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EXAMINATION OF THE PERIPHERAL PULSES IN PATIENTS WITHOUT PERIPHERAL ARTERIAL DISEASE

Author Block D Armstrong, D Brouillard, U Jurt, M Matangi

Kingston, Ontario

Abstract:
BACKGROUND: To determine the prevalence of absent peripheral foot pulses in patients with normal ankle brachial indexes (ABI) and toe brachial indexes bilaterally.
METHODS: Our cardiology database was searched for all patients who underwent PAD testing. We included patients where all 4 ABIs were in the range of 0.90-1.30 and the toe-brachial index being ≥0.70. Duplicate studies were removed. The peripheral pulse examination is performed by a Nurse who has performed 3,342 PAD studies. Pulses are recorded as absent (0/3), reduced (1/3), normal (2/3) or increased (3/3). Of the 3,342 studies, 2,965 had all 4 ABIs recorded and of these, 1,706 had all normal ABIs. Of the 1,706, 1,388 had all 4 ABIs and both TBIs being normal. Once duplicate studies were removed 1,338 remained and make up the study population.
RESULTS: There were 879 males and 459 females with a mean age of 64.2±10.7. The mean right ABI was 1.15±0.08 and TBI 0.92±0.14. The mean left ABI was 1.14±0.08 and TBI 0.92±0.14. 387 patients had at least one absent foot pulse, (28.9%). The main results are seen in the table below.
Table 1.
  R) DP R) PT Both R) L) DP L) PT Both L) Both DP Both PT All pulses
Absent pulse 197 116 33 216 120 32 139 82 18
Percentage 14.7 8.7 2.5 16.1 9.0 2.4 10.4 6.1 1.3
DP = Dorsalis pedis. PT = Posterior tibial. R) = Right. L) = Left.

CONCLUSION: An absent peripheral foot pulse in a patient without PAD is common, (28.9%). Overall approximately 15% had an absent dorsalis pedis pulse and 9% an absent posterior tibial pulse. Both dorsalis pedis pulses were absent in 10.4% and both posterior tibial pulses in 6.1%. In a small percentage all foot pulses were absent, (1.3%).