Prevalence of peripheral arterial disease using plethysmographic ankle‑brachial index and correlation with carotid intima‑media thickness among diabetics at the University of Benin Teaching Hospital

Main Article Content

Matthew Cedric Agbede
Adanike O. Akhigbe
O. Festus Ehigiamusoe
A. Eregie
A. E. Edo

Abstract

Background: Diabetes mellitus is an important risk factor for the development of atherosclerosis which leads to macrovascular and cardiovascular complications such as peripheral arterial disease (PAD). PAD has been associated with an increased risk of lower limb amputation, morbidity, and mortality from major cardiovascular events such as stroke and myocardial infarction.


Materials and Methods: This was a prospective cross‑sectional descriptive study which involved the use of an automated ankle‑brachial index (ABI) assessment known as plethysmography to determine the prevalence of PAD and to analyze the pulse volume waveform (PVW) among 100 people living with diabetes. The ABI values were correlated with the subject’s common carotid artery intima‑media thickness(CCA‑IMT). Collated data were analyzed using the Statistical Package for the Social Sciences version 20.0. Statistical tests were considered significant at P < 0.05 and 95% confidence interval.


Results: Twenty‑three (23%) had ABI of ≤ 0.9 indicating PAD, while 75 (75%) had normal ABI indicating those without the disease. The presence of PAD correlated significantly with abnormal PVW pattern (P = 0.0001). The mean CCA‑IMT from this study was 1.01 ± 0.28 mm. A statistically significant correlation was found between the PAD, mean CCA‑IMT and right CCA‑IMT (P = 0.017, r = 0.238 and P = 0.003, r = 0.290). 


Conclusion: The prevalence of PAD in type 2 diabetic was found to be 23% in this study; in addition, a significant correlation of PAD with CCA‑IMT and other risk factors for diabetes was also found. Hence, screening for PAD should be done in all diabetic patients to detect this complication early. 

Downloads

Download data is not yet available.

Article Details

Section

Original Article

How to Cite

Agbede, M., Akhigbe, A., Ehigiamusoe, O. F., Eregie, A., & Edo, A. E. (2025). Prevalence of peripheral arterial disease using plethysmographic ankle‑brachial index and correlation with carotid intima‑media thickness among diabetics at the University of Benin Teaching Hospital. West African Journal of Radiology, 31(2), 15-24. https://doi.org/10.60787/wajr.vol31no1.95

References

1. WHO. Definition, Diagnosis and Classification of Diabetes Mellitus and Iuhts Complication, part 1, Geneva: WHO; 1999. Available from: https://whqlibdoc.who.int/hq/1999/WHO_NCD_NCS_99.2.pdf. [Last accessed on 2019 Aug 08].

2. WHO Fact Sheet; 2018. Available from: https://www.who.int/News/Factsheets. [Last accessed on 2019 Aug 08].

3. International Diabetes Federation. Diabetes Atlas. 8th ed. Brussels: International Diabetes Federation; 2017. Available from: https://diabe4tesatlas.org/resources/2017-atlas.html. [Last accessed on 2019 Aug 08].

4. IDF Diabetes Atlas. 6th ed. Belgium: International Diabetes Federation; 2013. Available from: https://www.idf.org/diabetesatlas. [Last accessed on 2018 Apr 17].

5. Dieter RS, Chu WW, Pacanowski JP Jr., McBride PE, Tanke TE. The significance of lower extremity peripheral arterial disease. Clin Cardiol 2002;25:3‑10.

6. Federman DG, Trent JT, Froelich CW, Demirovic J, Kirsner RS. Epidemiology of peripheral vascular disease: A predictor of systemic vascular disease. Ostomy Wound Manage 1998;44:58‑62, 64, 66 passim.

7. Hirsch AT, Criqui MH, Treat‑Jacobson D, Regensteiner JG, Creager MA, Olin JW, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA 2001;286:1317‑24.

8. White CJ. Atherosclerotic peripheral arterial disease In: Goldman L, Goldman SA. Cecil Medicine. 25th ed., Vol. 1. Philadelphia: Elsevier Saunders; 2016. p. 497‑503.

9. American Diabetes Association. Standards of medical care in diabetes. Diabet Care 2015;38:51‑94.

10. Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, et al. Recommended standards for reports dealing with lower extremity ischemia: Revised version. J Vasc Surg 1997;26:517‑38.

11. Fontaine R, Kim M, Kieny R. Surgical treatment of peripheral circulation disorders. Helv Chir Acta 1954;21:499‑533.

12. Lundberg C, Hansen T, Ahlström H, Lind L, Wikström J, Johansson L. The relationship between carotid intima‑media thickness and global

atherosclerosis. Clin Physiol Funct Imaging 2014;34:457‑62.

13. Kablak‑Ziembicka A, Tracz W, Przewlocki T, Pieniazek P, Sokolowski A, Konieczynska M. Association of increased carotid intima‑media thickness with the extent of coronary artery disease. Heart 2004;90:1286‑90.

14. Bots ML, Hofman A, Grobbee DE. Common carotid intima‑media thickness and lower extremity arterial atherosclerosis. The Rotterdam

study. Arterioscler Thromb 1994;14:1885‑91.

15. Dasgupth A, Mazumdar A. Peripheral arterial disease in the lower extremities prevalence and epidemiology. EJ Cardiol Pract 2018;15:4‑14.

16. Tyagi V, Gupta A Bansal N, Virmani SK. Prevalence of peripheral arterial disease in diabetes mellitus. Int J Res Med Sci 2017;5:4881‑5.

17. Criqui MH, Aboyans V. Epidemiology of peripheral artery disease. Circ Res 2015;116:1509‑26.

18. Iana S. Intima‑media thickness: Appropriate evaluation and proper measurement, described. E J ESC Counc Cardiol Pract 2015;13:1.

19. Nicolaï SP, Kruidenier LM, Rouwet EV, Bartelink ML, Prins MH, Teijink JA. Ankle brachial index measurement in primary care: Are we doing it right? Br J Gen Pract 2009;59:422‑7.

20. DaviesJH, Kenkre J, Williams EM. Current utility of the ankle‑brachial index (ABI) in general practice: Implications for its use in cardiovascular

disease screening. BMC Fam Pract 2014;15:69.

21. Mohler ER 3rd, Treat‑Jacobson D, Reilly MP, Cunningham KE, Miani M, Criqui MH, et al. Utility and barriers to performance of the ankle‑brachial index in primary care practice. Vasc Med 2004;9:253‑60.

22. Verberk WJ, Kollias A, Stergiou GS. Automated oscillometric determination of the ankle‑brachial index: A systematic review and meta‑analysis. Hypertens Res 2012;35:883‑91.

23. Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, et al. Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013;127:1425‑43.

24. Araoye MO. Research Methodology with Statistics for Health and Social Sciences. 1st ed. Ilorin: Nathadex Publishers; 2004. p. 116‑25.

25. Buse JB, Polonsky KS, Burant CF. Type 2 diabetes mellitus. In: Kronenberg HM, Polonsky KS, Larsen RP, editors. Williams Textbook of Endocrinology. 11th ed. Canada, Ottawa: Saunder Elsevier; 2008. p. 1329‑90.

26. WHO/Europe. Nutrition‑Body Mass Index‑BMI. Available from: https://www.euro.who.int/en/health-topics/disease-prevention/body-mass-index-bmi.pdf.AQ13

27. Arger PH, Iyoob SD. Peripheral arterial system. In: The Complete Guide to Vascular Ultrasound. 1st ed. Philadelphia, USA: Lippincott and Williams; 2004. p. 26‑44.

28. LewisJE, Williams P, DaviesJH. Non‑invasive assessment of peripheral arterial disease: Automated ankle brachial index measurement and pulse volume analysis compared to duplex scan. SAGE Open Med 2016;4:2050312116659088.

29. Soyoye DO, Ikem RT, Kolawole BA, Oluwadiya KS, Bolarinwa RA, Adebayo OJ. Prevalence and correlates of peripheral arterial disease in Nigerians with type 2 diabetes. Adv Med 2016;2016:3529419.

30. Rasheed J, Naz J, Akram Z. Prevalence of peripheral arterial disease (PAD) in type II diabetics and its association with various risk factors. PJMHS 2018;12:368‑70.

31. Umuerri EM, ObasohanAO. Lower extremity peripheral artery disease: Prevalence and risk factors among adult Nigerians with diabetes mellitus. West Afr J Med 2013;32:200‑5.

32. Arora E, Maiya AG, Devasia T, Bhat R, Kamath G. Prevalence of peripheral arterial disease among type 2 diabetes mellitus in coastal Karnataka. Diabetes Metab Syndr 2019;13:1251‑3.

33. Kota SK, Mahapatra GB, Kota SK, Naveed S, Tripathy PR, Jammula S, et al. Carotid intima media thickness in type 2 diabetes mellitus with

ischemic stroke. Indian J Endocrinol Metab 2013;17:716‑22.

34. Kumar A, Kumar A, Kumar H, Jha HK, Nayaks, Roy C. Prevalence of peripheral arterial disease and associated risk factors among type 2 diabetes mellitus patients attending diabetic health camp. Int J Med Res 2018;3:90‑2.

35. OgberaAO, AdeleyeO, SolagberuB, AzenaborA. Screening for peripheral neuropathy and peripheral arterial disease in persons with diabetes mellitus in a Nigerian University Teaching Hospital. BMC Res Notes 2015;8:533.

Similar Articles

You may also start an advanced similarity search for this article.