A1 Vertaisarvioitu alkuperäisartikkeli tieteellisessä lehdessä
Toe pressure should be part of a vascular surgeon's first-line investigation in the assessment of lower extremity artery disease and cardiovascular risk of a patient
Tekijät: Mirjami Laivuori, Harri Hakovirta, Petteri Kauhanen, Juha Sinisalo, Reijo Sund, Anders Albäck, Maarit Venermo
Kustantaja: C.V. Mosby Co.
Julkaisuvuosi: 2021
Journal: Journal of Vascular Surgery
Tietokannassa oleva lehden nimi: Journal of vascular surgery
Lehden akronyymi: J Vasc Surg
Vuosikerta: 73
Numero: 2
Sivujen määrä: 12
ISSN: 0741-5214
eISSN: 1097-6809
DOI: https://doi.org/10.1016/j.jvs.2020.06.104
Rinnakkaistallenteen osoite: https://helda.helsinki.fi/bitstream/10138/338855/1/Toe_pressure_should_be_part_of_a_vascular_surgeon_s_first_line_investigation_in_the_assessment_of_lower_extremity_artery_disease_and_cardiovascular_risk_of_a_patient.pdf
Toe pressure (TP) is an accurate indicator of the peripheral vascular status of a patient and thus cardiovascular risk, with less susceptibility to errors than ankle-brachial index (ABI). This study aimed to analyze how ABI and TP measurements associate with overall survival and cardiovascular death and to analyze the TP of patients with ABI of 0.9 to 1.3.The first ABI and TP measurements of a consecutive 6784 patients treated at the Helsinki University Hospital vascular surgery clinic between 1990 and 2009 were analyzed. Helsinki University Vascular Registry and the national Cause of Death Registry provided the data.The poorest survival was in patients with ABI >1.3 (10-year survival, 15.3%; hazard ratio, 2.2; 95% confidence interval, 1.9-2.6; P < .0001; reference group, ABI 0.9-1.3), followed by the patients with TP <30 mm Hg (10-year survival, 19.6%; hazard ratio, 2.0; 95% confidence interval, 1.7-2.2; P < .0001; reference group, TP ≥80 mm Hg). The best 10-year survival was in patients with TP ≥80 mm Hg (43.9%). Of the 642 patients with normal ABI (0.9-1.3), 18.7% had a TP <50 mm Hg. The highest cardiovascular death rate (64.6%) was in the patients with TP <30 mm Hg, and it was significantly lower than for the patients with TP >50 mm Hg.Low TP is associated significantly with survival and cardiovascular mortality. Patients with a normal ABI may have lower extremity artery disease (LEAD) and a considerable risk for a cardiovascular event. If only the ABI is measured in addition to clinical examination, a substantial proportion of patients may be left without LEAD diagnosis or adequate treatment of cardiovascular risk factors. Thus, especially if ABI is normal, LEAD is excluded only if TPs are also measured and are normal.
