Birinci basamak sağlık hizmetinde ayak bileği brakial indeks ölçümü: Basit, ucuz ama çok değerli bir yöntem

Abstract

Amaç: Periferik arter hastalığı (PAH) dünyada 30 milyondan fazla insanı etkileyen bir hastalıktır. Ayak Bileği Brakiyal İndeksi (ABI), PAH'ı saptamak için basit bir yöntemdir. Hastalar PAH öntanısı ile vasküler cerrahi bölümüne yönlendirilir, ancak çoğunda teşhis doğrulanamamaktadır. Bu çalışmanın amacı, birinci basamak sağlık hizmetlerinde ABI ölçümünün önemini belirlemektir.

Gereç ve Yöntemler: Aralık 2017 – Kasım 2018 tarihlerinde 108 hasta birinci basamak sağlık biriminden bölümümüze yönlendirildi. Tüm hastalar risk faktörleri, ABI ve gerçek tanı ile ilgili olarak retrospektif analiz edildi.

Bulgular: 24 hastada (% 22,22) PAH tanısı doğrulanmıştır. PAH ve PAH olmayan hastalardaki ortalama ABI sırasıyla 0,545±0,193 ve 0,996±0,093 idi.

Sonuç: Birinci basamak sağlık hizmetlerinde ABI ölçümünün kullanılması, PAH'ın yanlış teşhisini ve bununla ilgili zaman kaybını ve ek maliyetleri önleyecektir.

Keywords

• Ayak bileği brakial indeksi,birinci basamak sağlık hizmeti,periferik arter hastalığı

Ankle brachial index measurement in first-line health care: A simple and inexpensive but very valuable method

Abstract

Aim: Peripheral arterial disease (PAD) affects more than 30 million people in the World. Ankle Brachial Index (ABI) is a simple method to detect PAD. Patients are referred to vascular surgery department with prediagnosis of PAD, but many of them are mis-diagnosed. The aim of this study was to determine the importance of ABI in first-line health care. Material and Methods: From December 2017 – November 2018;  108 patients were referred from first-line health care units to our department. Patients were analyzed retrospectively regarding risk factors, ABI and real diagnosis.

Results: 24 patients (22,22%) were diagnosed PAD. Mean ABI in PAD and non-PAD patients was 0.545±0.193 and 0.996±0.093, respectively.

Conclusion: The  use of ABI measurement in first-line health care could avoid the mis-diagnosis of PAD and related loss of time and additional costs. 

Keywords

• Ankle brachial index,first-line health care,peripheral arterial disease

References

1. 1. Welten GM, Schouten O, Chonchol M, Hoeks SE, Bax JJ, Van Domburg RT, Poldermans D. Prognosis of patients with peripheral arterial disease. J Cardiovasc Surg (Torino). 2009; 50: 109-21.
2. 2. Shammas NW. Epidemiology, classification, and modifiable risk factors of peripheral arterial disease. Vasc Health Risk Manag. 2007; 3: 229-34.
3. 3. Nastasi DR, Smith JR, Moxon JV, Trollope A, Golledge J. Prescription of Pharmacotherapy and the Incidence of Stroke in Patients With Symptoms of Peripheral Artery Disease. Stroke. 2018; 49: 2953-60
4. 4. Gardner AW, Afaq A. Management of lower extremity peripheral arterial disease. J Cardiopulm Rehabil Prev 2008; 28: 349-57.
5. 5. Fowkes FG, Murray GD, Butcher I et al. Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. JAMA. 2008; 300: 197-208.
6. 6. Królczyk J, Piotrowicz K, Chudek J. Clinical examination of peripheral arterial disease and ankle-brachial index in a nationwide cohort of older subjects: practical implications. Aging Clin Exp Res Dec 2018.
7. 7. Ramos R, Quesada M, Solanas P. Prevalence of symptomatic and asymptomatic peripheral arterial disease and the value of the ankle-brachial index to stratify cardiovascular risk. Eur J Vasc Endovasc Surg 2009; 38: 305-11.
8. 8. Suominen V, Rantanen T, Venermo M, Saarinen J, Salenius J. Prevalence and risk factors of PAD among patients with elevated ABI. Eur J Vasc Endovasc Surg 2008; 35: 709-14.

9. 9. Poredos P, Jug B. The prevalence of peripheral arterial disease in high risk subjects and coronary or cerebrovascular patients. Angiology 2007; 58: 309-15.
10. 10. Ostchega Y, Paulose-Ram R, Dillon CF, Gu Q, Hughes JP. Prevalence of peripheral arterial disease and risk factors in persons aged 60 and older: data from the National Health and Nutrition Examination Survey 1999-2004. J Am Geriatr Soc 2007; 55: 583-89.
11. 11. Menke A, Muntner P, Wildman RP, Dreisbach AW, Raggi P. Relation of borderline peripheral arterial disease to cardiovascular disease risk. Am J Cardiol 2006; 98: 1226-30.
12. 12. Kamalesh M, Shen J. Diabetes and peripheral arterial disease in men: trends in prevalence, mortality, and effect of concomitant coronary disease. Clin Cardiol. 2009; 32: 442-46.
13. 13. Selvin E, Erlinger TP. Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999-2000. Circulation 2004; 110: 738-43.
14. 14. Carbayo JA, Divisón JA, Escribano J. Using ankle-brachial index to detect peripheral arterial disease: prevalence and associated risk factors in a random population sample. Nutr Metab Cardiovasc Dis. 2007; 17: 41-49.
15. 15. Cunha PG, Boutouyrie P, Nilsson PM, Laurent S. Early Vascular Ageing (EVA): Definitions and Clinical Applicability. Curr Hypertens Rev. 2017; 13: 8-15
16. 16. Pearson T, Kukulka G, Rahman ZU. Ankle Brachial Index measurement in primary care setting; How long does it Take? South Med J 2009; 11: 1106-10