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Tempo de aceleração pedal na avaliação da doença arterial periférica em doentes diabéticos
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Abstract(s)
Introdução e objetivos: A doença arterial periférica (DAP) é uma manifestação comum da aterosclerose e representa um indicador significativo de risco cardiovascular, afetando a qualidade de vida dos doentes devido à claudicação e, em estadios avançados, a lesões tróficas, sendo a principal causa não-traumática de amputação dos membros inferiores. A Diabetes Mellitus é um dos principais fatores de risco para DAP, com acometimento preferencial das artérias infra-poplíteas pela presença de calcificação arterial (mediocalcinose), o que pode condicionar incompressibilidade arterial. O índice tornozelo-braço (ITB) é uma das ferramentas diagnósticas mais utilizadas para avaliação de DAP, sendo uma das suas limitações a incapacidade de avaliar artérias extensamente calcificadas. O tempo de aceleração pedal (TAP), medido por eco-Doppler, surge como uma alternativa diagnóstica, através da medição do tempo de aceleração sistólico medido nas artérias do pé em milissegundos, correspondendo valores mais elevados de TAP a pior prognóstico e com um cut-off estabelecido de 180 ms como preditor de cicatrização de feridas. Esta tese visa validar o TAP em doentes diabéticos, verificando a sua capacidade de prever a cicatrização de feridas e a sua correlação com diferentes estadios de DAP.
Métodos: Foi realizado um estudo transversal retrospetivo em doentes diabéticos com DAP no serviço de Cirurgia Vascular da Unidade Local de Saúde de Coimbra. Foram medidos os valores de TAP e de ITB, excluindo-se membros com TAP imensurável. Os doentes foram divididos em dois grupos: com feridas (Grupo I) e sem feridas (Grupo II), sendo os doentes com ferida avaliados quanto à evolução da cicatrização, revascularização ou amputação. No Grupo II, os doentes foram classificados conforme a classificação de Leriche-Fontaine para DAP (Grau I, II e III).
Resultados: O estudo incluiu 123 doentes, 181 membros, 55,2% com feridas (Grupo I) e 44,8% sem feridas (Grupo II). Validou-se o cut-off de 180 ms para cicatrização de feridas na amostra em estudo. No Grupo I, 26% dos membros cicatrizaram, 31% não cicatrizaram, 33% necessitaram de revascularização e 7% foram amputados. Apenas feridas cicatrizadas apresentaram valores médios de TAP ≤ 180 ms (159,81 ms). No Grupo II, observou-se correlação inversa entre TAP e ITB para todos os graus da doença, com membros claudicantes (Grau II) a apresentar valores de TAP mais elevados que os assintomáticos (Grau I). Igualmente os doentes do Grupo I possuíram valores de TAP mais elevados que os do Grupo II.
Conclusões: Os resultados desta tese confirmam a utilidade do TAP como ferramenta para diagnosticar a gravidade da DAP e prever a cicatrização de feridas numa população diabética, validando o cut-off de 180 ms como preditor de cicatrização. Adicionalmente, estes achados suportam a ideia de que valores mais elevados de TAP se associam a maior severidade de isquémia em diferentes fases da doença, podendo servir de apoio à tomada de decisão clínica.
Introduction and aims: Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis and represents a significant indicator of cardiovascular risk, affecting patients quality of life due to claudication and, in advanced stages, foot ulcer and gangrene, being the main cause for non-traumatic lower limb amputations. Diabetes Mellitus is one of the main factors for PAD, with involvement of the infra-popliteal arteries and the presence of arterial calcification (mediocalcinosis), which can lead to arterial incompressibility. The ankle-brachial index (ABI) is one of the most widely used diagnostic tools for assessing PAD, one of its limitations being its inability to assess extensively calcified arteries. Pedal acceleration time (PAT), measured by Duplex ultrasound, has emerged as a diagnostic alternative, by measuring the systolic acceleration in the arteries of the foot in milliseconds, with higher PAT values corresponding to a worse prognosis and with an established cut-off of 180 ms as a predictor of wound healing. This thesis aims to validate the PAT in diabetic patients, verifying its ability to predict wound healing and its correlation with different stages of PAD. Methods: A retrospective cross-sectional study was carried out on diabetic patients with PAD in the Vascular Surgery department of the Coimbra Local Health Unit. PAT and ABI were measured, excluding limbs with immeasurable PAT. Patients were divided into two groups: with wounds (Group I) and without wounds (Group II), with the former being assessed according to wound healing, need for revascularisation or amputation. In Group II, patients were categorised according to the Leriche-Fontaine classification for PAD (Grade I, II and III). Results: The study included 123 patients and 181 limbs, 55,2% with wounds (Group I) and 44,8% without wounds (Group II). The 180 ms cut-off for wound healing was validated in the study sample. In Group I, 26% of limbs healed, 31% did not heal, 33% required revascularisation and 7% were amputated. Only healed wounds had a mean PAT ≤ 180 ms (159,81 ms). In Group II, there was an inverse correlation between PAT and ABI for all grades of the disease, with claudicant limbs (Grade II) having higher PAT values than asymptomatic limbs (Grade I). Patients in Group I also had higher PAT values than those in Group II. Conclusions: The results of this thesis confirmed the usefulness of PAT as a tool for diagnosing the severity of PAD and predicting wound healing in a diabetic population, validating the 180 ms cut-off as a predictor of wound healing. In addition, these findings support the idea that higher PAT values are associated with greater severity of ischaemia at different stages of the disease, thus supporting clinical decision-making.
Introduction and aims: Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis and represents a significant indicator of cardiovascular risk, affecting patients quality of life due to claudication and, in advanced stages, foot ulcer and gangrene, being the main cause for non-traumatic lower limb amputations. Diabetes Mellitus is one of the main factors for PAD, with involvement of the infra-popliteal arteries and the presence of arterial calcification (mediocalcinosis), which can lead to arterial incompressibility. The ankle-brachial index (ABI) is one of the most widely used diagnostic tools for assessing PAD, one of its limitations being its inability to assess extensively calcified arteries. Pedal acceleration time (PAT), measured by Duplex ultrasound, has emerged as a diagnostic alternative, by measuring the systolic acceleration in the arteries of the foot in milliseconds, with higher PAT values corresponding to a worse prognosis and with an established cut-off of 180 ms as a predictor of wound healing. This thesis aims to validate the PAT in diabetic patients, verifying its ability to predict wound healing and its correlation with different stages of PAD. Methods: A retrospective cross-sectional study was carried out on diabetic patients with PAD in the Vascular Surgery department of the Coimbra Local Health Unit. PAT and ABI were measured, excluding limbs with immeasurable PAT. Patients were divided into two groups: with wounds (Group I) and without wounds (Group II), with the former being assessed according to wound healing, need for revascularisation or amputation. In Group II, patients were categorised according to the Leriche-Fontaine classification for PAD (Grade I, II and III). Results: The study included 123 patients and 181 limbs, 55,2% with wounds (Group I) and 44,8% without wounds (Group II). The 180 ms cut-off for wound healing was validated in the study sample. In Group I, 26% of limbs healed, 31% did not heal, 33% required revascularisation and 7% were amputated. Only healed wounds had a mean PAT ≤ 180 ms (159,81 ms). In Group II, there was an inverse correlation between PAT and ABI for all grades of the disease, with claudicant limbs (Grade II) having higher PAT values than asymptomatic limbs (Grade I). Patients in Group I also had higher PAT values than those in Group II. Conclusions: The results of this thesis confirmed the usefulness of PAT as a tool for diagnosing the severity of PAD and predicting wound healing in a diabetic population, validating the 180 ms cut-off as a predictor of wound healing. In addition, these findings support the idea that higher PAT values are associated with greater severity of ischaemia at different stages of the disease, thus supporting clinical decision-making.
Description
Keywords
Doença arterial periférica Tempo de Aceleração Pedal Diabetes mellitus Peripheral Arterial Disease Pedal Acceleration Time