Key result
In a systematic review of 1,671 patients, diagnostic methods like NIRS, TcpO2, CEUS, and scintigraphy showed distinct advantages over ankle and toe-pressure for measuring peripheral blood flow.
Why the study?
Systolic ankle and toe pressure measurements in patients with combined T2DM and PAD face obstacles due to vascular changes, prompting a review of exercise blood flow methods to diagnose arterial insufficiency.
Do advanced diagnostic methods (NIRS, TcpO2, CEUS, scintigraphy) improve the measurement of peripheral blood flow during exercise compared to standard pressure measurement in patients with T2DM and PAD?
Systematic Review (n=1,671)
Do advanced diagnostic methods (NIRS, TcpO2, CEUS, scintigraphy) improve the measurement of peripheral blood flow during exercise compared to standard pressure measurement in patients with T2DM and PAD?
Advanced diagnostic methods like NIRS, TcpO2, CEUS, and scintigraphy offer distinct advantages over standard ankle and toe pressure for measuring peripheral blood flow and grading arterial insufficiency in patients with combined T2DM and PAD.
Advanced perfusion assessment may refine PAD grading in T2DM beyond pressure indices; extends diagnostic evidence and warrants outcome trials before routine adoption.
INTRODUCTION: Measurement of systolic ankle and to some extent toe pressure in patients suffering from combined type 2 diabetes mellitus (T2DM) and peripheral arterial disease (PAD) face several obstacles due to complex changes in the vascular bed. The aim of this review was to address the current literature on blood flow during exercise in patients with PAD and T2DM and assess the feasibility of these methods to diagnose and grade arterial insufficiency. EVIDENCE ACQUISITION: A systematic review of the PubMed and EMBASE databases, supplemented by hand searching was performed according to PRISMA guidelines. Clinical studies evaluating methods to investigate peripheral blood flow in patients with PAD and T2DM during exercise were included. EVIDENCE SYNTHESIS: In total nine eligible studies consisting of 1105 non-diabetic PAD patients, 336 diabetic PAD patients, 161 diabetic patients without PAD and 69 healthy controls were included in the review. Near-infrared spectroscopy (NIRS) was described in three studies, transcutaneous oxygen pressure measurement (TcpO2) in two and the following methods described in single studies: thermodilution, contrast enhanced ultrasound (CEUS), scintigraphy and TcpO2 in combination with ultrasound. These studies shows that patients with PAD and T2DM compared with patients with only PAD suffers different atherosclerotic lesions characterised by increased arterial stiffness and microcirculation abnormalities, not well differentiated by pressure measurement alone. Investigating patients with PAD and T2DM during exercise reveals that NIRS, TcpO2, CEUS, and scintigraphy have distinct advantages over ankle and toe-pressure. CONCLUSIONS: Using methods like NIRS, TcpO2, CEUS and scintigraphy, peripheral blood flow during exercise can be measured at a detailed level and potentially improve future severity grading in patients with combined T2DM and PAD.
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Eiken et al. (2019) conducted a systematic review in Type 2 diabetes mellitus and peripheral arterial disease (n=1,671). Diagnostic methods (NIRS, TcpO2, CEUS, scintigraphy) vs. Ankle and toe-pressure was evaluated on Feasibility to diagnose and grade arterial insufficiency. In a systematic review of 1,671 patients, diagnostic methods like NIRS, TcpO2, CEUS, and scintigraphy showed distinct advantages over ankle and toe-pressure for measuring peripheral blood flow.
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