Tag: Toe pressure measurement

SysToe, an accurate option for the diagnosis and evaluation of Peripheral Arterial Disease (PAD)

Peripheral arterial disease (PAD) occurs when plaque builds up in the arteries that carry blood to head, organs, and limbs.

Limitations of Ankle Brachial Index (ABI)

The Ankle Brachial Index (ABI) test has been in use for diagnosis and evaluation of peripheral arterial disease (PAD) for over half a century. Nevertheless, it is not without its issues.

  • Training is required before the operator is able to carry out reliable measurements
  • Some patients feel pain in the leg during cuff inflation
  • It takes time to perform the measurement
  • False values can result from medial calcification of the tibial/peroneal arteries which may prevent the measurement of ABI.

Why measure Toe Systolic Pressure?

The toe arteries are affected by medial calcification later than the leg arteries. The toe systolic pressure can be measured to circumvent the problem of medial calcification of the tibial/peroneal arteries.

Toe pressure measurements show a good agreement with ABI and remain measurable and reliable in patients with arterial wall calcification.

Does the measurement of toe systolic pressure using SysToe improve the diagnosis and reliability of diagnosis?

The SysToe is easy to use, quick and fully automatic and not operator dependent. It improves clinical evaluation and follow-up of PAD in every day practice.

SysToe drastically improves the reliability of distal toe pressure measurement, especially in diabetic and chronic renal failure patients, since the measurement of ankle pressure and ankle brachial index may be difficult or impossible in these patients because of medial calcification.

As a fully automated, totally non-invasive and painless (unlike ankle pressure measurement)  technique, systolic toe pressure measurement with SysToe is easily performed outside the Vascular Lab by Diabetologists, Podiatrists and General Practitioners for the follow-up of patients with peripheral arterial disease.

Therefore, the use of more expensive examinations (such as complete duplex Doppler ultrasound of lower limb arteries) can now be reduced. The use of a SysToe can have major clinical care pathway advantages and cost savings as well as saving patient assessment time.

PMS customers use the SysToe for

  • Assessment and diagnosis of peripheral arterial disease
  • Diagnosis of critical limb ischemia
  • Follow up of diabetic patients, patients with chronic renal failure, elderly patients
  • Assessment of healing potential of ulcers

Why Is There A Need For The Systoe Toe Pressure Measurement System?

Clinical situation

Peripheral arterial disease (PAD) is when the arteries, in this case, to the legs, become fully or partially blocked. This blockage most commonly occurs due to atherosclerotic (cholesterol) plaques.

Arterial blood brings oxygen and nutrients to the muscles of the legs, and when blocked may result in pain in the legs, also called intermittent claudication. Intermittent claudication is typically described as pain in the patient’s calf after walking a distance that goes away when the patient rests.

In advanced peripheral arterial disease, the patient may have pain in the legs at rest, and may develop leg ulcers and gangrene.

When a patient is first seen and suspected of having PAD, the underlying diagnosis is usually not difficult if a proper history and physical examination is performed.

For this purpose the Ankle brachial index (ankle systolic pressure/brachial systolic pressure) is usually measured.

Why is there a need for the Systoe?

Limitations of Ankle Brachial Index (ABI)

In the case of diabetic patients, old patients and renal failure patients, medial calcification (deposit of calcium on the middle part of the artery wall) of the tibial/peroneal arteries may prevent the measurement of the ABI pressure.

ABI measurement is impossible in

  • 15 %  of diabetic patients at the time of the diagnosis.
  • 20 % of the diabetic patient present a PAD
  • 30 % after 15 years

Weitz et al. Circulation. 1996; 94: 3026-3049

As the toe arteries are affected by medial calcification later than the leg arteries, the toe systolic pressure can be measured to circumvent the problem of medial calcification of the tibial/peroneal arteries. Toe pressures are a clinical indicator. For clinical purposes a normal Toe brachial Index (TBI = toe systolic pressure/brachial systolic pressure) is considered to be higher than 0.7

For any value less than that, the patient will be found to have some occlusive disease proximal to the recording site.

A major advantage of TBI is its use following the progress of disease and after any form of intervention.

The Atys SysToe can also be used in the following circumstances

  • Triage patients before referral to vascular specialist
  • Opportunistic Screening and follow up after intervention
  • Wound and Ulcer healing

The Atys SysToe is a fully automatic clinically validated device that gives consistent readings which are not operator dependent. Using the SysToe clinicians can quickly determine whether a patient does or doesn’t have PAD without necessarily referring to a specialist Ultrasound Dept saving time and money

SysToe – Putting your Patient’s Feet First

In this digital day and age, you might not be surprised to hear me ask if you’ve had your digital pressure taken recently? Of course, I mean your toe and finger pressure – simple to forget but important not to ignore.

Today, we’re specifically talking about Peripheral Arterial Disease (PAD), which is when the arteries to the legs get either completely or partially blocked, most commonly due to atherosclerotic (cholesterol) plaques. These blockages lead to intermittent claudication, a leg pain in the patient’s calf as a result of walking, which eases at rest. Many might consider this calf pain as fairly normal, and ignore the symptoms, especially if they felt normal again when resting. If Peripheral Arterial Disease is left unchecked, it may become more advanced, eventually leading to pain at rest, leg ulcers and even gangrene.

PAD has previously been diagnosed with a physical examination by a GP, who would compare blood pressure in the patient’s arm and ankle. A difference in the two readings would be a possible indication of PAD. Whilst this technique has been in use for over half a century, it comes with problems; most notably the need for operator training and that the patient can experience some discomfort throughout the process. We now have the ‘SysToe’ machine, meaning PAD can be quite easily diagnosed with a simple reading of the Toe Brachial Index (TBI). This reading can also be used following diagnosis to track disease and help aid recovery.

So why is the SysToe system so great?

The SysToe system is a fully automated clinically validated patented device. It is not operator dependent so gives reliable and repeatable measurements. This not only saves on NHS time and money, but also helps to create more accurate diagnosis than ever before. It’s the full automation which make the SysToe so great; once the cuff and the sensor are placed on the toe (an easy job for anyone to do), just press the START button for cuff inflation and deflation to take place at the data value displayed within three minutes.

For the quick assessment of lower limb arterial diseases, the SysToe is a must have piece of equipment. Fast measurements, accurate and reproducible results, time & money saving; can your surgery or clinic not afford to have one?