Validez de los métodos diagnósticos para la detección de vasculopatía periférica en diabéticos tipo-2

Abstract

Background: The diabetes is one of the main causes of peripheral vascular disease (PVD), its precocious diagnosis allows to restore a fast processing and a greater control of the risk factors associate. Objective: To analyze the validity of the different diagnostic methods for the detection of PVD in type 2 diabetics (DM2) in relation to the ankle/arm index (AAI) obtained by echo-doppler (AAI-D). Design: A descriptive crossover study. Setting: Valls - Tarragona, Urban Health Center. Patients: Random sample of 130 DM2 patients (260 lower extremities). Measurements: Anamness, physical examination (by mean of only before trained explorer) and the existence of pedal and posterior tibial pulses was explored by palpation and echo-doppler, oscillometry and AAI's calculated. Considering 3 PA's categories: severe (AAI <0.6), moderate (AAI 0.6-0.9) and artherosclerotic (AAI>1). Main results: The prevalence of PVD by means of AAI recorded was 33.1% (IC 95%: 5.7%), 23.8% (IC 95%: 5.2%) moderate; 2.7% (IC 95%: 1.9%) severe; 6.5% (IC 95%: 3.0%) artheriosclerotic. The PVD's global prevalence in DM2 detected by means of AAI-D (33.1%) was significantly high (p<0.05) to the detected by means of other explorations: 22.3% posterior tibial pulse by palpation; 23.1% oscillometry, 4.6% pedal pulse by palpation, 4.2% pedal pulse by echo-doppler and 6.54% posterior tibial pulse by echo-doppler. For an AAI <0.9 (moderate PVD) we estimated bigger sensitivity in the oscillometry and bigger specificity and positive predictive value in the tibial pulse by echo-doppler (98.3 and 76.9% respectively). Conclusions: The tests that are in the habit of realizing routine in our health center for detection of PVD (palpation of pedal pulse and oscillometry), present a low sensitivity for the detection of this pathology and it would be necessary to have a portable echo-doppler (trustworthier for the detection of PVD).