Abstract

A large proportion of amputations of lower extremity secondary to aPAD is the major cause of significant disability and hence economic burden on individual and as well as the healthcare system in developing countries like India. LEAD is characterized by a spectrum ranging from no symptoms, intermittent claudicating, pain at rest to finally non-healing wounds & gangrene. ABPI is a not only a sensitive but cost-effective screening tool for LEAD. Pulse oximetry (PO) which is a simple, noninvasive, readily available & inexpensive tool for measurement of oxygen saturation in peripheral blood (SpO2). This study was conducted to comapre (ABPI) plus Pulse oximetry with Duplex Ultrasound in detecting LEAD in Diabetes Mellitus. Material and Methods: Inclusion Criteria: Adults more than 40 years with known diagnosis of Diabetes Mellitus. Exclusion Criteria: Patient having lower limb amputation, fracture, or gangrenous limb, Patient with pedal oedema or ulcer, Previous history of hypercoagulable states, congestive heart failure, suspected arteritis, or collagen vascular diseases, Patients with coarctation of aorta & Patients with pre-existing diagnosis of lower extremity arterial disease (LEAD). Results: This study was carried out at TMMC & RC (Moradabad, UP). It was a prospective hospital based observational study. Out of 55 participant 30 (54.5%) are smoker and 25 (45.5%) are non-smoker. Among 30 smoker 29 (96.7%) are pulse oximeter positive and 1 (3.33%) are pulse oximeter negative. In our study, Right limb analysis suggestive of 75% of sensitivity, 39.1% of specificity, 63.2% of PPV and 52.9% of NPV. Right ABPI has 60% of accuracy. Left limb analysis suggestive of 65.5% sensitivity, 42.3% specificity, 55.9% PPV and 52.4% NPV. Left limb ABPI has 54.5% of accuracy. Left limb pulse oximeter method analysis suggestive of 93.1% sensitivity, 23.1% specificity, 57.4% PPV and 75% NPV. Left limb pulse oximetry method has 60% of accuracy. Average pulse oximeter analysis: 91.8% sensitivity, 22.4% specificity, 60% PPV and 68.7% NPV. Average ABPI had an accuracy of 60.9%. Conclusion: A combination of ABPI & PO is most sensitive with highest negative predictive value. These methods are simple, cost effective, quick, non-invasive and easily available tools. Hence, detection of LEAD should be a part of regular work-up of DM patients

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