The role of automated, four-limb blood pressure monitors in the screening of peripheral artery disease
Fendrik Krisztina, Biró Katalin, Endrei Dóra, Koltai Katalin, Tóth Kálmán, Késmárky Gábor
PTE KK, I.sz. Belgyógyászati Klinika, Angiológiai Tanszék és Kardiológiai Tanszék, Pécs
Peripheral artery disease (PAD) is a progressive atherosclerotic disease that most commonly affects the lower limbs. Despite its high prevalence, it is often recognized late, in the stage of critical limb ischemia. The first non-invasive test accepted by the guidelines to diagnose PAD is ankle-brachial index (ABI) determination using a Doppler device and a manual sphygmomanometer. The test is cost-effective, widely available, but requires expertise and time investment on the part of the examiner. Automatic, four-limb blood pressure measuring devices specially developed for ABI determination work on the plethysmographic or oscillometric principle. Their use does not require special skills, and the time required for ABI measurement can be cut in half with them. Their disadvantage is that their sensitivity is lower compared to the Doppler method, and they are not suitable for accurate PAD diagnostics, as they do not perform accurate measurements at low ankle pressure. Several studies have recommended the use of an automatic ABI cutoff of around 1.0 to increase sensitivity. An important role can be played by the additional functions available on automatic devices (e.g., determination of toe-brachial index, measurement of pulse wave velocity), which increase the sensitivity in the recognition of PAD. Overall, according to the meta-analyses, the use of automatic devices for accurate diagnosis is not recommended in specialist care, but their use may be justified in primary care and within the framework of screening programs. Their widespread use to improve vascular care in Hungary should definitely be considered.