Hydrostatic toe pressure measurement, a noninvasive screening method for arterial peripheral vascular disease of diabetic and nondiabetic origin

Objective: To assess whether the hydrostatic toe pressure measurement is a reliable method for diagnosing peripheral arterial vascular disease (PAVD) in diabetics. Patients and methods: The systolic anterior tibial artery pressure was measured hydrostatically and by sphygmomanometry in 245 legs of 133 patients (94 males, 39 females; mean age 65 [61-68] years) with PAVD, stages II-IV (staging after Fontaine). 106 were diabetics. in addition the systolic toe pressure was measured hydrostatically and by sphygmomanometry in 155 legs. The sensitivity and specificity of the results in stages III/IV were calculated. Results: Up to 27% of sphygmomanometric anterior tibial pressure measurements (including PAVD stage III/IV) stages could not be evaluated because they were above the measuring limit of 300 mm Hg. 81% of hydrostatic measurements (including PAVD III/IV) were above the 60 mm Hg measuring limit. The hydrostatic systolic pressure was outside the measuring limit of 70 mm Hg only in healthy subjects and those with PAVD < III. Hydrostatically measured systolic pressure < 50 mm Hg in the large toe indicated PAVD > II with a sensitivity of 83% (87% in diabetics) and a specificity of 82% (94% in diabetics). Conclusion: Hydrostatically measured systolic pressure in the large toe of < 50 mm Hg is suitable as a diagnostic criterion for PAVD, stages III-IV.