Test characteristics of the ankle-brachial index and ankle-brachial difference for medial arterial calcification on X-ray in type 1 diabetes.

Journal of Vascular Surgery
Joachim H IxTrevor J Orchard

Abstract

Medial arterial calcification (MAC) is common in diabetes, has a characteristic appearance on X-ray imaging, and has been linked with peripheral arterial stiffness and cardiovascular disease. However, few studies have measured X-ray MAC. It has been suggested that an ankle-brachial index (ABI) >1.30 or an ankle-brachial difference (ABD) >75 mm Hg may identify X-ray MAC, but test characteristics are unknown. We hypothesized that an ABI >1.30 and ABD >75 mm Hg would have high specificity but low sensitivity for MAC on X-ray imaging. This was a cross-sectional study of 185 community-living individuals with type 1 diabetes. The ABI and the ABD were assessed. The outcome was linear "tram-track" calcifications in the lower limbs characteristic of MAC. Mean age was 32 ± 6 years, and mean diabetes duration was 23 ± 7 years. X-ray MAC was noted in 97 individuals (57%), 15 (8%) had ABI >1.30, and 14 (8%) had ABD >75 mm Hg. As assessed by the ABI, the area under the receiver operating characteristic curve for MAC was modest (0.65) and was slightly higher for the ABD (0.75). An ABI >1.30 had high specificity (99%) and positive predictive value (93%) but poor sensitivity (14%) and an overall accuracy of 55% for MAC. An ABD >50 mm Hg remaine...Continue Reading

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Citations

May 2, 2014·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Jeffrey J HsuMichael G Shlipak
Dec 18, 2014·European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery·R M StoekenbroekM J W Koelemay
Jun 20, 2014·Journal of Vascular Nursing : Official Publication of the Society for Peripheral Vascular Nursing·Dayana FreitasLeila Maria Marchi-Alves
Feb 27, 2016·Journal of Vascular Surgery·Whitney Laurel QuongYork Nien-Hsiung Hsiang
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Jul 25, 2019·Journal of Vascular Surgery Cases and Innovative Techniques·Cassius Iyad Ochoa ChaarAlan Dardik

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