Londero Louise S, Lindholt Jes S, Thomsen Marie D, Hoegh Annette
Elitary Research Centre of Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark; Department of Cardiovascular and Thoracic Surgery, Odense University Hospital, Odense, Denmark.
Elitary Research Centre of Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark; Department of Cardiovascular and Thoracic Surgery, Odense University Hospital, Odense, Denmark; Departments of Vascular Surgery and Vascular Research Unit, Viborg Hospital, Viborg, Denmark.
J Vasc Surg. 2016 May;63(5):1305-10. doi: 10.1016/j.jvs.2015.11.044. Epub 2016 Mar 3.
There is a strong association between peripheral arterial disease (PAD) and future cardiovascular events. Therefore, intensive atherosclerotic risk factor reduction is recommended for people with PAD, and early detection is essential. This study assessed whether systematic pedal pulse palpation is an effective screening method for PAD in population-based screening programs.
As part of a randomized screening project, The Viborg Vascular Screening trial, 18,681 men (mean age, 69.3 years; range, 65-74 years) participated in a screening program, which included bilateral pulse palpation and ankle-brachial index (ABI) measurement. PAD was defined as ABI ≤0.9 or ≥1.4. Analysis was conducted on sensitivity, specificity, positive predictive value, and negative predictive value for PAD and for the number of pedal pulses.
PAD was present in 2215 participants (12.1%). The pedal pulse palpation test was set to be positive for having PAD if one or more pulses were missing. Sensitivity was 71.7% and specificity was 72.3%. No palpable pulses were associated with a 50% chance of ABI-verified PAD or with a false finding. Four palpable pulses were associated with 5% false-negative PAD cases.
Pedal pulse palpation is was shown to be a reliable initial screening tool for PAD in population-based programs but only when four pedal pulses were present. Therefore, ABI measurement should routinely be measured in patients with fewer than four palpable pedal pulses so cardiovascular preventive actions can be initiated if PAD is confirmed.
外周动脉疾病（PAD）与未来心血管事件之间存在密切关联。因此，建议对PAD患者强化降低动脉粥样硬化风险因素，且早期检测至关重要。本研究评估了在基于人群的筛查项目中，系统的足部脉搏触诊是否为PAD的有效筛查方法。
作为随机筛查项目“维堡血管筛查试验”的一部分，18681名男性（平均年龄69.3岁；范围65 - 74岁）参与了一个筛查项目，该项目包括双侧脉搏触诊和踝臂指数（ABI）测量。PAD定义为ABI≤0.9或≥1.4。对PAD及足部脉搏数量的敏感性、特异性、阳性预测值和阴性预测值进行了分析。
2215名参与者（12.1%）存在PAD。足部脉搏触诊试验设定为若一个或多个脉搏缺失则判定为PAD阳性。敏感性为71.7%，特异性为72.3%。无可触及脉搏与经ABI验证的PAD有50%的可能性相关或与假发现相关。四个可触及脉搏与5%的PAD假阴性病例相关。
在基于人群的项目中，足部脉搏触诊被证明是PAD可靠的初始筛查工具，但仅在存在四个足部脉搏时如此。因此，对于足部可触及脉搏少于四个的患者应常规测量ABI，以便在确诊PAD时能够启动心血管预防措施。
