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Italian Society of Angiology and Vascular Pathology: ABI and TBI are essential in PAD diagnostics


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On 20 April 2024, the Italian Society of Angiology and Vascular Pathology issued a statement entitled “The measurement of blood pressure in the lower extremities. A simple method for the diagnosis of Peripheral Arterial Disease”. It highlights the importance of ABI (Ankle-Brachial Index (ABI), Toe Pressure (TP) and Toe-Brachial Index (TBI) measurement, especially in primary care, as this could lead to faster Peripheral Arterial Disease diagnosis and treatment. For this purpose, “an ideal system could be one in which both measurements are possible and can be quickly performed”. [1] This shows the relevance of solutions like the MESI mTABLET system, which enables fast and comprehensive arterial assessment with automated ABI, TBI as well as pulse wave velocity on one handy device. With simple application in primary care, the MESI mTABLET system could greatly contribute to timely diagnosis of this dangerous disease, saving lives and preserving the quality of life of the patients affected.

In this blog you will learn:

The mission and aims of the Italian Society of Angiology and Vascular Pathology (SIAPAV)

The Italian Society of Angiology and Vascular Pathology (Società Italiana di Angiologia e Patologia Vascolare, SIAPAV) was founded in 1978 with vascular medicine as its focus. The organisation follows scientific and educational aims. On the one hand, it promotes the scientific study of the epidemiological, diagnostic, epidemiological, clinical, rehabilitative, therapeutic and prophylactic aspects of vascular conditions. On the other, it furthers continuing medical education (CME) for all categories of healthcare professionals, in the form of conferences and other types of educational events, both live and online. [2]

The SIAPAV statement from 20 April 2024

On 20 April 2024, the SIAPAV issued a statement entitled “The measurement of blood pressure in the lower extremities. A simple method for the diagnosis of Peripheral Arterial Disease”. It stresses the dangers of Peripheral Arterial Disease and the importance of its early discovery, recommending exams of risk groups at primary care level.

The dangers of Peripheral Arterial Disease and the importance of early diagnosis

The SIAPAV statement defines Peripheral Arterial Disease as a condition caused by partial or complete stenosis of limb arteries. In the legs, it can cause walking difficulties (pain – intermittent claudication), but more severe consequences include ulcers and gangrene. In the case of critical ischemia, there is a risk of limb amputation.

However, Peripheral Arterial Disease is more than a limb pathology; it is regarded as a systemic pathology. Atherosclerosis, the condition that causes the formation of occlusions in the arteries of the (lower) limbs, affects the arteries of all areas of the body. Therefore, early diagnosis of PAD can also prevent death due to stroke or heart attack.

When to measure ABI, TP and TBI

The statement defines ABI and TP (toe pressure, TBI is calculated on its basis) as simple methodologies not only for the evaluation of the level of ischemia in lower limbs, but also as an index of cardiovascular risk.

The statement recommends ABI, TP and TBI measurement in the following cases:

  • in the population over 65 years of age, with cardiovascular risk factors such as smoking, hypercholesterolemia, hypertension or diabetes mellitus,
  • in patients with a history of coronary and carotid disease (heart attack and stroke),
  • in patients over 50 years of age with a history of Peripheral Arterial Disease.

Difficulties surrounding ABI, TP and TBI measurements as well as proposed solutions

According to some SIAPAV surveys, ABI, TP and TBI are measured only in 50% of the patients with suspected PAD. This is due to several factors:

  • lack of awareness,
  • difficulties in obtaining the necessary equipment,
  • long execution times (connected with Doppler exams),
  • the required skills, which affect the reliability of the result (connected with Doppler exams).

These problems can be overcome by recent technological progress. The SIAPAV statement defines the ideal system: one with which both ABI and TBI could be measured in a fast and effective manner.

The ideal criteria for this system would be to:

  • Upgrade the methods for measuring arterial pressure in the limbs and the calculation of the Ankle-Brachial Index (ABI) and Toe-Brachial Index (TBI). This can be done by using digital technology that can provide fast ABI, TP and TBI results.
  • Simplify the ABI and TBI measurement processes so that they can be performed by non-specialised medical staff, with the possibility of remote consultation.
  • Reduce the time needed for ABI, TP, and TBI measurement compared to the Doppler probe technique. Doppler involves separate blood pressure measurements for each limb and specifically for the anterior and posterior tibial arteries in each lower limb. This requires highly skilled and experienced operators for accurate results.

In this way, the following improvements could be achieved:

  • enhance the sensitivity and accuracy of peripheral arterial disease diagnosis,
  • ensure timely and appropriate treatments,
  • improve patient outcomes,
  • lower the morbidity and mortality rates associated with peripheral arterial disease and
  • make these diagnostic methods feasible for use in primary care.

Comprehensive arterial assessment with the MESI mTABLET: ABI, TBI and pulse wave velocity on one device

The MESI mTABLET diagnostic system enables comprehensive arterial assessment in two simple steps:

STEP 1: Wireless, automated Ankle-Brachial Index measurement in 1 minute,

STEP 2 (if needed): automated Toe-Brachial Index extension for immediate further PAD assessment in 1 minute.

You can also add Pulse Wave Velocity for advanced (arterial age) assessment. Perform it as a quick, 2-in-1 measurement of arterial stiffness and the Ankle-Brachial Index together!

ABI and TBI measurement reports are automatically synched with the built-in electronic medical record. This gives you access to the full history of the previous measurements and the patient’s trend analysis in the form of graphs. The measurement can also be immediately shared with the GP or a specialist for a second opinion, contributing to a faster diagnosis. The MESI mTABLET provides comprehensive arterial assessment with the Ankle-Brachial Index, Toe-Brachial Index and Pulse Wave Velocity in minutes!

Why the MESI mTABLET ABI?

  • ABI measurement in 1 minute
  • SmartArm™ detection – to determine the higher blood pressure of the two
  • Automated, 3-cuff simultaneous measurement
  • Multiple cuff sizes and ability to mix-and match different size cuffs during one measurement
  • Pulse waveforms and oscillation graphs
  • Advanced review and alerts, thanks to PADsense™ algorithm

Why the MESI mTABLET TBI?

MESI-mTABLET-TBI
  • TBI measurement in 1 minute 
  • Simultaneous measurements in the arms and toes. Adaptive infrared LED PPG light detects toe skin temperature and thickness 
  • FirstWave™ algorithm for detecting the first returning pulse waveform in the toes 
  • Comprehensive TBI report with pulse waveforms and oscillation graphs for the arms and PPG pulse waveforms for the toes 
  • Reusable toe cuffs available