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ABSTRACT: Modern guidelines for evaluation of leg ischemia in patients with diabetes and foot ulcer recommend toe blood pressure (TBP) measurements rather than the often unreliable ankle blood pressure (ABP). A drawback with TBP is the complicated measurement procedure, unsuitable the outpatient clinic. The aim of this study was to evaluate the validity of a new automatic TBP device (PresTo, Moor Instruments Ltd) developed for use outside vascular laboratories.
Cross-sectional comparative study.
Twenty-three legs in 16 consecutively included diabetic patients with PAD were examined. TBP was measured three times with 2 min in-between. Three examiners read the obtained graphs (n=69), which were analyzed for variability over time and between examiners. These results were compared with those obtained from an automated TBP device.
The mean TBP was 50.9 mm Hg (SD 10.9) when read by examiners compared to 56.4 mm Hg (SD 12.6) when automatically assessed. The 2-min variability was 4.9 mm Hg (SD) for visual readings and 8.1 mm Hg for automatic measurements. The short, long term and examiner dependent variability of visually read TBP ranged from 3.9 to 9.6% of the values. In patients with TBP <45 mm Hg the difference between automatic and visual assessments was small.
The automatic TBP device is reliable for measuring low pressures and thus for exclusion of critical limb ischemia in patients with diabetes. After algorithm adjustment the device's reliability appears to be acceptable in the entire spectrum of TBP values. TBP appears to have less inter and intraobserver variability than what is reported for ABP.
European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 10/2008; 36(5):576-81. · 2.92 Impact Factor
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ABSTRACT: toe blood pressure (TBP) is an important method to assess peripheral arterial disease especially in patients with diabetes, but remains difficult to measure. We have developed a simple portable device for TBP measurements.
first, TBP was determined in 40 ischemic legs with both laser Doppler and photoplethysmography for perfusion monitoring, to assess if laser Doppler can be used for measurements. The median values recorded were identical, but slightly higher values were obtained with laser Doppler (p=0.03). Secondly, a computer based algorithm for automatic TBP readings with laser Doppler was compared to manual assessment in 28 legs of 20 patients. The median values differed 3mmHg (p=0.10). Finally the applicability of the new device was tested in eight legs of six patients by two nurses.
laser Doppler is appropriate for perfusion monitoring during TBP measurements and automatic pressure readings seem accurate. The automatic portable device is simple to use and can probably determine TBP.
European Journal of Vascular and Endovascular Surgery 11/2002; 24(4):304-8. · 2.99 Impact Factor
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ABSTRACT: We have studied the therapeutic effects of ketanserin, a specific serotonin antagonist, on digital ischaemia in 11 patients with the CREST syndrome of systemic sclerosis. Ketanserin was administered as a bolus of 10 mg intravenously, followed by an infusion over 72 h and then oral therapy. Skin blood flow as measured by thermography, bolometry, ultrasound Doppler pulses and laser light scattering, showed significant improvement. There was also marked clinical improvement with a reduction in the pain and healing of digital ulceration. These improvements were maintained on oral therapy. In 7 patients detailed studies were performed comparing oral and intravenous ketanserin therapy. When ketanserin was administered as a bolus 10 mg intravenous dose, followed by an infusion at 2 mg/h, steady state was reached by 12 h. Following oral treatment (40 mg tds) therapeutic blood levels were achieved.
Scandinavian Journal of Rheumatology 02/1989; 18(2):107-11. · 2.47 Impact Factor
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ABSTRACT: Ketanserin, 40 mg b.i.d., or matching placebo were administered for 8 weeks each in a randomised double-blind crossover design to 23 patients with Raynaud's phenomenon. Ketanserin had no effect on Doppler arterial patency or blood flow at rest, 37 degrees C, 15 degrees C, or during recovery after cold challenge. Red cell deformability index and whole blood viscosity were not significantly affected by ketanserin treatment. In vivo bleeding time was prolonged on ketanserin (p less than 0.05) but beta-thromboglobulin and platelet factor 4 were unaffected. There was a nonsignificant decrease in platelet aggregation response to serotonin but no change at all with other aggregating agents on treatment with ketanserin.
Journal of Cardiovascular Pharmacology 02/1985; 7 Suppl 7:S99-101. · 2.29 Impact Factor
