- and toe blood pressure and indices was found, but a correlation between systemic (brachial) and toe blood pressure variations over time may suggest that indices are more correct in assessing peripheral arterial circulation.

Furthermore, toe blood pressure measurements can be performed using either the great toe or dig II and a strong concordance is found between these measurements. In addition, since the pole-test, another non-invasive method to measure peripheral blood pressure which is less sensitive to the presence of mediasclerosis compared to ABI, correlated significantly with toe blood pressure measurements this method may be used as an alternative screening method in subjects with previously known LEAD.

Age, hypertension and glycemic control are well known risk factors and, in addition, high tissue plasminogen activator (tPA) activity turned out to be a novel early marker for asymptomatic LEAD in diabetic subjects, particularly in patients with type 2 diabetes. Age and hyperglycemia are the most important risk factors for development and progression of subclinical lower extremity arterial disease in type 2 diabetic subjects. No independent associations between markers of inflammation, such as CRP, interleukin-6 and TNF-α and early asymptomatic LEAD were seen among non-diabetic or diabetic subjects.

In conclusion, impaired arterial circulation in the lower extremities is common in diabetic subjects even in the absence of symptoms. Including toe blood pressure measurement when screening for asymptomatic LEAD in diabetic subjects improves the ability to detect reduced peripheral circulation and this method avoids falsely elevated blood pressures readings due to mediasclerosis in the ankle arteries. Moreover, an altered fibrinolytic activity should be further evaluated as an early marker of atherosclerosis and LEAD.

sted, utgiver, år, opplag, sider
Umeå: Umeå university, 2009. s. 45
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1302
Emneord
diabetes mellitus, ankle blood pressure, toe blood pressure, screening, risk markers, mediasclerosis, macroangiopathy, fibrinolysis, inflammation
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-26711 (URN)978-91-7264-884-5 (ISBN)
Disputas
2009-11-13, Betula UnodL0, Umeå Universitet, Umeå, 09:00 (engelsk)
Opponent
Veileder
Tilgjengelig fra: 2009-10-26 Laget: 2009-10-22 Sist oppdatert: 2018-06-08bibliografisk kontrollert

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