Evaluating the Role of Arterial Duplex Ultrasound in Diabetic Foot Ulcer Patients with Normal Ankle Brachial Pressure Index and Peripheral Pulses

Abstract

Background: Requesting a arterial duplex scan has been a recent trend in management of diabetic foot ulcer, as it is considered the gold standard modality of investigation for diagnosing peripheral arterial diseases. Nevertheless, increased burden of the diabetic foot ulcer patients and limited availability of the facilities and trained radiologists prompts us to use this investigation judiciously. Most of the studies focus on role of abnormal ABPI as a predictor of PVD that needs to be confirmed by duplex scan. But in this study we are focussing on role of duplex scan when ABPI is normal and all peripheral pulses are present. Aim of the Study: This study was conducted to find out whether careful history taking and clinical examination including ABPI measurement would help in selecting appropriate patients for duplex scan. Methods: 25 Patients with diabetic foot ulcer, who had no symptoms of claudication or rest pain, with palpable and normal peripheral pulses and normal ABPI, were selected for study. Arterial duplex ultrasound of the limb with diabetic foot ulcer, was done in all patients after clinical assessment. Proper wound care and offloading dressings were done. Results: Negative predictive value of ABPI combined with normal peripheral pulses in patients with no symptoms of PVD was found out to be 72%. No endovascular or vascular surgery intervention was needed in any of the patients. Conclusion: Arterial duplex scan can safely omitted if all 3 criteria are fulfilled. l If patient does not have symptoms suggestive of claudication pain or rest pain. l If all the peripheral pulses are felt and normal, with ABPI >0.9 and < 1.3 l If ulcer is healing well with proper debridement, dressing and offloading.