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TBI or not TBI The Question for Vascular labs with Diabetic patients Liz Lawrence, RDMS, RDCS, RVT 1.

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Presentation on theme: "TBI or not TBI The Question for Vascular labs with Diabetic patients Liz Lawrence, RDMS, RDCS, RVT 1."— Presentation transcript:

1 TBI or not TBI The Question for Vascular labs with Diabetic patients Liz Lawrence, RDMS, RDCS, RVT 1

2 2 Diabet Med.Diabet Med Jul;18(7): TBI or not TBI: that is the question. Is it better to measure toe pressure than ankle pressure in diabetic patients? Brooks BBrooks B, Dean R, Patel S, Wu B, Molyneaux L, Yue DK.Dean RPatel SWu BMolyneaux LYue DK

3 REQUIREMENT IS BLOOD PRESSURE CUFF AND DOPPLER PROBE REQUIREMENT IS BLOOD PRESSURE CUFF AND DOPPLER PROBE ANKLE BRACHIAL INDEX 3

4 DIAGNOSTIC CRITERIA FOR ABI This is the typical chart for categorizing arterial disease based on the ankle brachial index. Note that ‘normal’ is a value greater than.95 4 Table 1. Interpretation Of Ankle-Brachial Pressure Index (ABI) Worksheet Clinical PresentationAnkle-Brachial Index Normal> 0.95 Claudication Rest pain Tissue loss< 0.21

5 DIABETIC ARTERIES ABI VALUES > Media calcifications

6 P P G Photo - Pleths - moGraphy 6

7 Blood Pressure of the Toe is an alternative to ABI Expensive Physiological Testing Equipment New Affordable TBI equipment 7

8 Diagnostic Criteria for TBI Range Interpretation >0.7 Normal Mild Moderate <0.35 toe pressure 40 mmHg Moderate-Severe <0.35 toe pressure < 30 mmHg Severe 8 Toe Brachial Index for reliable data From the Mayo Clinic Vascular Lab

9 TBI or not TBI: that is the question. Is it better to measure toe pressure than ankle pressure in diabetic patients? 9 ARTICLE REVIEWED

10 ….agreement between the tests (ABI vs TBI) when ABI is low or normal ABITBI >.7.50 –

11 Patients with ABI > 1.3 have ABI-TBI differences outside this range Patients with ABI > 1.3 have ABI-TBI differences outside this range ABITBI >

12 Conclusion assessment of TBI conveys no advantage over ABI ABI > or = 1.3, are toe pressure measurements superior. In the majority of patients with diabetes, assessment of TBI conveys no advantage over ABI in determining perfusion pressure of the lower limbs. Only in those patients with overt calcification, which gives an ABI > or = 1.3, are toe pressure measurements superior. 12

13 Diabetes is the dominant risk factor for a high (> or =1.40) ABI. Occlusive PAD is highly prevalent in subjects with high ABI, and these subjects should be considered as PAD-equivalent. 13 The association between elevated ankle systolic pressures and peripheral occlusive arterial disease in diabetic and nondiabetic subjects. J Vasc Surg.J Vasc Surg Nov;48(5): Aboyans VAboyans V, Ho E, Denenberg JO,Ho EDenenberg JO Ho LAHo LA, Natarajan L, Criqui MH.Natarajan LCriqui MH

14 Use and utility of ankle brachial index in patients with diabetes. Potier LPotier L, Abi Khalil C, Mohammedi K, Roussel R.Abi Khalil CMohammedi KRoussel R 14 Eur J Vasc Endovasc Surg.Eur J Vasc Endovasc Surg Jan;41(1): ….Therefore, ABI thresholds of less than 0.9 and more than 1.3 are highly suspicious for PAD and high CV risk in diabetic patients.

15 CONSIDERATIONS TBI is most reliable for monitoring patients with Diabetes If TBI is not available, any patient with increased ABI > 1.3 should be suspected of having PAD Duplex Arterial Scanning can help with identifying PAD in Diabetics with increased ABI 15


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