Use of the toe brachial index to detect lower extremity arterial disease in diabetics

Česká verzia

Authors: O. Machaczka ^1,2,3; M. Homza ⁴; P. Macounová ²; M. Kovalová ²; J. Janoutová ^1,3; V. Janout ¹
Authors place of work: Univerzita Palackého v Olomouci, Fakulta zdravotnických věd, Centrum vědy a výzkumu, Ředitel: prof. MUDr. Vladimír Janout, CSc. ¹; Ostravská univerzita v Ostravě, Lékařská fakulta, Ústav epidemiologie a ochrany veřejného zdraví, Vedoucí: doc. MUDr. Rastislav Maďar, PhD., MBA, FRCPS. ²; Univerzita Palackého v Olomouci, Fakulta zdravotnických věd, Ústav zdravotnického managementu, Přednostka: doc. MUDr. Jana Janoutová, Ph. D. ³; Ostravská univerzita v Ostravě, Lékařská fakulta, Katedra interních oborů, Vedoucí: MUDr. Ivo Valkovský, Ph. D. ⁴
Published in the journal: Prakt. Lék. 2020; 100(6): 270-275
Category: Reviews

Summary

The toe brachial index (TBI) is used for the detection of lower extremity arterial disease in the case of reduced effectiveness of the ankle brachial index (ABI). This is most common in diabetics due to arterial calcification. It is assumed that the arteries on the toe are less stressed by calcification and thus TBI can give more accurate results.

The aim of this work is to provide a brief overview of current knowledge about TBI and its use to detect lower extremity arterial disease in diabetics in comparison with ABI.

For the purposes of this work, a search of information and current scientific knowledge focused on the use of TBI in the detection of lower extremity arterial disease in diabetics was performed.

In contrast to well-defined ABI limits, the diagnostic criteria for a normal TBI value remain ambiguous. According to international guidelines, a value of 0.7 is recommended. Studies show that the arteries on the toe are less stressed by calcification, allowing TBI to give more accurate results than ABI. According to some studies, this can only happen when the ABI is > 1.3, which indicates obvious arterial calcification. However, calcification is common among diabetics even with an ABI value < 1.3. In general, studies on the validity of TBI in diabetics differ in their results as well as in their validity. The difference in results can be due, to the use of different methods and procedures, an ambiguous criterion value and a greater susceptibility of the measurement to ambient temperature fluctuations. However, according to the latest international guidelines, the TBI method is recommended in diabetics on the basis of high evidence of identification. Thus, TBI appears to be an equivalent alternative to ABI, which can be used in diabetics not only to supplement the examination, but also on its own.

Keywords:

toe brachial index – diabetes mellitus – lower extremity arterial disease

Zdroje

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