Regional Vascular Surgery Unit, Royal Victoria Hospital Belfast, Belfast Health and Social Care Trust, Belfast BT12 6BA, Northern Ireland, UK.
Ir J Med Sci. 2011 Jun;180(2):363-7. doi: 10.1007/s11845-011-0679-3. Epub 2011 Jan 25.
Peripheral arterial disease causing intermittent claudication (IC) causes decreased quality of life and significant morbidity. We hypothesized that triage of patients referred with suspected IC at a nurse-led rapid access vascular examination (RAVE) clinic would identify those patients requiring vascular surgery assessment.
A prospective cohort study was performed. Patients referred with suspected IC were assessed using the Edinburgh claudication questionnaire (ECQ) and arterial Doppler assessment with segmental waveform analysis and calculation of ankle brachial pressure index (ABPI). Data were collected regarding cardiovascular risk and its modification.
Of 451 consecutive patients, mean age was 65 years (range 30-89). Cardiovascular risk factors included: 173/451 (38%) current smokers (162/451 (36%) were ex-smokers); diabetes, 22%; hypertension, 46%; ischaemic heart disease (angina), 29%; dyslipidaemia, 27%. Therapeutic risk modifications included: antiplatelet therapy, 64.4%; lipid-lowering therapy, 57.8%. abnormal ABPI readings were present in 264/451 (59%), with ratio <0.9 in 209/451 (46.3%), >1.3 in 48/451 (10.6%), and incompressible vessels 7/451 (1.5%). Normal ABPI (ratio >0.9 and <1.3, triphasic Doppler waveforms) were found in 187/451 (41%), these patient were considered inappropriate referrals. Considering those patient with PAD diagnosed on abnormal ABPI (<0.9 or >1.3), Doppler waveform analysis was more sensitive and specific than ECQ.
Diagnosis of IC with clinical history alone is inaccurate in 41 percent of cases, leading to inappropriate referral to vascular surgery. Doppler waveform analysis had excellent sensitivity and specificity for prediction of ABPI <0.9. ABPI measurement in primary care could result in a more efficient use of clinical resources.
外周动脉疾病（PAD）导致间歇性跛行（IC），降低了生活质量并导致严重的发病率。我们假设，在护士主导的快速血管检查（RAVE）诊所对因疑似 IC 就诊的患者进行分诊，将能够识别出需要血管外科评估的患者。
进行了一项前瞻性队列研究。使用爱丁堡跛行问卷（ECQ）和动脉多普勒评估对疑似 IC 就诊的患者进行评估，包括节段性波形分析和踝肱血压指数（ABPI）的计算。收集了心血管风险及其改变的数据。
451 例连续患者的平均年龄为 65 岁（范围 30-89 岁）。心血管危险因素包括：173/451（38%）为当前吸烟者（162/451（36%）为曾吸烟者）；糖尿病 22%；高血压 46%；缺血性心脏病（心绞痛）29%；血脂异常 27%。治疗性风险改变包括：抗血小板治疗 64.4%；降脂治疗 57.8%。451 例患者中有 264 例（59%）存在异常 ABPI 读数，其中 209 例（46.3%）比值<0.9，48 例（10.6%）比值>1.3，7 例（1.5%）血管不可压缩。187/451 例（41%）患者的 ABPI（比值>0.9 和<1.3，三相多普勒波形）正常，这些患者被认为是不适当的转诊。考虑到 ABPI 异常（<0.9 或>1.3）诊断为 PAD 的患者，多普勒波形分析比 ECQ 更敏感和特异。
仅凭临床病史诊断 IC 不准确，41%的病例导致不适当的血管外科转诊。多普勒波形分析对预测 ABPI<0.9 具有很好的敏感性和特异性。在初级保健中测量 ABPI 可以更有效地利用临床资源。
