Early diagnosis of asymptomic chronic ischemia of the lower extremities.

Abstract

The aim: To assess the possibility of using a questionnaire and determining the Ankle Brachial Index(ABI) for early diagnosis of asymptomatic ischemia of the lower extremities in patients with various somatic diseases. Materials and methods: The study involved 294 patients who were receiving inpatient treatment at Communal Non-Profit Enterprise «Uzhgorod Central City Clinical Hospital»,Communal Non-Profit Enterprise «Transcarpathian Regional Clinical Hospital» and Communal Non-Profit Enterprise «Uzhgorod District Clinical Hospital». The study was conducted in 36 patients of pulmonological, 52 – neurological, 22 – endocrinological, 28 – rheumatological, 67 – general therapeutic and 89 – surgical patients. In order to detect hidden ischemia, the patients were surveyed according to the Edinburg questionnaire, regional systolic pressure was measured on the tibial arteries of the lower extremities and calculation of the Bone-humerus index (ABI)at rest and after physical exertion (walking), also non-contact skin temperature was measured on the lower leg and thigh. Results: During the study, (ABI) less than 0.9 was found in 108 (36.7%) patients, while in 47 (43.5%) cases, (ABI) decreased only after exercise.In the majority of cases, 98 (90.7%) a decrease in (ABI) was observed on one lower limb. A decrease in the skin temperature of the lower extremities was observed in 141 (48%) patients, 134 (95.1%) of which were diagnosed with diabetes.Symptoms of hidden ischemia, according to the questionnaire, were found in 99 (33.7%) patients.Smoking was observed in 61 (56.5%) patients with symptoms of hidden ischemia. Conclusions: As a result of our study, it was found that the specificity of the Edinburg questionnaire in detecting the preclinical stage of ischemia of the lower extremities reaches 88.2%, and the sensitivity – 91.6%. The obtained results indicate the expediency of using the questionnaire in the complex of diagnostics of vascular pathology in patients of various profiles. False-negative results of(ABI)in people with diabetes are associated with mediacalcinosis. In such cases, it is necessary to assess the state of blood flow by measuring the pressure on the back of the foot after physical exertion.