The role of the ankle brachial pressure index in the diagnosis of peripheral arterial injury

BACKGROUND
Angiography is the “gold standard” diagnostic tool for patients presenting soft signs of arterial injury. To reduce the number of unnecessary angiographies, we aimed to evaluate the role of the ankle brachial pressure index (ABPI) in the diagnosis of peripheral arterial injury in extremity trauma with soft signs.
METHODS
The data of 1772 patients with the suspicion of peripheral arterial injury was recorded prospectively. Two hundred eighty-three patients (16%) with any hard sign underwent immediate surgery. ABPI was calculated in 1489 patients with soft signs. Patients with ABPI <1 were evaluated by duplex ultrasonography and/or angiography, and if arterial injury was detected, the patients underwent surgery. Patients with an ABPI ≥1 were followed up conservatively.
RESULTS
1343 (90%) patients had ABPI ≥1; seven (0.5%) of them developed symptoms and signs of arterial injury and healed without morbidity. One hundred forty-six (10%) patients had ABPI <1; with DUS/angiography, arterial injury was detected in 39 of them (26.7%), and they underwent surgery. The sensitivity of ABPI <1 was 84.8%; specificity 92.6%; positive predictive value 26.7%; negative predictive value 99.5%; and overall accuracy 92.3%.
CONCLUSION
ABPI excludes arterial injury in 99.5% of patients with soft signs of arterial injury and avoids unnecessary examinations in 90% of patients. In the management of extremities with soft signs, ABPI measurement should be the first-line diagnostic choice.

Periferik arter yaralanmalarýnda ayak bilek basýnç indeksinin rolü

AMAÇ
Anjiyografi, þüpheli bulgularýn varlýðýnda “altýn standart” taný yöntemidir; ancak, pahalý, uzun süren ve invaziv bir yöntemdir. Bu çalýþmada, gereksiz anjiyografi sayýsýný azaltmak amacýyla, hýzlý ve kolay uygulanabilir bir yöntem olan ayak bilek basýnç indeksinin (ABÝ) þüpheli periferik arter yaralanmalarýnýn tanýsýndaki rolü araþtýrýldý.
GEREÇ VE YÖNTEM
Periferik arter yaralanmasý þüphesi olan 1772 hastanýn verileri prospektif olarak incelendi. Fiziksel incelemede arter yaralanmasýnýn kesin bulgularý saptanan 283 (%16) hastaya acil cerrahi giriþim uygulandý. Þüpheli bulgularý olan 1489 (%84) hastanýn ABÝ hesaplandý. ABÝ ≥1 olan hastalar konservatif takip edilirken, ABÝ <1 olan hastalara dupleks USG ve/veya anjiyografi yapýldý. Arteriyel yaralanma saptanan hastalar ameliyata alýndý.
BULGULAR
Þüpheli bulgularý olan 1489 hastadan ABÝ ≥1 olan 1343 (%90) hastanýn 7’sinde (%0,5) takip sýrasýnda erken dönemde arter yaralanmasý saptanarak cerrahi giriþim uygulandý, morbidite gözlenmedi. ABÝ <1 olan 146 (%10) hastanýn 39’unda (%26,7) arter yaralanmasý saptandý. Þüpheli periferik arter yaralanmasýnda 1’in altýndaki ABÝ duyarlýlýðý %84,8; özgünlüðü %92,6; pozitif kestirim gücü %26,7; negatif kestirim gücü %99,5; taný deðeri %92,3 idi.
SONUÇ
Periferik arteriyel yaralanmaya ait þüpheli bulgularýn varlýðýnda, ABÝ ≥1 saptanmasý arteriyel yaralanmayý %99,5 oranýnda dýþlar ve hastalarýn %90’ýnda ek tetkik yapýlmasýný önler. Bu hastalarda, ileri tetkiklere geçilmeden önce ABÝ tercih edilecek ilk taný yöntemi olmalýdýr.