TA K I N G T H E M E A S U R E O F PA D
Doctors at ICE discover a correlation between “skinny legs” and PAD and develop an alternative screening method to x-rays that is just as accurate—a measuring tape! Tissue Loss in PAD Patients Presenting for PTA
Taha Baig: Orlando, Florida // Asad Qamar and Abbas Ali: Ocala, Florida ICE
I N T E G R AT I V E MEDICINE The days of tightly focused care to treat a patient’s ills—e.g. heart attack, stroke, migraines, leg pain— without considering the patient’s health as an inter-connected whole are ending. There’s even a name for it: Integrative Medicine. Medical schools are offering courses in it. Hospitals are offering new services to their patients to support it. Doctors are widening their treatment protocols to take advantage of it. Now, treatment for a patient who suffers a heart attack may also include sessions with a nutritionist to insure a healthier diet...Antidepressants prescribed early on to combat a common side-effect of serious heart problems... Stress-reduction techniques to promote healing...Herbal medicine... Exercise recommendations like yoga or tai-chi. The key is connection and acknowledging that treating a person as a whole instead of focusing on a singular acute or chronic condition can affect a person’s overall health.
Background At ICE, serving 25,000 patients across 10 counties in Central Florida, patients who underwent peripheral interventions (PTA) presented tissue loss. Peripheral Arterial Disease (PAD) has significant mortality and morbidity. Diagnosis is important to assess for further complications. In our studies patients with skinnier legs had severe bilateral PAD. Currently PAD is assessed initially with ABI but this method is inaccurate in diabetics. We investigate a simpler physical exam method to assess PAD with a measuring tape. Methods From patients undergoing PTA, 60 had usable images for analysis. Initial x-rays of maximum soft tissue in pixels were converted to cm and analyzed, calibrated against catheter of known size. Image J software was used for analysis. Patients with severe bilateral PAD had tissue loss of 9-11cm compared to cath lab staff volunteers. To verify the accuracy of these measurements, patients with both x-ray and tape measures were analyzed against controls. Amongst subjects with Xray and tape measurement available, regression analysis showed a very close correlation between circumference measured by either technique. Results
Conclusion Patients who presented for PTA to ICE had a significant tissue loss of 11cm on x-ray in comparison to staff volunteers; 4.5cm on tape measurement in comparison with controls. Our data suggests people with an increased risk of PAD can be effectively screened by a simple tape measurement and recommend taking maximum calf circumference of at risk patients, with <34cm as abnormal.
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