American Journal of Epidemiology Vol. 140, No. 6: 526-534
Copyright © 1994 by The Johns Hopkins University School of Hygiene and Public Health
research-article |
Screening for Peripheral Arterial Disease: The Sensitivity, Specificity, and Predictive Value of Noninvasive Tests in a Defined Population
1Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA
2Department of Family and Preventive Medicine, Division of Epidemiology, University of California San Diego, La Jolla, CA
3Department of Medicine, Division of Cardiology, University of California San Diego, La Jolla, CA
4Department of Surgery, Division of General Surgery, University of California San Diego, La Jolla, CA
5Graduate School of Public Health, Division of Epidemiology and Biostatistics, San Diego State University San Diego, CA
Reprint requests to Dr. Michael Criqui, Department of Family and Preventive Medicine, Division of Epidemiology-0607, University of California, San Diego, La Jolla, CA 92093-0607
Large vessel peripheral arterial disease (LV-PAD) is a common condition that causes significant morbidity and disability. The authors evaluated the individual components of a comprehensive noninvasive vascular examination to identify the most sensitive and specific measurements for diagnosing LV-PAD. This cohort, initially screened between 1979 and 1981 in Rancho Bernardo, California, included 421 normal subjects and 63 subjects with LV-PAD. Segmental blood pressure ratios and flow velocities by Doppler ultrasound were used to define cases of LV-PAD. The sensitivity, specificity, positive predictive value, and negative predictive value of each individual component of the diagnostic algorithm were determined. Overall, measurements of posterior tibial flow showed the highest sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy. In addition, an absent or non-recordable posterior tibial peak forward flow, occurring in 96% of all limbs with isolated posterior tibial disease, or an ankle ratio 
0.8 considered in parallel yielded a test with sensitivity of 89%, specificity of 99%, positive predictive value of 90%, negative predictive value of 99%, and overall accuracy of 98%. These results Indicate that the vast majority of LV-PAD cases can be detected with a single measurement using a handheld Doppler flowmeter employed at the ankle.
peripheral vascular diseases; predictive value of tests; sensitivity and specificity
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  E. Selvin, A. Kottgen, and J. Coresh Kidney function estimated from serum creatinine and cystatin C and peripheral arterial disease in NHANES 1999-2002 Eur. Heart J., August 1, 2009; 30(15): 1918 - 1925. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Agarwal The Association of Active and Passive Smoking With Peripheral Arterial Disease: Results From NHANES 1999-2004 Angiology, June 1, 2009; 60(3): 335 - 345. [Abstract] [PDF]
|
|
|
|
 |
|
 S.-C. Chen, J.-M. Chang, S.-J. Hwang, J.-C. Tsai, C.-S. Wang, H.-C. Mai, F.-H. Lin, H.-M. Su, and H.-C. Chen Significant Correlation between Ankle-Brachial Index and Vascular Access Failure in Hemodialysis Patients Clin. J. Am. Soc. Nephrol., January 1, 2009; 4(1): 128 - 134. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. P Reis, E. D Michos, D. von Muhlen, and E. R Miller III Differences in vitamin D status as a possible contributor to the racial disparity in peripheral arterial disease Am. J. Clinical Nutrition, December 1, 2008; 88(6): 1469 - 1477. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M.P. Khanolkar, S.C. Bain, and J.W. Stephens The diabetic foot QJM, September 1, 2008; 101(9): 685 - 695. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Arseven, J. M. Guralnik, E. O'Brien Kaleba, K. Liu, C. Chan, and M. McGrae McDermott Does Lower-Extremity Arterial Disease Predict Future Falling Among Older Men and Women? Angiology, January 1, 2008; 58(6): 725 - 733. [Abstract] [PDF]
|
|
|
|
 |
|
 E. Selvin, J. Coresh, and F. L. Brancati The burden and treatment of diabetes in elderly individuals in the u.s. Diabetes Care, November 1, 2006; 29(11): 2415 - 2419. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Nasir, E. Guallar, A. Navas-Acien, M. H. Criqui, and J. A.C. Lima Relationship of Monocyte Count and Peripheral Arterial Disease: Results From the National Health and Nutrition Examination Survey 1999-2002 Arterioscler Thromb Vasc Biol, September 1, 2005; 25(9): 1966 - 1971. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. I. Parameswaran, K. Brand, and J. Dolan Pulse Oximetry as a Potential Screening Tool for Lower Extremity Arterial Disease in Asymptomatic Patients With Diabetes Mellitus Arch Intern Med, February 28, 2005; 165(4): 442 - 446. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. R Mohler III, D. Treat-Jacobson, M. P Reilly, K. E Cunningham, M. Miani, M. H Criqui, W. R Hiatt, and A. T Hirsch Utility and barriers to performance of the ankle brachial index in primary care practice Vascular Medicine, November 1, 2004; 9(4): 253 - 260. [Abstract] [PDF]
|
|
|
|
 |
|
 E. Selvin and T. P. Erlinger Prevalence of and Risk Factors for Peripheral Arterial Disease in the United States: Results From the National Health and Nutrition Examination Survey, 1999-2000 Circulation, August 10, 2004; 110(6): 738 - 743. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Navas-Acien, E. Selvin, A. R. Sharrett, E. Calderon-Aranda, E. Silbergeld, and E. Guallar Lead, Cadmium, Smoking, and Increased Risk of Peripheral Arterial Disease Circulation, June 29, 2004; 109(25): 3196 - 3201. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Ono, A. Tsuchida, H. Kawai, H. Matsuo, R. Wakamatsu, A. Maezawa, S. Yano, T. Kawada, and Y. Nojima Ankle-Brachial Blood Pressure Index Predicts All-Cause and Cardiovascular Mortality in Hemodialysis Patients J. Am. Soc. Nephrol., June 1, 2003; 14(6): 1591 - 1598. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. I. Adler, R. J. Stevens, A. Neil, I. M. Stratton, A. J. M. Boulton, and R. R. Holman UKPDS 59: Hyperglycemia and Other Potentially Modifiable Risk Factors for Peripheral Vascular Disease in Type 2 Diabetes Diabetes Care, May 1, 2002; 25(5): 894 - 899. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. O'Hare and K. Johansen Lower-Extremity Peripheral Arterial Disease among Patients with End-Stage Renal Disease J. Am. Soc. Nephrol., December 1, 2001; 12(12): 2838 - 2847. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. H Long, M. H Criqui, E. E Vasilevskis, J. O Denenberg, M. R Klauber, and A. Fronek The correlation between the severity of peripheral arterial disease and carotid occlusive disease Vascular Medicine, August 1, 1999; 4(3): 135 - 142. [Abstract] [PDF]
|
|
|
|
|
|
S. Kiechl, A. Muigg, P. Santer, M. Mitterer, G. Egger, M. Oberhollenzer, F. Oberhollenzer, A. Mayr, A. Gasperi, W. Poewe, et al. Poor Response to Activated Protein C as a Prominent Risk Predictor of Advanced Atherosclerosis and Arterial Disease Circulation, February 9, 1999; 99(5): 614 - 619. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. E Bird, M. H Criqui, A. Fronek, J. O Denenberg, M. R Klauber, and R. D Langer Quantitative and qualitative progression of peripheral arterial disease by non-invasive testing Vascular Medicine, February 1, 1999; 4(1): 15 - 21. [Abstract] [PDF]
|
|